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At least 1,099 records · Page 61Linked to original sources
PubMed2006

Toronto hospital reduces sharps injuries by 80%, eliminates blood collection injuries. A case study: Toronto East General Hospital pioneers healthcare worker safety.

Needlestick and other sharps injuries are a key Canadian public health issue, affecting 70,000 people per year and costing some dollar 140 million. A safety program at Toronto East General Hospital--focusing on blood collection and patient injection--achieved an 80% reduction in injuries within one year (from 41 in 2003 to eight in 2004), with blood collection injuries eliminated entirely.

Blood Specimen Collection↗
PubMed2003

Laser-assisted penetration of topical anesthetic in adults.

OBJECTIVE: To determine whether pretreatment of skin with erbium:YAG (Er:YAG) laser-assisted delivery facilitates the penetration of lidocaine cream to provide anesthesia suitable for needlesticks after just 5 minutes. DESIGN: Trial 1 was a double-blind randomized controlled trial, whereas trial 2 was a nonblinded randomized controlled trial. SETTING: The study was conducted in 2 facilities, an academic and a private clinical research unit. PARTICIPANTS: A total of 320 healthy volunteers, aged 18 to 65 years and of any Fitzpatrick skin phototype. INTERVENTIONS: Trial 1 involved an Er:YAG laser pretreatment to disrupt the stratum corneum followed by an application of 4% lidocaine cream on one arm, and a laser pretreatment plus placebo on the other arm. Trial 2 involved an application of 4% lidocaine cream alone on one arm, and a laser pretreatment followed by an application of 4% lidocaine cream on the other arm. MAIN OUTCOME MEASURE: Self-reported pain perception on a 100-mm visual analog scale after quick insertion and removal of a 25-gauge hypodermic needle on the treatment sites. RESULTS: Data from the 2 trials showed that there was a 62% pain reduction with laser pretreatment plus lidocaine compared with laser pretreatment plus placebo, and a 61% pain reduction with laser pretreatment plus lidocaine, compared with lidocaine alone. The decrease in pain in both trials was statistically significant (P<.001). Adverse events reported 48 hours after treatment were few and mild. CONCLUSION: Treatment with the Er:YAG laser followed by lidocaine cream is a safe, effective, and efficient means of inducing skin anesthesia that significantly reduces the pain of hypodermic needle insertion.

Administration, Topical↗
PubMed1994

Phentolamine reversal of epinephrine-induced digital vasospasm. How to save an ischemic finger.

A 17-year-old girl accidently injected her thumb with an adult autoinjector epinephrine syringe, resulting in rapid digital ischemia. Local infiltration of 0.5% phentolamine mesylate injected at the puncture site immediately resolved the ischemia and resulted in no long-term sequelae. Similar cases of epinephrine-induced digital ischemia are reviewed herein, revealing phentolamine to be the drug of choice for reversal of this type of ischemia. Alternative attempts to restore blood flow included warm water immersion, amyl nitrite inhalations, metacarpal nerve block, and application of topical nitroglycerin paste; each was found to be ineffective. We conclude that digital ischemia secondary to accidental injection of epinephrine can be quickly and safely reversed with the use of 0.5% phentolamine locally infiltrated in the region of accidental injection.

Accidents↗
PubMed2000

Occupational human immunodeficiency virus exposure among residents and medical students: an analysis of 5-year follow-up data.

BACKGROUND: Findings of a needlestick survey at our institution yielded an estimate that 1 case of occupationally acquired human immunodeficiency virus (HIV) among the approximately 1100 residents and third- and fourth-year medical students would potentially occur every 2 to 3 years, and also revealed types of exposures, circumstances, rates of reporting, and reasons for not reporting. OBJECTIVE: The present study is a 5-year follow-up study to investigate changes in these parameters. METHODS: A self-administered, anonymous 2-page questionnaire covering occupational exposures and other risk factors was distributed to medical students in classes, and to residents in grand rounds and required conferences. The response rate was 71%. RESULTS: The incidence of needlestick accidents dropped dramatically over 5 years (1994-1995 vs 1989-1990), especially for surgical residents. Because the proportion of known sources positive for HIV increased over the same period, estimates of occupational HIV risk remain essentially the same, with a projection that 1 student or resident would be expected to experience an occupationally acquired HIV infection approximately every 2 years. The nonoccupational risk for this population, in contrast, seems to be lower than in their age group as a whole. CONCLUSIONS: While the decrease in overall occupational exposures (especially for surgical residents) coupled with slight increases in rates of exposure documentation and use of universal precautions constitute positive findings, the increased proportion of exposure sources who are HIV positive leads to an unchanged estimate of occupational HIV risk for residents and students. Study findings therefore support the continued need for educational efforts aimed at prevention, along with timely dissemination of advances in approaches to postexposure prophylaxis.

Follow-Up Studies↗
PubMed1993

The risk of exposure of third-year surgical clerks to human immunodeficiency virus in the operating room.

The exposure of third-year medical students to blood and blood products in the operating room was assessed with a questionnaire distributed at the end of their clerkship in surgery. Sixty-six (68%) of ninety-seven students reported having been exposed to blood in the operating room during their 3-month rotation in surgery. During the year there was a decrease in the exposure rate that correlated with the students' knowledge of universal precautions (r = .96). Consistent with this observation was a significant decrease in the exposure rate from the first quarter of the year to the last quarter (88% vs 56% of the students). Of the 32 students stuck or cut in the operating room, 21 (66%) were injured by the surgeon. These data underscore the risk to medical students during their clerkships and the important role that universal precautions had in their protection.

Accidents, Occupational↗
PubMed2001

Prevalence of HTLV-I-associated T-cell lymphoma.

In order to assess the prevalence rate of HTLV-1-associated T-cell lymphomas and human retrovirus infection in general, approximately 21,000 individuals representing various patient populations, retroviral risk groups, and blood donors were examined for HTLV-I, HTLV-II, HIV-1, or HIV-2 infection using serologic and PCR assays. The prevalence rates among volunteer blood donors were 0.02% and 0% for HTLV and HIV, respectively. Significantly increased HTLV prevalence rates were observed among paid blood donors, African American health care clinic patients, Amerindians, recipients of HTLV-positive cellular blood products, intravenous drug users, sexual contacts and family members of HTLV-positive people, and patients with primary thrombocytosis and other-than-low-grade non-Hodgkin's lymphoma (NHL). Among some of these groups there were significant differences in the prevalence of HTLV-I versus HTLV-II. The eight HTLV-positive NHL patients all had mature, high-grade, CD4+ T-cell lymphomas with clonally integrated HTLV-I, for a prevalence of 4% among other-than-low-grade NHL patients. Seven of the eight died from their disease within 2 years despite treatment. Interestingly, two groups at risk for HTLV infection, namely needle stick victims and recipients of HTLV-infected and/or pooled plasma products, showed no evidence for infection. Significantly increased HIV-1 prevalence was observed among paid blood donors, African Americans, homosexuals, female prostitutes, hemophiliacs, and other-than-low-grade NHL patients. Only one patient was infected with HIV-2. Of the nine HIV-positive, other-than-low-grade NHL patients, seven HIV-1 positives had B-cell lymphomas, one HIV-1 positive had an HTLV-I-positive CD4+ T-cell lymphoma, and one infected with HIV-2 had a CD4+ T-cell lymphoma that was HTLV negative. The data indicate that HTLV-I lymphoma, while uncommon, is not necessarily rare among other-than-low-grade NHL cases in the United States and, given its poor prognosis, should probably be studied separately in clinical trials.

Black or African American↗
PubMed1993

Body fluid exposure in an urban tertiary care medical center.

The increasing prevalences of the human immunodeficiency (HIV) and hepatitis B viruses have focused attention on the risks that health care workers face when exposed to potentially infective body fluids. This study establishes a profile of 320 parenteral exposure incidents and 47 exposure incidents to mucous membranes or abraded skin, reported in our medical center between July 1988 and July 1990. We found that 102 (27.8%) of the incidents involved an HIV-positive patient, that 130 (35.4%) of the reporting employees had completed their hepatitis B vaccination at the time of the incident, and that, although the majority of incidents involved employees with patient contact, unfortunately, service workers also were represented (4.6%, n = 17). Factors contributing to incidents included recapping (10.9%, n = 40), full needle-boxes (7.6%, n = 28), and inappropriate disposal (13.1%, n = 48). A health fair featuring walk-in hepatitis B immunization attracted 260 participants, 90% of whom completed the entire immunization series. This significantly improved the immunization rate of employees subsequently reporting body fluid exposure.

Adult↗
PubMed1996

Randomized trial of blunt-tipped versus cutting needles to reduce glove puncture during mass closure of the abdomen.

Eighty-five consecutive patients were randomized to undergo mass closure of the abdomen with no. 1 polydioxanone mounted on either a blunt-tipped (n = 46) or cutting (n = 39) needle. Gloves were changed before closure and tested for perforation afterwards using standard air or water techniques. Fourteen pairs of gloves were punctured when using a cutting needle, and three pairs when a blunt-tipped needle was used. The majority of punctures were to the non-dominant glove. The surgeon was aware of the puncture in eight of the 14 instances involving a sharp needle and in one of the three involving a blunt-tipped needle. Blunt-tipped needles, while not eliminating the risk, significantly reduced the incidence of surgical glove puncture (P < 0.001, Fisher's exact test). The use of cutting needles for abdominal closure should be abandoned.

Abdomen↗