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PubMed1987

The management of health care workers' accidental parenteral exposures to biological specimens of HIV seropositive individuals.

Health care workers can reduce risks associated with caring for HIV seropositive individuals by strict adherence to routine infection control procedures. Educating personnel in infection control should be increasingly stressed in all health-related settings. When accidents occur, however, the health care industry must respond with appropriate care and follow-up of their employees. The outlined approach for the management of health care workers with needlestick injuries from HIV-contaminated biological specimens provides increased follow-up for workers at higher risk (those who develop illness in the months following an exposure) than current CDC guidelines; and less but sufficient follow-up of those who have a lower risk (no illness) of acquiring HIV infection. Overall, this protocol will provide a more economical, practical, and medically adequate method for follow-up of exposed health care personnel.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Health correlates of autonomy, control and professional relationships in the nursing work environment.

BACKGROUND: Internationally, nursing is facing a variety of challenges including changes in health systems, an ageing workforce and escalating shortages of Registered Nurses. New Zealand is no exception. Here as elsewhere these challenges are taking their toll on the resources and demands of hospital environments, on the health and well-being of nurses themselves and most certainly on the people for whom they care. In the United States of America (USA), three aspects of the nursing work environment--autonomy, control and nurse-physician relations--have been identified as linked to staff retention, levels of staff burnout and needlestick injury, as well as to a range of patient outcomes. AIM: To examine the New Zealand nursing situation and to see whether aspects of the work environment are associated with health status. METHODS: A total of 225 Registered Nurses in a general hospital completed the Revised Nursing Work Index (NWI-R) and Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36). RESULTS: Ratings indicated that the New Zealand hospital environment was characterized by less autonomy and control and better nurse-physician relations than in USA hospitals. Results of correlations demonstrated that more positive ratings of the three workplace attributes were associated with better health status amongst the nurses. The results of regression analyses were indicative either of a confounding relationship or of a mediating relationship such that nurses' relations with physicians, administration and other departments mediate the associations between autonomy, control and health status. CONCLUSIONS: The study offers an insight into a New Zealand hospital environment and suggests the importance of good relationships with physicians and other departments for the health of nurses.

Adult↗
PubMed1997

Transmission routes and clinical courses in sporadic acute hepatitis C.

Between March 1994 and March 1996 we studied transmission routes and clinical courses in eight patients with sporadic acute hepatitis C (two men, six women). Of the eight patients, three were treated for another illness 1-2 months before the onset of hepatitis, one was a parenteral drug abuser, one had an accidental needlestick injury and two had sexual contact with a partner with chronic hepatitis C virus (HCV) infection. Clinical courses included four women whose HCV RNA and alanine aminotransferase (ALT) became persistently negative without treatment, and four men and two women with the same results following interferon (IFN) treatment. It is thought that IFN therapy may prevent the progression to chronic liver disease. Results from this study might be useful in the future management of patients with sporadic acute hepatitis C.

Acute Disease↗
PubMed2002

Evaluation of procedural skills training in an undergraduate curriculum.

CONTEXT: A substantial proportion of medical students enter their intern year without any basic skills experience. Lack of experience is a significant source of stress for many junior doctors. OBJECTIVES: To evaluate the effect of a basic procedural skills tutorial for Year 3 medical students on their competence in relevant skills at Year 5. SUBJECTS: The control group consisted of 93 medical students who completed Year 3 in 1996. The intervention group consisted of 92 medical students who completed Year 3 in 1997. The intervention group received a practical skills tutorial in Year 3; the control group did not. Both groups were assessed on their practical skills competence during Year 5. METHODS: A 3-hour practical tutorial on injection and suturing techniques was delivered to the intervention group. The effectiveness of the intervention was assessed by self-reported experience of giving injections, inserting sutures and sustaining needlestick injuries, and by teacher-rated competency in four basic procedural skills. RESULTS: Students who received the Year 3 tutorial were significantly more likely to record a satisfactory assessment for their performance in all four basic skills compared with students who did not receive the tutorial. They were less likely than controls to refuse invitations to give injections, but not invitations to insert a suture, during Years 4 and 5. CONCLUSIONS: A single session of formalised teaching in procedural skills in the early stages of a medical degree can have long-term effectiveness in basic skills competence and may increase students' confidence to practise their skills.

Chi-Square Distribution↗
PubMed1986

Occupational risk of the acquired immunodeficiency syndrome among health care workers.

In August 1983, we initiated nationwide prospective surveillance of health care workers with documented parenteral or mucous-membrane exposures to blood or other body fluids of patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related illnesses. The purpose of the surveillance project is to quantitate prospectively the risk to health care workers of acquiring the AIDS virus, human T-cell lymphotropic virus Type III/lymphadenopathy-associated virus (HTLV-III/LAV), as a result of occupational exposures. By December 31, 1985, 938 health care workers were being followed in the surveillance project. The mean length of follow-up was 15 months (range, 0 to 56) and 531 health care workers (57 percent) had been followed for more than one year. Needlestick injuries and cuts with sharp instruments accounted for 76 percent of the exposures. Over 85 percent of all exposures were to blood or serum. None of the health care workers have acquired signs or symptoms of AIDS. Analyses of T-lymphocyte subsets were performed for 341 (36 percent) of the exposed health care workers, and tests for antibody to HTLV-III/LAV were performed for 451 (48 percent). Seven health care workers who had low helper/suppressor T-lymphocyte ratios on initial testing were retested; only three had persistently low ratios. Only two health care workers tested were seropositive for antibody to HTLV-III/LAV. The results of this surveillance project, thus far, suggest that the risk to health care workers of occupational transmission of HTLV-III/LAV is low (the upper bound of the 95 percent confidence interval for the seroprevalence rate among workers with greater than or equal to 3 months of follow-up with HTLV-III/LAV antibody testing is 1.65 percent) and appears to be related to parenteral exposure to blood.

Accidents, Occupational↗
PubMed2000

Nonoccupational HIV postexposure prophylaxis: a new role for the emergency department.

Despite numerous primary prevention campaigns, new cases of HIV infection are occurring at high rates. Postexposure prophylaxis (PEP) after possible HIV exposures from sexual encounters or injection drug use may prove to be a worthwhile means of reducing HIV infection. Although there are no studies that directly demonstrate its efficacy, indirect support comes from animal and human studies. Multiple animal studies have shown that antiretroviral medications can reduce simian immunodeficiency virus infections if given early and for a prolonged period. A study of health care workers suggests that zidovudine taken after needlestick injuries can dramatically reduce HIV seroconversion. Zidovudine and nevirapine use recently showed great reductions in perinatal HIV transmission. Studies of dendritic and T-cell processing of simian immunodeficiency virus and HIV indicate that antiretroviral medications taken soon after a viral exposure may terminate viral replication. Regimens of 2 or 3 antiretroviral medications have been suggested as prophylactic measures after certain exposures. Even though limited experience exists with these populations, HIV PEP is most likely safe in pregnancy and for children. Emergency departments are encouraged to anticipate the probable demands for nonoccupational HIV PEP by establishing protocols for its rapid provision and ensuring proper follow-up care.

Anti-HIV Agents↗
PubMedDate not supplied

Puncture wound during CPR from sternotomy wires: case report and discussion of periresuscitation infection risks.

Performing resuscitations presents multiple infectious risks to critical care providers. Potential sources for infection include direct contact with blood and other bodily fluids and possible inoculation through needlestick injuries. In this article, we present a case of a cardiac care unit nurse who, while providing cardiopulmonary resuscitation, suffered a puncture wound to her left hand from the patient's sternotomy wires from previous cardiac surgery. The patient died despite these resuscitation efforts. He was seronegative for human immunodefiency virus, hepatitis B, and hepatitis C, and the nurse's wound healed without complications. This is the first reported case of such an injury occurring during a resuscitation. It demonstrates how a subtle, invisible, and unrecognized physical risk could cause infection in critical care providers.

Adult↗
PubMed1999

Bloodborne exposures at a United States Army Medical Center.

With the ultimate goal of minimizing exposures, we conducted a hazard analysis on bloodborne disease transmission at our hospital to identify appropriate control interventions. We utilized basic principles of occupational epidemiology to gather information on the severity and extent of exposures. Because we suspected inadequate reporting of needlestick injuries, we collected 339 reported exposures of health care workers; we conducted a survey of all workers requiring universal precautions training for bloodborne pathogens. The annual incidence of exposures reported was 93.7 per 1000 workers who required this training. Sharps accounted for 83.5 percent of these exposures. Exposure sources demonstrated 4.3 percent positive for HIV, 4.4 percent positive for hepatitis B, and 7.1 percent positive for hepatitis C. The survey indicated that blood/body fluid exposures were underreported by at least fourfold. House officers were most at risk. At-risk behaviors were identified by the significant differences in knowledge of HIV transmission and work practices between groups reporting no or single exposures versus groups reporting multiple exposures. Increased emphasis should be placed on education, reporting exposures, and training house officers in procedures requiring the use of hollow bore needles. This study shows how the use of occupational epidemiology principles and methods were utilized in conducting a thorough hazard analysis and in identifying appropriate control methods.

Adult↗
PubMed2001

A cohort study of health care workers to assess nosocomial transmissibility of Nipah virus, Malaysia, 1999.

During 1998-1999, an outbreak of Nipah virus encephalitis occurred in Malaysia. To assess the possibility of nosocomial transmission, 338 health care workers (HCWs) exposed and 288 HCWs unexposed to outbreak-related patients were surveyed, and their serum samples were tested for anti-Nipah virus antibody. Needlestick injuries were reported by 12 (3%) HCWs, mucosal surface exposure to body fluids by 39 (11%), and skin exposure to body fluids by 89 (25%). No encephalitis occurred in either group. Three exposed and no unexposed HCWs tested positive by EIA for IgG antibodies. It is likely that these 3 were false positives; no IgM response occurred, and the serum samples were negative for anti-Nipah virus neutralizing antibodies. The risk of nosocomial transmission of Nipah virus appears to be low; however, given the high case-fatality rate and the presence of virus in respiratory secretions and urine of some patients, standard and droplet infection-control practices should be maintained with these patients.

Antibodies, Viral↗
PubMed1999

Use of personal protective equipment and operating room behaviors in four surgical subspecialties: personal protective equipment and behaviors in surgery.

OBJECTIVE: To evaluate Universal Precautions (UP) compliance in the operating room (OR). DESIGN: Prospective observational cohort. Trained observers recorded information about (1) personal protective equipment used by OR staff; (2) eyewear, glove, or gown breaks; (3) the nature of sharps transfers; (4) risk-taking behaviors of the OR staff; and (5) needlestick injuries and other blood and body-fluid exposures. SETTING: Barnes-Jewish Hospital, a 1,000-bed, tertiary-care hospital affiliated with Washington University School of Medicine, St Louis, Missouri. PARTICIPANTS: OR personnel in four surgical specialties (gynecologic, orthopedic, cardiothoracic, and general). Procedures eligible for the study were selected randomly. Hand surgery and procedures requiring no or a very small incision (eg, arthroscopy, laparoscopy) were excluded. RESULTS: A total of 597 healthcare workers' procedures were observed in 76 surgical cases (200 hours). Of the 597 healthcare workers, 32% wore regular glasses, and 24% used no eye protection. Scrub nurses and medical students were more likely than other healthcare workers to wear goggles. Only 28% of healthcare workers double gloved, with orthopedic surgery personnel being the most compliant. Sharps passages were not announced in 91% of the surgical procedures. In 65 cases (86%), sharps were adjusted manually. Three percutaneous and 14 cutaneous exposures occurred, for a total exposure rate of 22%. CONCLUSION: OR personnel had poor compliance with UP. Although there was significant variation in use of personal protective equipment between groups, the total exposure rate was high (22%), indicating the need for further training and reinforcement of UP to reduce occupational exposures.

Adolescent↗
PubMed2000

Primer on hepatitis C for hospital epidemiologists.

First identified in the late 1980s as the main causative agent of non-A, non-B hepatitis, hepatitis C virus (HCV) infection is now the most common chronic bloodborne infection in the United States. It is likely that the number of deaths attributable to HCV-related chronic liver disease will increase substantially during the next 2 decades, and the potential economic and clinical burden related to HCV is staggering. Accordingly, it is essential to identify risk factors for transmission of HCV and implement appropriate precautions to decrease the prevalence of this emerging infection. The relative importance of the two most common types of exposures associated with transmission of HCV, ie, blood transfusion and injection drug use, has evolved over time. Strict blood-donor selection and the use of reliable serological tests have led to a significant reduction in transfusion-associated risk. Injection drug use is currently the single most important risk factor for HCV infection in the United States. Transmission of HCV poses a serious threat to healthcare workers and patients if infection control techniques or disinfection procedures are inadequate. Potential exposures include contact of the eyes, mucous membranes, broken skin, or needlestick injury. Hospitalized patients may serve as a reservoir for transmission, and the prevalence of anti-HCV seropositivity among such patients can be as high as 20%. The infected healthcare worker is a potential source of transmission. A recent molecular phylogenetic analysis demonstrated that a cardiac surgeon likely transmitted HCV to five of his patients during open heart surgery. In summary, nosocomial transmission has been unequivocally confirmed and underscores the need for strict infection control practices.

Base Sequence↗
PubMed1996

Attitudes, practices, and infection risks of hemophilia treatment center nurses who teach infection control for the home.

OBJECTIVE: To examine the practices toward infection control training and to assess the attitudes about, and risks for, exposures to blood among hemophilia treatment center (HTC) nurses who teach home infusion therapy (HIT). DESIGN AND POPULATION: Written and telephone interview surveys of the 153 nurses who teach HIT at federally funded HTCs. MAIN OUTCOME MEASURES: Hemophilia treatment center nurses' teaching practices and infection control messages taught, and frequency of exposures to blood. RESULTS: The response rate to the written nurses' survey was 60% and to the telephone interview 88%. Nurses taught patients a median of three HIT sessions totaling 4 hours of instruction. Reevaluation of patients' HIT practices took place every 6 months by 22% and every 12 months by 59% of nurses. Nurses frequently reported teaching proper use of a sharps disposal container (99%) and gloves (93%), but less often reported teaching patients to wash hands after infusions (26%) and to report needlestick injuries to HTCs (11%). The respondents identified several barriers to effective infection control as it is practiced in the home by patients. Although at least 30% of HTC nurses recalled having had percutaneous exposure to blood, they considered their risk for hepatitis B infection low but greater than for infection with the human immunodeficiency virus (HIV). CONCLUSIONS: While some important infection control messages are stressed during HIT teaching, others may be underemphasized. Failure to instruct patients about all infection control precautions may be related to nurse educators' perception of low to moderate personal risk for hepatitis B and HIV infection. Patients receiving HIT, and those who assist them, need to be fully aware of, and to have reinforced periodically, universal infection control strategies in the home.

Health Knowledge, Attitudes, Practice↗
PubMed1997

The infection control practices of general dental practitioners.

OBJECTIVES: To investigate the infection control practices of general dentists in Ontario in 1994. DESIGN: Confidential coded questionnaires were mailed to all general dental practitioners in Ontario (n = 5,176), with three follow-up attempts. Data were analyzed using Pearson's chi-squared test and multiple logistic regression. SETTING: Offices of general dental practitioners in Ontario. PARTICIPANTS: General dental practitioners actively involved in treating patients. RESULTS: The response rate adjusted for nondelivery was 70%. A high proportion of respondents reported using gloves (always, 91.8%; sometimes, 7.8%), masks (always, 74.8%; sometimes, 21.1%), or protective eyewear (always, 83.6%; sometimes, 13%); heat sterilization of handpieces (83.9%); and hepatitis B (HBV) vaccination of dentists (92.3%). However, only 61.4% of respondents reported HBV vaccination of all clinical staff, and 87.7% used additional precautions for patients with human immunodeficiency virus (HIV). Significant predictors of the use of recommended infection control procedures (i.e., always using gloves, masks, and eye protection; heat sterilization of handpieces; HBV vaccination for dentist and staff; and no extra precautions for patients with HIV) were age < 40 years (odds ratio [OR], 2.6), lack of concern regarding increased personal risk (OR, 2.0) or costs of infection control procedures (OR, 1.5), and knowledge of the low infectivity of HIV after a needlestick injury (OR, 2.0) and that infection control procedures for HBV are adequate for HIV (OR, 2.7). CONCLUSION: Additional education is required to promote a more realistic perception of risk of HIV transmission in the dental office and the use of all recommended infection control practices, including Universal Precautions.

Adult↗
PubMed2004

Injection practices in Burkina Faso in 2000.

BACKGROUND: Unsafe delivery and overuse of injections can result in the spread of hepatitis B virus, hepatitis C virus, and HIV. The aim of the present survey was to estimate the frequency of safe injection practices in Burkina Faso. METHOD: Using the new standardized World Health Organization tool to assess injection practices, we selected 80 primary health facilities with a two-stage cluster sampling method, collected information using structured observations and provider interviews, and analyzed the data using Epi-Info software. RESULTS: We observed 116 injections in 52 facilities. In 50 facilities [96%; 95% confidence interval (CI) 85-99%] injections were given with a new, single-use syringe and needle. In 29 facilities (56%; 95% CI 36-74%), staff recapped needles using two hands. All 80 facilities visited had a stock in the community to provide new, single-use syringes and needles. In 61% (95% CI 54-79%) of facilities, staff reported needlestick injuries in the last 12 months. Used needles were discarded in open containers in 66 facilities (83%; 95% CI 55-96%) and observed in the surroundings of 46 facilities (57%; 95% CI 32-80%). CONCLUSIONS: In 2000, most of the health facilities in Burkina Faso were using sterile injection equipment. However, practices were still observed that could expose patients, health care workers, and communities to risks, and that required specific interventions.

Burkina Faso↗
PubMed1987

Prevalence of hepatitis B surface antigen and antibody (hepatitis B virus markers) in personnel at a children's hospital.

After two cases of acute hepatitis B infection occurred in phlebotomists at The Hospital for Sick Children in 1985, a seroprevalence survey of hepatitis B virus markers was undertaken. Directors in high-risk areas were advised by phone and memorandum to screen employees. Participation was entirely voluntary, and employees who did not respond were contacted six weeks after initial notification. Information obtained from each participant through a self-administered questionnaire included age, duration of employment in current pediatric occupation, history of blood transfusions, immune globulin prophylaxis, needlestick injury, and country of birth (North America/United Kingdom or other). Sera identified by code were tested by radioimmunoassay. Interactions were analyzed by using a multiple logistic regression model. A total of 10% of the personnel in high-risk areas, in which there was frequent exposure to blood or blood products, had hepatitis B markers in their blood, compared with 2% who did not have this exposure. Birthplace and occupation have independently significant effects on the likelihood of having hepatitis B markers. There appears to be an increased risk to employees in pediatric units, depending on the patient (and parent) population being served, although the risk may be lower than in adult hospitals.

Adult↗
PubMed2006

National multicenter study of HIV testing and HIV seropositivity in patients with chronic hepatitis C virus infection.

BACKGROUND: Although HIV testing is recommended for persons with hepatitis C virus (HCV) infection who are at risk for HIV, little is known about HIV testing in this population. METHODS: Data were prospectively collected in 4364 HCV-infected patients at 24 Veterans Affairs medical centers across the United States, including demographics, risk factors for HIV infection, and self-reported information on HIV testing. RESULTS: Overall, 76.8% had been tested for HIV at least once, 14.8% were never tested, 6.6% did not know if they were tested, and 1.8% declined to answer. Multivariable analysis identified injection drug use, needlestick injury, sex with a same-sex partner, a greater number of lifetime sexual partners, and sex with an injection drug user as factors that were independently associated with HIV testing. At least one risk factor for HIV infection was present in 84.5% of the 646 patients who were never HIV tested. Among the 3350 subjects who were tested for HIV, 8.4% were positive, 88.3% were negative, 2.4% did not know the results of their test, and 0.9% declined to answer. Multivariable analysis identified African American and Hispanic race/ethnicity, income < or = 10,000 dollars, sex with a same-sex partner, and sex with an injection drug user as the only variables that were independently associated with HIV seropositivity. CONCLUSIONS: Although a substantial proportion of HCV-infected patients have been tested for HIV, missed opportunities for early diagnosis of HIV infection exist. Public health strategies to improve HIV testing among patients with chronic HCV infection are needed.

AIDS Serodiagnosis↗
PubMed1991

Technique for drawing blood for cultures: is changing needles truly necessary?

After drawing blood for culture, medical students and house officers are often taught to change needles before inoculating the culture media. Data to support this practice have been scarce. We obtained simultaneous blood cultures on 75 hospital patients using two techniques: changing needles (C) or not changing needles (NC) before inoculating the cultures. Positive cultures judged to be contaminants were obtained in 4/75 patients in the NC group (5.3%) and in 1/75 patients in the C group (1.3%). This difference was not statistically significant. The practice of changing needles after drawing blood for culture may not be necessary, thus reducing the risk of needlestick injury.

Adult↗
PubMed1995

Methods of transmission of hepatitis C.

The route of transmission of hepatitis C virus is still controversial. Parenteral exposure via blood or blood products leads to infection in the majority of cases, and the majority of intravenous drug users become infected by repetitive exposure to contaminated injection equipment. The risk of infection from a single needlestick injury is 5-15% and may depend on the size of the innoculum. Other parenteral routes of transmission may include traditional healing practices and the use of contaminated medical equipment. Transmission is less common within a family but the prevalence of hepatitis C viral antibodies is higher in family members and sexual partners of carriers than in the general population. There are some well-documented instances of acute hepatitis C occurring after a defined sexual exposure. Vertical transmission is rare unless the mother has high levels of circulating HCV RNA as may occur in those also infected with HIV. The detection of hepatitis C in saliva and the higher than expected prevalence of infection in dentists may point to the possibility of transmission by salivary contamination. There remain large numbers of hepatitis C carriers in whom no route of infection can be identified.

Female↗