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At least 469 records · Page 26Linked to original sources
PubMed2005

Hepatitis B vaccination in correctional health care workers.

BACKGROUND: Data on bloodborne pathogen risk among health care workers (HCWs) employed in the correctional setting are sparse, even though the prevalence of bloodborne infections, including hepatitis B virus (HBV), among inmates is high. To address this, we determined prevalence and correlates of hepatitis B virus vaccination status in correctional health care workers (CHCWs) employed in 3 state correctional health care facilities. METHODS: A confidential, self-administered cross-sectional survey was performed. RESULTS: Four hundred eleven (69.8%) of 588 eligible participants completed the survey. Of these, 264 (64.2%) reported receiving a primary hepatitis B (HB) vaccine series. Vaccination rates varied by state and by job category. Parenteral exposures were not uncommon; 8.6% (n = 24) of clinical CHCWs and 2.0% (n = 7) of nonclinical CHCWs reported one or more needlesticks in the 6-month period prior to the study. Among clinical staff, vaccination correlated with licensure (RN or MD) and race (white) and in nonclinical staff with history of close contact with HBV infected inmates and with needlestick injury. CONCLUSION: Although the HB vaccination rate among CHCWs was generally high, given their potential risk of exposure to HBV, universal vaccination should be encouraged and should include those nonclinicians with job duties that may involve potential exposure to blood/body fluids.

Adult↗
PubMed2005

Daytime sleepiness, sleep habits and occupational accidents among hospital nurses.

AIM: This paper reports a study to determine the prevalence of excessive daytime sleepiness and sleep habits among hospital nurses and to analyse associations between excessive daytime sleepiness and different types of medical error. BACKGROUND: It has been reported that sleep disorders, and the tiredness and sleepiness brought about by sleep disorders may be associated with occupational accidents. However, to our knowledge, there has so far been no report on associations between sleep disorders, excessive daytime sleepiness in particular, and occupational accidents among hospital nurses. METHODS: The study was a cross-sectional study targeting 4407 nurses working in eight large general hospitals in Japan. An anonymous self-administered questionnaire was used to investigate their sleep patterns and experience of occupational accidents. The data were collected in 2003. RESULTS: The prevalence of excessive daytime sleepiness among hospital nurses in the present study was 26.0%. A statistically significant relationship was observed between having or not having occupational accidents during the past 12 months and excessive daytime sleepiness. Multiple logistic regression analyses on factors leading to occupational accidents during the past 12 months showed statistically significant associations between (1) drug administration errors and (2) shift work and age, between (1) incorrect operation of medical equipment and (2) excessive daytime sleepiness and age, and between needlestick injuries and age. CONCLUSIONS: Excessive daytime sleepiness is an important occupational health issue in hospital nurses. It is possible that occupational policies and health promotion measures, such as a provision of sleep hygiene advice and social support at worksites, would be effective in preventing occupational accidents among hospital nurses.

Accidents, Occupational↗
PubMedDate not supplied

A multicenter study of costs and nursing impact of cartridge-needle units.

A multicenter study of the overall costs and impact on medication administration of sterile cartridge-needle units (Carpuject) and conventional disposable syringes with multiple- and single-dose vials was conducted in six hospitals in the Voluntary Hospitals of America (VHA) system. Data collection involved a time and motion phase measuring procurement, preparation, and disposal of both systems and a 6-month prospective global cost analysis of component costs, waste disposal, nursing time, needlestick injuries, and subsequent treatment. Nonacquisition costs were substantially lower with the use of the cartridge-needle units. When all costs are considered, sterile cartridge-needle units are a cost-effective alternative to conventional disposable syringes and multidose vials.

Cost-Benefit Analysis↗
PubMed1994

Residents' perspectives on violence and personal safety in the emergency department.

STUDY OBJECTIVE: To assess emergency medicine residents' perspectives on violence and personal safety in the emergency department. DESIGN AND PARTICIPANTS: Survey of all 461 current emergency medicine residents and 1992 graduates in the 13 emergency medicine residency programs in California. RESULTS: Eighty-five percent of residents responded to the survey questionnaire. Sixty-two percent of respondents worry about their own safety while working in the ED. The majority of these respondents (72%), however, most fear a needlestick injury from an HIV-positive patient. Fifty percent of the respondents believe that their hospital/residency programs do not provide adequate security in the ED. Respondents overwhelmingly favor some form of gun control legislation. CONCLUSION: Violence and personal safety in the ED are major concerns of emergency medicine residents.

Attitude of Health Personnel↗
PubMed2004

Evaluation of potential reduction in blood and body fluid exposures by use of alternative instruments.

BACKGROUND: Injuries from needlestick, sharps injuries and splashes lead to exposure to blood and body fluids with the potential for transmission of blood-borne viruses. AIMS: To identify alternative instruments, which if used would improve worker safety. METHODS: Retrospective review of 161 injuries with identification of safer alternative products for instruments that caused injury. The proportion of injuries that could be prevented was calculated [with 95% confidence intervals (CI)]. RESULTS: The average rate of injury was 7.8/1000 employees per annum (95% CI, 6.8-9.4/1000). In the 2 years the highest rates of injury occurred in pre-registration house officers (164/1000; 95% CI, 64-264/1000), phlebotomists (154/1000; 95% CI, 15-291/1000) and senior house officers (45/1000; 95% CI, 13-77/1000). An upper estimate of 65% (95% CI, 58-72%) of incidents would have been preventable with a change to alternative devices. CONCLUSIONS: Change to the use of intrinsically safer instrumentation has the potential to prevent injury to healthcare workers.

Accidents, Occupational↗
PubMed2006

Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis.

BACKGROUND: The role of iatrogenic transmission within the HIV/AIDS pandemic remains contentious. Estimates of the risk of HIV transmission from injections and blood transfusions are required to inform appropriate prevention policy. OBJECTIVES: Systematic review and meta-analysis of the literature on HIV-1 infectivity for parenteral transmission and blood transfusion. REVIEW METHODS: All identified studies with relevant transmission probability estimates up to May 2005 were included. STATISTICAL METHODS: When appropriate, summary estimates for accidental percutaneous and blood product exposures were derived. RESULTS: Infectivity estimates following a needlestick exposure ranged from 0.00 to 2.38% [weighted mean, 0.23%; 95% confidence interval (CI), 0.00-0.46%; n = 21]. Three estimates of infectivity per intravenous drug injection ranged from 0.63 to 2.4% (median, 0.8%); a summary estimate could not be calculated. The quality of the only estimate of infectivity per contaminated medical injection (1.9-6.9%) was assessed. Instead we propose a range of 0.24-0.65%. Infectivity estimates for confirmed contaminated blood transfusions range from 88.3 to 100.0% (weighted mean, 92.5%; 95% CI, 89.0-96.1%; n = 6). CONCLUSIONS: Infectivity estimates for infected blood transfusions are larger than for other modes of HIV transmission. Few studies on transmission risk per contaminated injection were found. However, transmission risk per needlestick injury, where needles are more likely to be rinsed or disinfected between recipients (especially for medical injections), may be representative of non-intravenous medical injections and lower than the risk from intravenous injections, which are likely to be deeper and to involve more fluids. Further work is needed to better estimate transmission probability related to contaminated injections and its likely contribution to overall HIV transmission.

HIV Infections↗
PubMedDate not supplied

Zero-Stik-Safety Syringe: an automatic safety syringe.

Needlestick injury (NSI) is an important although rare cause of the transmission of blood-borne viruses to healthcare staff. Many NSIs are avoidable. The use of universal precautions and careful sharps disposal are key factors in the prevention of injury. The availability of safety devices is increasing as it is recognized that action is necessary to prevent NSI. Devices that are easy to use and require no extra effort on behalf of the healthcare worker are preferred. There is evidence that safety devices decrease the rate of NSI. Zero-Stik Safety Syringe, manufactured by New Medical Technology, automatically retracts the needle once the injection is complete. It is simple to use and requires no formal training.

Accidents, Occupational↗
PubMedDate not supplied

Implementation of a customized needleless intravenous delivery system.

Occupational exposure to human immunodeficiency virus (HIV), hepatitis, and other bloodborne pathogens concerns all health care workers, especially those in high-risk clinical settings such as the emergency room, operating room, intravenous therapy department, etc. In response to the increased attention to needlestick injuries in the workplace, hospitals are adopting a more proactive approach to establishing precautions to eliminate this occupational hazard. Many technologies to address the situation are available today, but most offer only a partial solution. The need for a comprehensive needleless IV delivery system recently sparked a collaboration between the IV therapy coordinator and a manufacturer's representative (Abbott Laboratories) that resulted in a new product design that was recently implemented house wide at our two hospitals.

Accidents, Occupational↗
PubMed1997

The role of skin dendritic cells in the initiation of human immunodeficiency virus infection.

Human immunodeficiency virus (HIV) can be transmitted by accidental puncture with needles containing HIV-contaminated blood. However, the molecular and cellular interactions that occur between HIV and cells of the skin following percutaneous needlestick injury are unknown. Direct inoculation of exogenous virus into recipient blood vessels of the dermis is possible. In addition, skin dendritic cells (DC; e.g., epidermal Langerhans cells, dermal DC, lymphatic veiled cells) may also play a role in the initiation of HIV infection. Evidence to suggest that DC are important in primary HIV infection is derived largely from in vitro experiments and animal models. For example, cutaneous DC can be infected with HIV in vitro, can capture HIV on their cell surface (independent from DC infection), and can efficiently transmit HIV to CD4+ T cells. In recent in vivo experiments using rhesus macaques, submucosal DC were the first cells infected following intravaginal exposure to simian immunodeficiency virus (SIV). In this review, I discuss the possible immunologic events that occur within skin and draining lymph nodes following needlestick exposure to HIV-contaminated blood, with a particular emphasis on DC-HIV interactions.

Animals↗
PubMedDate not supplied

Needlesticks: what to do after it happens.

A needlestick injury can be a frightening and even potentially a life-threatening event. It needs to be treated with compassion and some urgency. The dentist-employer should act with knowledge of the current law and with the desire to do whatever is best for the affected people.

Accidents, Occupational↗
PubMed2006

Needlestick and sharps injuries among nurses in a tropical Australian hospital.

Although needlestick and sharps injuries (NSI) represent a major hazard in nursing practice, most studies rely on officially reported data and none have yet been undertaken in tropical environments. Therefore, we conducted a cross-sectional NSI survey targeting all nurses within a tropical Australian hospital, regardless of whether they had experienced an NSI or not. Our overall response rate was 76.7%. A total of 39 nurses reported 43 NSI events in the previous 12 months. The most common causative device was a normal syringe needle, followed by insulin syringe needles, i.v. needles or kits and blood collection needles. Half of the nurses' NSI events occurred beside the patient's bed: drawing up medication was the most common reason. Nurses working in the maternity/neonatal wards were only 0.3 times as likely to have experienced an NSI as their counterparts in the medical or surgical wards. Overall, our study has shown that NSI events represent an important workplace issue for tropical Australian nurses. Their actual rate might also be higher than official reports suggest.

Accidents, Occupational↗
PubMed2001

Infection control among dentists in private practice in Durban.

The general fear, superstition and alarm surrounding HIV/AIDS warrant that the highest standards of care be available to our patients. A survey on infection control was undertaken in Durban to assess the current state of infection control procedures among dentists in private practice. A self-administered 44-item questionnaire was hand-delivered to a random sample of 75 dentists (31.3%)--see comments in Methods--in private practice. The response rate was 90.7% (68 dentists). The routine use of gloves, masks, and protective eyewear was reported by 97.1%, 82.4% and 52.9% of dentists respectively. Although 89.7% of dentists had autoclaves in their practices, only 45.2% autoclaved their high speed handpieces and 39.7% their slow handpieces. Almost 60% of dentists did not use rubber dam at all whilst 46.3% did not disinfect impressions before sending them to the laboratory. Approximately 6% of respondents reported re-using local anaesthetic cartridges and 1.5% re-used needles. Needlestick injuries in the previous six months were reported by 13.8% of dentists but two thirds of them did not follow any specific protocol after injury. Almost 90 per cent of dentists were immunised against Hepatitis B but more than 60% of their staff were not. The results of the study showed that adherence to universally accepted guidelines for infection control remain low amid a climate of an ever-increasing HIV pandemic.

Adult↗
PubMed2003

Exploring the fear of contracting HIV/AIDS among trauma nurses in the province of Kwazulu-Natal.

A qualitative study, using phenomenology as an approach was conducted. The title of the study was "Exploring the fear of contracting HIV/AIDS among trauma nurses in the province of Kwazulu-Natal". Participants were selected on the basis of category (registered nurses), workplace (level one trauma units), and work experience (six months experience in a trauma unit). Twelve nurses participated in the study, six from the state institutions and six from the private institutions. The objectives of the study were to explore the fear of contracting HIV/AIDS, its effect on their personal/working lives and how they coped with it. The findings of the study revealed that trauma nurses perceived themselves to be at risk of acquiring HIV/AIDS from their working environment despite the available precautionary measures. Needlestick injuries appeared to be the main source of fear. They used different coping and defence mechanisms effectively to cope with this fear of contracting HIV and none were in any emotional crisis. Education at different levels and development of support networks has been recommended as the key strategies to decrease these fears. Other recommendations include improving the quality and availability of protective materials and equipment, making HIV/AIDS a notifiable disease as well as improving general and specific beliefs that increase coping.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Development of guidelines on nonoccupational HIV postexposure prophylaxis for the state of Rhode Island.

The Brown University AIDS Program and the Rhode Island Department of Health joined with health care practitioners, researchers, and representatives of community-based health, social service, and advocacy organizations to create comprehensive guidelines on nonoccupational HIV postexposure prophylaxis for the state of Rhode Island. These guidelines offer health care practitioners detailed advice on the evaluation and management of blood or body fluid exposures outside the health care setting, e.g., through sexual assault, consensual sex, injecting-drug use, or needlestick injuries. In these circumstances, HIV postexposure prophylaxis serves those for whom primary prevention measures have failed or were impractical or impossible. The guidelines represent the end product of coordination among private and public, academic and nonacademic, clinician and layperson groups committed to decreasing the incidence of HIV infections in the state of Rhode Island. The guidelines serve as both a resource for health care practitioners and a means of educating them on this method of HIV prevention.

Anti-HIV Agents↗
PubMed2002

AIDS update: occupational exposure & post-exposure treatment of HIV/AIDS.

HCPs in the United States have many benefits that work in their favor to help reduce the risk for disease transmission. The United States has laws and regulations regarding the implementation of needlesafe devices to reduce needlestick injuries. PEP is readily available when needed, and AIDS cases continue to decline nationwide. Personal protective equipment is readily available. Case numbers for occupational transmission of HIV infection to HCPs remain low. The United States also has set a national goal to cut new HIV infections in half by the year 2005. Federal law requires every EMS department to establish a designated infection control officer. Infection control officers must review and evaluate exposure incidents and ensure prompt, proper medical follow-up.

AIDS Serodiagnosis↗
PubMed1997

Nonresponse bias in a survey of Ontario dentists' infection control and attitudes concerning HIV.

OBJECTIVE: This study investigated late response and nonresponse bias in an HIV-related survey of dentists. METHODS: Questionnaires with ID numbers were mailed to all dentists in Ontario (N = 5,997) with additional mailings four and seven weeks later. RESULTS: Proportionately more respondents who returned questionnaires less than four weeks after the first mailing reported that they knowingly treated (P < .05) or were willing to treat HIV-infected patients (P < .05); that they had an accurate perception of risk of HIV infection after a needlestick injury (P < .01), and preferred not to refer HIV-infected patients (P < .01). Linear extrapolation of cumulative percent responses indicated nonresponse bias in terms of attitude and knowledge items; however, the magnitude was low. CONCLUSIONS: The effects of late response and nonresponse bias on the results of this study were small. However, these results cannot be generalized beyond the study population, and obtaining high response rates and testing for nonresponse bias in surveys of attitudes related to HIV are recommended.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Nonresponse bias in a national study of dentists' infection control practices and attitudes related to HIV.

The aim was to investigate late response and nonresponse bias in a survey related to HIV and infection control. Questionnaires with ID numbers were mailed to a stratified random sample of dentists in Canada with additional mailings 4 and 7 weeks later (n = 6444). We compared responses received after < 4 weeks, 4-7 weeks, > 7 weeks. Extrapolation was used to estimate nonresponse bias. Univariate analyses showed significant differences between responses received < 4 weeks after initial mailing and those received later for items on sociodemographics, knowledge, infection control practices and attitudes: late responders were more likely to report that they would refuse to treat any patients with HIV (P < 0.01). Multiple logistic regression indicated that the best predictors of responses received > or = 4 weeks were disagreement that HBV is more infectious than HIV (OR = 1.7); unwillingness to attend a dentist who treats HIV/AIDS patients (OR = 1.3); incorrect perception of the risk of HIV infection after an HIV-contaminated needlestick injury (OR = 1.2); and sometimes or never heat-sterilizing handpieces after each patient (OR = 1.2). Extrapolation indicated that the percentage of all respondents who reported refusal to treat (15.2%) would have been 17.1% if a 100% response rate had been obtained. We found significant evidence of late response and nonresponse bias primarily in knowledge and fears related to HIV infectivity; however, the impact on the final results was small and we concluded that additional follow-up to improve response rates would not be worthwhile.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Is hepatitis C serology reliable? Problems with clinical application.

OBJECTIVE: To describe some inherent difficulties in the interpretation of anti-hepatitis C virus (HCV) antibody testing. CLINICAL FEATURES: A 30-year-old carpark attendant sustained an accidental needlestick injury. The results of serological and biochemical investigations were suggestive of HCV infection but were not conclusive. INTERVENTION AND OUTCOME: Further testing was carried out on his stored sera in an attempt to establish a diagnosis. Two second generation enzyme-linked immunosorbent assay tests (Abbott and Ortho) gave differing results but were suggestive of seroconversion and subsequent seroreversion to HCV. Further testing with recombinant immunoblot assay and polymerase chain reaction did not resolve the issue. CONCLUSION: Our findings in this patient illustrate how the use of anti-HCV antibody tests in some clinical settings can result in confusion and misdiagnosis. These tests should be restricted to situations in which diagnostic usefulness has been established.

Adult↗