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PubMed2006

Potential compromise of hospital hygiene by clinical waste carts.

Bulk waste storage carts are common in hospitals and undoubtedly assist in the day-to-day management of clinical wastes. They are used for the transport and interim storage of primary clinical waste containers and are often located close to or within hospital buildings to receive such wastes from clinical departments. Examination of a random selection of bulk clinical waste carts at nine acute hospitals across Greater London revealed external soiling in all of 23 carts. Eight of 13 carts were also soiled on the inner surfaces, with evidence of bloodstains and free fluids in the base of five carts. Staphylococcus aureus and enterococci were recovered in low numbers from the lids (N=7) and wheels (N=10) of carts and Escherichia coli, Enterobacter spp. and Pseudomonas aeruginosa were recovered from the wheels of a further five carts. Two carts were heavily contaminated with Aspergillus spp. Pathogens originating from clinical wastes may be transferred from contaminated bulk waste carts to the wider hospital environment. It may be advisable to keep bulk carts outside clinical areas, and preferably outside all hospital buildings. This becomes particularly important in circumstances where carts supplied by contractors are not dedicated to a single hospital or National Health Service trust.

Blood-Borne Pathogens↗
PubMed2006

Preventing nosocomial infections: improving compliance with standard precautions in an Indonesian teaching hospital.

Standard precautions can prevent transmission of micro-organisms. This study investigated hand hygiene, handling of needles and use of personal protective equipment in an Indonesian teaching hospital, and performed a multi-faceted intervention study to improve compliance. An intervention was performed in an internal medicine ward and a paediatric ward, consisting of development of a protocol for standard precautions, installation of washstands, educational activities and performance feedback. Before, during and after the intervention, observers monitored compliance with hand hygiene, safe handling of needles and use of gloves, gowns and masks. A gynaecology ward served as the control. Unobtrusive observations were performed to check for an influence of the observers on the overt observations. In total, 7,160 activities were observed. Compliance with hand hygiene increased from 46% to 77% in the internal medicine ward and from 22% to 62% in the paediatric ward. Before the intervention, no safe recapping of needles was recorded in either ward. After the intervention, 20% of needles were recapped safely. Inappropriate gown use decreased in the internal medicine ward. There were no significant changes in use of gloves and masks. There may have been an effect of the overt observations in the paediatric ward, but there was no effect in the internal medicine ward. There were no significant changes in the control ward, except for a decrease in the use of gloves. In conclusion, compliance with hand hygiene procedures improved significantly due to an intervention project focused on education and improved facilities. Compliance with safe handling of needles improved slightly due to introduction of the one-handed method for safe recapping of used needles.

Cross Infection↗
PubMed2006

How much do medical students know about infection control?

Changes in undergraduate medical training mean that students have direct patient contact from an early stage of their training. This study aimed to assess the knowledge of third-year medical students at the University of Birmingham Medical School, UK on infection control policy and procedures. A semi-structured questionnaire was distributed to medical students. Out of 322 students, 156 returned completed questionnaires (48%). Results showed that 58% of medical students did not know the correct indications for using alcoholic hand gel, 35% did not know the correct use of gloves, and 50% did not know the exclusion period after an episode of diarrhoea and vomiting. Sixty-four percent of medical students reported formal teaching on hand hygiene, 12% reported informal teaching, 19% reported both types of teaching and 5% reported no hand hygiene teaching at all. Forty-nine percent of medical students thought that there was insufficient emphasis on infection control in their course. These results raised concerns about medical students' knowledge about infection control. The University is currently reviewing the need for a more structured model for the teaching and assessment of infection control.

Clinical Competence↗
PubMed2006

Parental reassurance and pediatric procedural pain: a linguistic description.

UNLABELLED: Certain parental behaviors are associated with child coping and others with child distress when children undergo painful medical procedures. The finding that parental reassurance is linked with increases in child distress is perplexing and counterintuitive. The objective of the present study was to provide a detailed linguistic description of the speech functions and tones parents use when reassuring during painful medical procedures. Videotapes of 28 5-year-old children (12 boys, 16 girls) receiving immunizations who were accompanied by their parents were examined. The majority of reassuring verbalizations were statements; minor clauses (eg, "okay") were the next most frequent type of utterance. Half of the reassuring verbalizations were spoken with a falling tone, which is indicative of speaker certainty and protectiveness. This detailed linguistic approach offers new insights into the qualities of parental reassurance during painful medical procedures. Further research is needed to elucidate the complex interactions of tone, speech function, and reassurance and their effects on child distress. PERSPECTIVE: This article presents a detailed description of parental reassurance during pediatric immunizations. The description of the linguistic qualities of reassurance can help inform future research examining which characteristics of reassurance are associated with child distress and can help guide parental behavior during immunizations.

Adaptation, Psychological↗
PubMed2005

Septic monoarthritis of the first carpo-metacarpal joint caused by Mycobacterium kansasii.

A case of septic carpal monoarthritis due to Mycobacterium kansasii developing 16 months after accidental inoculation in a healthy laboratory technician is reported. No predisposing factor such as immunosuppression, preexisting degenerative, inflammatory arthritis or cortisone injection was present. Treatment with antituberculous oral medication alone resulted in resolution of the disease. Synovectomy was unnecessary. Ten years after the initial causative event, the patient remains free of symptoms.

Adult↗
PubMedDate not supplied

[Occupational risk for blood exposure and staff behaviour: a cross-sectional study in 3 Moroccan healthcare centers].

OBJECTIVE: As in other countries, Moroccan health-care workers are exposed to occupational blood exposure (OBE) hazards. The purpose of this study was to estimate the occupational safety and hygiene conditions determining the OBE risk for health-care workers. WORKERS AND METHODS: In March 2000, a multicentric study was carried out in Morocco on 420 health-care workers, with an anonymous questionnaire. The study included health-care workers in the Taza and Temara hospitals and health centers, as well as in a Rabat public medical analysis laboratory. RESULTS: The participation rate was 67.8% (285/420). The population was mainly female (61%) with a mean age of 41.4 years (+/-7 years). Health-care workers answered that: occupational hygiene and safety were inadequate (55.1%); wearing single-use gloves was rare (34.5%); resheathing used needles was frequent (74.5%); safe containers were often missing (67%). In 1999, the annual average incidence of OBE was 1.5 (+/-4.3) per capita. If we consider the whole career of health-care workers, the incidence reached about 14.3+/-28.1 per capita. The absence of post-exposure chemoprophylaxis was the rule. CONCLUSION: The study shows that there is a need to improve occupational hygiene and safety conditions for Moroccan health-care workers in order to reduce OBE hazards.

Adult↗
PubMed2004

Selling comfort: A survey of interventions for needle procedures in a pediatric hospital.

Abstract Needle procedures are a necessary component of the treatment of hospitalized children. However, for many children they can be both painful and distressing. There was concern among the nurses at our pediatric hospital that we were not adequately controlling pain from needle procedures. We were interested in obtaining more information about the incidence and types of needle procedures and the current use of topical analgesics. A survey was designed to describe the frequency, type, time to complete, and perceived ease of needle procedures. The use of topical anesthetics and other comfort measures was also examined. The most common needle procedures performed were venipunctures for blood work, followed by intravenous cannulations, capillary sticks, port-a-cath access, and intramuscular injections. In total, 387 procedures were performed over a 23-day period. The majority of the procedures were perceived as easy, and the modal time to complete the procedures was 5 minutes. A topical anesthetic was used for 74 procedures (i.e., 19%), and the majority of these procedures were performed on the medical day unit with oncology patients. Results of the survey provided information about the day-to-day practice of needle procedures in order to identify both the supports and the barriers to providing these procedures atraumatically. Examining needle procedures within a framework of atraumatic care broadened our perspective and enabled us to integrate the use of topical anesthetics as just one of a number of strategies to minimize the pain and distress associated with needle procedures.

Adaptation, Psychological↗
PubMed2006

Nigerian medical students are at risk for hepatitis B infection.

Medical students are exposed to blood and body fluids. This study was conducted to estimate the prevalence of hepatitis B virus (HBV) infection amongst medical students of the Lagos State University College of Medicine, Ikeja, Nigeria. Data were collected through a self-administered questionnaire and through blood analysis for hepatitis B surface antigen (HBsAg), hepatitis B 'e' antigen (HBeAg) as well as antibodies to the core (anti-HBc), surface (anti-HBs) and 'e' (anti-HBe) antigens. Three hundred and thirteen of 325 students (96%) participated. The mean age was 24.3+/-3.98 years; 231 (74%) were pre-clinical students and 82 (26%) were in the clinical years of study. Only 8 (2.6%) had received three doses of vaccination against HBV. Eighty-one (26%) tested positive for anti-HBc, 10 (3.2%) were positive for HBsAg and 56 (17.9%) had anti-HBs antibodies. A significant relationship was found between students who had a positive history of hepatitis B in the family and anti-HBc (P=0.03). Age was also significantly associated with HBsAg (P=0.012). Two hundred and twenty-five (72%) students were susceptible to the infection and required vaccination. Most students at this medical school are susceptible to HBV infection and should be vaccinated.

Adult↗
PubMed1996

The use of a surgical assist device to reduce glove perforations in postdelivery vaginal repair: a randomized controlled trial.

OBJECTIVE: Our purpose was to compare the effectiveness of a surgical assist device, SutureMate, to decrease glove perforations during postdelivery vaginal repair. STUDY DESIGN: This was a prospective randomized trial. After delivery surgeons who needed to perform vaginal repair were randomized to use the surgical assist device or to perform the repair in the usual fashion. After the repair, gloves were collected and the operator was asked to complete a standardized data form that was submitted with the gloves. The gloves were tested for perforations within 24 hours by the Food and Drug Administration-approved hydrosufflation technique. Comparisons were made with chi(2) statistics with p < 0.01 taken as being statistically significant with the use of a Bonferoni adjustment for multiple comparisons. RESULTS: A total of 476 glove sets were evaluated. The use of the surgical assist device significantly reduced the overall glove perforation rate from 28.3% in the control arm to 8.4% in the study arm (p = 0.0001). Rates of perforation varied with level of training and expertise but fell in all groups that used the device. Family physicians had the highest perforation rate in the control arm and benefited most from the device. A total of 76% of perforations were located in the thumb, index, and second fingers of the nondominant hand. Perforations were recognized in only 16% of the glove sets. The level of satisfaction with the device was mixed, but overall 50% of operators indicated that they were either satisfied or very satisfied with the device. CONCLUSION: The rate of glove perforation in postdelivery vaginal repair is high. The surgical assist device significantly reduced the rate of glove perforations.

Delivery, Obstetric↗
PubMed1998

Accidental needlesticks in the phlebotomy service of the Department of Laboratory Medicine and Pathology at Mayo Clinic Rochester.

OBJECTIVE: To determine the change in accidental needlestick rates in the Phlebotomy Service at Mayo Clinic Rochester and to identify safety practices implemented from 1983 through 1996. MATERIAL AND METHODS: We retrospectively reviewed yearly Phlebotomy Service accidental needlestick rates from 1983 through 1996. Interviews were conducted with representatives of the Infection Control Committee and the management team for the Phlebotomy Service, and minutes of meetings of these two groups were reviewed to identify implemented safety improvements that may have had an effect on accidental needlestick exposures. RESULTS: Accidental needlestick exposures in the Phlebotomy Service declined from a high of 1.5/10,000 venipunctures to 0.2/10,000 venipunctures. Several safety improvements were made during that time, including the implementation of a one-handed recapping block, change to single-use evacuated tube holders, increased number and improved locations of disposal containers for needles, implementation of resheathing needles and retractable capillary puncture devices, discontinuation of the practice of changing needles before inoculation of blood culture bottles, increased emphasis on safety for new and experienced phlebotomists, and improved exposure reporting tools. CONCLUSION: We believe that the decrease in our accidental needlestick exposure rate is correlated with the changes in education, practices, and products that we have implemented.

Accidents, Occupational↗