Self-reported percutaneous injuries in dentists: implications for HBV, HIV, transmission risk.
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Acquired Immunodeficiency Syndrome↗
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Monitoring sharps injuries: EPINet surveillance results.
Sharps injuries are one of the main types of accident sustained by NHS staff. The RCN's Be Sharp Be Safe campaign was launched in 2001 with the aim of reducing sharps injuries and includes a surveillance project to describe the current pattern of sharps injuries being experienced in participating trusts. This article gives an overview of the results from the second year of the surveillance project and indicates how the data can be used to help improve practice. Nurses emerge as the staff group reporting the highest proportion of injuries recorded in the study period. The most common sharps injury scenario involves nurses giving injections in the patient's room or ward area. Aspects of poor disposal practice and incidents involving the recapping of needles continue to result in injuries and are worthy of further investigation. Analysis of the data by location can highlight specific tasks which could be reviewed to identify safer working practices.
Accidents, Occupational↗
Risk of needle-stick injuries in the transmission of hepatitis C virus in hospital personnel.
To assess the risk to hospital personnel of acquiring an hepatitis C virus (HCV) infection as a result of occupational exposure to needle-stick injuries, 81 employees who had parenteral exposure to an anti-HCV-positive source were followed for 12 months. None developed hepatitis and anti-HCV testing by a second-generation ELISA system of serum samples collected on the day of exposure and at 3, 6 and 12 months was negative. Consequently, a low efficacy of needle-stick injuries in the transmission of HCV in hospital personnel may be suggested.
Follow-Up Studies↗
Injection safety: knowledge and practice among health workers.
The increase in the spread of human immune-deficiency virus (HIV) infection among our population calls for measures to check its transmission. Health workers are at risk especially those in clinical practice who work with needles and other sharp objects that could aid transmission of the virus. Professionalism is at its lowest at Primary Health Care level and workers responsible for giving immunization with injections need clear understanding of principles of safe injection. To appreciate how to formulate a training programme, the knowledge and practice of injection safety among the workers were assessed through the use of a questionnaire. Fifty eight percent thought only children receiving immunization were at risk of a disease, 58.3% know the diseases transmissible by needle stick injury. On reasons for prevalence of unsafe injection practices, 27% suggested inadequate provision, 18.3% poverty, 17.7% ignorance, 17.2% improper disposal, 11.8% lack of surveillance and health supervision for workers and 8% negligence. On syringes and needles disposal, 53.2% suggested burning only, 2.1% burying and 44.7% both burning and burying. Less than 9% knew that auto-destruct syringes exist while 38.9% were aware of the joint WHO and UNICEF statement on "bundling approach" in vaccine packaging. Only about 50% of respondents had facilities for disposal of needles and syringes in their health centers, 45.6% wear protective clothing during service delivery. On making injection safer 33.7% suggested re-training of health workers, 22% retraining of workers and public re-education, 16.8% suggested planning budgeting and purchasing of auto-destruct syringes, 16.5% social mobilization and advocacy and 11% suggested the provision of facilities for disposal. It was concluded that awareness on safe injection practices was low among the health workers and that their practices could put them at greater risk of needles stick injury and hence the spread of HIV and other infection among them. Training on safe injection practices is therefore recommended.
Disposable Equipment↗
Strategies to reduce the risk of needle and sharps injuries.
Needle or sharps injuries are common, underreported and often preventable (Department of Health, 2004). This article describes when, how and why these injuries occur and who is at risk. It provides an overview of recent legislation and outlines strategies to minimise risks.
Government Regulation↗
[Collecting sharp instruments: useful or not?].
78 per cent of the exposure incident are needle punctures (40 per cent during recapping of the needle). Housekeeping personnel, laboratory personnel, nursing personnel, dentists and physicians experienced the highest incidence of needle stick injuries. Many needle stick injuries can be prevented by not recapping used needles and using a rigid punction resistant needle disposal system.
Dental Waste↗
Disposal-related sharps injuries at a New York City Teaching Hospital.
OBJECTIVE: To characterize disposal-related sharps injuries. DESIGN: A three-part study including (a) descriptive analysis of disposal-related injuries in a 1-year period, (b) 4:1 matched case-control study of nurses injured while using sharps disposal containers, and (c) survey to solicit opinions of users of containers. SETTING: An 1,181-bed teaching hospital in New York City. PARTICIPANTS: For epidemiologic analyses, persons with self-reported injuries identified via New York State and Occupational Safety and Health Administration forms and control nurses without self-reported injuries. For survey, convenience sample of hospital nurses, laboratory workers, and maintenance workers. MAIN OUTCOME MEASURES: Circumstances of injuries determined by study questionnaires. Employee opinions obtained by questionnaires and discussions during small group sessions. RESULTS: Three hundred sixty-one persons reported sharps injuries, of whom 72 (20%) had disposal-related injuries. Persons with disposal-related injuries included four hospital visitors and one patient. Of 67 disposal-related injuries among employees, 25 (37%) directly involved use of a sharps disposal container. Significant risk factors for injury included container height greater than 4 ft above the floor, distance less than 5 ft from site of sharp object use to nearest container, and lack of attendance at universal precautions inservice classes. Survey groups involved 69 employees who identified a variety of preferred features for sharps disposal containers. CONCLUSIONS: Disposal of sharp objects is an important cause of sharps injuries. Ergonomic factors, worker education, and appropriate container design should be considered in injury prevention strategies. Relevant guidelines and regulations are lacking and are needed.
Case-Control Studies↗
[Characterisation of an HBsAg mutant of hepatitis B virus (HBV) isolated from a dialysed patient involved in an occupational accident].
BACKGROUND: Mutants of the hepatitis B virus (HBV) following vaccination (escape mutants) have been isolated over the course of the last decade. They consist most commonly of an aminoacid change from glycine to arginine at position 145 of the highly antigenic a determinant of the surface antigen (HBsAg). OBJECTIVE: Description of an escape mutant of HBV identified in the course of the post-exposure follow-up of a percutaneous exposure. METHODS: The viral DNA was extracted from serum samples of a dialysed patient vaccinated against hepatitis B, who developed an acute infection. A direct sequencing was performed on the amplified DNA followed by a sequence analysis. RESULTS AND CONCLUSIONS: A threonine to lysine substitution at position 118 of HBsAg (Thrll8Lys) was observed in the analysed viral aminoacid sequence. Such mutation could have significantly changed the antigenic profile of the HBsAg compared to that of the wild type.
Accidents, Occupational↗
Analysis of sharp-edged medical-object injuries at a medical center in Taiwan.
A total of 733 incidents by sharp-edged objects occurred among healthcare workers between 1995 and 1998. Injuries occurred most frequently among interns. The workplace location with the highest incidence of injury was the patient ward, and the object that most frequently inflicted injury was a needle. The most frequent work practice was recapping of syringes. One healthcare worker demonstrated seroconversion for hepatitis C.
Hepatitis C↗
Transmission of drug-resistant HIV after an occupational exposure despite postexposure prophylaxis with a combination drug regimen.
We documented a case of occupational human immunodeficiency virus (HIV) despite postexposure prophylaxis (PEP) with a combination drug regimen after percutaneous injury with a needle from a sharps disposal container in the hospital room of an HIV-infected patient. This failure of PEP with a combination drug regimen may have been related to antiretroviral drug resistance, other factors, or both. This case highlights the importance of preventing injury to prevent occupational transmission of HIV.
Adult↗
Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998.
OBJECTIVE: To construct a single estimate of the number of percutaneous injuries sustained annually by healthcare workers (HCWs) in the United States. DESIGN: Statistical analysis. METHODS: We combined data collected in 1997 and 1998 at 15 National Surveillance System for Health Care Workers (NaSH) hospitals and 45 Exposure Prevention Information Network (EPINet) hospitals. The combined data, taken as a sample of all U.S. hospitals, were adjusted for underreporting. The estimate of the number of percutaneous injuries nationwide was obtained by weighting the number of percutaneous injuries at each hospital by the number of admissions in all U.S. hospitals relative to the number of admissions at that hospital. RESULTS: The estimated number of percutaneous injuries sustained annually by hospital-based HCWs was 384,325 (95% confidence interval, 311,091 to 463,922). The number of percutaneous injuries sustained by HCWs outside of the hospital setting was not estimated. CONCLUSIONS: Although our estimate is smaller than some previously published estimates of percutaneous injuries among HCWs, its magnitude remains a concern and emphasizes the urgent need to implement prevention strategies. In addition, improved surveillance could be used to monitor injury trends in all healthcare settings and evaluate the impact of prevention interventions.
Hospitalization↗
Survey of hepatitis B exposure and sharps injuries in dental health-care professionals.
Injuries associated with the category of dental surgical instruments known as "sharps" (i.e., syringe needles, glass, scalpel blades, dental burs, and hand instruments) are a serious concern for dental professionals because of the possible transmission of communicable diseases such as tuberculosis, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV). Hepatitis B virus has been recognized as an occupational hazard for dentists and other health-care professionals for several decades. The transmission of HIV from dentist to patient in the dental office has been known to occur in only one practice, and the vector of transmission remains unknown. No dentist has ever been reported to have contracted HIV from a patient. Adherence to infection-control procedures, especially barrier protection, has been linked closely to keeping the incidence of these infections low. This article discusses the results of an anonymous survey about "sharps" injuries and communicable diseases that was given to dentists/faculty, students, and support staff at an urban dental-school clinic.
Dental Instruments↗
Injury prevention in anesthesiology.
Anesthesia personnel routinely perform procedures that put them at risk for contact with blood and body fluids. Some of these exposures are to skin and mucous membranes; many are percutaneous injuries associated with the frequent use of needled devices. The high risk in anesthesia procedures for contact with infected body fluids is associated with a high incidence rate of actual infection with bloodborne pathogens.
Accidents, Occupational↗
Accidental blood contact during orthopedic surgical procedures.
A questionnaire study was carried out of all orthopedic surgical procedures in the operating rooms of a teaching hospital over an 8-week period to describe the frequency and circumstances of accidental blood contact. Blood exposure occurred in 11% of the procedures. Contamination of intact skin was the most common incident (79%); percutaneous injury occurred in 13%. The majority of the incidents were believed to be preventable.
Attitude of Health Personnel↗
Acute ureteral obstruction following transvaginal oocyte retrieval for IVF.
Transvaginal, ultrasound-guided oocyte retrieval has become the gold standard for IVF therapy. Despite a low reported complication rate, here a case is reported of acute ureteral obstruction following seemingly uncomplicated oocyte retrieval. Prompt diagnosis and ureteral stenting led to rapid patient recovery with no long-term urinary tract sequelae. Ureteral injury needs to be included in the differential diagnosis of a patient presenting with pelvic/abdominal pain following oocyte retrieval.
Abdominal Pain↗
Needle stick injuries among nurses in sub-Saharan Africa.
OBJECTIVES: Despite a heavy burden of HIV/AIDS and other blood borne infections, few studies have investigated needle stick injuries in sub-Saharan Africa. We conducted a cross-sectional study at Mulago national referral hospital in Kampala, Uganda, to assess the occurrence and risk factors of needle stick injuries among nurses and midwives. METHODS: A total of 526 nurses and midwives involved in the direct day-to-day management of patients answered a questionnaire inquiring about occurrence of needle stick injuries and about potential predictors, including work experience, work load, working habits, training, and risk behaviour. RESULTS: A 57% of the nurses and midwives had experienced at least one needle stick injury in the last year. Only 18% had not experienced any such injury in their entire career. The rate of needle stick injuries was 4.2 per person-year. Multiple logistic regression analysis showed that the most important risk factor for needle stick injuries was lack of training on such injuries (OR 5.72, 95% CI 3.41-9.62). Other important risk factors included working for more than 40 h/week (OR 1.90, 95% CI 1.20-3.31), recapping needles most of the time (OR 1.78, 95% CI 1.11-2.86), and not using gloves when handling needles (OR 1.91, 95% CI 1.10-3.32). CONCLUSIONS: The study showed a high rate of needle stick injuries among nurses and midwives working in Uganda. The strongest predictor for needle stick injuries was lack of training. Other important risk factors were related to long working hours, working habits, and experience.
Adult↗
Frequency of and prevention measures for needle-stick injuries among hospital healthcare workers in Saudi Arabia.
This study was undertaken to determine the frequency of needle-stick injuries among healthcare workers in hospitals in the Eastern Province of Saudi Arabia from 1995 to 1997, and to gather information about the measures these hospitals are taking to protect their employees against these injuries. Precautionary measures taken to protect healthcare workers from injury and the follow-up after injuries were surveyed. The total overall prevalence rate of needle-stick injuries was significantly lower among healthcare workers in governmental hospitals than among those in private hospitals. The extremely low prevalence rate of needle-stick injuries indicated that there were serious defects in the reporting systems of the hospitals studied. All hospitals should have a mandatory, clear, and unified policy to help reduce the number of needle-stick injuries. Hospitals must adopt a policy to ensure that precautions are taken to reduce healthcare workers' accidental exposures to potentially infected blood.
Blood-Borne Pathogens↗
[Medical interns and AIDS: perceptions and attitudes in 3 French regions].
This study has been conducted to clarify certain issues regarding residency training with regard to acquired immunodeficiency syndrome (AIDS). The objective was to evaluate resident physicians' experiences in, and attitudes toward, the care of persons with AIDS in France. The design was a cross sectional study, using a self administered mailed questionnaire to 627 residents in 3 French areas: Ile-de-France, Nord-Pas de Calais and Province-Côte d'Azur, with a follow up of non responders. The subjects of this study were a random sample of residents in the second year of specialty medicine or family medicine residencies (biological residents, surgeons, public health residents and research residents were excluded). The response rate was 56%. More than half of residents indicated that their training was deficient in AIDS ambulatory care and less of 40% felt competent to provide usual and primary care for AIDS patients. The social and psychosocial aspect of care seems to be the greatest difficulties for them. About the half of residents reported at least one needle stock contaminated by a patient's blood. Needle stick injuries from patients known to have HIV infection were reported by 8% of them. About 25% expressed great concern about the professional risk of HIV contamination and 24% indicated it is dangerous to provide care for AIDS patients. It appears that an important component of future education in medical residency programs should emphasize strategies to address social and psychosocial issues in the medical care of AIDS patients and to decrease the risk of needle stick injuries.
Accidents, Occupational↗