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PubMed1999

Cervical epidural steroid injection with intrinsic spinal cord damage.

Explore the source record for details and available documents.

Cervical Vertebrae↗

PubMed1996

An occupational transmission of HIV: collision of ethical worlds in nursing practice.

This article proposes a new theoretical frame for ethical practice in nursing by locating ethical questions within the worlds of everyday nursing experience. The authors advocate a process of ethical thought and action that is not so much a weighing of dichotomized alternatives as a continual journey in which nurses delve deeper into their examination of clinical contexts, structural contingencies, and the meanings of experience for themselves and their clients. This theoretical vision is illustrated with a case study about a nurse who was infected with HIV on the job. The purposes in presenting the case study are to give testament to this brave woman's story, illustrate the dynamics of a contextualized ethics, and challenge nurses to make changes in practice, policy, and structure to foster truly ethical work and relations with others.

Attitude of Health Personnel↗

PubMed1998

Community-based programs for safe disposal of used needles and syringes.

OBJECTIVES: To review issues related to discarded syringes in the community and to describe community-based programs for the safe disposal of used needles and syringes. METHODS: We used the medical literature and chain referral to identify community-based syringe disposal programs other than syringe exchange programs (SEPs). We held a workshop in June 1996 involving staff from disposal programs; manufacturers of syringes, sharps containers, and other disposal devices; solid waste companies; public health staff; and researchers. RESULTS: Fifteen programs for the safe disposal of syringes were identified in the United States, Canada, and Australia. Of these, 12 primarily served persons with diabetes who use insulin, and 3 primarily served injection drug users (IDUs). The programs used three major strategies: puncture-resistant containers discarded in trash, community drop boxes, and sharps containers turned in for biohazard disposal at community sites, hospitals, or pharmacies. Participants in the workshop described key points in developing syringe disposal programs. Programs should involve pharmacists, physicians, waste disposal companies, public health departments, hospitals, diabetes educators, persons with diabetes who use insulin, and IDUs. For IDUs, criminal penalties for possession of syringes are a substantial deterrent to participation in community efforts to safely dispose of used syringes. The multiple and sometimes conflicting local, state, and federal laws and regulations concerning medical waste hinder development of multistate or national approaches to the safe disposal of syringes. More information is needed on community-based syringe disposal programs. CONCLUSION: Communities in the United States, Canada, and Australia have developed different approaches to achieve safe disposal of used syringes.

Australia↗

PubMed1995

Needlesticks in medical students in university hospitals.

The incidence of needlesticks and the effect of experience and other personal characteristics on the risk of needlesticks in medical students are unknown. Eighty-nine medical students were given a self-administered questionnaire. The questionnaire was completed by 86 students, and there were 91 sticks in 43 students. The incidence of needlesticks was 5.8/1000 procedures on the first rotation and 0.1/1000 during the second 4-month period (relative risk, 6.5, with 95% confidence interval (CI) of 3.4-125; P < 0.001). Personal characteristics were not associated with needlesticks except for tension felt while drawing blood and accident proneness. Those who were stuck during the first rotation were more likely to be stuck subsequently (odds ratio, 9.0, with 95% CI of 1-422; P < 0.05). We conclude that experience decreases the risk for needlesticks and therefore effective instructional intervention may have the biggest impact during the first medical student ward experience. Emphasis may have to be placed on those students who are accident prone or have been stuck in the past. Further studies are warranted to substantiate our findings and to test the effectiveness of various interventional approaches.

Adult↗

PubMed2000

Antiretroviral prophylaxis of health care workers at two urban medical centers.

We examined the influence of job category, source patient HIV status, and exposure type as predictors of whether health care workers initiated antiretroviral prophylaxis after potential blood-borne pathogen exposures. Of 639 exposures over an 18-month period, 82 individuals (13%) elected to receive prophylaxis, of whom 66% took medications for fewer than 96 hours and 12% completed a 4-week course. Reasons for early drug discontinuation included confirmation of source patient HIV-negative serological status (65%), gastrointestinal side effects (13%), headache (4%), and personal decision after counseling/other input (18%). Individuals exposed to HIV-positive source patients were more likely to initiate prophylaxis (odds ratio [OR], 5.1; 95% confidence interval [CI] 2.6 to 9.9). Licensed nurses were less likely than others to accept prophylaxis (OR, 0.5; 95% CI, 0.3 to 0.8), whereas physicians and medical students were more likely to accept prophylaxis (OR, 1.9; 95% CI, 1.1 to 3.3).

Adult↗

PubMed2002

Needle perforations of Molteno tubes.

PURPOSE: To investigate the effects of needle perforation of proximal Molteno tubes on intraluminal pressure in a constant flow system. MATERIALS AND METHODS: Balanced salt solution was infused at a rate of 2 microL/min through nonexpansile silicon tubing attached to a manometric reservoir, pressure transducer, and an occluded proximal Molteno glaucoma drainage device tube. As the intraluminal pressure rose to approximately 30 mm Hg, the tube was perforated once with needles ranging in size from 23G to 29.5 G (disposable insulin syringe). Intraluminal pressure was measured continuously throughout each test run for an average of 71 minutes each. RESULTS: The average stable intraluminal pressure ranged from 25 mm Hg for 29.5-G perforation to 15 mm Hg for 23-G perforation. The lowest single pressure recorded ranged from 3 mm Hg for 23-G perforations to 17 mm Hg for 29.5-G perforations. Pressures of less than 15 mm Hg were recorded in more than 60% of the 23-G and 25-G perforations, less than 20% of the 27-G perforations, and none of the 29.5-G perforations. CONCLUSION: At a flow rate of 2 microL/min of balanced salt solution, 23-G and 25-G needle perforations of silicone glaucoma drainage device tubes produce intraluminal pressures in vitro, which may result in low intraocular pressures. Immediate postoperative hypotony risk can be reduced if a smaller needle perforation is used.

Molteno Implants↗

PubMedDate not supplied

Bloodborne pathogen exposure and recommendations for management.

Bloodborne pathogens pose a continuing threat to healthcare workers. The frequency of needlesticks and wounds from other sharps has been reduced by the use of safety devices in many healthcare workplaces but it has not been eliminated. The need for appropriate management of a needlestick or other exposure that could carry a bloodborne pathogen has become increasingly clear as more is learned about the factors affecting transmission of these infectious agents. With better diagnostic tools and more therapeutic agents the success rate of postexposure prophylaxis (PEP) will continue to improve. This article will focus on those agents as they pose the greatest known threats and offer the potential for intervention.

Blood-Borne Pathogens↗

PubMedDate not supplied

Effectively evaluating and converting your organization to the use of infusion safety products.

This article explains the process of converting an organization to infusion safety products as mandated by the Needlestick Safety and Prevention Act and the subsequent OSHA directive regarding safer needle devices.

Blood-Borne Pathogens↗

PubMedDate not supplied

Summary of product trials for 10, 164 patients: comparing an intravenous stabilizing device to tape.

Inadequate catheter securement is an underrecognized patient safety issue that contributes significantly to catheter-related complications, including dislodgment, occlusion, infiltration, and infection. Pooled data from prospective product trials at 83 hospitals compared tape to a standard peripheral intravenous (PIV) securement method with a PIV-specific catheter-stabilizing device (StatLock). A 67% reduction (P<.001) in total patient complications was observed in the stabilizing device group, as compared with the tape group. Also, the need for unscheduled PIV restarts was reduced by 76% with the stabilizing device (P<.001). An annual cost savings of $18,000 per hospital on PIV materials and a combined savings of $277,000 on materials, complication costs, and nursing time were estimated on the basis of these reduced complications. Newer catheter-stabilizing technologies can help to reduce patient complications, for an overall cost savings, and consequently reduce needlestick exposures for healthcare providers by reducing restarts and prolonging dwell times.

Accidents, Occupational↗

PubMed1992