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PubMed2001

Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries; final rule. Occupational Safety and Health Administration (OSHA), Department of Labor. Final rule; request for comment on the Information Collection (Paperwork) Requirements.

The Occupational Safety and Health Administration is revising the Bloodborne Pathogens standard in conformance with the requirements of the Needlestick Safety and Prevention Act. This Act directs OSHA to revise the Bloodborne Pathogens standard to include new examples in the definition of engineering controls along with two new definitions; to require that Exposure Control Plans reflect how employers implement new developments in control technology; to require employers to solicit input from employees responsible for direct patient care in the identification, evaluation, and selection of engineering and work practice controls; and to require certain employers to establish and maintain a log of percutaneous injuries from contaminated sharps.

Blood-Borne Pathogens↗
PubMed1991

Percutaneous injury during dermatologic surgery.

An anonymous survey was conducted among 100 randomly selected fellows of the American Society for Dermatologic Surgery. Forty-one respondents provided information about their experience with percutaneous injury. Causes of injury during 6278 invasive procedures performed during a 1-month period included suture needlesticks (two injuries), injection needlestick (one), needle recapping (one), scalpel blade (one), skin hook (one), and an injury during the transport of an instrument (one). Dermatologic surgeons were more likely to injure their dominant fingers. Attitudes of dermatologic surgeons were surveyed regarding operating on patients while the physician or assistant was actively infected with human immunodeficiency virus, hepatitis B virus, herpetic whitlow, or paronychia caused by Staphylococcus aureus. Dermatologic surgeons believed that they should be allowed to operate while infected with human immunodeficiency virus (41.5%), hepatitis B virus (40%), herpetic whitlow (25%), and paronychia caused by S. aureus (20%). Few dermatologic surgeons would disclose preoperatively to patients infections present in themselves or in operating team members that were due to human immunodeficiency virus (29.4%), hepatitis B virus (27.8%), herpetic whitlow (28.6%), or paronychia caused by S. aureus (33.3%).

Accidents, Occupational↗
PubMedDate not supplied

Percutaneous injuries in a high-volume podiatric surgical residency program.

Percutaneous injuries (i.e., needlesticks) are a possible occupational hazard to all residents performing invasive procedures. Transmission of blood-borne pathogens has become a potential risk in these injuries. As such, the purpose of this investigation was to assess the frequency and circumstances involving percutaneous injuries in the podiatric surgical resident. A survey of 20 present residents from July 1991 to July 1999 was conducted to assess percutaneous injuries. These residents participated in 19,505 surgical cases in this timeframe; 16,185 were podiatric cases and 3,347 were nonpodiatric. Using a two-part questionnaire to assess the circumstances surrounding any percutaneous injury, 80% of the residents reported at least one percutaneous injury during their training. A total of 33 were injuries reported for the 19,505 cases. The incidence of injury per surgical case was 0.17% overall, and 0.14% for foot and ankle cases. Analysis of the data showed a median = 2, mode = 2, and a mean = 1.63 injuries per resident with a range of 0-5. When analyzing the circumstances involving the injuries, most injuries were self-inflicted (66.7%), occurred during wound closure (72.7%), and were caused by a nonhollow bore needle or instrument (81.8%). Also, no correlation could be made to the time of day during which the procedure was performed, the year of residency training, or the number of cases that the resident performed that day before the injury occurred. Interestingly, over 67% of the injuries occurred to the resident's left hand. Although 97% of the injuries were reported to the employee health officer, the patient and resident were screened for HIV and hepatitis B or C in only 78.8% of the cases. In those tested, no resident was exposed to HIV or hepatitis B or C.

Accidents, Occupational↗
PubMed1996

Needle puncture resistance of surgical gloves, finger guards, and glove liners.

New puncture resistant materials are being developed for health professional use as protection against disease and needle stick injuries. The needle puncture resistance of protective gloves and glove liners from DePuy DuPont Orthopaedics and of finger guards from Zimmer was evaluated using a computerized needle penetration system to determine maximal penetration forces and the penetration work required for taper point and for cutting edge needles to penetrate these membranes. The Medak portion of the Life Liner glove liner and the Spectra portion of the FingGuard finger guard offered remarkable resistance against needle penetration as compared to the other glove liners and gloves tested. The cutting edge needles required considerably less penetration force and work to penetrate the FingGuard and Life Liner than that required with comparable size taper point needles. Because these unique protective materials had a limited distribution over the hand, the surgeon's hand remained susceptible to inadvertent needle puncture. While this protection against needle penetration in the Life Liner and the FingGuard represents an exciting advance in surgery, it is important to emphasize that this development is only one consideration in the selection of surgical gloves.

Biomechanical Phenomena↗
PubMed1995

Retrobulbar blocks.

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Anesthesia, Local↗
PubMed1996

Retrobulbar block revisited and revised.

In recent years, the traditional Atkinson retrobulbar block anesthesia technique has been modified to reduce the risk of certain complications. Technique modifications described in this paper eliminated anesthesia-induced postoperative extraocular muscle malfunction in a series of 8500 procedures.

Anesthesia, Local↗
PubMed1992

Freon injection injury to the hand. A report of four cases.

During a 6-month period, the poison center was consulted on three occasions for advice regarding accidental injection of hexafluorethane (Freon) used in the manufacturing process of athletic shoes. A fourth case was later identified after consulting physicians near the manufacturing facility. Little information exists in the medical literature concerning injection of freon or other volatile substances. In each of these cases, workers inadvertently injected concentrated hexafluorethane into a finger while holding the shoe component and attempting to inject hexafluorethane. Each case presented with edema, limitation of motion, and crepitation. Hand roentgenogram revealed subcutaneous gas. Treatment was nonsurgical, consisting of splinting, tetanus immunization, and antibiotics. Rapid resolution of symptoms occurred in all four cases. Hexafluorethane is relatively inert when injected and has low toxicity. However, potential rapid expansion warrants observation for pressure injury.

Accidents, Occupational↗
PubMed1995

Penetrating ocular injury following local anaesthesia.

A series of 13 cases of globe perforation following local ocular anaesthesia are reported. All cases were associated with cataract surgery. Perforation occurred with the retrobulbar approach in nine cases and with the peribulbar approach in two cases. In two cases the approach for local anaesthesia was not recorded. In 12 of the 13 cases, a perforating wound was found in the inferotemporal quadrant. All cases were found to have vitreous haemorrhage. All cases had significant posterior segment injury. Vitrectomy was carried out in nine of the 13 cases. At final review the retina was attached in 12 of the 13 cases. A final visual acuity of between 6/9 and 6/12 was achieved in six cases, four cases had acuity of between 6/18 and 6/24 and three cases had a visual result of less than 6/60.

Anesthesia, Local↗
PubMed1999

[An uncommon occupational accident: tuberculous tenosynovitis of the extensor tendons of the hand].

We present a case of tuberculous tenosynovitis of the extensor tendons of the hand. Our patient was a young doctor working in the respiratory medicine department. He was injured on the dorsal aspect of the hand with a needle used for pleural aspiration. The clinical features consisted of gradually swelling, mild pain and stiffness of the metacarpophalangeal joint. The diagnosis was made after synovectomy. Histological and bacteriological examinations revealed tuberculosis. Treatment consisted of synovectomy and appropriate antibiotics. The clinical course was excellent after one year follow-up. Tuberculous tenosynovitis of the hand is a rare manifestation of extrapulmonary tuberculosis occurring in fewer than 5% of all cases of skeletal tuberculosis. Thickening of the tendon or synovial sheath and local accumulation of fluid are the characteristic manifestations. The diagnosis must be confirmed by surgical biopsy. Antibiotics and synovectomy achieve a good functional result.

Antibiotics, Antitubercular↗