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PubMedDate not supplied

Universal precautions--do Irish anaesthetists comply?

BACKGROUND: Anaesthetists are at high risk from blood-borne pathogens. Universal Precautions (UP) include the routine use of appropriate barrier precautions and techniques to reduce the likelihood of exposure to blood, body fluids and tissues that may contain pathogens. The compliance of Irish anaesthetists with these precautions has not been studied. AIM: To study the attitudes of Irish anaesthetists to Universal Precautions. METHOD: A postal questionnaire was sent to 210 anaesthetists currently practising in Ireland. The questionnaire was based on a model used in Australia and New Zealand. RESULTS: There was a 50% response rate to the survey. Only 15% of respondents had taken a risk history from a patient in the preceding four weeks. Resheathing of needles was commonplace. The effectiveness of hepatitis B immunisation was rarely checked and only 66% of respondents believe implementation of Universal Precautions to be practical. CONCLUSION: Irish anaesthetists comply poorly with Universal Precautions.

Anesthesiology↗
PubMed1998

[Recurrent soft tissue infections after accidental inoculation with BCG vaccine].

Complications after BCG vaccine (bacilli Calmette-Guérin) occur rarely. They can reach from a local acute abscess to chronic ulceration's. Therapeutically concepts of these complications range from conservative to operative treatment. In the following case history recurrent soft tissue infections occurred after accidental inoculation with BCG vaccine. The time course of these recurrent infections with its therapeutic options is discussed and a treatment strategy is suggested. Currently, radical excision combined with antituberculotic treatment seems to be the most promising therapy of this specific soft tissue infection.

Antitubercular Agents↗
PubMed2003

A study of the incidence and recognition of surgical glove perforation during obstetric and gynecological procedures.

OBJECTIVES: The purpose of this study was to compare the frequency of surgical glove perforation among obstetric and gynecological surgical procedures, and to evaluate surgeons' perceptions. MATERIALS AND METHODS: A cross-sectional study was conducted in which nursing personnel examined the gloves used in obstetric and gynecological procedures, immediately after the surgery, in order to detect perforations. RESULTS: Surgical glove perforation occurred in 20.8% of 817 obstetrics procedures and 24.4% of 131 gynecology procedures. The observed difference between groups was not statistically significant (p=0.35). Obstetricians perceived the occurrence of perforation in 30.6% of the events, and gynecologists in 37.5%. This difference was not statistically significant (p=0.44).

Brazil↗
PubMed1998

Single limb patency of polytetrafluoroethylene dialysis loop grafts maintained by traumatic fistulization.

The purpose of this report is to describe an unusual presentation of obstructive neointimal hyperplastic lesions in loop prosthetic dialysis grafts. The case histories and imaging studies of two patients with partial graft thrombosis are presented. The literature of unexpected fistulae from prosthetic dialysis grafts to adjacent veins is reviewed. Signs and symptoms that would lead a clinician to suspect the diagnosis are emphasized. There were two dialysis grafts with partial thrombosis and arterial limb patency maintained by iatrogenic fistula. These fistulae occurred from the erosion of pseudoaneurysms in one case and an apparent needle stick without pseudoaneurysm in the other. Both grafts had high-grade stenotic lesions affecting the venous outflow. In the first case this was not recognized until the graft reclotted 2 days after thrombectomy. In the most extreme cases of graft/vein fistulae, i.e., partial graft thrombosis with arterial limb patency maintained by the fistula there is always associated venous anastomotic or outflow stenoses which must be addressed.

Adult↗
PubMed2004

Management of occupational and nonoccupational postexposure HIV prophylaxis.

The principles of managing patients with recent HIV exposures are similar whether the exposure occurs in an occupational or nonoccupational setting. For both settings, clinicians should 1) assess the likelihood that HIV and other bloodborne viruses will be transmitted as a consequence of the exposure; 2) advise the patient about the risks and benefits of treatment; 3) choose an appropriate antiretroviral treatment regimen (if the decision is made to treat); 4) screen for other illnesses that may complicate treatment or follow-up; 5) counsel patients about the importance of adhering to treatment; 6) promote safe-sex practices and methods to avoid future exposures; 7) follow the patient for potential side effects of treatment; 8) provide follow-up care including repeat HIV testing for seroconversion, surveillance for primary HIV infection, and reinforcement of counseling messages.

Anti-HIV Agents↗
PubMed1992

Occupational exposure to human immunodeficiency virus and hepatitis B virus: a comparative analysis of risk.

OBJECTIVE: To estimate the occupational risk from infection with the human immunodeficiency virus (HIV) in terms of loss of (quality-adjusted) life expectancy, and to compare that risk to those posed by other hazards faced by health care workers. DESIGN: Decision-analytic model. RESULTS: For a 30-year-old female health care worker (unvaccinated for hepatitis B virus [HBV]), the loss of life expectancy from a needlestick from a symptomatic HIV-positive (HIV+) patient is 39 days (range, 17 to 93 days), as compared with a loss of 17 days from a needlestick from a patient who is hepatitis-B-surface-antigen-positive (HBsAg+), and 38 days from a needlestick from a patient who is hepatitis-B-e-antigen-positive (HBeAg+). When morbidity is included in the analysis of risk (through calculation of the quality-adjusted loss of life expectancy), the risk from both HBV and HIV increases. The quality-adjusted loss of life expectancy due to a needlestick exposure from a symptomatic HIV+ patient is 45 days (range, 20 to 108 days), as compared with a quality-adjusted loss of life expectancy of 48 days from a needlestick from an HBsAg+ patient, and 109 days from a needlestick from a patient who is known to be HBeAg+. By comparison, a cross-country automobile trip is associated with a loss of life expectancy of approximately 1 day. The 45- to 50-day loss of quality-adjusted life expectancy from percutaneous exposures to HIV and HBV is approximately the same magnitude as the gain in life expectancy from 10 years of annual screening for breast cancer with mammography and physical examination. CONCLUSIONS: The risk associated with percutaneous exposures to symptomatic HIV+ patients is comparable to other risks that health care workers have faced knowingly and have accepted in the recent past. However, the loss of quality-adjusted life expectancy associated with a needlestick exposure is significant. Identification of cost-effective methods that increase the safety of medical personnel but also ensure full access to high-quality care for HIV+ patients should be a high priority.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Percutaneous and mucous membrane exposure protocol in a southeastern dental school.

A southeastern dental educational institution formalized a Percutaneous and Mucous Membrane Exposure Protocol in 1990. This article outlines the development, implementation, and administration of the protocol including risk assessment and rationale for testing health care workers and source persons. Pretest and posttest counseling for HIV testing is also discussed.

AIDS Serodiagnosis↗
PubMed1992

Simian immunodeficiency virus needlestick accident in a laboratory worker.

The macaque monkey infected with simian immunodeficiency virus (SIV) is an animal model of the acquired immunodeficiency syndrome. We investigated a laboratory worker who was exposed by needlestick accident to blood from an SIV-infected macaque. Seroreactivity to SIV developed within 3 months of exposure, with antibody titres peaking from the third to the fifth month and declining thereafter. Polymerase chain reaction for SIV sequences and cultures of peripheral-blood mononuclear cells failed to show infection. Inoculation of an SIV-negative monkey with blood from the worker did not cause infection. Animal-care and laboratory workers should adhere strictly to recommended procedures to avoid accidental exposures when working with SIV-infected animals or specimens.

Animals↗
PubMed1991

Phlebotomy in inoculation risk patients: a questionnaire survey of knowledge and practices of hospital doctors in Liverpool.

To assess the knowledge of hospital doctors about patients at increased risk of infection with human immunodeficiency virus (HIV) or hepatitis B virus, and the precautions they took during phlebotomy in such patients, an anonymous postal questionnaire was sent to all 307 hospital doctors working at two District General Hospitals in Liverpool, UK. Two hundred and thirty-eight (77.5%) of the questionnaires were returned. More than 90% of respondents considered a history of male homosexuality, intravenous drug abuse, prostitution or a child of a prostitute to indicate an inoculation risk. There was uncertainty about a previous prison sentence in the 1980s, residence in a home for the mentally handicapped, previous residence in the tropics and hospital treatment in the tropics. Thirty-eight percent of doctors would never enquire about sexual preference, 54.1% about a previous prison sentence and 15.7% about intravenous drug abuse in their clinical history. Although 97.4% of doctors would sometimes or always wear gloves during phlebotomy of an inoculation risk patient, 25.5% always resheathed the needle after phlebotomy and 20.8% would never take the sharps box to the patient. More effort is required to identify accurately inoculation risk patients and greater care is needed in phlebotomy techniques.

Blood Specimen Collection↗
PubMed1994

Prevalence of hepatitis B virus markers among hospital personnel in Israel: correlation with some risk factors.

During 1986-1987, 480 employees of the Tel-Aviv Medical Center were screened for hepatitis B virus (HBV) markers as a preliminary step in a vaccination campaign. One hundred and seventeen (24.4%) had evidence of previous infection, including nine (1.9%) carriers. The effect of potential risk factors on seropositivity was evaluated by multiple logistic regression analysis, which enabled assessment of the individual contribution of each risk factor under the specific environmental conditions. The following risk factors were found to influence seropositivity: origin from Third World countries as opposed to the Western World, employment as sanitary workers, age over 40 years, and history of accidental needle punctures. In the heterogeneous Israeli population, hospital workers had a relatively high prevalence of HBV markers, probably resulting from occupational exposure.

Adult↗