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PubMed2003

A review of sharps injuries and preventative strategies.

Exposure to bloodborne pathogens from sharps injuries continues to pose a significant risk to healthcare workers (HCW). The number of sharps injuries sustained by HCW is still unclear, primarily due to under-reporting. In this review a mean rate of 4.0% (range 1.0-6.2%) sharps injuries per 10000 HCW was calculated from eight studies involving more than 7000 HCW. Nurses and doctors were most at risk of sharps injuries, frequently from hollow-bore needles. Approaches to reduce this risk have included education and training on the safe handling and disposal of sharp devices, awareness campaigns and legislative action. More recently, preventative strategies have focused on needle protective devices, which may reduce the rate of sharps injuries. Introducing needle protective devices should be considered particularly in high-risk areas, after training, education, evaluation and cost-benefit analysis.

Blood-Borne Pathogens↗
PubMed2006

Percutaneous injuries among dental professionals in Washington State.

BACKGROUND: Percutaneous exposure incidents facilitate transmission of bloodborne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV). This study was conducted to identify the circumstances and equipment related to percutaneous injuries among dental professionals. METHODS: We used workers' compensation claims submitted to the Department of Labor and Industries State Fund during a 7-year period (1995 through 2001) in Washington State for this study. We used the statement submitted by the injured worker on the workers' compensation claim form to determine the circumstances surrounding the injury including the type of activity and device involved. RESULTS: Of a total of 4,695 accepted State Fund percutaneous injury claims by health care workers (HCWs), 924 (20%) were submitted by dental professionals. Out of 924 percutaneous injuries reported by dental professionals 894 (97%) were among dental health care workers in non-hospital settings, including dentists (66, 7%), dental hygienists (61, 18%) and dental assistants (667, 75%). The majority of those reporting were females (638, 71%). Most (781, 87%) of the injuries involved syringes, dental instruments (77, 9%), and suture needles (23%). A large proportion (90%) of injuries occurred in offices and clinics of dentists, while remainder occurred in offices of clinics and of doctors of medicine (9%), and a few in specialty outpatient facilities (1%). Of the 894 dental health care workers with percutaneous injuries, there was evidence of HBV in 6 persons, HCV in 30 persons, HIV in 3 persons and both HBV and HVC (n = 2) exposure. CONCLUSION: Out of hospital percutaneous injuries are a substantial risk to dental health professionals in Washington State. Improved work practices and safer devices are needed to address this risk.

Accidents, Occupational↗
PubMedDate not supplied

Percutaneous injuries on the "front line": a survey of housestaff and nurses.

Our objective was to assess the frequency of work-related percutaneous injuries in two high-risk groups and to compare patterns of injury and reporting in these groups. Data were collected through an anonymous, self-administered survey distributed to all full-time nurses and housestaff. The survey results were compared to Employee Health Service records. Surveys were returned by 258 of 330 housestaff and 455 of 593 nurses for a response rate of 77% (housestaff = 78%; nurses = 76%). The respondents were highly representative of the nursing divisions and residency programs surveyed. The percentage of nurses who had ever sustained percutaneous injuries was 64.7%; for housestaff it was 74.1% (prevalence difference = -9.4%, 95% confidence interval [CI] = -16.4%, -2.4%). The percentage of nurses who had sustained recent injuries was 34.6%; for housestaff it was 43.0% (prevalence difference = -8.4%, 95% CI = -15.9%, -0.9%). Injuries with syringe needles were the most common, followed by injuries with suture needles, scalpels, and then a variety of other sharp objects and instruments. The nurses were more likely to seek care as directed by hospital policy at the Employee Health Service (reporting difference = 29.7%, 95% CI = 19.5%, 39.9%) or the Emergency Room (reporting difference = 11.9%, 95% CI = 8.1%, 20.0%). Knowledge of policy increased the probability of reporting by nurses. The housestaff were more likely to evaluate injuries themselves (reporting difference = -16.7%, 95% CI = -26.8%, -6.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗
PubMed2001

Spinal cord injury caused by direct damage by local anaesthetic infiltration needle.

We describe a case of spinal cord injury caused by direct trauma from a local anaesthetic infiltration needle. During local anaesthetic infiltration before placement of an epidural catheter, the patient suddenly rolled over onto her back, causing the infiltrating needle to advance all the way to its hub. She immediately showed signs of spinal cord injury, confirmed by MRI scan. However, her neurological status gradually improved, and on discharge she was able to walk, with a sensory deficit localized to her left foot.

Adult↗
PubMed2005

Intervention study of needle stick injury in Iran.

OBJECTIVES: Injury resulting from contaminated sharp devices among health care workers (HCWs) is one of the most important concerns in medical centers. This can lead to dangerous infections such as human immunodeficiency virus, hepatitis B virus and hepatitis C virus among such people. The documentation of needle stick injuries started in Sadi Hospital, Isfahan, Iran in 2003, and our objective was to study cases of injuries by sharp devices before and after the implementation of intervention methods. METHODS: In an intervention survey of the type of before and after study, we studied injuries by needle and other sharp devices among 87 HCWs in Sadi Hospital, a private hospital in Isfahan, Iran, during the years 2003-2004. The groups under study were workers and paramedical staff; and the wards under study included surgery, internal, lab, x-ray and laundry. We entered and evaluated the data in SPSS software. RESULTS: In the first phase of the study in 2003, 55.2% of those injured had been injured by sharp devices. After intervention in 2004, this percentage was reduced to 19.5% (p < 0.05). At the beginning of the study, 26.4% of the injured had been injured by sharp devices more than twice, and at the end of the study this number was reduced to 2.3% (p < 0.05). Also, injuries resulting from recapping were 45.8% at the beginning of the study, which was reduced to 5.9% at the end (p < 0.05). DISCUSSION: With regard to this study and other studies carried out in other countries, a large number of injuries by contaminated sharp devices can be prevented by implementing suitable educational programs regarding disposal of sharp devices, and by using safe needle devices.

Health Surveys↗
PubMed1994

A study of needle-stick injuries among house officers in a major hospital.

House officers (HO) undergoing housemanship in the departments of Surgery, Medicine and Orthopaedics in a major hospital were studied with regard to the incidence and causes of needle-stick injuries via a self-administered recall questionnaire. A response rate of 79% (44 out of 56 HOs) was obtained, of which 35 HOs had completed 2 months of housemanship and 9 had completed 8 months. A total of 171 needle-stick injuries (1.2 per HO-month) were reported with 6 HOs never sustaining an injury. The more experienced HOs had less injuries than the less experienced HOs with an incidence rate of 4.65 (95% confidence interval of 4.08-8.87). Resheathing was the commonest reported cause of injury (45% of 113 described cases). Forty-three HOs (90%) reported that they frequently resheathed used needles before disposal. Most HOs (61%) felt that they were at nil to moderate risk of contracting an infectious disease from a needle-stick injury. A system of reporting and policies on management of infected personnel may be needed to monitor this health hazard.

Blood-Borne Pathogens↗
PubMed1994

The surgeon, needle-sticks, and HIV.

This review article looks at needle-stick injuries and human immunodeficiency virus (HIV) conversion from a surgical perspective. Is the risk high or low? That depends on: the rate of HIV in your patients (varies by region); the likelihood of getting injured (varies by specialty); and the HIV conversion rate from the injury (an elusive number that varies with the injury). The current literature was reviewed to see how risky surgery currently is. This leads us to speculate on the HIV risks of the near future.

AIDS Serodiagnosis↗
PubMed2001

Introducing safety syringes into a UK dental school--a controlled study.

AIM: How an appropriate safety syringe was chosen, how the change-over to it was achieved and what outcome measures were used to measure the effectiveness of this change. INTRODUCTION: One third of all reported sharps injuries in dental practice are due to the use of non disposable dental syringes with most injuries being sustained during removal and disposal of the disposable needle from the non-disposable syringe. METHOD: After evaluation of all available disposable safety syringes they were introduced into a dental school after appropriate education of all staff and students. Risk management provided data on all reported needle-stick injuries in the dental school and a control unit using non disposable syringes for a period of two years. RESULTS: Avoidable needle stick injuries reduced from an average of 11.8 to 0 injuries per 1,000,000 hours worked per year as compared with a control unit who reduced their frequency from 26 to 20 injuries per 1,000,000 hours worked. The cost of safety syringes is comparable to non-disposable syringes but the reduction in cost of management of needle stick injuries including the psychological effects are significant. CONCLUSION: Education plays a vitally important role in the effective implementation of the change to safety syringes which is advocated for all dentists.

Accidents, Occupational↗
PubMed2003

Cardiac surgery in patients infected with the human immunodeficiency virus.

BACKGROUND: Highly active antiretroviral therapy has dramatically impacted the natural history of human immunodeficiency virus (HIV) infection and may be associated with lipodystrophy and accelerated coronary artery disease. Patients with HIV are consequently increasingly likely to present for cardiac surgery. METHODS: A retrospective review of 37 consecutive patients at two integrated centers from 1994 to 2000 was conducted. Standard database and follow-up information was supplemented with data on opportunistic infections, CD4 count, viral load, New York Heart Association status, and angina status. Risk to operating room personnel was also reviewed. RESULTS: Median age was 41 years; 34 of 37 patients were male. Operations performed were coronary artery bypass graft ([CABG] 27), aortic valve replacement ([AVR] 4), AVR/CABG (2), AVR/mitral valve repair (1), mitral valve repair (1), excision of atrial masses (1), and tricuspid valve repair (1). Complications included death in 1 of 37 (2.7%), sepsis in 2 of 37 (5.4%), deep sternal infection in 1 of 37 (2.7%), bleeding in 2 of 37 (5.4%), prolonged ventilation in 2 of 37 (5.4%), and readmission in 8 of 37 (21.6%). Actuarial freedom from a composite end point of angina, death, myocardial infarction, repeat revascularization, and congestive heart failure was 81% at 3 years with no late deaths. Preoperative and follow-up CD4 counts and viral loads were not significantly different at a mean follow-up of 28 months. No patients progressed from HIV positive status to AIDS during the study period. Six "needle stick" injuries requiring antiretroviral prophylaxis occurred in 5 caregivers without seroconversion. CONCLUSIONS: In selected patients infected with HIV, risks and outcomes of cardiac surgery are acceptable. With concomitant highly active antiretroviral therapy, intermediate HIV and cardiac status appear to be favorable. Needle stick injuries occur at a rate mandating optimal reduction of patient viral loads preoperatively.

Adult↗
PubMed1995

Epidemiology of injuries by needles and other sharp instruments. Minimizing sharp injuries in gynecologic and obstetric operations.

Surgical and obstetric HCWs and epidemiologists will benefit from working together to describe the frequency and circumstances of percutaneous injuries in operating and delivery rooms. Rates of percutaneous injury vary among institutions, and attending and resident surgeons are among those at greatest risk for injury. Gynecologic surgery appears to have one of the highest rates of injury of the surgical specialties, and rates of injury vary by procedure within a given specialty. Suture needles cause the majority of injuries. Certain actions such as holding tissue while suturing or cutting are associated with a higher risk of injury. Many percutaneous injuries appear to be preventable. Epidemiologic data can be used to develop strategies based on the industrial hygiene model to reduce the incidence of percutaneous injury and to collect and disseminate data on the efficacy of new preventive measures. Potentially safer instruments and suture needles, technique modification strategies, and personal protective equipment such as cut-resistant gloves and finger protective strips are now available. Scientific assessment is needed of these and other new measures to determine whether they will decrease the risk of percutaneous injury, be acceptable to users, be cost effective, and avoid adverse consequences to patients or HCWs.

Accidents, Occupational↗
PubMed2003

Sharps-related injuries in California healthcare facilities: pilot study results from the Sharps Injury Surveillance Registry.

BACKGROUND AND OBJECTIVES: In 1998, the California Department of Health Services invited all healthcare facilities in California (n = 2,532) to participate in a statewide, voluntary sharps injury surveillance project. The objectives were to determine whether a low-cost sharps registry could be established and maintained, and to evaluate the circumstances surrounding sharps injuries in California. RESULTS: Approximately 450 facilities responded and reported a total of 1,940 sharps-related injuries from January 1998 through January 2000. Injuries occurred in a variety of healthcare workers (80 different job titles). Nurses sustained the highest number of injuries (n = 658). In hospital settings (n = 1,780), approximately 20% of the injuries were associated with drawing venous blood, injections, or assisting with a procedure such as suturing. As expected, injuries were caused by tasks conventionally related to specific job classifications. The overall results approximate those reported by the Centers for Disease Control and Prevention's National Surveillance System for Health Care Workers and the University of Virginia's Exposure Prevention Information Network. CONCLUSION: These data further support findings from previous studies documenting the complex and persistent nature of sharps-related injuries in healthcare workers. In the future, mandated reporting using standardized forms and consistent application of decision rules would facilitate a more thorough analysis of injury events.

Adult↗
PubMed2004

Needle-stick injuries in the National Health Service: a culture of silence.

Injury by contaminated sharp instruments and needles constitutes a major occupational hazard for healthcare workers. In a confidential survey at a district general hospital, 300 healthcare professionals were asked about their personal experience of needle-stick injury and their attitudes to reporting. 279 individuals responded, of whom 38% had experienced at least one needle-stick (mean 1.8) in the past year and 74% had sustained such an injury during their careers (mean 3.0). Although 80% of respondents were aware that such incidents should be notified, only 51% of those affected had reported all needle-stick injuries. Doctors were less likely to report than nurses, despite a higher liability to injury. This survey adds to evidence of a culture of silence pertaining to needle-stick injuries. The consequent risks to health, and the ethical and financial implications, remain uncertain.

Accidents, Occupational↗
PubMed2006

Epidemiology of exposure to blood borne pathogens on a surgical service.

BACKGROUND: The goal of this study was to analyze the type and mechanism of blood exposure injuries on the surgical service in order to develop appropriate preventative strategies. METHODS: A retrospective review of all exposure injuries affecting members of the operative care line at a single teaching institution between December 2002 and December 2005 was performed. RESULTS: Of 98 exposure injuries on the surgical service, only 17 (17%) were inflicted by hollow-bore needles. Seventy-four (76%) of these reported injuries occurred in the operating room (OR) and 24 (24%) occurred in other clinical areas. Sharps injuries accounted for 69 (93%) of OR injuries and were inflicted by suture needles (n = 37, 50%), hollow-bore needles (n = 7, 9%), and sharp instruments (n = 25, 34%). Mucocutaneous contamination accounted for 5 (7%) of the OR exposures. Professionals most frequently injured were residents (n = 43, 44%), followed by nurses (n = 28, 29%), students (n = 17, 17%) and other healthcare workers (n = 10, 10%). CONCLUSIONS: Blood exposure prevention strategies should be directed at safety within the surgical field and focused beyond hollow-bore needle stick injuries to include education, mentoring, and competency training.

Blood-Borne Pathogens↗
PubMed1995

A new device for collecting cord blood.

Safe sampling of cord blood can reduce the risk of exposure to infectious agents by obstetric personnel. We developed a new device for collecting umbilical cord blood. Using a modified closed-cup instrument, gravity drainage within the sealed device allows for guarded-needle vacuum tube blood collection. The mean (+/- standard deviation) volume of blood collected with the device was 6.1 +/- 3.1 mL. Adding heparin into the device increased the volume collected by approximately 2 mL. The diameter and length of the cord were also related to the amount obtained. Only two of 122 samples (1.6%) had less than 1 mL of blood. The introduction of a closed container, umbilical cord sampling device offers a clear potential for risk reduction, particularly the risk of needle-stick injuries but also direct blood contamination. The device is simple to use, offers easy and safe disposal, and can be operated by physicians or nurses.

Blood Specimen Collection↗
PubMed1995

Inferior oblique muscle injury from local anesthesia for cataract surgery.

BACKGROUND: Vertical rectus muscle injury is commonly cited as a cause of strabismus after cataract surgery. Injury to the inferior oblique muscle or nerve as a complication of cataract surgery has not been described previously. METHODS: Four patients without pre-existing strabismus who had diplopia after cataract surgery were studied. Analysis included prism and cover testing, Lancaster red-green testing, and fundus torsion assessment. RESULTS: Three patients had a delayed-onset hypertropia with fundus extorsion in the eye that underwent surgery, which is consistent with inferior oblique muscle overaction secondary to presumed contracture. The fourth patient had an immediate-onset hypotropia with fundus intorsion in the eye that underwent surgery, which is consistent with inferior oblique muscle paresis. Damage to a vertical rectus muscle or "unmasking" of a pre-existing superior oblique muscle paresis could not explain the history and findings in this group of four patients. CONCLUSION: The inferior oblique muscle contracture observed in three patients may have been caused by local anesthetic myotoxicity, whereas the paresis observed in one patient may have been due to mechanical trauma or anesthetic toxicity directly to the nerve innervating the muscle. Inferior oblique muscle or nerve injury should be considered as another possible cause of postoperative strabismus, especially when significant fundus torsion accompanies a vertical deviation.

Aged↗
PubMed1991

Blunt needles in fascial closure.

Blunt needles have been developed that are easily used in fascial closures while limiting penetrating cutaneous injury to the surgeon and the operating staff. These needles offer the surgeon further protection from inadvertent exposure to blood borne pathogens.

Abdominal Muscles↗
PubMedDate not supplied

A comparison between two intermittent intravenous systems without needles.

Needle-stick injury remains the most dangerous exposure to blood and body fluids. Needleless intermittent intravenous devices are available to assist the health care professional in avoiding the risk of needle-stick injury. The i.v. team at North Shore University Hospital in Manhasset, New York designed a method to evaluate and compare different needleless systems. In this article, the method followed and results obtained in this study are discussed.

Accidents, Occupational↗