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PubMedDate not supplied

Sharp thinking.

Nurses are the healthcare professionals most at risk from neeldestick and sharps injuries, according to the latest figures from the RCN's EPINet project. During 2004, 1,990 injuries were reported from the 20 self-selecting participating sites. Nurses sustained 43 per cent of these injuries. Disposable syringes and needles were the most common equipment to cause injury. Although discouraged, 4 per cent of injuries occurred during recapping of needles. Just under a third of injuries were sustained by staff other than the original user of the sharp.

Accidents, Occupational↗
PubMed1997

A critical review of the literature on sharps injuries: epidemiology, management of exposures and prevention.

This article reviews the literature related to the epidemiology, prevention and management of sharps injuries in health care workers, particularly nurses, and the subsequent risk of harm. The studies are reviewed chronologically, beginning with the efforts to reduce sharps injuries by changing behaviours, followed by the introduction of barriers to protect the caregiver, and finally, the engineering of safer products. Initial efforts to prevent sharps injuries focused on placing rigid, disposal containers at the site where sharps were used and instructing health care workers to refrain form the practice of recapping. When these interventions were shown to alter the type, but not the overall number, of sharps injuries, alternative measures were sought. This search intensified with the increasing evidence of the small, but measurable, risk of the transmission of human immunodeficiency virus from sharps injuries. The current knowledge of the factors related to sharps injuries has been collected primarily through retrospective surveillance. This surveillance has been conducted primarily in hospital settings and has focused on the type of sharp and the purpose for which it was used rather than prospective research. Research is now needed to elucidate the organizational and behavioural factors leading to sharps injury both within the hospital as well as other health care settings. The implications for nursing practice are discussed.

HIV Infections↗
PubMed2001

Occupational exposures to blood in a dental teaching environment: results of a ten-year surveillance study.

Evaluation of occupational exposures can assist with practice modifications, redesign of equipment, and targeted educational efforts. The data presented in this report has been collected as part of a ten-year surveillance program of occupational exposures to blood or other potentially infectious materials in a large dental teaching institution. From 1987 to 1997, a total of 504 percutaneous/non-intact skin and mucous membrane exposures were documented. Of these, 494 (98 percent) were percutaneous, and 10 (2 percent) were mucosal, each involving a splash to the eye of the dental care worker (DCW). Among the 504 exposures, 414 (82.1 percent) occurred among dental students, 60 (11.9 percent) among staff, and 30 (6 percent) among faculty. One hundred ninety-one (37.9 percent) exposures were superficial (no bleeding), 260 (51.6 percent) were moderate (some bleeding), and 53 (10.5 percent) were deep (heavy bleeding). Regarding the circumstances of exposure, 279 (54.5 percent) of the injuries occurred post-operatively (after the use of the device), and most were related to instrument clean-up; 210 (41.0 percent) occurred intra-operatively (during the use of the device); and 23 (4.5 percent) occurred when a DCW collided with a sharp object in the dental operatory (eight cases involved more than one circumstance). The overall exposure rate for the college was 2.46+/-0.11 SD per 10,000 patient visits. The average rate for the student population was 4.02+/-0.20 SD per 100 person-years, with the highest rates being observed among junior year students. The observed rates of occupational exposures to blood and body fluids in this report are consistent with published reports from several other educational settings. Dental teaching institutions are faced with the unique challenge of protecting the student and patient populations against bloodborne infections. Educational efforts must go beyond mere teaching of universal precautions and should include the introduction of safer products and clinical procedures that can minimize the risks associated with the hands-on aspects of the students' learning process.

Blood-Borne Pathogens↗
PubMed1993

Puncture injuries due to needles removed from intravenous lines: should the source patient routinely be tested for bloodborne infections?

OBJECTIVE: To better assess the risk of exposure to bloodborne pathogens following puncture injuries due to needles removed from intravenous (IV) lines. SETTING: Tertiary care community medical center. PATIENTS: A convenience sample of hospitalized patients requiring IV piggy-back medications. METHODS: Examination of 501 IV ports of peripheral lines, heparin-locks, and central venous lines for visible blood and testing the residual fluid in the needles removed from these ports for the presence of occult blood by using guaiac-impregnated paper. RESULTS: The proximal ports of central venous lines and heparin-locks were statistically more likely to contain visible blood than proximal and distal ports of peripheral lines (17% and 20% versus 1% and 3% respectively, P < 0.05). Similarly, needles removed from proximal ports of central venous lines and heparin-locks were statistically more likely to contain occult blood than those from peripheral lines (11% and 14% versus 2%, respectively, P < 0.05). Only two needles removed from IV lines without visible blood contained occult blood: one from the proximal port of a central line and another from a heparin-lock. None of the needles from peripheral lines without visible blood contained occult blood. Estimation of the risk of transmission of hepatitis B and C and human immunodeficiency virus (HIV) following injury by needles from various IV lines revealed that injury due to needles removed from peripheral IV lines and distal ports of central lines without visible blood was associated with "near zero" risk of transmission of these bloodborne infections at our medical center. CONCLUSIONS: Routine serological testing of source patients involving injury due to needles removed from peripheral IV lines and distal ports of central lines without visible blood is not necessary at our medical center. Conversely, due to the relatively high rate of occult blood in the needles removed from proximal ports of central venous lines and heparin-locks, puncture injuries due to these needles are considered significant and managed accordingly.

Catheterization↗
PubMed1998

Occupational exposure to bloodborne pathogens: request for information--OSHA. Request for information.

OSHA requests information and comment on engineering and work practice controls used to eliminate or minimize the risk of exposure to bloodborne pathogens due to percutaneous injuries from contaminated needles and o ther contaminated sharps in occupational environments. Percutaneous injuries continue to be a concern in work settings where employees are exposed to bloodborne pathogens. The Agency is considering possible actions that it can undertake to assist in addressing this issue. Consequently, OSHA is interested in strategies for reducing percutaneous injury rates that have been successfully implemented in the work environment, including work practices and, in particular, the use of devices designed to limit the risk of such injuries. The information received in response to this notice will be carefully reviewed and will assist OSHA in determining effective approaches to reducing percutaneous injury rates and what role the Agency may have in these approaches.

Blood-Borne Pathogens↗
PubMed2000

Needle stick injuries among medical students.

Questionnaires were distributed among 200 medical students regarding safety precautions observed while perfonning various invasive procedures during their clinical posting. Only 106 students responded with the completed questionnaire. The most common procedure performed by the students was drawing of blood, with an average frequency of 60.8 per month. Sixty-one per cent of the students reported being injured during the various procedures and only 3 5.5% of them used gloves. Resheathing the needle was responsible for causing injury to 69% of the students, which was significantly higher than injuries occurring while entry into the vein or withdrawing the needle (p<0.05).

Adult↗
PubMedDate not supplied

Eye on the needle. Interview by Lynne Pearce.

Sally O'Toole has been a driving force in the introduction of safer cannulas and reducing the number of sharps injuries in her large NHS trust. Sharps injuries featured among the top three categories of injuries in the trust. Getting key stakeholders on board was crucial to the introduction of new cannulas. Working with the manufacturer meant product costs were not increased. An extensive programme of staff training was undertaken. Changing the way sharps injuries are reported should allow better monitoring.

Accidents, Occupational↗
PubMed1998

A five year survey of inoculation injuries in Exeter.

A new policy was introduced in Exeter as part of the process of improving the management of inoculation injuries. Completion of detailed questionnaires by injured health care workers has enabled us to monitor their occurrence. This has helped in the management of individual incidents, provided valuable data for staff education, prevented injuries, and identified deficiencies in compliance with procedures.

England↗
PubMed2000

Expression of vascular endothelial growth factor by reactive astrocytes and associated neoangiogenesis.

Injury to the central nervous system (CNS) invokes a reparative response known as astrogliosis, characterized largely by hypertrophy, proliferation and increased expression of glial fibrillary acidic protein (GFAP), resulting in reactive astrocytosis. Based on our prior observation that peritumoral reactive astrocytes express Vascular Endothelial Growth Factor (VEGF), a highly potent and specific angiogenic growth factor, we have hypothesized that reactive astrocytosis also contributes to the neovascularization associated with astrogliosis. To evaluate this hypothesis we evaluated human surgical/autopsy specimens from a variety of CNS disorders that induce astrogliosis and an experimental CNS needle injury model in wild type and GFAP:Green Fluorescent Protein (GFP) transgenic mice. Using computer image semi-quantitative analysis we evaluated the number of GFAP-positive reactive astrocytes, degree of VEGF expression by these astrocytes, associated Factor VIII-positive microvascular density (MVD) and Ki-67 proliferating endothelial cells. The degree of reactive astrocytosis correlated to levels of VEGF immunoreactivity and MVD in the neuropathological specimens. The mouse-needle-stick brain injury model demonstrated this correlation was temporally and spatially related and maximal after 1 week. These results, involving both human pathology specimens augmented by experimental animal data, supports our hypothesis that the neoangiogenesis associated with reactive astrogliosis is correlated to increased reactive astrocytosis and associated VEGF expression.

Animals↗
PubMed1997

Incidence of percutaneous injuries at a dental school: a 4-year retrospective study.

BACKGROUND: Infection control training for predoctoral dental students, dental hygiene students, and dental assistant students has assumed an important role in the educational process at our institution. As part of an ongoing review of the curriculum at our school, we conducted a retrospective analysis of reported percutaneous injuries during the years 1991 through 1994 to determine whether the increase in infection control training introduced at the school in 1990 has had an effect on our rate of percutaneous injuries. METHODS: The population examined in this retrospective study consisted of predoctoral and postdoctoral dental students, dental hygiene students, dental assistant students, and staff. The data for this retrospective study were obtained from annual reports of occupational exposures incurred by students and staff. These annual reports were generated by compiling and summarizing all percutaneous injury incident reports that were prepared for that year. RESULTS: Our results indicate, that except for an increase in 1992, the total number and incidence of reported percutaneous injuries decreased from 1991 to 1994. Statistically significant decreases were seen in the total number of reported percutaneous injuries for all students, staff, and all groups combined. On the basis of data available for 1993 and 1994, the incidence of reported percutaneous injuries per 1000 procedures was fairly constant over these 2 years. Distribution of percutaneous injuries by source varied during the 4-year period. CONCLUSIONS: As part of the outcomes assessment program at our institution, we conducted a retrospective study of reported percutaneous injuries from 1991 to 1994. This study demonstrated that, although the total number of injuries decreased significantly, the rates within certain individual groups remained unchanged. On the basis of this observation, increased emphasis in the prevention of percutaneous injuries through additional training is indicated for these groups.

Curriculum↗
PubMed1995

Needlestick/sharps injuries and HIV exposure among health care workers. National estimates based on a survey of U.S. hospitals.

Exposure to HIV in the workplace is a major concern for health care workers. The greatest risk for bloodborne pathogen transmission is associated with percutaneous injuries involving hollow-bore needles contaminated with patient blood. Limited data are available about how many sharps injuries (SIs) and needlesticks (NSs) occur in the United States, with estimates ranging from 100,000 to 1 million injuries per year. We conducted a survey of 100 infection control practitioners located at randomly selected U.S. hospitals to assess the number of SIs or NSs occurring during 1990; 65 (65%) responded. The mean number of NS/SIs reported was 45, with a mean of 1.1 known HIV-related NS/SIs. The underreporting rate was estimated to be 18.5%. Assuming that the hospitals provided exact numbers of injuries and were representative of the approximately 5,100 U.S. hospitals, then about 252,000 NS/SIs were reported in U.S. hospitals in 1990 (95% CI = 193,000-312,000). If the under-reporting rate was 33% to 66%, then the point estimate for the total number of NS/SIs ranges from 378,000 to 756,000. Similar extrapolation involving the reported number of NS/SIs contaminated with blood from an HIV-infected patient yields an estimate of 5,610 exposures in 1990 (95% CI = 1,300-8,300). The number of U.S. hospital workers sustaining NS/SIs with potential exposure to HIV appears to be considerable. Efforts to reduce the risk of bloodborne pathogen transmission from NS/SIs are warranted.

Bias↗
PubMed2001

Some epidemiological aspects of needle stick injuries among the hospital health care workers: Eastern Province, Saudi Arabia.

This study was conducted to provide some epidemiological aspects of needle stick injuries among health care workers in the eastern province in Saudi Arabia. Data about 282 injuries reported from the hospitals of the Eastern Province of Saudi Arabia were collected through specially designed questionnaire retrospectively from 1995 to 1997. Results showed that 50% of injuries occurred in the first 3 years of employment. Workers in medical and surgical specialties suffered an equal degree of reported exposure. The highest percentage (46.8%) of injuries occurred during syringe related actions. Patients' wards were the major location of incidents (48.5%) followed by ICUs and dialysis units (17.7%), theatres (15.6%) and accidents and emergency departments (13.8%). There was no significant association between injuries and type of shifts. The middle hours of the shifts showed a significant association with injuries. The pattern of injuries was significantly associated with over loaded periods of medical practices. Deficiencies in implementing the standard recommendations for prevention and control of needle stick injuries were noted in the studied hospitals.

Adult↗
PubMedDate not supplied

Knowledge, attitude and practices among health care workers on needle-stick injuries.

OBJECTIVE: This study aimed to assess the knowledge, attitude and practices among health care workers on needle stick injuries. METHODS: A 15-item questionnaire was administered to seventy health care workers including nurses and paramedical staffs from different departments of Kathmandu Medical College and Teaching Hospital to measure knowledge, attitude and practices on needle stick injuries. RESULTS: Results showed that 4% and 61% of health care workers, respectively, were unaware of the fact that hepatitis B and hepatitis C can be transmitted by needle-stick injuries. 52 subjects (74%) had a history of needle-stick injuries and only 21% reported the injuries to the hospital authority. Only 23% were in the habit of using gloves for phlebotomy procedures all the time. 79% were of the impression that needle should be recapped after use. Only 66% were aware of Universal Precaution Guidelines. 16 subjects (23%) were negative for HBsAg, Anti-HCV and Anti-HIV and 54 subjects (77%) do not know about their immune status. 42 subjects (60%) had been vaccinated against hepatitis B, while 28 subjects (40%) were not vaccinated against hepatitis B. Only 6 subjects (14%) had been tested for Anti-HBs antibody after hepatitis B vaccination. CONCLUSION: The survey revealed that knowledge of health care workers about the risk associated with needle-stick injuries and use of preventive measures was inadequate. A standing order procedure (SOP) should be formulated regarding needle-stick injuries in all the health institutions. It should outline precautions to be taken when dealing with blood and body fluids. It should also contain reporting of all needle-stick injuries. Health care workers should be made aware of hazards, preventive measures and post-exposure prophylaxis to needle-stick injuries. A hospital-wide hepatitis immunization programme should also be started.

Adult↗