Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital

Occupational Exposure to Blood and Body Fluids amongst Health Care Workers in a Teaching Hospital of the Armed Forces

BACKGROUND

Health care workers (HCWs) are at risk of infection with blood-borne viruses in the course of their work. Over 90% of these infections are occurring in low-income countries and most are preventable. However, the situation in the Armed Forces hospitals has always been thought to be much better than the public health facilities in India. The focus of the study was on assessing the exposure frequency amongst HCWs in a teaching hospital in the Armed Forces.

METHODS

A cross-sectional survey amongst HCWs involved in collecting blood samples and administering injections in all wards of the hospital was conducted. Selection of study participants was by simple random sampling. A pre-tested questionnaire was administered by unlinked, anonymous method.

RESULT

Total sample studied was 70. The proportion of HCWs experiencing exposure to blood body fluid splash (BBF) and needlestick injury (NSI) during last one week was 47.1 % and 31.43 %, respectively. The incidence density of BBF exposure was 537.14 per 100 person years and that of NSI episodes was 228.57 per 100 person years. The reasons for not using personal protective equipment (PPE) ranged from busy schedule (37.14%), non use of PPE by co-workers (67.14%), emergencies (91.43%) risk that patients may get offended by PPE use by HCWs (27.14%) to discomfort while using PPE (24.29%). All components of PPE were available as per only 34.29 percent.

CONCLUSION

The high level of occupational exposure to blood and body fluids and consequent risk of infection amongst a group of HCWs in the Armed Forces highlights the urgent need for interventions to enhance the occupational safety of workers.

Examining the dimensions of hospital safety climate and psychosocial risk factors among Japanese nurses

PURPOSE

The purpose of this study was to examine the dimensions, reliability, and main loading factors associated with a Japanese safety climate and psychosocial risk factor scale.

DESIGN

The authors used a cross-sectional survey of nurses from a university teaching hospital in Japan during 2008 (N = 996). The survey tools were based on components previously identified in a variety of international studies, including the Hospital Safety Climate Scale (HSCS) originally developed by Gershon et al. in 2000.

RESULTS

Factor analysis of the Japanese HSCS demonstrated key themes in the areas of workplace-related issues, protective devices or mechanisms, and managerial dimensions (Cronbach's α = .887). Factor analysis of the psychosocial scale revealed key themes comprising individually related items and group dynamics (Cronbach's α = .882).

CONCLUSIONS

This study revealed high internal consistency in the Japanese-language safety climate and psychosocial risk factor scales. The authors also identified various factors and themes consistent with previous international research.

IMPLICATIONS FOR PRACTICE

Transcultural research using standard psychosocial tools can reveal important and reliable findings if carefully translated and adapted for the host environment.

Frequency and barriers of underreported needlestick injuries amongst Iranian nurses, a questionnaire survey

AIMS AND OBJECTIVES

To determine the frequency of needlestick injuries and barriers of reporting such injuries amongst Iranian nurses.

BACKGROUND

Exposure to blood-borne pathogens because of needlestick injuries in particular is a potential risk for healthcare workers, including clinical nurses. The burden of sharp injuries sustained by healthcare workers is still unclear, primarily because of underreporting.

DESIGN

A cross-sectional study was undertaken amongst 111 clinical nurses working in five major teaching hospitals in Tehran/Iran during 2007-2008 who were randomly selected.

METHODS

A validated self-reported questionnaire containing demographic characteristics and history of experiences with contaminated needlesticks as well as probably reason/s for underreporting such injuries was used.

RESULTS

More than half of the enrolled nurses (54.1%, n = 60) had no experience of contaminated injuries, while the rest of 45.9% (n = 51) had experienced at least one contaminated needlestick injuries during their clinical performance. More than one-third (34.0%, n = 38) had experienced a mean of 58 contaminated needlestick injuries during the past 12 months (crude incidence: 0.52 NSI/nurse/year). Only 14 nurses (36.8%) with needlestick injuries experiences had officially reported their experiences. The major reasons for not reporting needlestick injuries were dissatisfaction with follow-up investigations by officials after reporting the events (33.3%) and safe/low risk considering of source patients (29.2%).

CONCLUSIONS

Increased frequency and underreporting of needlestick injuries amongst Iranian nurses is going to be a major concern. As a preventive strategy, further interventions such as constant staff training, life-long learning and standardising postexposure procedures are recommended.

RELEVANCE TO CLINICAL PRACTICE

Determining the prevalence, burden and reasons for underreporting needlestick injuries by clinical nurses are required for establishing a preventive strategy to decrease hospital infections.

Management practices and risk of occupational blood exposure in U.S. paramedics: Needlesticks

BACKGROUND

The purpose of this study was to present risk estimates for needlestick in U.S. paramedics and estimated risk ratios for selected management practices.

METHODS

A mail survey was conducted among a national sample of U.S. paramedics in 2002-2003.

RESULTS

The adjusted response rate was 55% (n = 2,664). The overall 12-month risk of needlestick was 6.7% (95% confidence interval, 5.4-7.9). Risk ratios for provision of safety-engineered medical devices and two supervisory behaviors that emphasized safe work practices ranged from 2.5 to 3.2. The protective effect of working in an environment that included both of the supervisory behaviors was greater than the protective effect of always being provided with safety devices. A sensitivity analysis indicated that the risk ratio estimates were unlikely to be inflated by nonresponse bias.

CONCLUSIONS

These results suggest that greater provision of safety devices and interventions aimed at management practices that promote worker safety could substantially reduce the risk of needlestick among U.S. paramedics.

Mandatory overtime regulations and nurse overtime

A descriptive study used data from the 2004 National Sample Survey of Registered Nurses to examine the nature and occurrence of RN mandatory, voluntary overtime, paid on-call, and total work hours and their association with mandatory overtime regulations in United States. About half of the nurses worked more than 40 hrs per week. Nurses working in states regulating mandatory overtime reported lower levels of mandatory overtime hours than states without regulations or states restricting total work hours. The percent of RNs working 61 hrs and over per week in states without regulations was lower than that in states with regulations. Nurses working in nursing homes reported higher levels of the percentage of mandatory overtime hours worked than those working in hospitals. This suggested that governments need to continuously supervise healthcare institutions, including both hospitals and nursing homes, to ensure adherence to mandatory overtime regulations.

Hospital safety climate, psychosocial risk factors and needlestick injuries in Japan

To investigate the interactions between safety climate, psychosocial issues and Needlestick and Sharps Injuries (NSI), a cross-sectional study was undertaken among nurses at a university teaching hospital in Japan (89% response rate). NSI were correlated with various aspects of hospital safety climate including supporting one another at work, the protection of staff against blood-borne diseases being a high management priority, managers doing their part to protect staff from blood-borne disease, having unsafe work practices corrected by supervisors, having the opportunity to use safety equipment to protect against blood-borne disease exposures, having an uncluttered work area, and having minimal conflict within their department. In conclusion, this study has demonstrated the importance of hospital safety climate in Japanese health care practice, particularly its relationship with NSI. Although the provision of safer devices remains critical in preventing injuries, ensuring a positive safety climate will also be essential in meeting these important challenges for nurses' occupational health.

Adherence to management after occupational exposure to bloodborne pathogen among health care workers in Taiwan

The study purpose was to investigate the adherence to postexposure management of health care workers (HCWs) in Taiwan. A total of 685 HCWs of 1164 HCWs who had reported exposure incidents during 2003-2005 completed questionnaires. Only 33% of the 567 exposed HCWs adhered to the postexposure management. Adherence was associated with percutaneous injury and knowledge of the seropositive status of source patients. Regular follow-ups for seroconversion testing are essential to improving the quality of postexposure management.

Organizational climate and its relationship with needlestick and sharps injuries among Japanese nurses

BACKGROUND

Although certain aspects of organizational climate have been shown to influence needlestick and sharps injuries (NSI) among nurses, this issue has not been adequately investigated in Japan.

METHODS

Our study involved a modified version of the Hospital Safety Climate Scale, which was distributed to a large cross section of nurses in a Japanese teaching hospital.

RESULTS

Various aspects of safety climate were associated with a reduced NSI risk, such as being involved in health and safety matters (odds ratio [OR], 0.13; 95% confidence interval [CI]: 0.02-0.65) and being properly trained in risk control procedures (OR, 0.32; 95% CI: 0.12-0.78). Nurses working in departments in which health and safety information was readily available were more likely to report any NSI they sustained (OR, 4.91; 95% CI: 1.30-18.51), whereas nurses working in departments with minimal conflict were less likely to underreport their NSI (OR, 0.45; 95% CI: 0.22-0.87).

CONCLUSION

Overall, this study suggests that hospital safety climate has an important influence on NSI injury rates and reporting behavior among Japanese nurses. Given the multifaceted nature of identified risk, a comprehensive approach to infection control is clearly required and one that encompasses preventive strategies in both the cultural and physical domains.

Circumstances surrounding occupational blood exposure events in the National Study to Prevent Blood Exposure in Paramedics

More than 20% of U.S. paramedics are exposed to blood each year. Little is known about the circumstances that lead to these exposures. The objective of this study was to describe blood exposure events among U.S. paramedics. A mail survey was conducted in 2002-2003 among a nationally representative sample of licensed paramedics. Eighty percent of needle/lancet sticks involved non-safety devices. A third of mucous membrane exposures occurred even though the paramedic was wearing eye or face protection; in half of the events, the exposures were caused by the patient vomiting, spitting, or coughing up blood; in a third of the events, the patient was being uncooperative or combative. In 83% of the non-intact skin exposures, the paramedic was wearing disposable gloves; the non-intact skin was covered before the call in a third of the events, but the cover did not prevent exposure; 40% of the events occurred when the patient was being uncooperative or combative. These results suggest that blood exposure among paramedics could be reduced through increased use of safety devices and personal protective equipment, improved engineering and design, and increased compliance with Universal Precautions, and that paramedics need techniques for avoiding blood exposure while treating uncooperative or combative patients.

Occupational exposure to blood and body fluids among health care workers in a general hospital, China

OBJECTIVES

To understand current status of occupational exposure to blood and body fluids (BBF), and awareness of knowledge about occupational bloodborne pathogen exposures and universal precaution among hospital-based health care workers (HCWs).

METHODS

A cross-sectional study was conducted during April to May 2004 to study incidence of occupational exposure to BBF among 1,144 hospital-based HCWs.

RESULTS

The total incidence and the average number of episodes exposure to BBF was 66.3/100 HCWs per year and 7.5 per person per year in the past year, respectively. The incidence (per 100/HCWs per year) and the average number of episodes (per HCW per year) of percutaneous injury (PCI), mucous-membrane exposure (MME), and exposure to BBF by damaged skin was 50.3 and 1.8; 34.4 and 1.7; and 37.9 and 4.0, respectively. The leading incidence and the average number of episodes of PCI occurred in delivery room (82.6 and 1.8). The highest percentage of PCI's that occurred during the previous 2 weeks occurred during a surgical operation (22.8%). Of all sharp instruments, the suture needle contributed the highest percentage of PCI's (24.7%) among HCWs in the last 2 weeks. Over two-thirds (68.3%) of respondents were immunized with Hepatitis B vaccine; less than one-half (47%) of HCWs wore gloves while doing procedures on patients. The respondents demonstrated a lack of knowledge regarding transmission of bloodborne diseases and universal precautions.

CONCLUSIONS

Risk for potential exposure to BBF appears high in HCWs, and almost all of episodes are not reported. It is urgent to establish the Guideline for Prevention and Control of Occupational Exposure to Bloodborne Pathogens among HCWs. Am. J. Ind. Med. 52:89-98, 2009. (c) 2008 Wiley-Liss, Inc.

Percutaneous injuries correlates in the nursing team of a Brazilian tertiary-care university hospital

The study aims to identify percutaneous injuries correlates in the nursing team from a Brazilian tertiary-care hospital. A case-control study was conducted from January 2003 to July 2004, including 200 cases and 200 controls. Cases and controls were paired by gender, professional category, and work section. To evaluate the relationship between potential risk/protective factors and the outcome, odds ratios were estimated, using multivariate logistic regression methods. The results shown six predictors of percutaneous injuries: "recapping needles" (OR 9.48; CI(95%): 5.29-16.96); "hours worked per week > 50 hours" (OR 2.47; CI(95%): 1.07-5.67); "years in nursing practice < 5 years" (OR 6.70; CI(95%): 2.42-18.53); "work shift in night" (OR 2.77; CI(95%): 1.35-5.70); "low self evaluation of risk" (OR 10.19; CI(95%): 3.67-28.32) and "previous percutaneous injuries" (OR 3.14; CI(95%): 1.80-5.48). The results support the recommendation of applying effective strategies to prevent percutaneous injuries in the nursing team working on tertiary-care institutions.

Non-hospital based registered nurses and the risk of bloodborne pathogen exposure

The aim of this study was to assess the risk of blood and body fluid exposure among non-hospital based registered nurses (RNs) employed in New York State. The study population was mainly unionized public sector workers, employed in state institutions. A self-administered questionnaire was completed by a random stratified sample of members of the New York State Nurses Association and registered nurse members of the New York State Public Employees Federation. Results were reviewed by participatory action research (PAR) teams to identify opportunities for improvement. Nine percent of respondents reported at least one needlestick injury in the 12-month period prior to the study. The percutaneous injury (PI) rate was 13.8 per 100 person years. Under-reporting was common; 49% of all PIs were never formally reported and 70% never received any post-exposure care. Primary reasons for not reporting included: time constraints, fear, and lack of information on reporting. Significant correlates of needlestick injuries included tenure, patient load, hours worked, lack of compliance with standard precautions, handling needles and other sharps, poor safety climate, and inadequate training and availability of safety devices (p<0.05). PAR teams identified several risk reduction strategies, with an emphasis on safety devices. Non-hospital based RNs are at risk for bloodborne exposure at rates comparable to hospital based RNs; underreporting is an important obstacle to infection prevention, and primary and secondary risk management strategies appeared to be poorly implemented. Intervention research is warranted to evaluate improved risk reduction practices tailored to this population of RNs.

Prevalence and prevention of needlestick injuries among health care workers in a German university hospital

OBJECTIVE

Health care workers (HCWs) are exposed to bloodborne pathogens, especially hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) through job-related risk factors like needlestick, stab, scratch, cut, or other bloody injuries. Needlestick injuries can be prevented by safer devices.

METHODS

The purpose of this study was to investigate the frequency and causes of needlestick injuries in a German university hospital. Data were obtained by an anonymous, self-reporting questionnaire. We calculated the share of reported needlestick injuries, which could have been prevented by using safety devices.

RESULTS

31.4% (n = 226) of participant HCWs had sustained at least one needlestick injury in the last 12 months. A wide variation in the number of reported needlestick injuries was evident across disciplines, ranging from 46.9% (n = 91/194) among medical staff in surgery and 18.7% (n = 53/283) among HCWs in pediatrics. Of all occupational groups, physicians have the highest risk to experience needlestick injuries (55.1%-n = 129/234). Evaluating the kind of activity under which the needlestick injury occurred, on average 34% (n = 191/561) of all needlestick injuries could have been avoided by the use of safety devices. Taking all medical disciplines and procedures into consideration, safety devices are available for 35.1% (n = 197/561) of needlestick injuries sustained. However, there was a significant difference across various medical disciplines in the share of needlestick injuries which might have been avoidable: Pediatrics (83.7%), gynecology (83.7%), anesthesia (59.3%), dermatology (33.3%), and surgery (11.9%). In our study, only 13.2% (n = 74/561) of needlestick injuries could have been prevented by organizational measures.

CONCLUSION

There is a high rate of needlestick injuries in the daily routine of a hospital. The rate of such injuries depends on the medical discipline. Implementation of safety devices will lead to an improvement in medical staff's health and safety.