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PubMedDate not supplied

Safety in urine sampling: maintaining an infection-free environment.

The insertion of an indwelling urinary catheter is thought to be implicated in 80% of all urinary tract infections (UTI). In patients with an indwelling catheter, one of the most effective ways to determine whether or not there is evidence of a UTI is to aspirate a sample of urine for analysis, typically using a syringe and needle. Inevitably this puts the healthcare worker at risk of a percutaneous needle stick injury and accidental exposure to serious and potentially life-threatening viruses. Infection control is now taken increasingly seriously in UK hospitals, and the elimination of infection risk is regarded as a priority. In addition to training, and safer working practices the government recognizes the need for new technological innovation to help further reduce risks. In the urine sampling environment, there is a new needle-free port (EZ-Lok from Bard Ltd), designed specifically to reduce the occupational health risk of needle stick injuries.

Catheters, Indwelling↗
PubMed2003

Penetrating needle injury of the eye causing cataract in children.

PURPOSE: To review the presentation, management, and outcome of children with cataract caused by ocular needle penetration. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Forty-two children with cataract caused by ocular needle penetration. INTERVENTION: Cataract surgery. MAIN OUTCOME MEASURES: Best-corrected postoperative visual acuity. RESULTS: Injuries were unintentional and occurred during unsupervised play. The type of needle involved was hypodermic in 24 cases, sewing in 7, and undetermined in 11. Endophthalmitis developed in 14 cases and retinal detachment in 6. Endophthalmitis occurred in 12 cases (50%) of hypodermic needle injury but in no case of sewing needle injury. With a mean postoperative follow-up of 2.3 years, the best-corrected visual acuity was 20/40 or better in 19 cases, 20/50 to 20/80 in 7, 20/100 to counting fingers in 6, light perception in 1, no light perception in 6, and undetermined in 3. Eyes with endophthalmitis and/or retinal detachment had a worse visual prognosis. CONCLUSIONS: Ocular penetration causing cataract occurred in children during unsupervised play with inadequately stored or disposed of hypodermic or sewing needles. Endophthalmitis occurred frequently in injuries caused by hypodermic needles but not in those caused by sewing needles. Visual outcome after management was good in approximately half of the cases especially if endophthalmitis or retinal detachment did not develop.

Adolescent↗
PubMed2002

Ocular explosion after peribulbar anesthesia.

We report 3 cases of globe rupture after peribulbar anesthesia. We discuss the predisposing factors, presenting features, and visual outcome after this complication. Globe explosion is a severe complication of inadvertent intraocular injection during peribulbar anesthesia. Visual outcome after vitrectomy is generally poor; however, cases that do not develop a retinal detachment may achieve good results.

Adult↗
PubMed2003

Consequence of perforation during peribulbar anesthesia in an only eye.

A patient with a blind fellow eye had cataract surgery in the right eye; anesthesia comprised an intraocular injection of lidocaine and bupivacaine. Forty-eight hours after surgery, visual acuity in the right eye was light perception (LP). Three days later, fundus examination showed inferotemporal hemorrhage, retinal whitening consistent with needle tracking, and a diffusely pale optic disc in the operated eye. Computed tomography showed an intact optic nerve in both eyes and high-density vitreal lesions in the right eye. Laser photocoagulation was applied to the retinal break. We believe that a jet stream of anesthetic agent may have transiently increased intraocular volume enough to occlude the central retinal artery. Although the retina remained attached, visual acuity failed to improve beyond LP.

Aged↗
PubMed2000

Altered globe dimensions of axial myopia as risk factors for penetrating ocular injury during peribulbar anaesthesia.

We measured the range of equatorial horizontal widths (EHW) in axially myopic eyes and identified the sites of staphyloma using B scan echography. One hundred eyes in 50 patients were studied. The axial lengths (ALs) were sorted into five groups of increasing severity of myopia. The group mean AL, group mean EHW and the ratio of EHW/AL was calculated for each range. The results suggest that the increase in the AL in an axially myopic eye is associated with an increase in the EHW. However, this increase in the group mean EHW is relatively small (2.3 mm) compared with the increase mean AL (8.2 mm) across the entire range. The ratio of EHW/AL decreased with an increase in the group mean AL. Therefore, the increase in EHW in an axially myopic eye is unlikely to be a significant risk factor for inadvertent ocular injury for peribulbar injections if a careful single medial canthal approach is used. There was high incidence of staphylomas in eyes with AL > 29 mm, most were inferior to the posterior pole of the globe, and there were none at the equator.

Aged↗
PubMed2002

Mid-gestation right basal ganglia lesion: clinical observations in two children.

OBJECTIVE: To describe the neurobehavioral syndrome in two children with destruction of the right basal ganglia ostensibly from amniocentesis needle penetration at 17 weeks of gestation. BACKGROUND: Early-life unilateral lesions of the basal ganglia are rare and the resulting syndrome not described. METHODS: Both children had repeated clinical assessments, MRI and (18)F-fluorodeoxyglucose PET scans, and psychometric and achievement testing over 10 years. RESULTS: Right basal ganglia destruction was similar and virtually coextensive in both children; optic nerve and oculomotor dysfunction were disparate. One had a right temporal pole porencephalic cyst with anomalous overlying cortex. The clinical syndrome included left hemiparesis with distal spasticity and without hypotrophy; extraocular movement disorders; severe episodic disinhibition, impulsiveness, hitting reflexively, and extreme emotional lability. Outbursts of screaming and cursing resembled "sham rage." Both had mild intellectual retardation with competent language but poor nonverbal and visual-spatial abilities, visual memory, and daily living and socialization skills. CONCLUSIONS: The shared behavioral and cognitive syndrome is most reasonably attributed to the right basal ganglia lesions, which were complete and coextensive in both, whereas other lesions were partial, milder, and disparate. Early destruction of the right basal ganglia may preclude normal development of right hemisphere functions without evidence of plasticity and appears associated with intense disinhibition and impulsiveness of aggressive attack activities and with general lability and dyscontrol of emotion.

Adolescent↗
PubMed1999

Management of ocular perforations resulting from peribulbar anaesthesia.

PURPOSE: To analyze the clinical presentation and outcome of treatment for globe perforation secondary to peri-bulbar anaesthesia. METHODS: Eight patients (3 females and 5 males) aged 66-84 years were included in the study. Ocular perforations were suspected in 3 cases before or during surgery, in 4 cases diagnosis was established within one week and in one case at 3 weeks. Three patients underwent indirect argon laser photocoagulation to seal the retinal break, one patient had cryotherapy, 3 patients underwent a pars plana vitrectomy with fluid gas exchange and endo-laser; and one patient refused any further treatment. RESULTS: The final visual acuity after a mean follow up of 14 months was better than 6/9 in 2 patients, between 6/9-6/12 in 4 patients, and perception of light in 2 patients. CONCLUSION: If diagnosed early and treated adequately, a majority of patients with globe perforation during periocular anaesthetic could be saved.

Aged↗
PubMed1992

Two cases of accidental transmission of hepatitis C to medical staff.

Two medical doctors (a 38-year-old male and a 25-year-old female) were admitted to our department with jaundice. They had injured themselves with, respectively, a scalpel and a needle contaminated with anti-hepatitis C virus antibody-positive blood, at 2 and 1.5 months, respectively, prior to admission. They were both suffering from clinically typical acute hepatitis. The polymerase chain reaction showed that hepatitis C RNA and anti-hepatitis C virus antibody were transiently positive in the male doctor, while serum transaminase levels were transiently abnormal. In the female doctor, hepatitis C RNA was initially negative, but became strongly positive, and abnormal serum transaminase levels persisted. Interferon therapy resulted in the hepatitis C RNA's becoming negative again, and the transaminase levels returned to normal. The clinical and other findings strongly suggested that in both patients hepatitis C developed as a result of the respective in-hospital accidents.

Accidents, Occupational↗