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PubMed1998

Acute hepatitis C during pregnancy. Case report and review of the literature.

Treatment of chronic hepatitis C with interferon is well established (Fried 1995, Zein 1995) though not very successful. We report a case of a pregnant doctor who developed acute hepatitis C six weeks after accidental needle-stick injury from a hepatitis C virus positive patient. We review the literature that deals with such cases.

Adult↗
PubMed1998

Hepatitis G virus infection from needle-stick injuries in hospital employees.

A new RNA virus, hepatitis G virus (HGV) is known to be transmissible by blood transfusion. The aim of this study was to assess whether HGV is an occupational risk to hospital employees as a result of exposure to needle-stick injuries. Among 220 cases of needle-stick injuries, 21 employees were contaminated with HGV. Initially none of the 21 recipients were HGV positive. Fourteen of the 21 recipients were followed up and further tested for HGV RNA and serum anti-envelope (E2) specific antibody. None of the 21 recipients exposed to HGV developed liver function abnormalities, but one of the 14 recipients became positive for HGV RNA after the injury. Anti-E2 was negative in all recipients tested. These findings suggests a low clinical risk of occupational exposure to HGV in hospital employees. Nevertheless HGV is transmissible by needle-stick injury.

Acute Disease↗
PubMed2005

Occupational blood and body fluid exposure in an Australian teaching hospital.

To examine work-related blood and body fluid exposure (BBFE) among health-care workers (HCWs), to explore potential risk factors and to provide policy suggestions, a 6-year retrospective study of all reported BBFE among HCWs (1998-2003) was conducted in a 430-bed teaching hospital in Australia. Results showed that BBFE reporting was consistent throughout the study period, with medical staff experiencing the highest rate of sharps injury (10.4%). Hollow-bore needles were implicated in 51.7% of all percutaneous injuries. Most incidents occurred during sharps use (40.4%) or after use but before disposal (27.1%). Nursing staff experienced 68.5% of reported mucocutaneous exposure. Many such exposures occurred in the absence of any protective attire (61.1%). This study indicated that emphasis on work practice, attire, disposal systems and education strategies, as well as the use of safety sharps should be employed to reduce work-related injuries among HCWs in Australia.

Blood-Borne Pathogens↗
PubMed1998

Occupational risk of HIV infection among western health care professionals posted in AIDS endemic areas.

In this study on occupational risks of HIV infection among 99 Dutch medics working in AIDS endemic areas, 61% reported percutaneous exposures during an average stay of 21 months. The mean number of injuries was lower among physicians (2.0 versus 3.9 per year) and higher among nurses (1.9 versus 1.2) than in previous research conducted in 1987-1990 among Dutch medics returning from Africa. But the reduction of exposures among physicians might be explained by the fact that the number of procedures they carried out was less in the later study. Also among nurses a shift of tasks was seen. On the basis of an estimated HIV prevalence in the patient population of 19%, a chance of transmission per accident of 0.3%, and 1.9 percutaneous exposures per year, the mean occupational risk of HIV infection per year can be estimated at 0.11% per person. Besides length of stay and number of activities, characteristics of the work setting were associated with the frequency of different kinds of injuries. From the analysis of 109 extensive descriptions of recent accidents, it appeared that the majority of the injuries occurred during routine activities and were self-inflicted. Injuries with hollow needles usually occurred after the actual medical act (e.g. during recapping). Carelessness (e.g. due to fatigue) or being in a hurry (e.g. because of an emergency) were also often the cause of percutaneous injuries, as were the poor quality of the equipment, lack of professional skills, or a combination of these factors. Prevention activities are still important to reduce the frequency of occupational exposures. But they will not eliminate them totally; from the descriptions of recent exposures it was clear that some of the injuries occurred in spite of precautions.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Differences in percutaneous injury patterns in a multi-hospital system.

OBJECTIVE: Determine differences in patterns of percutaneous injuries (PIs) in different types of hospitals. DESIGN: Case series of injuries occurring from 1997 to 2001. SETTING: Large midwestern healthcare system with a consolidated occupational health database from 9 hospitals, including rural and urban, community and teaching (1 pediatric, 1 adult) facilities, ranging from 113 to 1,400 beds. PARTICIPANTS: Healthcare workers injured between 1997 and 2001. RESULTS: Annual injury rates for all hospitals decreased during the study period from 21 to 16.5/100 beds (chi-square for trend = 22.7; P = .0001). Average annual injury rates were higher at larger hospitals (22.5 vs 9.5 PIs/100 beds; P = .0001). Among small hospitals, rural hospitals had higher rates than did urban hospitals (14.87 vs 8.02 PIs/100 beds; P = .0143). At small hospitals, an increased proportion of injuries occurred in the emergency department (13.7% vs 8.6%; P = .0004), operating room (32.3% vs 25.4%; P = .0002), and ICU (12.3% vs 9.4%; P = .0225), compared with large hospitals. Rural hospitals had higher injury rates in the radiology department (7.7% vs 2%; P = .0015) versus urban hospitals. Injuries at the teaching hospitals occurred more commonly on the wards (28.8% vs 24%; P = .0021) and in ICUs (11.4% vs 7.8%; P = .0006) than at community hospitals. Injuries involving butterfly needles were more common at pediatric versus adult hospitals (15.8% vs 6.5%; P = .0001). The prevalence of source patients infected with HIV and hepatitis C was higher at large hospitals. CONCLUSIONS: Significant differences exist in injury rates and patterns among different types of hospitals. These data can be used to target intervention strategies.

Database Management Systems↗
PubMed2004

[Remaining of a safety clip within the hub of the Surshield Surflow II i.v. catheter].

Terumo's Surshield Surflow II i.v. catheter automatically engages a stainless steel clip to shield its needle tip when the needle goes out from the catheter hub. However, in our experience the safety clip of Surshield Surflow II remains in the catheter hub in a high proportion of cases when the catheter hub is held with a pair of forceps. The hub wall is so thin that the force existed to hold the hub can be easily transmitted to the safety clip. Another factor is the loose attachment of the safety clip to the needle tip. To prevent needle stick injury, further improvement of safety i.v. catheters is necessary to lead their increased use.

Catheterization↗
PubMed2006

Blunt and penetrating object injuries in housekeepers working in a Turkish University Hospital.

BACKGROUND: Hospitals have been described as hazardous work environments with an increase in job-related injuries. This situation creates great risks and hazards for housekeepers while carrying out their job. METHODS: This descriptive study was performed on 402 housekeepers working in patient-care services in Turkey. The data of this study were collected using a questionnaire form. This form included 26 questions about general features of housekeepers and working units, blunt and penetrating object injuries in the past 3 months and hepatitis B virus immunization. RESULTS: The majority of housekeepers (71.1%) are men, (54%) are graduates of primary school or are illiterate, and (73.6%) are married. Their mean age is 31.5 years; the mean length of employment is 3.2 years. Sixty-two point nine percent of them are working in medical/surgical units, 88.8% of them are working in routine cleaning, and 29.1% of them have been injured with various blunt and penetrating objects while working in hospital in the past 3 months. Only 26.6% of the housekeepers have been administered the hepatitis B vaccination. CONCLUSION: This study showed a high frequency of blunt and penetrating object injuries in housekeepers. Therefore, more efforts are necessary to increase compliance with vaccination in housekeepers.

Accidents, Occupational↗
PubMed2004

Effect of implementing safety-engineered devices on percutaneous injury epidemiology.

OBJECTIVE: To assess the effect of implementing safety-engineered devices on percutaneous injury epidemiology, specifically on percutaneous injuries associated with a higher risk of blood-borne pathogen exposure. DESIGN: Before-and-after intervention trial comparing 3-year preintervention (1998--2000) and 1-year postintervention (2001--2002) periods. Percutaneous injury data have been entered prospectively into CDC NaSH software since 1998. SETTING: A 427-bed, tertiary-care hospital in Manhattan. PARTICIPANTS: All employees who reported percutaneous injuries during the study period. INTERVENTION: A "safer-needle system," composed of a variety of safety-engineered devices to allow for needle-safe IV delivery, blood collection, IV insertion, and intramuscular and subcutaneous injection, was implemented in February 2001. RESULTS: The mean annual incidence of percutaneous injuries decreased from 34.08 per 1,000 full-time-equivalent employees preintervention to 14.25 postintervention (P < .001). Reductions in the average monthly number of percutaneous injuries resulting from both low-risk (P < .01) and high-risk (P was not significant) activities were observed. Nurses experienced the greatest decrease (74.5%, P < .001), followed by ancillary staff (61.5%, P = .03). Significant rate reductions were observed for the following activities: manipulating patients or sharps (83.5%, P < .001), collisions or contact with sharps (73.0%, P = .01), disposal-related injuries (21.41%, P = .001), and catheter insertions (88.2%, P < .001). Injury rates involving hollow-bore needles also decreased (70.6%, P < .001). CONCLUSIONS: The implementation of safety-engineered devices reduced percutaneous injury rates across occupations, activities, times of injury, and devices. Moreover, intervention impact was observed when stratified by risk for blood-borne pathogen transmission.

Equipment Design↗
PubMed2003

Occupational sharps injuries in a Dublin teaching hospital.

Contaminated sharps injuries pose a risk of infection to health care workers and represent a major workload for hospital occupational health departments (OHDs). The aim of this study was to review the epidemiology and management of sharps injuries in an Irish tertiary referral centre, which has not been previously described. Occupational health records of sharps injuries occurring between January 1998 and December 2000 inclusive were reviewed from the hospital OHD. A total of 332 sharps injuries were reported to the OHD in this period. More than two-thirds of injuries involved medical or nursing staff. Support staff such as cleaners and porters accounted for 13.5% of injuries. The majority of sharps injury recipients (86%) were immune to hepatitis B. Of those injured, 22% were not wearing gloves at the time of their injury. Eight source patients were hepatitis C antibody positive, two were HIV antibody positive and one was hepatitis B surface antigen positive. No instances of occupational acquisition of blood borne viruses were documented. The results of this study confirm that health care workers need further education to prevent sharps injuries, and that the risk of blood borne virus acquisition through an occupational sharps injury is low but not negligible.

Accidents, Occupational↗
PubMed2004

Sharps discarded in inner city parks and playgrounds--risk of bloodborne virus exposure.

The objectives of this study were to determine the number of discarded syringes found in four parks in Southwark, South London, over a specific time period and to test their contents for the presence of hepatitis B virus (HBV) and hepatitis C virus (HCV). Of 106 syringes collected over a four-month period, evidence of HBV was detected in 4.7% (5/106) and HCV in 4.7% (5/106). Urban children, park users and workers are at risk of contact with sharps which may be contaminated with both viruses. Park users need more information on what to do in the event of an injury, and park workers should be immunised against HBV and educated on safe disposal of sharps.

Blood-Borne Pathogens↗
PubMed1998

Frequency of percutaneous injuries requiring postexposure prophylaxis for occupational exposure to human immunodeficiency virus.

New recommendations regarding prophylaxis of healthcare workers exposed to human immunodeficiency virus (HIV) prompted us to examine the frequency and nature of percutaneous injuries at this hospital. Four previously defined risk factors for transmission of HIV were evaluated. Between 1993 and 1995, 1,070 percutaneous injuries were reported, including 11 in which the source patient had acquired immunodeficiency syndrome (AIDS). Five of these injuries involved at least one risk factor for transmission. No source patient was found to have AIDS as a result of testing following exposure. We conclude that high-risk injuries are infrequent and that postexposure prophylaxis will not increase costs greatly at this medical center.

Cross Infection↗
PubMed2002

Willingness to pay to avoid sharps-related injuries: a study in injured health care workers.

BACKGROUND: Injuries caused by sharp medical devices are common among health care workers and may result in the transmission of human immunodeficiency virus and hepatitis C virus. OBJECTIVE: The direct medical costs associated with treating these injuries are well characterized but fail to capture the costs of such intangible factors as worker anxiety and distress. The objective of this study was to estimate these intangible costs. SUBJECTS: Subjects included health care workers reporting sharps-related injuries to 2 hospital occupational health services. METHOD: A contingent valuation approach was used to assess willingness to pay to avoid sharps-related injuries among recently injured health care workers. Workers were presented with the option of paying out of pocket for a hypothetical injury-prevention device. The median amount of money subjects were willing to pay was estimated with logistic regression, and multivariable regression was performed to assess confounding by worker characteristics and circumstances surrounding injuries. RESULTS: Study interviews were conducted for 116 subjects; median time from injury to interview was 3 days (range, 0-15). Most subjects were women (73%), and most were nurses (44%) or trainees (32%). The crude median amount subjects were willing to pay to avert injury was $850 (US); when adjusted for patient risk status (human immunodeficiency virus and hepatitis C virus status), and working with an uncooperative patient at the time of injury, median amount increased to $1270. CONCLUSION: The high median amount subjects were willing to pay to avoid a sharps-related injury suggests that the costs of "intangible" aspects of worker injury, such as anxiety and distress, may equal costs associated with the medical evaluation of these injuries. These costs should be incorporated in economic analyses of sharps-injury prevention.

Adult↗
PubMed2001

Rare but serious complications of acupuncture: traumatic lesions.

Acupuncture has a reputation among the public of being safe. Although recently performed prospective studies on the frequency of adverse effects of acupuncture found no severe complication, since 1965 many case reports of serious or even life-threatening incidents caused by acupuncture have appeared in the scientific literature. The most frequently reported complications are pneumothorax and lesions of the spinal cord. Severe injuries of peripheral nerves and blood vessels due to acupuncture seem to be very rare. Although case reports do not produce reliable data on the frequency of adverse events. information on sources of application errors can be extracted to increase the quality of acupuncture in education and therapy. All traumatic injuries described in this article could be avoided if practitioners had better anatomical knowledge, applied existing anatomical knowledge better, or both.

Acupuncture Therapy↗