Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Needlestick Injuries”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,063 records · Page 59Linked to original sources
PubMed2003

Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States.

OBJECTIVE: To characterize occupationally acquired human immunodeficiency virus (HIV) infection detected through case surveillance efforts in the United States. DESIGN: National surveillance systems, based on voluntary case reporting. SETTING: Healthcare or laboratory (clinical or research) settings. PATIENTS: Healthcare workers, defined as individuals employed in healthcare or laboratory settings (including students and trainees), who are infected with HIV. METHODS: Review of data reported through December 2001 in the HIV/AIDS Reporting System and the National Surveillance for Occupationally Acquired HIV Infection. RESULTS: Of 57 healthcare workers with documented occupationally acquired HIV infection, most (86%) were exposed to blood, and most (88%) had percutaneous injuries. The circumstances varied among 51 percutaneous injuries, with the largest proportion (41%) occurring after a procedure, 35% occurring during a procedure, and 20% occurring during disposal of sharp objects. Unexpected circumstances difficult to anticipate during or after procedures accounted for 20% of all injuries. Of 55 known source patients, most (69%) had acquired immunodeficiency syndrome (AIDS) at the time of occupational exposure, but some (11%) had asymptomatic HIV infection. Eight (14%) of the healthcare workers were infected despite receiving postexposure prophylaxis (PEP). CONCLUSIONS: Prevention strategies for occupationally acquired HIV infection should continue to emphasize avoiding blood exposures. Healthcare workers should be educated about both the benefits and the limitations of PEP, which does not always prevent HIV infection following an exposure. Technologic advances (eg, safety-engineered devices) may further enhance safety in the healthcare workplace.

Adult↗
PubMed2006

[Accidental exposure to blood by midwives in French maternity units: results of the national surveillance 2003].

OBJECTIVE: Midwives appear to be the health care workers exposed to the highest rates of bloodborne injury. In this paper - based on a national survey - we describe the bloodborne injuries occurring in this profession. MATERIAL AND METHOD: During the year 2003, 241 hospitals took part in a national survey of bloodborne injuries. Employees registered anonymous standardized reports of bloodborne events with the Occupational Medicine Unit. The data were processed by the coordination center for the fight against nosocomial infections (C. CLIN) which is in charge of the national analysis of all the events reported in this database. RESULTS: 169 of the 6973 bloodborne events reported during 2003 (2.4%), were signed by midwives or midwife students. The first three most frequent accidents reported were: ocular projections during childbirth, pricks when repairing episiotomy, pricks or cuts when handling soiled instruments. CONCLUSION: Improving knowledge of risk as well as promotion of protection/prevention measures well adapted to this profession should be helpful in optimizing future attitudes.

Adult↗
PubMed2006

Sustained viral response of a case of acute hepatitis C virus infection via needle-stick injury.

A 29-year-old nurse with a hepatitis C virus (HCV) infection caused by needle-stick injury was treated with interferon-beta starting about one year after the onset of acute hepatitis. The patient developed acute hepatitis C with symptoms of general fatigues, jaundice, and ascites 4 wk after the needle-stick injury. When these symptoms were presented, the patient was pregnant by artificial insemination. She hoped to continue her pregnancy. After delivery, biochemical liver enzyme returned to normal levels. Nevertheless, HCV RNA was positive and the pathological finding indicated a progression to chronicity. The genotype was 1b with low viral load. Daily intravenous injection of interferon-beta at the dosage of six million units was started and continued for eight weeks. HCV was eradicated without severe adverse effects. In acute hepatitis C, delaying therapy is considered to reduce the efficacy but interferon-beta therapy is one of the useful treatments for hepatitis C infection in chronic phase.

Acute Disease↗
PubMed2001

Needle stick injuries during medical training among Thai pre-clinical year medical students of the Faculty of Medicine, Chulalongkorn University.

OBJECTIVE: To study episodes of needle stick injuries during medical training among pre-clinical year medical students of the Faculty of Medicine, Chulalongkorn University. SETTING: Faculty of Medicine, Chulalongkorn University. DESIGN: Retrospective descriptive study. SUBJECTS: 375 pre-clinical year medical students of the Faculty of Medicine, Chulalongkorn University during academic year 1998-1999. METHOD: Questionnaire survey and interviewing. RESULTS: In this study only 5 students revealed that they had ever had accidental exposure during venipuncture training. Each episode of exposure was different in the details. Most of the accidents occurred after venipuncture practice (80%). CONCLUSION: Although the universal precautions are taught in many subjects, we also found that accidental exposures still occur. Not only prevention of accidents but also post-exposure management should be frequently reiterated to the medical students at every level. Any medical practice of students should be under supervisor control.

Adolescent↗
PubMed2003

[Early treatment of acute hepatitis C with interferon alpha-2b or interferon alpha-2b plus ribavirin: study of sixteen patients].

AIM OF THE STUDY: To assess the mode of transmission and the efficacy of antiviral therapy in the outcome of treated and untreated patients with acute hepatitis C. PATIENTS AND METHODS: From December 1995 to January 2001, 16 consecutive patients and their response to therapy were studied, including clinical, biochemical, virological and histological data. RESULTS: Hepatitis C virus (HCV) exposure was IVDU (38%), needle-stick injury (19%), medical procedure (6%), piercing (6%), suspected sexual contact (19%), and unknown in 2. Among 13 patients treated for acute hepatitis C, all 12 patients who completed therapy had a biochemical and virological sustained response for more than 15 months (range: 4-36 months) after stopping therapy. Therapy was tolerated in all but one patient, who stopped after 10 weeks because of side effects. Duration of treatment, type of interferon and combination with ribavirin did not modify the response to treatment. CONCLUSION: These results suggest that early intervention with interferon alpha is effective in preventing the progression of acute HCV infection to chronic hepatitis in most patients regardless of duration, type of interferon, or combination with ribavirin.

Acute Disease↗
PubMed1996

Influence of HIV-infection risk on resident physicians.

PURPOSE: To determine the influence of the risk of contracting the human immunodeficiency virus (HIV) on the attitudes and behavior of resident physicians. METHOD: A 15-item questionnaire was sent in January 1994 to the 268 residents in the major specialty training programs at the three clinical campuses of the University of Medicine and Dentistry of New Jersey. The residents' responses about HIV were analyzed in light of their specialty, postgraduate-year level, and training location. Z-tests were used to determine the statistical significance of the responses, and Yates corrections were applied to all calculations. RESULTS: A total of 121 residents (45%) responded. These residents were similar demographically to the non-respondents. Fifty-one of the responding residents (42%, p < .02) reported that they tended to minimize performing invasive procedures on HIV-positive patients. A surprisingly high number-73 (60%, p < .005)-had been tested for HIV. Only 14 had sustained needle-stick injuries. The risk of HIV infection had not appreciably affected the residents' choices of specialty, but it did dampen their enthusiasm for the practice of medicine. It also influenced their choices of training location, with 34 (28%, p < .001) listing HIV as an important factor. Given the hypothetical situation that they themselves were infected with HIV, 89 (75%, p < .001) of the residents reported that they would not terminate their careers, but 70 (61%, p < .005) indicated that they would refrain from performing invasive procedures. CONCLUSION: The residents' responses show a high level of emotional stability as well as a practical acceptance of the reality of HIV in the workplace. The impact on resident physicians of HIV requires further attention by medical educators and program directors.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Risk of transmission of viral disease by needle punctures and cuts in hospital health care workers].

The accidental exposure of the health care workers (HCW) to blood and blood products constitutes a danger for transmission of blood-borne pathogens and the development of severe diseases. Most attention is focused on exposure to the viruses of hepatitis B, C and human immunodeficiency. The objectives of this prospective study were to determine the rate of exposure of our HCW to blood and blood products; to define the high risk groups; and to establish recommendations to prevent transmission or reduce the risk of exposure to these viruses. During the year 1996, 103 injuries from needle-puncture or other sharp objects were reported to our infectious diseases control unit. Most of those injured were women. 58.4% of the events occurred in the vicinity of the patient. The source of exposure was known in 60% of the cases. 73.8% of those injured had already been immunized against hepatitis B. The departments in which most exposures occurred were the operating theater (12.5%), medical departments A (10.6%) and B (9.6%), and the emergency department (7.7%). Nurses were at highest risk, constituting 47% of those injured. Our recommendations are that a continuous teaching program be established for the high risk groups; that HCW be urged to report every event of exposure; and to encourage HCW to undergo active immunization against hepatitis B.

Accidents, Occupational↗
PubMed1993

Occupational exposure to the human immunodeficiency virus and other blood-borne pathogens. A six-year prospective study.

OBJECTIVE: To prospectively study occupational exposures to human immunodeficiency virus (HIV) and other blood-borne pathogens. DESIGN AND SETTING: Detailed clinical information was collected and follow-up was performed on all health care workers with occupational exposures to potentially infected substances at Fairfield Infectious Diseases Hospital during the period January 1985 to September 1991. RESULTS: There were 230 occupational exposures reported. One hundred and forty-one were considered "significant" or "potentially significant"; these involved exposure (or the potential for exposure) to blood or body fluids by the parenteral route or contamination of non-intact skin or mucous membranes. Needle/syringe assemblies accounted for 59% of the "significant" injuries, "butterfly" needles for 21% and lancets for 8%. "Butterfly" needles were over-represented relative to their degree of use. Seventy-seven of the 230 exposures were HIV-related and 27 of these were considered "significant". The number of HIV positive patients attending the hospital increased progressively over the survey period but the rate of HIV-related exposures fell during that time. After 1988, 13 individuals with "significant" exposure to HIV received a six-week prophylactic course of zidovudine. No health care workers seroconverted for HIV, hepatitis B or hepatitis C during the survey period. CONCLUSIONS: The risk of acquiring HIV (and other blood-borne diseases) through occupational exposure is very low and this risk can be further reduced by adopting safe work practices.

Blood↗
PubMed1999

HIV infection and oral health care in South Africa.

This study determined the knowledge, attitude and practice of oral health care workers in public clinics in South Africa towards HIV/AIDS and investigated the implementation of infection control measures. A total of 727 questionnaires were distributed to dentists, dental therapists, oral hygienists and chairside assistants in the public dental clinics of 9 provinces, of which 276 were returned from 8 provinces, giving a response rate of 38%. The questionnaire covered demographic factors and assessed issues such as knowledge, infection control practices, continuing education, legal, ethical and psychosocial issues and available support for HIV/AIDS. The common oral manifestations seen by respondents were candidiasis, acute necrotising ulcerative gingivitis (ANUG), hairy leukoplakia and Kaposi's sarcoma. Of the 174 who had a previous HIV test, 48% were for insurance purposes and 21% for post-needle-stick injury. Over 10% of the respondents indicated that gloves were not available at all, that there was an inadequate supply of water, and that there was no autoclave in their clinic. Nearly 50% of the clinicians had not had hepatitis B vaccination in the last 3 years. Fifteen respondents (5.4%) were not willing to treat HIV-positive patients. Only 48% had access to a written post-exposure management protocol and post-exposure medication was available to only 36.6%. The vast majority of the respondents clearly expressed a need for additional education on HIV/AIDS. The study demonstrated a need to add knowledge, enhance personal skills and improve the application of universal precautions.

AIDS Serodiagnosis↗
PubMed2002

Effectiveness of the hands-free technique in reducing operating theatre injuries.

BACKGROUND: Operating theatre personnel are at increased risk for transmission of blood borne pathogens when passing sharp instruments. The hands-free technique, whereby a tray or other means are used to eliminate simultaneous handling of sharp instruments, has been recommended. AIMS: To prospectively evaluate the effectiveness of the hands-free technique in reducing the incidence of percutaneous injuries, contaminations, and glove tears arising from handling sharp instruments. METHODS: For each of 3765 operations carried out in main and surgical day care operating theatres in a large urban hospital, over six months, circulating nurses recorded the proportion of use of the hands-free technique during each operation, as well as other features of the operation. The hands-free technique, considered to be used when 75% or more of the passes in an operation were done in this way, was used in 42% of operations. The relative rate of incidents (percutaneous injuries, contaminations, and glove tears) in operations where the hands-free technique was used and not used, with adjustment via multiple logistic regression for the different risk profiles of the two sets of operations, was calculated. RESULTS: A total of 143 incidents (40 percutaneous injuries, 51 contaminations, and 52 glove tears) were reported. In operations with greater than 100 ml blood loss, the incident rate was 4% (18/486) when the hands-free technique was used and 10% (90/880) when it was not, approximately 60% less. When adjusted for differences in type and duration of surgery, emergency status, noisiness, time of day, and number present for 75% of the operation, the reduction in the rate was 59% (95% CI 23% to 72%). In operations with less than 100 ml blood loss, the corresponding rates were 1.4% (15/1051) when the hands-free technique was used and 1.5% (19/1259) when it was not used. Adjustment for differences in risk factors did not alter the difference. CONCLUSIONS: Although not effective in all operations, use of the hands-free technique was effective in operations with more substantial blood loss.

Accidents, Occupational↗
PubMed2000

Safety of immunization injections in Africa: not simply a problem of logistics.

In 1995, the WHO Regional Office for Africa launched a logistics project to address the four main areas of immunization logistics: the cold chain, transport, vaccine supply and quality, and the safety of injections in the countries of the region. The impact of this logistic approach on immunization injection safety was evaluated through surveys of injection procedures and an analysis of the injection materials (e.g. sterilizable or disposable syringes) chosen by the Expanded Programme on Immunization (EPI) and those actually seen to be used. Re-use of injection materials without sterilization, accidental needle-stick injuries among health care workers, and injection-related abscesses in patients were common in countries in the WHO African Region. Few health centres used time-steam saturation-temperature (TST) indicators to check the quality of sterilization and, in many centres, the injection equipment was boiled instead of being steam sterilized. Facilities for the proper disposal of used materials were rarely present. Although the official EPI choice was to use sterilizable equipment, use of a combination of sterilizable and disposable equipment was observed in the field. Unsafe injection practices in these countries were generally due to a failure to integrate nursing practices and public awareness with injection safety issues, and an absence of the influence of EPI managers on health care service delivery. Holistic rather than logistic approaches should be adopted to achieve safe injections in immunization, in the broader context of promoting safe vaccines and safety of all injections.

Africa↗
PubMed1997

Combination of subcutaneous abdominal wall retraction and optical trocar to minimize pneumoperitoneum-related effects and needle and trocar injuries in laparoscopic surgery.

BACKGROUND: Both pneumoperitoneum and blind needle and trocar insertion may cause complications: because of the well-known physiological effects, CO2 insufflation is not indicated in patients with impairment of cardiorespiratory function and high-risk patients; injuries to underlying viscera and vessels by needles and trocars have been reported even when the open technique is used. METHODS: A technique which combines abdominal wall suspension by a new subcutaneous lifter (LaparoTenser) and optical trocar (OptiView) insertion has been evaluated in a random series of 22 patients undergoing various laparoscopic procedures. The optic trocar was inserted without previous insufflation, but low-pressure (1-5 mmHg) pneumoperitoneum was associated during the course of the procedure in 16 cases. RESULTS: The exposure of the operating field was good or sufficient in 21 cases (95%), while the placement of the optical trocar was always safe. One complication related to the insertion of the subcutaneous needles of the wall lifter occurred (suprafascial hematoma). CONCLUSIONS: The subcutaneous retractor allows the use of conventional cannulae and the combination of abdominal wall suspension with or without low-pressure pneumoperitoneum, thus enhancing the quality of exposure with no effect on the hemodynamic and respiratory functions.

Abdominal Muscles↗
PubMed1997

Percutaneous blood exposure among Danish doctors: exposure mechanisms and strategies for prevention.

The objective of this study was to describe the mechanisms of percutaneous blood exposure (PCE) among doctors and discuss rational strategies for prevention. Data were obtained as part of a nation-wide questionnaire survey of occupational blood exposure among hospital employed doctors in Denmark. The doctors were asked to describe their most recent PCE, if any, within the previous 3 months. Detailed information on the instruments, procedures, circumstances and mechanisms that caused the PCE was obtained. Of 9375 doctors, 6256 (67%) responded, and 6005 questionnaires were eligible for analysis. Of 971 described PCE the majority were caused by suture needles (n = 483), i.v.-catheter-stylets (n = 94), injection needles (n = 75), phlebotomy needles (n = 53), scalpels (n = 45), arterial blood sample needles (n = 41) and bone fragments (n = 23). Inattentiveness was the most common cause, contributing to 30.5% of all PCE. Use of fingers rather than instruments was a major cause of injury in surgical specialities and was a contributing cause of 36.9% PCE on suture needles. Common contributing causes when fingers were used (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. It was often argued that instruments were not practical to use or might harm the tissue. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines like recapping only, but other mechanisms like sudden patient movements and 'acute situation' were common, especially in the case of PCE on i.v.-catheter-stylets. It is concluded that the exposure mechanisms of PCE reflect both unsafe routines, difficult working conditions and unsafe devices. Education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.

Blood-Borne Pathogens↗
PubMed1995

Management of sharps injuries and contamination incidents in health care workers: an audit in the Wessex and Oxford regions.

Fifteen NHS occupational health departments from the Wessex and Oxford regions took part in an audit of the management of sharps injuries and contamination incidents. Data were collected prospectively for a series of 1102 incidents notified over a nine-month period. The rates of notified incidents for each department ranged from 9 to 44 incidents per 1000 staff members per year. The proportion of injured employees who were naturally immune to hepatitis B or had completed a full course of vaccination against the infection ranged from 57 to 83%, with the main shortfall occurring in ancillary workers. Some departments rarely stored source serum, while others did so in the majority of cases. The proportion of cases where the injured person was known to have had hepatitis B antibody levels > 100 IU/l within the past 12 months, or underwent immediate antibody assessment or had an immediate vaccination against hepatitis B varied from 26 to 97%, with a median of 68%. On the basis of these findings, the audit group has set targets against which performance will be re-assessed in a follow-up exercise.

Accidents, Occupational↗
PubMed2002

Needle-stick injuries in an Ugandan teaching hospital.

The on-going HIV epidemic has generally increased fear of needle-stick injuries (NSI) and renewed interest in the problem such injuries pose in Africa. The aims of the present study were to evaluate the frequency of NSI, explore the circumstances surrounding each injury and estimate the corresponding infection risk, among healthcare workers (HCW) in Uganda. Questionnaires, asking the recipients how many NSI they had suffered in the past year, how each of these NSI had occurred, what (perceived) risk of infection was associated with each injury, and what their practical and psychological reactions were, were sent to the HCW associated with the Mbarara Teaching Hospital in Uganda. Of the 280 individuals who received questionnaires, 180 (64%) responded and 100 (55% of the respondents) each reported suffering at least one NSI in the previous year. The total number of NSI reported (336) represented an incidence of 1.86 NSI/HCW-year. Interns suffered more NSI (annual mean=4.8) than any other occupational group. Most NSI occurred when patients moved during procedures, when HCW re-sheathed needles, or during suturing (each reported by 55 HCW--30% of those responding). Following NSI, 60 HCW said they squeezed the site of the injury and washed it with bleach, 43 believed they had a 10% risk of HIV infection, 87 felt anxious, 54 felt depressed, 40 prayed, 24 had an HIV test, and four were counselled. To estimate actual infection risk, 435 patients were screened for antibody to HIV (1 and 2) and for the surface antigen of the hepatitis B virus (HBSAg); 26% and 2.8% were found seropositive, respectively. These seroprevalences were multiplied by previously determined probabilities of transmission to give estimated risks of infection (following a single NSI) of 0.08% for HIV and 0.135% for hepatitis B. During 3 years of training as a clinician (i.e. 2 years as a medical student and 1 year as an intern), more than six in 1000 individuals would be infected with HIV as a result of NSI and almost 10 in 1000 would be infected with hepatitis B virus by the same route. NSI are common, preventable sources of infection and stress for HCW in Africa.

Accidents, Occupational↗
PubMed1999

Nurses failure to appreciate the risks of infection due to needle stick accidents: a hospital based survey.

One of the most important occupational risks to healthcare workers is exposure is to blood-borne viruses. This study examined nurses' perceptions of risk of contracting infection following single or multiple exposure to blood or body fluids. Two hundred and ninety nurses were surveyed using a questionnaire. One hundred and thirty-three responded; 85 worked in higher risk areas (ITU, Haematology, Haemodialysis and Neonatal Surgical Units) (Group A) and 48 worked in lower risk areas (medical wards, an orthopaedic and an ENT ward) (Group B). Forty-nine percent of subjects from group A and 60% of subjects from Group B believed that a needle stick injury with a needle contaminated with infected blood was an unlikely source of infection. Fifteen percent from group A and 20% from group B thought that infection with a blood-borne virus following a needle stick injury contaminated with Human Immunodeficiency Virus (HIV) infected blood was very unlikely. Twelve percent from group A and 10% from Group B did not know whether resheathing needles between use can provide protection against HIV. Sixty-seven percent from group A and 71% from group B disagreed with the statement that nurses are at higher risk of exposure to HIV/HBV than the other healthcare workers. Thirteen percent from group A and 5% from group B agreed with the statement, whereas 8% from group A and 5% from group B thought that nurses are at less risk. Only 22% from group A and 23% from group B would take more precautions if they knew that the patient had HIV/HBV infection, whilst 11% and 8% respectively admitted that they would take special precautions only when the patient has clinical symptoms of HIV/HBV infection. The findings suggest that these nurses would benefit from further education regarding infection from blood-borne viruses.

Attitude of Health Personnel↗
PubMedDate not supplied

Risk of hepatitis C transmission from infected medical staff to patients: model-based calculations for surgical settings.

CONTEXT: Concern is increasing in both the medical community and among the general public about the possible transmission of hepatitis C virus (HCV) from infected health care workers to their patients. Until now, no reliable estimates for the risk of such transmission exist. OBJECTIVE: To estimate the probability of HCV transmission from a surgeon to a susceptible patient during invasive procedures. DESIGN: A model consisting of 4 probabilities was used: (A) the probability that the surgeon is infected with HCV, (B) the probability that the surgeon might contract percutaneous injuries, (C) the probability that an HCV-contaminated instrument will recontact the wound, and (D) the probability of HCV transmission after exposure. Values for the calculations were taken from published studies. RESULTS: When the surgeon's HCV status is unknown, the risk of HCV transmission during a single operation is 0.00018% +/- 0.00002% (mean +/- SD). If the surgeon is HCV RNA positive, this risk equals 0.014% +/- 0.002%. The likelihoods of transmission in at least 1 of 5000 invasive procedures performed by a surgeon during 10 years are 0.9% +/- 0.1% (HCV status unknown) and 50.3% +/- 4.8% (HCV RNA positive), respectively. CONCLUSIONS: The calculated risks for HCV transmission from a surgeon to a susceptible patient during a single invasive procedure are comparable to the chance of acquiring HCV by receiving a blood transfusion. These figures could provide a basis for further discussions on this controversial subject and might also be relevant for future recommendations on the management of HCV-infected health care workers.

Blood-Borne Pathogens↗
PubMedDate not supplied

Use of double gloves to protect the surgeon from blood contact during aesthetic procedures.

The potential for blood contact with nonintact skin puts operating room personnel at an increased risk of exposure to hepatitis or HIV virus. Frank needle-stick injury to the surgeon has been shown to occur once every 20-40 operations. It has been shown that blood contact exposure during aesthetic surgery occurs in 32% of the operations in which a single pair of surgical gloves is used (surgeon 39.7%, assistant 23%). The reduction of blood contact exposure during aesthetic surgical procedures by using two pairs of gloves was tested and demonstrated. Contact rates decreased by 70%. Outer-glove perforations occurred in 25.6% of the cases, while inner-glove perforations occurred in only 10% of the cases (surgeon 8.7%, assistant 3.5%). All of the inner-glove perforations occurred during procedures that lasted longer than two hours, and in no case was there an inner-glove defect without a corresponding outer-glove perforation. The nondominant index finger (33%) was the most common location. Double gloving during aesthetic procedures reduced the operating room personnel's risk of blood contact exposure by 70% when compared with single-glove use.

Blood-Borne Pathogens↗