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PubMed1989

Universal precautions: CDC perspective.

We know that the risk to health-care workers of acquiring HBV infection in the health-care setting is greater than that of acquiring HIV infection. We know that blood is the primary concern and that the risk following needlestick injury or a cut involving exposure to blood from an HIV-infected individual is approximately 0.5%. We know that transmission can occur without such injuries, but that the risk of such transmission is lower than after a needlestick or cut. We know that many exposures are preventable and that new prevention strategies and technologies are needed. We need to know the risk of infection in groups of health-care workers with extensive blood exposures, whether alterations in the design of devices can reduce the risk of needlesticks and other injuries, and the optimal strategies for ensuring compliance with recommendations.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Sharps injuries in dental practice.

Sharps injuries are common in dental practice and may allow transmission of blood-borne viruses. The transmission rates of hepatitis B (HBV) to non-vaccinated recipients, hepatitis C (HCV) and human immunodeficiency virus (HIV) after a needlestick injury are 6-30%, 2.7-10% and 0.1-0.3% respectively. Five strategies to prevent percutaneous injuries in dental surgeries are considered: a universal level of infection-control, surgery design, working practices, glove use and vaccinations. First-aid for sharps injuries and post-exposure management of those involving sources with HBV and HIV are described. Anticipation, planning and training can reduce the incidence of injuries and minimise their impact.

Accidents, Occupational↗
PubMed2006

Fatigue increases the risk of injury from sharp devices in medical trainees: results from a case-crossover study.

BACKGROUND: Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers. DESIGN: Case-crossover study. SETTING: Five academic medical centers in the United States and Canada. PARTICIPANTS: Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue. RESULTS: Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week (P<.001) and slept less the night before an injury (P<.001) than did other healthcare workers. Fatigue increased injury risk in the study population as a whole (incidence rate ratio [IRR], 1.40 [95% confidence interval {CI}, 1.03-1.90]), but this effect was limited to medical trainees (IRR, 2.94 [95% CI, 1.71-5.07]) and was absent for other healthcare workers (IRR, 0.97 [95% CI, 0.66-1.42]) (P=.001).Conclusions. Long work hours and sleep deprivation among medical trainees result in fatigue, which is associated with a 3-fold increase in the risk of sharps injury. Efforts to reduce trainee work hours may result in reduced risk of sharps-related injuries among this group.

Academic Medical Centers↗
PubMed2004

Critical incidents of nonadherence with standard precautions guidelines among community hospital-based health care workers.

OBJECTIVE: To identify, categorize, and assess critical incidents of nonadherence to standard precautions. DESIGN: Qualitative and quantitative analysis of a written, mail-out survey. SETTING: Community hospitals. PARTICIPANTS: Statewide stratified random sample of community hospital-based health care workers at risk for blood exposure. MAIN VARIABLE: Responses to the question: "Think of an incident during the past year when you didn't adhere to universal precautions. Please describe the situation and why you didn't adhere." RESULTS: Reasons given for not using precautions included: belief that stopping to use standard precautions would have put the patient at risk (22%); using precautions would have interfered with patient care (20%); precautions were not warranted in a specific situation (14%); did not anticipate the potential for exposure (14%); and high job demands that had caused respondent to be in a hurry (11%). Less often, equipment was not available (7%), respondent forgot (6%), respondent thought that the patient did not pose a risk (4%), or the available equipment was not effective (3%). In terms of overall exposure rates, 34% of those who described an incident had experienced a sharps injury during the previous 3 months and 42% had experienced a mucocutaneous exposure. In terms of overall nonadherence, 44% wore gloves less than 100% of the time, while 61% washed their hands less than 100% of the time. Needlestick injuries were lowest among those who had forgotten to use precautions, while mucocutaneous exposures were highest among those who had not anticipated potential exposure while performing the task. Failure to wear gloves routinely was highest among those who said that following precautions interfered with their ability to provide care and among those who believed a particular patient to be low risk; failure to wash hands routinely was also highest among the latter group and lowest among those who said necessary equipment was not available. CONCLUSIONS: Using specific information about local incidents of nonadherence to standard precautions may enhance training, especially if the program identifies incidents of unanticipated exposure and helps workers plan for them in the future. Closer examination of job demands and responsibilities that interfere with standard precautions may increase the likelihood of adherence.

Blood-Borne Pathogens↗
PubMedDate not supplied

Acute hepatitis C transmitted by needlestick accident despite short duration interferon treatment.

Hepatitis C virus (HCV) transmission by needlestick accidents involving hospital employees has become an important problem. The present report is of a case of acute hepatitis C that developed after a needlestick injury, despite short duration interferon treatment performed just after the accident in a trial effort to prevent HCV transmission. Nosocomial infection of HCV in medical employees is reviewed, and the current prospects for protecting them from HCV transmission after needlestick accident are discussed.

Accidents↗
PubMed1999

Is skin puncture beneficial prior to arterial catheter insertion?

PURPOSE: To compare the insertion time and incidence of catheter damage between skin puncture (SP) and no skin puncture (NP) techniques prior to arterial catheter insertion in patients undergoing neurosurgery. METHODS: Patients undergoing surgery for intracranial tumours or cervical spine lesions were randomized to receive either SP or NP prior to arterial catheter insertion. The total insertion time, number of passes made, number of catheters used, method of insertion (direct or transfixation) and whether catheter was inserted with patients awake or anesthetised were recorded. After removal, catheters were examined microscopically for damage. RESULTS: Eighty-two patients, 36 in SP group and 46 in NP group were recruited. Microscopic damage was seen in 36.5% of catheters and there was no difference between the two groups. The mean/median insertion time were 180/62 sec and 205/77 sec for SP and NP respectively (P:NS). The insertion time was shorter for the direct than for the transfixation technique with median of 42 vs 174 sec (P = 0.001). CONCLUSION: There are no differences in insertion time or catheter damage between skin puncture and no skin puncture techniques prior to arterial catheter insertion. The practice of skin puncture may be abandoned resulting in decreased risk of needlestick injury.

Anesthesia, General↗
PubMed2005

Needle-stick epidemiology in Navy health care workers based on INJTRAK reports (2001-2002).

We provide a descriptive epidemiological analysis of needlestick injuries in Navy medical personnel from the Naval Safety Center database (INJTRAK) for a 1-year period (October 2001 through September 2002). The reports of needle sticks were reviewed on the basis of the Bureau of Labor Statistics Occupational Injury and Illness Classification system for exposure code 3431 (N = 265). Most of the reported needle sticks occurred in men (60.8%) and were from personnel <30 years of age (73.8%). Hospital corpsmen represented the most common work group (57%). Fingers were the most commonly reported anatomical location (77%) for needle sticks. The information suggests several focus areas for reducing needle-stick injuries and improving training. The analysis also reinforces the importance of timely and accurate reporting of injuries related to medical apparatus to the Naval Safety Center.

Adult↗
PubMed1991

Epidemiology of sharps accidents in general surgery.

A prospective study was carried out of all general surgical operations in one theatre of a teaching hospital over a 6-week period to identify the predisposing factors involved in the occurrence of sharps accidents and their relative importance. Although various predisposing factors have been intimated, the relative importance has never been ascertained. Glove puncture was used as an objective measure of a sharps accident and this was compared with subjective reporting of needlestick injury. The overall rate of sharps accidents per surgeon per operation was 23%. The position at the operating table and medical rank of operator affected the rate of accidents more than duration of operation. The group at most risk of sharps accidents was junior surgeons acting as the principal operator. It is important to recommend inoculation against hepatitis B in this group before starting surgical training. Another method of minimizing the risk to junior surgeons would be compulsory training on surgical rigs. Operations on patients with AIDS or hepatitis B should be carried out by the most senior surgeon available to reduce the risk of sharps injury and disease transmission.

Accidents, Occupational↗
PubMed2006

Posttraumatic stress disorder after occupational HIV exposure: two cases and a literature review.

Two healthcare workers developed disabling chronic posttraumatic stress disorder after needlestick exposures to blood from a patient infected with human immunodeficiency virus (HIV), even though both continue to test negative for HIV antibody more than 22 months after their exposures. We describe these 2 cases and review the relevant literature. Prospective studies of psychological morbidity after occupational needlestick injuries are required to determine the role of long-term psychological follow-up, counseling, and support.

Female↗
PubMed1993

A deadly design.

On September 30, 1991, registered nurse Bev Holmwood sustained a needlestick injury while working in a Vancouver Island operating room. Just over two months later she died, the result of hepatitis C she contracted during the accident. Her story is a sad reminder of what research has already shown: Sharps injuries are the single greatest cause of serious, and often deadly, infection among nurses and other health care workers.

Equipment Safety↗
PubMed2002

Comply with regs for needlestick prevention.

A new compliance directive clarifies enforcement of regulations to prevent needlestick injuries. Involve staff in the selection of safer devices. Have nurses complete evaluation forms for new devices. Encourage nurses to ask questions about products even after the initial inservice.

Emergency Service, Hospital↗
PubMed2006

Lowering standards of clinical waste management: do the hazardous waste regulations conflict with the CDC's universal/standard precautions?

Clinical waste is a costly and troublesome commodity. Comprising the detritus of medical care, the foremost hazard is the risk of infection from micro-organisms present in these wastes. Infection commonly occurs through penetrating injury, the so-called 'sharps' or 'needlestick' injury, although contamination of non-intact skin or splashes to the eye may transmit infection. Bloodborne viruses (hepatitis B, hepatitis C, human immunodeficiency virus) are the most serious threat, although respiratory, soft tissue and enteric infections are not unknown. The European Hazardous Waste Directive, that harmonizes the categorization and control of wastes, permits downregulation of clinical wastes where the risk of infection may be low. Although strengthened by the requirement for risk assessment in waste classification, UK regulatory guidance promoting classification of some clinical wastes as non-hazardous completely ignores the Centers for Disease Control and Prevention's Universal Precautions for the prevention of transmission of human immunodeficiency virus, hepatitis B virus and other bloodborne pathogens in healthcare settings, which seek to prevent bloodborne virus infection in healthcare workers and others, and the more extensive Standard Precautions that extend these principles to the prevention of healthcare-associated infections and the environmental spread of nosocomial pathogens. By creating a potent cost driver encouraging downregulation of some clinical wastes, UK legislation based on the European Hazardous Waste Directive conflicts with the CDC's Universal/Standard Precautions.

Animals↗
PubMed2004

Serial nosocomial transmission of Plasmodium falciparum malaria from patient to nurse to patient.

BACKGROUND: Nosocomial transmission of malaria is a rare phenomenon in the United States. OBJECTIVE: To describe the probable transmission of Plasmodium falciparum malaria from a patient to a healthcare worker and then from the healthcare worker to another patient. DESIGN: Case series. SETTING: Two community hospitals in Massachusetts. INTERVENTION: Routine medical and supportive care. MEASUREMENTS: Clinical and laboratory evaluation. RESULTS: A nurse developed falciparum malaria after a needlestick injury from a patient with documented falciparum malaria. Three days prior to her diagnosis, she cared for another patient, who subsequently developed falciparum malaria. That patient's parasite isolate genetically matched the nurse's isolate by two independent DNA fingerprinting techniques. CONCLUSION: After extensive evaluation, we believe that a nurse who had acquired falciparum malaria via needlestick subsequently transmitted malaria to another patient via a break in standard precautions. The implications of this mechanism of transmission are discussed.

Adult↗
PubMed1997

The potential for catheter microbial contamination from a needleless connector.

Needleless connectors have been widely introduced into clinical practice to allow the connection of syringes and luers to peripheral and central vascular catheters. The potential for microbial contamination of catheters via these devices is currently unclear. A recently introduced connector, the 'Connecta Clave', was assessed by various in-vitro methods. The 'Connecta Clave' is specifically devised to separate external components from the fluid pathway. The compression seals of 50 devices were contaminated with 1 x 10(4) cfu Staphylococcus epidermidis, disinfected with isopropanol, and fluid passed through. Only one device allowed organisms to pass through, despite this challenge, representing a contamination rate of 2%. In comparison, when 50 connectors were challenged with 20 cfu of S. epidermidis, no organisms passed through the device during use. In the clinical situation, after manipulation, < 16 cfu of skin organisms were found associated with the compression seal of the devices. It is, therefore, likely that the contamination rates in clinical practice will be extremely low. Three methods of disinfecting the compression seals and associated rims were also evaluated. A combination of alcohol chlorhexidine spray, followed by a 70% isopropanol swab, resulted in the most efficacious disinfection. The isopropanol swabs produced an adequate disinfection rate. The overall results suggest that by use of specially designed connectors, not only are needlestick injuries reduced, but the likelihood of microbial contamination of catheters via the internal route may also be diminished.

Catheters, Indwelling↗
PubMed2004

Blood and body fluid exposure risks among health care workers: results from the Duke Health and Safety Surveillance System.

BACKGROUND: Health care workers (HCWs) are at risk of exposures to human blood and body fluids (BBF). Needlestick injuries and splashes place HCWs at risk for numerous blood-borne infections including human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV). Utilizing a new comprehensive occupational health surveillance system, the objective of this research was to better define the BBF exposure risk and risk factors among employees of a large tertiary medical center. METHODS: A population of 24,425 HCWs employed in jobs with potential BBF exposures was followed for BBF exposure events from 1998 to 2002. BBF exposure rates were calculated for strata defined by age, race, gender, occupation, work location, and duration of employment. Poisson regression was used for detailed analyses of risk factors for BBF exposure. RESULTS: The study population reported 2,730 BBF exposures during the study period, resulting in an overall annual rate of 5.5 events/100 FTEs and a rate of 3.9 for percutaneous exposures. Higher rates were observed for males, persons employed less than 4 years, Hispanic employees, and persons less than 45 years of age. Much higher rates were observed for house staff, nurse anesthetists, inpatient nurses, phlebotomists, and surgical/operating room technicians. Poisson regression results strengthened and extended results from stratified analyses. Rates of percutaneous exposures from hollow needles were found to decrease over the study period; however, exposure rates from suture needles appear to be increasing. CONCLUSION: While continued training efforts need to be directed toward new HCWs, our data also suggest that employees who have been in their job 1-4 years continue to be at higher risk of BBF exposures. This research also points to the need for better safety devices/products and work practices to reduce suture-related injuries.

Adult↗
PubMed1993

Laboratory-acquired malaria, leishmaniasis, trypanosomiasis, and toxoplasmosis.

Because of renewed interest in parasitic diseases, increasing numbers of persons in clinical and research laboratories have the potential for exposure to parasites and therefore are at risk for acquiring parasitic infections. In this review of laboratory-acquired parasitic infections, we concentrate on protozoan diseases that frequently have been reported to be laboratory acquired: malaria, leishmaniasis, trypanosomiasis (American and African), and toxoplasmosis. These diseases can be severe, even fatal, and may be difficult to diagnose. Many laboratorians who have acquired these diseases did not recall having had an accident. Of those with recognized accidents, needlestick injuries were the most common. Laboratories should have established protocols for handling specimens that may contain viable organisms and for responding to laboratory accidents.

Animals↗
PubMed1999

Management of occupational exposure to HIV--what actually happens.

A year after the Department of Health issued guidelines on post exposure prophylaxis (PEP) for health care workers exposed to HIV, we conducted a telephone survey of occupational health nurses and junior doctors in London teaching hospitals, to assess implementation of the guidelines and awareness among junior doctors of local policies. The management and administration of PEP for HIV differed considerably between hospitals. Many junior doctors did not know what to do in the event of a needlestick injury. Both the implementation of and the briefing of staff about current management policies need to improve.

Data Collection↗
PubMed1992

Bilateral mycotic axillary artery false aneurysms in an intravenous drug user: unsuspected broken needle-tips pose a risk to the treating personnel.

Mycotic false aneurysms due to local arterial injury from attempted intravenous injections in drug addicts are increasing in frequency. The high incidence of HIV and hepatitis B virus in parenteral drug users may present a considerable risk to the treating personnel. This paper reports the unsuspected presence of broken needle-tips in the subcutaneous tissues of an intravenous drug abuser, in association with bilateral mycotic aneurysms of the axillary arteries. Broken needle-tips have the potential to cause needlestick injury to the operating team and the nursing staff, with the associated risk of transmission of HIV and hepatitis B virus infection. The presence of broken needle-tips should be suspected in drug users presenting with false aneurysms associated with local arterial injection injury and a specific history of needle-breakage should be sought. Preoperative plain radiographs should be performed of the planned operative field to exclude the presence of such needle-tips. Any soft tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management.

Adult↗