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PubMed1995

Dental care of infectious patients in Denmark, 1986-1993: theoretical considerations and empirical findings.

Changes in infection control and behavior and attitudes towards HIV-infected patients from 1986 to 1992/93 were studied among a random sample of 335 Danish dentists; previous studies among random samples of Danish dentists served as references. 249 (74.3%) returned a mailed questionnaire together with a time, steam, temperature (TST) control indicator strip processed in their steam autoclaves, 3.4% of the autoclaves had not sterilized properly, which was an insignificant decrease compared to 1986. Overall, infection control had improved since 1986. In 1992/93 17.3% of dentists surveyed reported use of gloves always: in 1986 0.8% did so. Many (60.2%) reported at least one needlestick or cut accident within the last year. The number of dentists who were willing to treat HIV-infected patients and the number of clinics that found they could treat infectious patients safely had increased from 56.1% to 78.7% and from 43.0% to 66.8%, respectively. Other attitudinal dimensions, for example views on secrecy of HIV test results and HIV screening policy, had not changed. A conceptual model based on the theory of reasoned action formed the framework for multiple logistic regression analysis with two different outcomes: Willingness to treat HIV-infected individuals and Treatment of HIV-infected patients. In particular, expected staff problems turned out to have a high explanatory value (odds ratio = 18.2) if HIV-infected patients were received. In both models Certainty about hygienic precautions had some explanatory value. The findings may give some clues about how to plan and implement future continuing education on infection control and attitudinal and behavioral aspects of caring for infectious patients.

AIDS Serodiagnosis↗
PubMed1996

A prospective study of hepatitis C virus infection after needlestick accidents.

There have been few prospective studies of hepatitis C virus (HCV) infection after needlestick accidents in hospital employees. In the present study, the prevalence and features of HCV infection after needlestick accidents were evaluated prospectively measuring serum HCV-RNA. Subjects were 56 employees who had HCV needlestick accidents. To monitor the development of hepatitis, the serum ALT levels and HCV-related seromarkers, such as first generation anti-HCV (RIA), second generation anti-HCV (PHA) and HCV-RNA (RT-PCR) were measured every month for at least 12 months after the accidents. Three of 56 (5.4%) recipients developed HCV infection. HCV-RNA was detected in all three recipients within 4 months after the exposure, and second-generation HCV antibody was detected in two of three recipients. The detection of HCV-RNA was earlier than that of HCV antibody. Two of three HCV-infected recipients developed type C acute hepatitis and one of two received interferon therapy; however, the other case received no medication. The detection of HCV-related seromarkers and the elevation of ALT levels were transient in these three recipients: thus, none developed chronic hepatitis. In conclusion, HCV infection developed in 5.4% of recipients within 4 months after HCV accidents. All of these HCV-infected recipients showed fair prognosis. HCV-RNA was a beneficial parameter for early detection of HCV infection.

Accidents, Occupational↗
PubMed1997

Risk of occupational exposure to potentially infectious nonhuman primate materials and to simian immunodeficiency virus.

Five hundred fifty persons who worked with nonhuman primates (NHP) or with NHP material in 13 North American research institutions were surveyed for potential occupational exposures and tested for antibodies to simian immunodeficiency virus (SIV). Needlesticks and mucocutaneous exposures were reported more frequently among persons who handled SIV-negative or SIV-status-unknown (SIV-N/U) animals (36% and 35%) or who worked with SIV-N/U material in the laboratory (18% and 17%) than among persons who handled SIV-positive NHP (SIV-P) (9% and 4%) or worked with SIV-P material (6% and 8%). The risk for needlesticks when working with both SIV-N/U and SIV-P animals and the risk for mucocutaneous exposures from SIV-N/U animals increased with the number of years working with NHP. Persons who performed invasive tasks (e.g., obtaining blood samples, performing surgery/autopsies) were more likely than others to sustain needlesticks (adjusted OR = 3.55, 95%CI = 1.40-9.02). Two (0.4%) of 550 persons had antibodies to SIV. One appears to be infected with SIV, as previously reported. These data suggest that persons who work with NHP or with NHP material are at risk for occupational exposure to potentially infectious materials including SIV. Prevention strategies are needed to reduce the risk for needlesticks and mucocutaneous exposures around all NHP, and safety guidelines should emphasize prevention options for invasive tasks performed with animals.

Animals↗
PubMed1997

Dental practitioner risk, knowledge and practice with regard to the hepatitis B vaccination in South Africa.

OBJECTIVES: To determine dental practitioner risk, knowledge and practice with regard to hepatitis B vaccination in South Africa. DESIGN: Cross-sectional, descriptive study. SUBJECTS: Dental students qualifying from the University of the Western Cape dental school between 1985 and 1995 (n = 173). METHODS: A telephonic survey, using a structured questionnaire. MAIN OUTCOME MEASURES: Knowledge and compliance with hepatitis B vaccination. RESULTS: The present study shows that (i) individuals are not maintaining HBV protection and (ii) individuals are at risk. CONCLUSIONS: Guidelines need to be developed to ensure that the entire dental team is not only vaccinated against HBV, but that post-vaccination testing and follow-up for booster vaccination is strictly adhered to.

Adult↗
PubMed2006

Infection control measures among senior dental students in Rio de Janeiro State, Brazil.

OBJECTIVE: The aim of this study was to verify the practices and attitudes of senior dental students about infection control procedures. METHODS: A cross-sectional survey was performed during the 1st semester of 2003. Open- and close-ended questions were given to 196 students in 6 universities. RESULTS: Overall, 90.8% of students had been vaccinated for hepatitis B. Only 25.0% have been assessed for anti-HBs. A total of 99.5% students reported always using gloves for all procedures. Eye protection were always used by 84.2% of students, and all the students used face masks for all procedures. Caps or hair covers were used by 92.3% of students and 87.8% reported no objection to treating patients with infectious diseases. Among instructors, the students observed that 60.2% of them did not use gloves for all procedures, 43.4% of those didn't change gloves between patients. CONCLUSIONS: These results address the need for an improved quality assurance, in order for the students and faculty to improve their practices and attitudes on infection control measures.

Accidents, Occupational↗
PubMedDate not supplied

Monitoring of universal precautions as a factor in patient and staff safety.

Quality improvement (QI) monitoring of universal precautions at the author's facility appeared to indicate that although personal protective equipment is always available and staff are increasingly aware of the need to protect themselves, compliance with medical center practices remained inconsistent. The use, throughout the QI program at the medical center, of appropriate indicators to monitor for sharps incidents and body fluid splashes continues to highlight the need for innovative activities to help staff achieve more optimal compliance with medical center policies. Causes for noncompliance are examined using a problem-solving approach accompanied by various continuous quality improvement (CQI) tools. Root causes are explored with the intention of providing support rather than blame for the findings. Outcomes of activities that were implemented to improve compliance with medical center policies and practices are highlighted.

Cooperative Behavior↗
PubMedDate not supplied

Cascading data sets: putting the pieces together.

Just as quality programs have evolved into organization-wide performance improvement efforts, the quality professional's role has expanded, bringing new challenges and expectations. The quality services umbrella, an operational framework for a total systems quality process, helps organization leaders and quality professionals identify organizational functions that contribute to overall performance. This article describes the benefits of utilizing the quality services umbrella framework through five examples. Each example highlights different benefits of the model, such as identifying a system's quality issues, enhancing performance improvement efforts, sustaining improvements, and effecting cost savings.

Accidental Falls↗
PubMed1991

[Risk of hepatitis C virus infection by needlestick among medical employees].

We have experienced 99 medical employees who had stuck themselves by the needles used by patients in the past 5 years. Sixteen of the 99 cases (16.2%) were of the patients who had hepatitis C Virus (HCV) antibodies. We followed up these 16 medical employees during 24.8 +/- 12.0 months. We could not find any case among them who had seroconverted HCV antibody positive in their serums. We concluded that the risk of HCV infection by the needlestick accident is not so high.

Adult↗
PubMed1994

[A case of needlestick-induced acute type C hepatitis].

The patient was a 25-year-old male doctor, who had pricked his finger with a needle contaminated with blood from a 69-year-old male patient with liver cirrhosis (HCV-Ab positive, genotype II). He was informed from the blood bank that his blood was positive for anti-HCV and his GPT being 148 IU/l on the 65th day after exposure. He was admitted on February 16, 1993 and received a liver biopsy, which was consistent with acute viral hepatitis. His genotype was the same (type II) with the donor patient. IFN-alpha-2b of total doses of 656 Megaunits resolved the hepatitis completely and the HCV-RNA became negative as early as two weeks after starting IFN therapy. Liver biopsy after IFN therapy showed convalescence of acute hepatitis. The progression of acute hepatitis C to chronicity could be prevented by interferon therapy even in unfortunate cases of HCV transmission by needlestick. In conclusion, accidental needlestick should be followed for at least six months, and serum GPT and second-generation anti-HCV ELISA tests are recommended for all infected personnel.

Acute Disease↗
PubMed2003

Evaluation of the rapid immunoassay determine HIV 1/2 for detection of antibodies to human immunodeficiency virus types 1 and 2.

We evaluated the reliability of a rapid human immunodeficiency virus type 1 test for quick clinical decision making, such as in needle-stick accidents. The test was evaluated with 1,160 patients. It proved to be a simple and useful test with 99.6% specificity and 99.4% sensitivity. One patient with late-stage AIDS had a false-negative result.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Control of infection in acupuncture.

This paper is an update on infections, and potential infections, related to acupuncture, and a brief review of the relevant infection control procedures. There is no evidence at present to suggest that significant numbers of infections are being transmitted through standard acupuncture treatments in the UK. None the less, good infection control is essential. Like any other science, new research forces infection control to evolve and refine its procedures. Acupuncturists need to constantly review their standards as new viruses and risks are identified.

Acupuncture Therapy↗
PubMed1997

Treatment of accidental digital injection of adrenaline from an auto-injector device.

Following an increase in the number of patients attending the accident and emergency department because of accidental injection of adrenaline from autoinjector devices prescribed for patients with severe allergic reactions, a review of published reports was undertaken to identify the best form of treatment. Local injection of phentolamine is effective for up to 13 hours after the inadvertent digital instillation of adrenaline.

Adrenergic alpha-Antagonists↗