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We conducted a multi-centre study in West African hospital wards to document accidental blood exposure (ABE) risks in these settings, and assessed the incidence of ABE in participating healthcare workers (HCWs) retrospectively. In total, 1241 HCWs participated in the survey from 43 hospital wards. Among them, 567 (45.7%) had sustained at least one ABE with an estimated incidence of 0.33 percutaneous injuries (PCIs) and 0.04 mucocutaneous contacts (MCCs)/HCW/year in medical or intensive care personnel and 1.8 PCIs/HCW/year in surgeons. The ABE was a needlestick in 454 (80.1%) of 567 cases, a cut in 19 cases (3.4%), a splash or contact with non-intact skin in 87 cases (15.3%), and was undocumented in seven cases (1.2%). The source patient's human immunodeficiency virus (HIV) serostatus was positive in 74 cases (13.1%), negative in 65 cases (11.5%), and unknown in 416 cases (73.4%). The ABE was not notified in the ward in 392 cases (69.1%). Healthcare structures can improve HCWs' safety and reduce the stigma against HIV-infected patients by improving access to training, information, primary prevention (ABE prevention equipment) and secondary prevention (postexposure prophylaxis) of occupational infection risks.
OBJECTIVES: An increasing number of cases are being recognized in which a periocular anesthetic for cataract surgery has been inadvertently injected directly into the globe under high pressure until the globe ruptures or "explodes." The objectives of the current study were to (1) analyze this injury clinically and histopathologically through a series of seven case reports; (2) reproduce the injury experimentally in human eyebank eyes, live anesthetized rabbit eyes, and human cadaveric eyes; (3) investigate the biophysical basis of the injury; and (4) outline recommendations to help decrease the risk of ocular rupture with periocular injections. DESIGNS/PARTICIPANTS: Clinical, histopathologic, experimental animal, autopsy eye, and theoretical biophysical study. METHODS: The clinical and histopathologic findings of the patients' eyes were documented. Human eyebank eyes, live anesthetized rabbit eyes, and human cadaveric eyes were exploded via direct intraocular saline injection. The laws of Bernoulli, LaPlace, Friedenwald, and Pascal were used to investigate theoretically the biophysics of the injury. RESULTS: The findings of anterior and posterior scleral rupture, retinal detachment, vitreous hemorrhage, and lens extrusion were observed clinically and experimentally. In some clinical and experimental cases, the anterior segment appeared entirely normal despite a posterior rupture. The surgeon proceeded with and completed the cataract surgery in two of the seven clinical cases without knowledge of the rupture. The pressure required to produce such an injury is in the range of 2800 to 6400 mmHg, and this pressure is more easily attained with a 3-ml syringe than with a 12-ml syringe. CONCLUSIONS: Explosion of an eyeball during the injection of anesthesia for ocular surgery is a devastating injury that may go unrecognized. The probability of an ocular explosion can be minimized by (1) the use of a blunt needle and a 12-ml syringe, (2) aspirating the plunger and wiggling the syringe before injection, (3) discontinuing the injection if corneal edema or resistance to injection is noted, and (4) inspecting the globe for evidence of intraocular injection before ocular massage or placement of a Honan balloon. On recognition of an ocular explosion, immediate referral to and intervention by a vitreoretinal surgeon is optimal.
BACKGROUND: Accidental perforation of the globe and intraocular injection of steroid is a potential complication of periocular injections. Final outcomes in eyes in which this complication has occurred have been reported to be unsatisfactory in the past. However, the advent of vitrectomy has altered their prognosis significantly. METHODS: A retrospective analysis was done of five cases of accidental intraocular steroid injection, treated by vitrectomy. Additional procedures involved treatment of retinal breaks (where required) with endolaser or transscleral cryopexy. Scleral buckling was done in one case. RESULTS: Barring one case in which retinal detachment developed, there were no postoperative complications. At last follow up all patients had satisfactory recovery of visual acuity; had attached retina; and quiet anterior chamber and vitreous cavities. CONCLUSION: Vitrectomy is associated with satisfactory results in cases of accidental intraocular steroid injection. Delay up to a few days does not seem to materially influence the outcome.
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BACKGROUND: In 1984 the first case of needle stick transmitted human immunodeficiency virus was reported. In 1986 Occupational Safety and Health Administration was petitioned by various unions representing health care employees to develop a standard which protects employees from occupational exposure to blood-borne diseases. Congress passed the Needle Stick Safety and Prevention Act. This specifies that "safer medical devices, such as sharps with engineered sharps injury protections and needle-less systems" constitute an effective engineering control, and must be used where feasible. This has been mandated in California as part of the labor code. Blood-borne pathogens of concern in needle stick injuries are human immunodeficiency virus, hepatitis virus B, and hepatitis virus C. OBJECTIVE: The objective of this study was to determine the incidence of accidental needlesticks (ANSs) and disease transmission in the allergy setting. METHODS: A retrospective survey of most California allergy practices and a few large multi-physician allergy practices. We received and used 121 of 400 surveys. RESULTS: Analysis of the survey data showed an overall incidence of 45 ANSs with 7.026 million 26-/27-gauge needles reported. There was zero rate of disease transmission; 6.41 ANSs per million compares favorably with an estimated 267 ANSs per million in the general medical setting. CONCLUSIONS: The rate of ANSs in the allergist's office is 2% that of general medical ANSs. The current "safety" needles have no proven effectiveness. There is no reported disease transmission in the allergist's office setting using existent methods. This solution needs further study before there is generalized implementation of the engineering devices of no proven effectiveness that may in fact increase ANSs.
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Patient and employee safety remains high on the list of hospital problems, with a number of new challenges facing safety officials. Lawsuits for negligent safety, the leading source of litigation against health care facilities, continue to produce costly judgments. In this update, we'll present a number of problems to watch out for and review some recent slip and fall and injury cases.
PURPOSE: To report ocular perforation that occurred during retrobulbar injection in 7 highly myopic eyes. METHODS: Seven patients with a diagnosis of globe injury during retrobulbar injection for ocular anesthesia before cataract surgery were managed by vitreoretinal surgery. All injections were performed by ophthalmologists. The surgeon recognized the perforation in 4 cases at the time of injection. The preoperative vision was hand motion perception in 4 eyes and light perception in 3 eyes. All patients underwent vitreoretinal surgery because of the presence of vitreous hemorrhage and/or retinal detachment diagnosed by funduscopy or ultrasonography. At the time of surgery, all eyes had vitreous hemorrhage and 4 eyes had rhegmatogenous retinal detachment. The number of vitreoretinal procedures performed was: 1 procedure in 4 patients, 2 procedures in 2 patients, and 3 procedures in 1 patient. The period of follow-up ranged from 4 months to 4 years, averaging 20 months. RESULTS: At the end of the follow-up period, the retina was attached in 6 patients. The postoperative vision was 20/400 in 3 eyes, finger counting in 3 eyes, and light perception in 1 eye. CONCLUSION: Special care should be taken in retrobulbar injection of highly myopic globes, which have an increased risk of perforation. The functional outcome of surgical repair of these eyes was poor.
This is a case presentation of an accidental contaminated needle stick injury from a patient known to be infected with both Human Immunodeficiency Virus (HIV) and hepatitis B. The patient was managed with prophylactic hepatitis B immune globulin, hepatitis B vaccination and the HIV retroviral drug zidovudine (AZT). At one year after treatment the patient was not infected with HIV or hepatitis B, and there was adequate immunity generated after vaccination for hepatitis B.
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