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At least 1,513 records · Page 84Linked to original sources
PubMed2004

Non-touch suturing technique fails to reduce glove puncture rates in an accident and emergency department.

OBJECTIVE: To assess the impact of introducing a safer non-touch suturing technique into an inner city emergency department. METHODS: The rate of glove perforation, measured by electrical conductance, was used as a marker. Gloves (Bodyguards) used in suturing were collected over a two month period. Two half day suture workshops were then conducted in the emergency department and gloves were collected for a further two months. All doctors (14) were included in the study regardless of grade. Gloves were tested for perforation by electrical conductance. RESULTS: There were 107 gloves and 19 perforations in the first group, 133 with 28 perforations in the second (p = 0.52), and one perforation in 100 control gloves. Most doctors reported inadvertent needlestick handling. CONCLUSION: Two half day suturing workshops are not enough to reduce glove perforations from suturing in the emergency department. Difficulty with compliance suggests that safe suturing practice must be taught before doctors develop bad habits that are difficult to change.

Education, Medical, Continuing↗
PubMed2004

Securing central venous catheters: a comparison of sutures with staples.

OBJECTIVES: Central venous access permits rapid drug delivery to the central circulation during cardiopulmonary resuscitation. Central venous catheters must be secured in place to prevent accidental removal and sutures are often used for this purpose. Staples may offer advantages over sutures by reducing the time needed to secure the central venous catheter and reducing exposure to contaminated sharps. The purpose of this study was to assess a staple anchoring device (Arrow, Reading, USA) and compare it with sutures for securing central venous catheters. METHODS: Prospective, randomised trial of 20 patients requiring insertion of a central venous catheter during elective surgery. RESULTS: Mean (SD) times were significantly shorter in the staples group than in the sutures group (staples 10.1 (3.5) seconds; sutures 50.5 (9.6) seconds; p<0.0001). However, 3 of 10 central venous catheters in the staples group were accidentally pulled out within the first three days. CONCLUSIONS: The use of staples significantly reduces the time to secure a central venous catheter. However, staples failed to secure the central venous catheters adequately and therefore cannot be recommended instead of sutures.

Catheterization, Central Venous↗
PubMed1998

Exposure to blood borne viruses and the hepatitis B vaccination status among healthcare workers in inner London.

Occupational exposure to blood borne viruses was examined during one year at a London teaching hospital. A total of 236 incidents occurred of which 83% were related to sharps, 32% were clearly avoidable, and 7% involved an infected source patient. Overall uptake of hepatitis B vaccine was 78% but it was particularly low in paramedical (70%) and domestic staff (45%). Continued effort needs to be applied to improve uptake of hepatitis B vaccine and to maintain high standards of control of infection.

Blood-Borne Pathogens↗
PubMed2001

Intraoperative glove perforation--single versus double gloving in protection against skin contamination.

Surgeons have the highest risk of contact with patients' blood and body fluids, and breaches in gloving material may expose operating room staff to risk of infections. This prospective randomised study was done to assess the effectiveness of the practice of double gloving compared with single gloving in decreasing finger contamination during surgery. In 66 consecutive surgical procedures studied, preoperative skin abrasions were detected on the hands of 17.4% of the surgeons. In the double gloving pattern, 32 glove perforations were observed, of which 22 were in the outer glove and 10 in the inner glove. Only four outer glove perforations had matching inner glove perforations, thus indicating that in 82% of cases when the outer glove is perforated the inner glove will protect the surgeon's hand from contamination. The presence of visible skin contamination was also higher in perforation with the single gloving pattern (42.1%) than with the double gloving pattern (22.7%). An overwhelming majority of glove perforations (83.3%) went unnoticed. Double gloving was accepted by the majority of surgeons, especially with repeated use. It is recommended that double gloves are used routinely in all surgical procedures in view of the significantly higher protection it provides.

Equipment Failure↗
PubMed2001

Post-exposure prophylaxis for human immunodeficiency virus: knowledge and experience of junior doctors.

OBJECTIVE: To assess the level of knowledge and experience of post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) among junior doctors. METHODS: A questionnaire was sent to all junior doctors working in two major teaching hospitals in London. RESULTS: Most junior doctors had heard of PEP (93%) but fewer were aware that it reduced the rate of HIV transmission (76%). Only a minority of doctors (8%) could name the drugs recommended in recent national guidelines and a significant proportion (43%) could not name any. Almost one third (29%) did not know within what period PEP should be administered. This was despite the fact that the majority of respondents (76%) had experienced high risk exposure to potentially infective material at some stage in their careers and that a significant proportion (18%) had sought advice about PEP following potential exposures. CONCLUSIONS: This study demonstrates that the junior hospital doctors in our survey had inadequate knowledge of PEP against HIV despite being at risk of occupational exposure.

Adult↗
PubMed1995

Risks of HIV infection in the health care setting.

Health care workers exposed to blood and body fluids have a low but measurable risk of occupational infection with human immunodeficiency virus (HIV). This risk is related to the prevalence of HIV among patients, the frequency of exposure to infected blood, and the method of exposure. The magnitude of risk is thus difficult to assess for any given situation, although the overall risk following percutaneous exposure is approximately 0.3%. Risk can be reduced by paying close attention to infection control procedures and by minimizing risky procedures. Exposure management should include preexposure education and immediate postexposure care and counseling. Chemoprophylaxis is widely used despite doubts as to its effectiveness, and much research is clearly needed to develop more effective prophylaxis. For patients, the risk of nosocomial acquisition of HIV remains extremely low and can be minimized by strict adherence to proper infection control procedures.

Cross Infection↗
PubMed2006

[Prevention of viral hepatitis].

Prevention of viral hepatitis infection involves health measures designed to avert transmission of viral agents and promote the use of gammaglobulin and vaccines. The availability of safe drinking water and improvements in quality of life result in better individual hygiene; these factors have had the greatest impact on hepatitis A prevention. Serum gammaglobulin administration has been replaced by vaccinations for pre-exposure, and to a great extent for post-exposure prophylaxis because of the progressively lower anti-HAV content of gammaglobulin and the short duration of the protective effect. Universal vaccination in childhood is the recommended measure for controlling hepatitis A. Adults belonging to high-risk groups should also undergo vaccination. The incidence of hepatitis B has decreased worldwide because of universal vaccination programs, initiated in preadolescence and childhood. Prevention of hepatitis C requires control of situations in which there is a likelihood of parenteral infection with the virus. Post-transfusion hepatitis has been virtually eradicated, but considerable effort is still needed to prevent nosocomial hepatitis.

Adult↗
PubMed1992

Iatrogenic pneumothorax: etiology and morbidity. Results of a Department of Veterans Affairs Cooperative Study.

The purpose of this study was to delineate the etiological factors for iatrogenic pneumothorax in the era of increased use of invasive procedures and to determine its impact on morbidity. Between 1983 and 1987 the Department of Veterans Affairs conducted a cooperative study at 13 medical centers to assess the utility of the intrapleural instillation of tetracycline for the prevention of recurrent pneumothorax. Since all patients with any type of pneumothorax were screened at each medical center, it was decided to collect data on all the iatrogenic pneumothoraces during that period. During the study period, the number of reported iatrogenic pneumothoraces were 538. Because of incomplete data, 3 iatrogenic pneumothoraces reported from one center were excluded. The leading causes of iatrogenic pneumothorax were transthoracic needle aspiration (128), subclavicular needle stick (119), thoracentesis (106), transbronchial biopsy (54), pleural biopsy (45) and positive pressure ventilation (38). Most patients required treatment for 4-7 days; however, hospitalization was prolonged due to this treatment in only 8% of patients, presumably because of their underlying disease which required long hospitalization. Patients with underlying chronic obstructive pulmonary disease required significantly longer duration of treatment than those without. We conclude that in our patient population, the three leading causes of iatrogenic pneumothorax are transthoracic needle aspiration, subclavicular needle stick and thoracentesis. Hospitalization is prolonged in only a small percentage of the patients who required treatment for the iatrogenic pneumothorax.

Adult↗
PubMed1995

ENV-specific cytotoxic T lymphocyte responses in HIV seronegative health care workers occupationally exposed to HIV-contaminated body fluids.

Identification of the components of protective immunity are crucial for the development of effective prophylactic and therapeutic vaccine strategies. Analysis of HIV-specific responses in exposed but uninfected individuals might thus provide a unique resource to elucidate the components and correlates of protective immunity to HIV. In the present study we analyzed HIV-specific cytotoxic and helper T lymphocyte responses in health care workers (HCW) exposed to body fluids from HIV-positive individuals. HCW exposed to blood from HIV-negative individuals as well as healthy donors served as controls. Cytotoxic T lymphocyte (CTL) responses to HIV envelope (env) peptides were detected in 7/20 (35%) HCW exposed to HIV-positive blood and in none of the 20 health care workers exposed to uninfected blood or the seven healthy blood donors studied. HIV-specific CTL responses were detected only after in vitro stimulation, and were MHC class I restricted. No MHC class I restriction elements were uniformly identified among the different responders. 21/28 (75%) HCW exposed to contaminated blood responded to env as measured by IL-2 production to the peptides, in contrast to only 9/38 (24%) HCW exposed to HIV seronegative blood and 3/35 (9%) healthy blood donors. All the HIV exposed individuals were seronegative on repeated ELISA tests, and no evidence of infection was obtained by PCR analysis. These findings indicate that a single exposure to HIV can induce CTL immunity to HIV antigens, in the absence of other evidence of infection.

Accidents, Occupational↗
PubMed1993

A comparison of three ported cannulae available in New Zealand.

A comparison was made of the three 22-gauge ported intravenous cannulae available in New Zealand--Venflon 2, Vasofix Braunule and Insyte. All cannulae performed satisfactorily in terms of overall success of cannulation although significant differences were apparent in both clinical and laboratory performance. Anaesthetists' clinical preference was for Insyte and Venflon 2 brands, perceiving these to have greater ease of handling and better packaging. In a series of laboratory studies, Vasofix was found to have the highest flowrate, the fastest time to flashback and the lowest valve opening pressure. Insyte required the least force of penetration. Venflon 2 had the greatest margin of safety between pressure to inject through the port and pressure required to blow the syringe/port assembly apart. Potential problems were identified with the Insyte port valve mechanism.

Anesthesiology↗