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PubMed1999

The occupational risk to dental anesthesiologists of acquiring 3 bloodborne pathogens.

OBJECTIVE: To estimate the occupational risk to dental anesthesiologists of contracting 3 bloodborne pathogens: hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). METHODS: Through an anonymously returned, mailed questionnaire, dental anesthesiologists in Canada and the United States provided information regarding percutaneous and mucocutaneous contacts with contaminated fluid during the treatment of patients under deep sedation and general anesthesia as well as other general practice information. A mathematical model was applied to determine the occupational risk. RESULTS: Of the 101 (65%) returned questionnaires, 98 reported having treated patients within the previous 6 months. Of these, 41 (42%) had at least one percutaneous accident (89 accidents in total), and the projected mean annual injury rate for dental anesthesiologists overall was 1.82. The most common causes of injury were burs, intraoral needles, and dental instruments. Operator error during use was associated with 31% of reported accidents. Significantly more injuries were reported by those who also reported a mucocutaneous contact and by those working more than 25 hours per week. The projected mean annual number of mucocutaneous exposures was 0.88 for dental anesthesiologists overall. CONCLUSIONS: The calculated annual risk to the average dental anesthesiologist of acquiring HBV (if not immune), HCV, and HIV following percutaneous injury was very low for all infections (HBV the most; HIV the least). The risk of contracting HIV following mucocutaneous contact was extremely low.

Anesthesia, Dental↗
PubMedDate not supplied

Reducing the risks of sharps injuries in health professionals.

Sharps injuries can transmit blood-borne infections and are a serious health risk to nurses and other health professionals. However, there is limited data on the incidence of these injuries in the UK, and low awareness of the risks they pose. New products with enhanced safety features are becoming available but their introduction should be accompanied by education and training to improve practice in relation to sharps and their disposal.

Accidents, Occupational↗
PubMed2003

Comparative assessment of two methods used for interdental immobilization.

AIM: This investigation was carried out to compare Dimac wires with arch bars for interdental immobilization. MATERIAL AND METHODS: The assessment was conducted on 50 patients who had mandibular fractures and in whom intermaxillary fixation was required as a part of the treatment. The time required for applying each method of fixation, the needle-stick injuries that occurred during their application, and the periodontal damage that followed interdental immobilization was investigated. RESULTS: The mean time required for the application of Dimac wires was significantly less than that required for arch bars. The needle-stick injuries were significantly less with Dimac wires. Patients reported difficulty with oral hygiene with arch bars in place. This was associated with periodontal damage following removal of fixation. CONCLUSION: Dimac wires is safer to use and less traumatic to the periodontium

Fracture Fixation↗
PubMed2003

Induction of pneumoperitoneum in morbidly obese patients.

BACKGROUND: Induction of pneumoperitoneum can be a difficult, time-consuming, and occasionally hazardous task in a morbidly obese patient. METHODS: We have induced pneumoperitoneum in 600 consecutive morbidly obese patients using a 120 mm Veress needle inserted <1 mm beneath the left costal margin, between the mid-clavicular and anterior axillary lines. Absolute muscular relaxation was necessary. RESULTS: A distinct "pop" was felt on entering the peritoneal cavity. The expected intraperitoneal pressure was 7-14 mmHg. A pressure >20 mmHg indicated that the Veress needle was in the abdominal wall. CO2 infusion began at a flow of <1 L/min. "Shaking" the Veress needle to-and-fro improved flow to 1-2 L/min. Complete filling of the abdomen occurred at 4.0 L or more at a pressure limit of 15 mmHg. Increasing the pressure limit to 17 mmHg did not change the rate or final volume of CO(2) infusion. After initial trocar placement, the Veress needle was observed. Frequently it was in the omentum and there was CO(2) beneath the omentum. There was one visceral injury in the 600 patients--a puncture wound to the muscularis, but not the lumen, of the transverse colon. It was repaired laparoscopically with a single stitch. There have been no episodes of perforation of a hollow viscus, no unusual bleeding from the abdominal wall or viscera, and no injuries to the liver or spleen. CONCLUSION: Percutaneous induction of a pneumoperitoneum with the Veress needle in the left upper quadrant is a safe and effective technique in morbidly obese patients.

Adult↗
PubMed1998

Frequency of parenteral exposure and seroprevalence of HBV, HCV, and HIV among operation room personnel.

A study was designed to determine the frequency of needle-stick injuries, immunization status for hepatitis B virus (HBV) and sero-prevalence of HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among operation room personnel. Self-assessment questionnaires were completed and blood tested for HBsAg, anti-HBc (total), anti-HCV and anti-HIV. Of 114 operation room personnel studied, the majority (58.8%) reported more than four needle-stick injuries per year, 36.8% one to three needle-stick injuries per year, while 4.4% reported no needle-stick injury in the last five years. Thirty-six percent of personnel had received a complete course of hepatitis B vaccination. There was serological evidence of hepatitis HBV virus and/or HCV infections in 31% of the studied population. Four percent were reactive for HCV infection, 7.5% for HBsAg infection and 25.43% for anti-HBc (total); none was HIV positive. Eighty percent of the HCV positive and 55% of the anti-HBc (total) positive personnel had more than four needle-stick injuries per year in the last five years, while 75% HBsAg-reactive personnel had received one to three needle-stick injuries per year. This study indicates a need for continued efforts to minimize the risk of blood-borne infection by enhancing the compliance of operation room personnel with HBV vaccination and adherence to infection control measures.

Adult↗
PubMed1998

Study of a needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes.

OBJECTIVE: To assess the effect on staff- and patient-related complications of a needleless intermittent intravenous access system with a reflux valve for peripheral infusions. DESIGN: A 6-month cross-over clinical trial (phase I, 13 weeks; phase II, 12 weeks) of a needleless intermittent intravenous access system (NL; study device) compared to a conventional heparin-lock system (CHL, control device) was performed during 1991 on 16 medical and surgical units. A random selection of patients was assessed for local intravenous-site complications; all patients were assessed for the development of nosocomial bacteremia and device-related complications. Staff were assessed for percutaneous injuries and participated in completion of product evaluations. A cost analysis of the study compared to the control device was performed. SETTING: A 1,100-bed, teaching, referral medical center. PATIENTS AND STAFF PARTICIPANTS: 594 patients during 602 patient admissions, comprising a random sample of all patients with a study or control device inserted within a previous 24-hour period on study and control units, were assessed for local complications. The 16 units included adult inpatient general medicine, surgical, and subspecialty units. Pediatrics, obstetrics-gynecology, and intensive-care units were excluded. All patients on study and control units were assessed for development of nosocomial bacteremia and device-related complications. All staff who utilized, manipulated, or may have been exposed to sharps on study and control units were assessed for percutaneous injuries. Nursing staff completed product evaluations. INTERVENTION: The study device, a needleless intermittent intravenous access system with a reflux valve, was compared to the control device, a conventional heparin lock, for peripheral infusions. RESULTS: During the study, 35 percutaneous injuries were reported. Eight injuries were CHL-related; no NL-related injuries were reported (P=.007). An evaluation of 602 patient admissions, 1,134 intermittent access devices, and 2,268 observed indwelling device days demonstrated more pain at the insertion site for CHL than NL; however, no differences in objective signs of phlebitis were noted. Of 773 episodes of positive blood cultures on study and control units, 6 (0.8%) were device-related (assessed by blinded investigator), with no difference between NL and CHL. Complications, including difficulty with infusion (P<.001) and disconnection of intravenous tubing from device (P<.001), were reported more frequently with CHL than with NL. Of nursing staff responding to a product evaluation survey, 95.2% preferred the study over control device. The projected annual incremental cost to our institution for hospitalwide implementation of NL for intermittent access for peripheral infusions was estimated at $82,845, or $230 per 1,000 patient days. CONCLUSIONS: A needleless intermittent intravenous access system with a reflux valve for peripheral infusions is effective in reducing percutaneous injuries to staff and is not associated with an increase in either insertion-site complications or nosocomial bacteremia. Institutions should consider these data, available institutional resources, and institution-specific data regarding the frequency and risk of intermittent access-device-related injuries and other types of sharps injuries in their staff when selecting the above or other safety devices.

Anticoagulants↗
PubMed2005

Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers.

BACKGROUND: The global burden of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infection due to percutaneous injuries among health care workers (HCWs) is estimated. METHODS: The incidence of infections attributable to percutaneous injuries in 14 geographical regions on the basis of the probability of injury, the prevalence of infection, the susceptibility of the worker, and the percutaneous transmission potential are modeled. The model also provides the attributable fractions of infection in HCWs. RESULTS: Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIV infections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries. The fraction of infections with HCV, HBV, and HIV in HCWs attributable to occupational exposure to percutaneous injuries fraction reaches 39%, 37%, and 4.4% respectively. CONCLUSIONS: Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs). These infections are highly preventable and should be eliminated.

Accidents, Occupational↗
PubMed1992

Epidemiology of reported sharps injuries in a tertiary care hospital.

Over a 12-month period 233 puncture wounds were reported in a 1112-bed tertiary medical care centre. Accident forms were reviewed to determine the epidemiology of puncture injuries. The nursing department accounted for the majority of all puncture injuries (68%). For nurses, medical and surgical units represented those clinical areas with the greatest number of puncture injuries. Areas with the highest incidence rates, however, included the clinical research centre, the emergency room, the surgical intensive care unit and areas where the intravenous team operated. Activities involving direct contact of a sharp instrument with a patient accounted for the majority of puncture injuries. Disposable syringes and loose needles were implicated in 50% of injuries although the incidence of injury per individual's low (3.2 out of 100,000 purchased). Recommendations include the redesigning of sharp instruments and the focusing of education programmes to target personnel for whom incidence rates are the highest.

Academic Medical Centers↗
PubMed1997

Percutaneous injuries during oral and maxillofacial surgery procedures.

PURPOSE: This study estimated the frequency of percutaneous injuries (Pls) to dental health-care workers during oral and maxillofacial surgery and examined the circumstances surrounding the incidents. MATERIAL AND METHODS: A self-reported, prospective study was conducted to document Pls incurred during oral and maxillofacial surgery performed on outpatients and inpatients over 1-month and 6-month periods, respectively. Among the study variables examined were the numbers of patients treated, number and types of procedures performed, duration of treatment, numbers and types of health care workers at risk, treatment setting, and number of injuries. RESULTS: Four injuries were recorded during 362 operating room procedures on 236 inpatients, for a rate of 1.1 Pls per 100 procedures (95% confidence interval: 0.3 to 2.8) and 1.7 Pls per 100 patients (95% confidence interval: 0.5 to 4.6). These four injuries occurred during 1,665 person-procedures (mean number of workers present at each procedure times the total number of procedures) for a rate of 0.24 Pls per 100 person-procedures (95% confidence interval: 0.1 to 1.0). Three injuries took place during fracture reductions; two were caused by surgical wire and the third by a needlepoint Bovie tip. One injury occurred during orthognathic surgery and involved a Woodson elevator. Residents recorded no injuries while treating 521 outpatients (0 Pls per 100 patients; 95% confidence interval: 0 to 0.6). CONCLUSION: The results support previous findings that Pls rarely occur during outpatients oral and maxillofacial surgery procedures. However, the findings suggest that operating room procedures for oral and maxillofacial surgery that use wire or involve fracture reduction may be associated with an increased risk of injury. Strategies such as using a cork or sponge to cap sharp wires or instruments, and protecting hands and fingers by double gloving, may be used to decrease the risk of Pl.

Accidents, Occupational↗
PubMed1998

Surgeons' concern and practices of protection against bloodborne pathogens.

OBJECTIVE: To evaluate surgeons' concern regarding risk awareness and behavioral methods of protection against bloodborne pathogen transmission during surgery. METHODS: A 29-item questionnaire was sent to 914 surgeons from two universities and two surgical societies. RESULTS: The questionnaire was returned by 768 active surgeons. Slight or moderate concern about contracting human immunodeficiency virus (HIV) was reported by most surgeons; 8% reported extreme concern and 4% reported no concern. In total, 605 surgeons reported having been vaccinated against hepatitis B; surgeons in practice <7 years were most likely to be vaccinated. Most surgeons did not routinely use double gloves: 92 of 768 surgeons reported that they always use double gloves when performing surgery, and 83 reported that they usually use double gloves. There was a statistically significantly higher proportion of surgeons who always or usually use double gloves who also had hepatitis B vaccinations. Most surgeons incorrectly estimated the seroconversion rates with exposure to a patient with HIV (66% incorrect), hepatitis B (88% incorrect), or hepatitis C (84% incorrect). Most surgeons never or rarely report needle-stick injuries, and only 17% always report needle-stick injuries. CONCLUSIONS: Most surgeons underestimate the risk of bloodborne pathogens and do not routinely use double gloves.

Attitude of Health Personnel↗
PubMed2000

Transient detection of plasma HIV-1 RNA during postexposure prophylaxis.

Transient plasma human immunodeficiency virus (HIV) copies were detected by nucleic-acid sequence-based amplification during combination antiretroviral prophylaxis in a healthcare worker who reported a percutaneous injury from a stylet and who remained HIV-antibody-negative. An HIV-specific T-helper response, assessed by interleukin-2 production, was observed when tested at 13 months following the exposure.

Adult↗
PubMed1996

Hepatitis B vaccine uptake among surgeons at a London teaching hospital: how well are we doing?

In order to determine the perceptions of surgical staff of the risks of hepatitis B virus (HBV) infection and its prevention through vaccination, and to assess frequency of 'sharps' injuries and compliance with the Department of Health (DoH) recommendations on vaccination, a questionnaire was distributed to surgical staff in the Guy's and St Thomas' Hospital Trust. Only 52 of the 88 surgeons who responded (59%) had documented vaccine-induced immunity to HBV. Eighty-five (97%) had received at least one dose of vaccine but 15 of these (18%) had failed to complete the course. Of the 70 surgeons completing the course, only 56 (80%) had had their immune responses checked and only 44 (63%) admitted sustaining a 'sharps' injury at least once a month, yet only 17% consistently reported these injuries. Those least likely to report were cardiothoracic and obstetric and gynaecology surgeons; these specialties also sustained the highest frequency of 'sharps' injuries. Ophthalmologists, who sustained the lowest rate of injury, were most likely to report. In conclusion, a significant number of surgeons appeared not to have completed a course of hepatitis B vaccine in the presence of a high frequency of 'sharps' injuries. Following the publication of DoH guidelines on protecting workers from HBV, it must be stressed that failure to comply with recommendations may have medicolegal implications.

Attitude of Health Personnel↗
PubMed1991

Epidemiology of hospital sharps injuries: a 14-year prospective study in the pre-AIDS and AIDS eras.

The world pandemic of acquired immunodeficiency syndrome (AIDS) has focused enormous attention on the problem of accidental sharps injuries sustained by health care workers (HCWs) and the risk of occupationally acquired infection by human immunodeficiency virus (HIV). At the 1980 Conference, we reported a 4-year epidemiologic study (1975-1979) of sharps injuries in HCWs at our hospital. Using the same reporting system and analyses, we now report the epidemiology of sharps injuries in our center during the current AIDS era (1987-1988) and assess trends over the 14-year period. Despite greatly increased institutional efforts to prevent sharps injuries, the annual incidence has increased more than threefold (60.4 to 187.0/1,000 HCWs), reflecting better reporting and increased exposure. Reported injuries by house officers have increased ninefold. Adjusting for inflation, the direct costs of sharps injuries has increased sevenfold ($5,354 to $37,271/year). Environmental service HCWs (305.8 sharps injuries per 1,000 employees) now have the highest incidence in our center, followed by nursing personnel (196.5/1,000) and laboratory personnel (169.9/1,000), but as in 1975-1979, two thirds of all injuries occur in nursing personnel. Although phlebotomy team members have a very low risk per procedure (1/26,871 draws), their annual incidence is extraordinarily high, 407.0/1,000. Injuries continue to occur mainly during disposal of waste, linen, or used procedure trays (19.7% of all injuries), administration of parenteral injections or infusion therapy (15.7%), surgery (16.0%), blood drawing (13.3%), or recapping of used needles (10.1%). Making disposal units available at every bedside has reduced injuries from needle disposal two-fold since 1975-1979. With consistent application of a stringent postexposure protocol, and wide acceptance of the hepatitis B vaccine, we have had no sharps injury-related infections during the past 3 years. These data indicate the increasing risk, complexity and cost of sharps injuries in HCWs and the need for more innovative--ideally, technology-based--approaches to prevention. Certain groups of HCWs are at very high risk. Comprehensive postexposure protocols that are uniformly applied can provide substantial protection to exposed HCWs.

Accidents, Occupational↗
PubMed1999

Prevalence of nonreporting behavior of sharps injuries in Taiwanese health care workers.

BACKGROUND: Health care workers (HCWs) were surveyed to identify factors associated with nonreporting behavior of sharps injuries (SIs) in Taiwan. METHODS: We surveyed 10,469 full-time medical, nursing, technical, and supporting personnel employed at 16 randomly selected hospitals from 132 available accredited teaching hospitals in Taiwan. Information about the most recent injury and reporting behavior after an SI were collected from July 1996 to June 1997 by using a pretested structured questionnaire. Eleven categories, including an open-ended option, were provided for participants to explain their nonreporting behavior. RESULTS: Questionnaires were completed by 82.6% (8645) of our sample, of whom 87.3% reported to have experienced a recent SI. A used item was the most commonly (P <. 001) involved item in an SI, and SIs with a used item were significantly more likely (odds ratio 3.6; CI 95%, 3.03-4.26; P <. 001) to be reported compared with an SI that involved unused items. A total of 81.8% of injuries were not reported, with job category significantly affecting reporting behavior (P <.001). Medical staff had the highest nonreporting rate (85.2%). Although attendees of a prevention program were statistically more likely (P <.001) to report an injury compared with nonattendees, the level of reporting in both groups was not encouraging (21.3% and 17.2%, respectively). All reasons given for nonreporting were disconcerting, but none more so than the use of subjective assessment of risk by 21.7% of HCWs who did not report their injuries. Other reasons for not reporting SIs included that the item was unused (34%) and that the HCW was too busy to report the SI (14.9%), unaware of reporting requirements (14. 4%), or immune to hepatitis B virus (12.4%). CONCLUSIONS: With 82% of SIs in Taiwanese HCWs going unreported, the expected national incidence will be seriously underestimated and impact the appropriateness of prevention programs. The very low rate of reporting suggests that the current reporting system requires simplification. Because most injuries involved used items, the reporting systems also should include a more responsive management component. The results also suggest that the current prevention programs, currently provided by the general nursing department, require expert content knowledge in infection control if nonreporting and SIs are to be reduced.

Humans↗
PubMed1998

Prevention of needle-stick injury by the scooping-resheathing method.

BACKGROUND: The objective of this study was to determine the effects of teaching the scooping-resheathing method on the incidence of needle-stick injuries in medical students. METHODS: Before starting their first clerkship, 81 medical students were given a 15-min lecture on the high incidence and dangers of needle-stick injuries and a demonstration of the scooping-resheathing method. The number of needle-stick injuries that occurred during the 3-month clerkship was compared with the number reported by 86 medical students who had completed their first clerkship 1 year previously and had not been given such instruction. RESULTS: Compared with controls, the study group had a 3.8-fold lower risk of needle-stick injury (95% confidence interval, 2.0-7.4, P < 0.0001) and a 8.3-fold lower risk of multiple needle-stick injuries (95% confidence interval, 2.0-35.0, P < 0.001). Those in the study group, who consistently used the scooping method had a much lower risk of injury than those who did not (1 of 36 [2.8%] vs. 8 of 45 [17.4%], P = 0.039). CONCLUSIONS: We conclude that a lecture recommending the scooping-resheathing method is effective in reducing the risk of needle-stick injuries in medical students during their first rotation. Because this is the first time that an intervention not requiring change in equipment has been successful, further studies are warranted to substantiate our findings and for extrapolation to other medical personnel in other cultural settings.

Accidents, Occupational↗
PubMed2003

Accidental injuries and cutaneous contaminations during general surgical operations in a Nigerian teaching hospital.

OBJECTIVE: To determine the prevalence of accidental injuries and body contaminations among the operating personnel during general surgical operation, those involved, the circumstances surrounding the injuries or body contaminations and the factors affecting the prevalence in a unit of a teaching hospital in Nigeria. DESIGN: Patients operated for general surgical conditions in a unit of a Teaching Hospital Complex during a period of two years (1997-1998) were studied. A proforma was designed to enter personal biodata, preoperative and intra-postoperative clinical information of all the patients. SETTING: Wesley Guild Hospital a unit of teaching hospital complex serving the large agrarian rural and semi-urban Nigerians. PATIENTS: Five hundred and eighty nine consecutive general surgical patients. All types of general surgical operations were included, emergency or elective, major or minor, carried out during the day or at night. INTERVENTION: All the patients were operated and operating personnel observed for sharp injuries and body contamination. MAIN OUTCOME MEASURES: Incidence of sharp injuries and cutaneous contamination and personnel at risk determined. RESULTS: Operating personnel sustained 62 sharp injuries (10.5%), these were caused by suture needle in 57 cases (92.0%), towel clips in three (4.8%), knife cut in two (3.2%). Operating physicians sustained 56 cases of sharp injuries (90.3%) and Scrub Nurses in six (9.7 %). Self-inflicted sharp injuries in 49 (79 %) and in 12 cases (21%) injuries were inflicted by the surgeons or their assistants. Left hand was injured in 39 cases (63%) and right in 23 (37%). Cutaneous or mucosa membrane contamination with blood or body fluid occurred in 232 cases (39.4 %). These were made up of wet gown contamination in 124(53.5 %), glove failure in 72(31%) and splashing of blood or fluids into the face or eyes in 36 cases (15.5 %). Contamination occurred in more than one operating personnel in more than half of the cases. Operating surgeons were affected in 211 cases (91%). The risks of accidental injuries and blood and body fluid contamination were significant, if the duration of the operation was more than one hour, among the operating surgeons and if the operation was major (p<0.05). CONCLUSION: This study has demonstrated that cutaneous, percutaneous, and mucous membrane exposure to patients blood and body fluids are common events during general surgical operations. Most accidental injuries were due to solid suture needle-sticks, mostly injured personnel were the primary operating surgeons, injuries occurred predominantly on the left hand. This may poses a significant risk of infection with blood borne pathogens when operating on infected patients.

Adolescent↗
PubMed2005

Tuberculous skin ulcer following needle-prick injury in a health care professional.

A case of cutaneous inoculation tuberculosis in a 25-year old health care professional is reported. The diagnosis was confirmed by histopathology and isolation of Mycobacterium tuberculosis by BACTEC 460TB radiometric method. Rapid healing of the ulcer was noted in response to surgical debridement and specific anti-tuberculous therapy.

Adult↗