Occupational exposure to blood and body fluids among health care workers in Ankara, Turkey

Prevalence of needle stick and its related factors in Iranian health worker: an updated systematic review and meta-analysis

Background

Healthcare workers (HCWs) are at risk of acquiring blood-borne infections such as hepatitis B, hepatitis C, and human immunodeficiency virus through needlestick injuries (NSIs). We aimed to investigate the prevalence of needlestick injuries and other related indicators among HCWs in Iran through a systematic review and meta-analysis.

Methods

We searched various databases until the end of May 2023 for studies reporting the prevalence of NSIs among healthcare workers in Iran. We used a random model with 95% confidence intervals (CIs) to analyse the data and the Joanna Briggs Institute (JBI) tool to evaluate the quality of included studies. We conducted and reported the study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results

We included 87 studies in the analysis and found that 47% (95% CI = 42-52, I2 = 98.9%) of Iranian HCWs experienced NSI. NSIs were most frequently related to syringe needles (58%; 95% CI = 52-65, I2 = 96.8%) and most often caused by recapping (30%; 95% CI = 22-38, I2 = 98.5%). In this study, 56% (95% CI = 45-67, I2 = 98.6%) of HCWs with NSIs did not report their injury. Moreover, the prevalence of NSIs the highest in the morning shift (0.44; 95% CI = 0.36-0.53, I2 = 97.2%), emergency unit (0.20; 95% CI = 0.16-0.24, I2 = 93.7%), and intensive care unit (0.20; 95% CI = 0.16-0.24, I2 = 94.3%).

Conclusions

To reduce the high prevalence of NSIs, HCWs, especially those in emergency departments, should use safety equipment. Healthcare managers should provide a calm and stress-free environment for HCWs, educate them on safety principles and standards, and support experienced HCWs with NSIs.

Occupational Exposure to Blood and Body Fluids Among Nurses in the Emergency Department and Intensive Care Units of Public Hospitals in Addis Ababa City: Cross-sectional Study

AIMS AND OBJECTIVES

This study investigated occupational exposure to blood and body fluids among nurses at the emergency department and intensive care units of public hospitals in Addis Ababa city.

METHODS

A cross-sectional study was conducted from June 18, 2021 to September 20, 2021. A simple random sampling method and semi-structured, self-administered questionnaires were used to collect the data, which were analyzed using SPSS version 25. A binary logistic regression model was used to identify factors associated with exposure to blood and body fluids on the AOR with a 95% confidence interval at a P-value of <.05.

PATIENT AND PUBLIC INVOLVEMENT

No patients were involved in this study.

RESULTS

Of the total study participants (260), 198 (76%) nurses had been exposed to blood and body fluids in their professional live, and 167 (64%) were exposed to blood and body fluids in the last 12 months. Being male (AOR = 2.88, 95% CI: (1.35, 6.12), lacking access to handwashing facilities (AOR = 5.02, 95% CI: (3.73, 14.51)), not consistently wearing all the required types of personal protective equipment (AOR = 6.21, 95% CI: (2.39, 9.55)), and the lack of the required personal protective equipment (AOR = 5.53, 95% CI: (1.87, 10.38)) were all significant factors that were positively associated with exposure to blood and body fluids.

CONCLUSION

This study showed that a higher proportion of nurses in the emergency department and intensive care unit were exposed to blood and body fluids in the study setting. Most nurses do not consistently wear all the required types of personal protective equipment, putting them at a higher risk of acquiring blood-borne pathogens. The authors recommended that there is a need to implement and strengthen appropriate and consistent use of all required personal protective equipment during any procedure, and patient care to reduce exposure to blood and body fluids.

RELEVANCE TO CLINICAL PRACTICE

This study provides baseline information for other action-based studies to assess exposure to blood and body fluids among nurses in emergency and intensive care units.

STROBE CHECKLIST

This manuscript was prepared based on the strobe checklist guidelines.

IMPACT STATEMENT

The study's findings and recommendations might be used for healthcare providers, non-governmental organizations, and policymakers for appropriate planning and interventions to minimize or safeguard nurses' exposure to blood and body fluids.

Rates of Underreported Needlestick and Sharps Injuries among Healthcare Workers in Turkey; in the Light of Infection Control Committee Data

BACKGROUND

Doctors and nurses are frequently exposed to needlestick and sharps injuries (NSIs) because of their work. It is estimated that NSIs are more common than the reported rates to Infection Control Committee. The purpose of this study was to determine the incidence and reporting rates of NSIs in our hospital.

METHODS

After their consent forms were obtained for the questionnaire, 670 doctors and nurses were interviewed face-to-face by the Infection Control Committee nurse. The questionnaire consisted of 22 questions, and the answers were recorded. The questions were on demographic data and injuries. The data of NSIs, whose active surveillance was made in our hospital since 2005 and in the last 1 year were also analyzed retrospectively.

RESULTS

A total of 119 (17%) out of 670 people who participated in the study had at least one NSIs; 43 (36%) of the 119 people were doctors, and 76 (63.9%) were nurses. The most common injuries among doctors were found in assistant doctors (60%). No statistically significant differences were detected between the doctors and nurses in terms of injury status (p=0.398). The most common injuries were found in surgical clinics, and a significant difference was detected here when compared to other clinics. The data that 20 (17%) of the 118 people who were injured by the NSIs reported the injury were obtained from the Infection Control Committee database.

CONCLUSION

It is seen that injuries are high in surgical clinics and assistant doctors who have high work stress and workload. There were more injuries with sharp objects than the expected rates in our hospital although the reports were made very rarely. First of all, we should determine strategies, especially education, to reduce injuries, and then remove the obstacles to unreported injuries. Activities of clinics with high reporting rates needs to be search and adapt them to our clinic.

What were the changes during the COVID-19 pandemic era concerning occupational risks among health care workers?

BACKGROUND

Accidental exposure to percutaneous needle stick and sharp injuries (NSSIs) and blood and other body fluids is the unintended contact with risky medical instruments or patient secretions during a medical intervention. During the COVID-19 pandemic, the significance of occupational injuries in healthcare professionals was revealed once again. To assess the occupational injuries, we compared rates, distribution and type of exposure to blood and body fluids and NSSIs of health care workers for 2019 (pre-pandemic era) and 2020 (pandemic era) years, respectively.

MATERIAL AND METHODS

Our study included data collected by the 'Hospital Infection Control Committee' for the years 2019-2020. Data collected using the active surveillance method were analyzed retrospectively.

RESULTS

During 2019 (pre-pandemic period) and 2020 (pandemic period), 112 (27.65%₀) and 82 (21.4%₀) NSSIs reported, respectively. Of the exposed HCWs in 2019 (pre-pandemic period), 16.8%₀ (14) were doctor, 53.6%₀ (60) were nurse and 47.4%₀ (14) were intern doctors. In the 2020 (pandemic period), NSSIs were observed most frequently in nurses and cleaning staff, 50.24%₀ and 33.64%₀, respectively. Concerning the total percentage of exposure to blood and other body fluids, a slight increase was revealed from 1.48%₀ to 2.62%₀ in 2019 and 2020, respectively. A significant decrease in exposure rate was reported among the doctors between the pre-pandemic and pandemic era; 3.6%₀ and 1.19%₀ at 2019 and 2020, respectively. A significant increase in exposure rate was reported among the nurses between pre-pandemic and pandemic era; 0.8%₀ and 6.89%₀, respectively.

CONCLUSION

In conclusion, the exposure to NSSIs during the pandemic period decreased; however, there was no severe difference at pre-pandemic and pandemic periods concerning exposure to blood and body fluids. Well-designed training and awareness programs can be effective in preventing exposure to NSSIs and blood and other body fluids and exposure to respiratory acquired viruses.

Occupation-Related Injuries Among Healthcare Workers: Incidence, Risk Groups, and the Effect of Training

Background and objective

Occupation-related injuries (ORIs) are undesirable and harmful situations among healthcare workers (HCWs) and may have serious consequences. In this study, we aimed to identify and analyze ORI incidences, risk groups, and the outcomes of a training program to prevent them.

Materials and methods

Between January 2011 and December 2019, HCWs who applied for infection prevention and control (IPC) due to ORIs (percutaneous needlestick and sharp-object injury or contact with blood or body fluids) were included in the study. Their characteristic features, vaccine histories, injury types, viral serologies, and administered prophylaxis were recorded. After 2014, a periodic ORI training program was started. We used joinpoint regression analysis to compare the ORI incidences before and after the education program.

Results

During the nine-year study period, 965 ORIs were registered. The mean age of HCWs was 39.3 ± 8.4 years, and 67.9% of them were female. The total injury incidence for all professions was 34.1 (95% CI: 33.1-37.5) per 1,000 HCWs. The injury incidences were significantly higher in nurses compared to other HCWs (p<0.01). Most of the injuries occurred in the ward setting (37%). HCWs were injured most commonly while administering treatment (36.7%). The trend analysis for the incidence of injuries showed no significant change throughout the study period. The trend in personal protective equipment (PPE) use showed a significant increase (annual percentage change: 1.7, p<0.01).

Conclusions

The major finding of this study with respect to its implication on the healthcare system is that nurses are an important risk group for ORIs. Although the ORI incidence did not change during the study period, a significantly increased use of appropriate PPE following a systematic training program implementation was observed.

A survey of sharps injuries and occupational infections among healthcare workers in Shanghai

Background

Healthcare workers (HCWs) are at greater risk of occupational exposure to sharp injuries in their daily routine work, which is extremely worrying due to the potential risk of transmitting bloodborne pathogens. This study aims to assess what procedures and factors present the greatest risk of sharp injuries to HCWs in Shanghai and to provide an evidence base for improving measures to reduce sharps injuries.

Methods

A cross-sectional study was administered to all HCW who might be exposed to sharp instruments in 81 hospitals in Shanghai. According to the voluntary, investigate as many HCWs as possible and get feedbacks N=61,309. The survey addressed the sharp injury (SI) incidents, SIs of common instruments, SIs of common locations, SIs of operating procedures, SIs of common instruments and common sources of SI occurrences. Statistical analysis was performed using the SPSS program.

Results

A total of 61,309 HCWs were surveyed for this study, and 935 (1.53%) HCWs experienced the various types of sharp injuries in one month. Of the 1,140 sharp injuries, 292 (25.61%) sharp injuries were reported, and 815 (71.49%) sharp injuries were traced to their sources. Interns experienced the highest proportion of sharps injuries (4.12%). General wards were the most common location where sharp injuries occurred to HCWs (36.05%), while disposable syringes were the most common medical devices that caused sharp injuries (32.11%). Nurses, doctors and logistical workers who did not receive relevant training had a higher incidence of SI (4.40%, 4.95% and 4.03%, respectively) than those who received training (1.58%, 1.03% and 0.67%, respectively, P<0.001). HBV infection was the main source of exposure to sharp injuries, with scalpel cuts being the most common related occurrence.

Conclusions

Sharp injuries occur among HCWs in Shanghai dented optimism. There are multiple high-risk factors for SI and exposure to blood-borne pathogens in their work such as interns, general wards, disposable syringes, and lack of relevant training. HBV infection was the main source of exposure to sharp injuries. As such, medical institutions shall pay closer attention to this topic.

Unintentional Injuries in the Three References Laboratories: Sana'a, Yemen

BACKGROUND

The aim is to determine the incidence rate of unintentional injuries and its associated factors and determine the pattern of these injuries among laboratory staff in three reference laboratories in Sana'a, Yemen.

METHODS

A cross-sectional study was conducted among laboratory staff in the three reference laboratories in Sana'a, Yemen. A pretested structured questionnaire was used to collect data on the unintentional injuries during the past 12 months including the type of injury.

RESULTS

A total of 93 technicians responded and filled the questionnaires. Of the 93 technicians, 51 (54.8%) technicians reported that they had been injured in the past 12 months. Of all injuries, 38% of technicians were caused by needle sticks, 21% by sharp materials other than needles, 15% by hot materials, 15% by exposure to chemicals, and 11% of them by other exposures. Only 18% of injuries were reported to safety officer in the laboratory. Those who had an experience of <5 years were more likely to experience injury in the past 12 months than those who had 5 years of experience or more (odds ratio = 8.3; 95% confidence interval: 2.2, 27.4; P < 0.005).

CONCLUSIONS

About half of laboratory technicians in Yemen reported that they had been injured in the past 12 months, with the needle stick being the most common cause of injury. Therefore, there is a need for targeted interventions to laboratory technicians to increase their awareness on the risk of injuries in the laboratory. Bio-safety training among laboratory technicians deemed very necessary.

Retrospective investigation of 9 years of data on needlestick and sharps injuries: Effect of a hospital infection control committee

BACKGROUND

The risk of occupational transmission of bloodborne pathogens to health care workers is primarily associated with needlestick and sharps injuries (NSIs). However, most NSIs are not reported, and most health care workers are not aware of postexposure procedures.

METHODS

Data for NSIs reported in our hospital between 2008 and 2016 were reviewed retrospectively.

RESULTS

A total of 546 staff members reported NSIs. Of these, 376 (68.9%) were women. NSIs were more commonly reported by trainee nurses (243 [44.5%]), followed by nurses (121 [22.2%]), cleaning staff (108 [19.8%]), and doctors (49 [9%]). The rate of postexposure interventions was 13% in 2008 and 92.6% in 2016 (P < .0001; χ² = 82.866). NSI rates also show that the number of applications with NSIs increased over the years. When occupational blood exposure was examined, the number of bloodborne pathogens was 50 (9.3%) cases of hepatitis B virus, 30 (5.6%) cases of hepatitis C virus, 3 cases of Crimean-Congo hemorrhagic fever, 1 case of HIV, and 2 cases of hepatitis B virus and hepatitis C virus coinfection.

DISCUSSION

Over the years, the increase in both the appropriate intervention rate and the number of reports to the hospital infection control committee after NSIs shows that regular training regarding NSIs is effective.

CONCLUSIONS

Hospital infection control committees may play a more active role in raising awareness in this regard and thus reducing the rate of unreported NSIs.

Sharp instrument injuries among hospital healthcare workers in mainland China: a cross-sectional study

OBJECTIVES

To determine the prevalence of sharp instrument injuries in hospital-based healthcare workers (HCWs) in mainland China and the contributing factors.

DESIGN

Cross-sectional study.

SETTING

The data were derived from public hospitals.

PARTICIPANTS

A total of 360 hospitals were recruited in the study, including 289 general hospitals and 71 specialised hospitals. Among them, 194 are tertiary-level hospitals and 166 are secondary level. The study population finally consisted of 223 149 hospital HCWs.

PRIMARY OUTCOME MEASURES

A questionnaire was designed based on the aim of the study. Profession of HCWs, workplace, circumstance and medical apparatus and instrument were covered in the survey. HCWs completed a self-administered questionnaire regarding details of sharp instrument injuries within the previous month. Prevalence estimates for the injuries were calculated for the overall HCWs and for subgroups according to profession, workplace, circumstance or instrument.

RESULTS

Within the included HCWs, the prevalence of sharp instrument injuries was 0.08 per person-month. Only 4.6% of the HCWs reported to their hospitals after injury. The highest number of injuries occurred in nursing staff (10.3%). Injuries took place most frequently on general wards (44.5%). The circumstances that involved most frequent injuries include surgical needle insertion, removing an arteriovenous needle from a patient and recapping the needle. Single-use syringe caused more injuries incidents than other instruments.

CONCLUSIONS

These results indicate that sharp instrument injuries have become a major occupational problem of HCWs in mainland China. Attentions need to be paid to the issue and strategies for preventing such injuries are needed.

Accidental exposures to blood and body fluids among health care workers in a Referral Hospital of Cameroon

Background

Accidental exposure to blood and body fluids is a public health concern, especially among health workers and constitutes a risk of transmission of blood-borne viruses including HIV, hepatitis B virus and hepatitis C virus. The objective of this study was to determine the frequency and the post exposure management of accidental exposures to blood and body fluid among health workers in the Yaoundé University Teaching Hospital.

Methods

It was a cross-sectional hospital-based study conducted from the 1st to the 30th of September 2013. Self-administered questionnaires to health workers were used to collect data on self-reported accidents, circumstances and post-exposure management. Their knowledge on accidental exposure to blood was also assessed. Data were entered and analyzed using Epi Info software version 3.5.4. Descriptive analysis was performed to measure the importance of AEB and to evaluate the risk of contamination.

Results

One hundred and fifty health workers were interviewed among which 36.7 % reported having been exposed to blood and body fluid at least once in the preceding 3 months. Splash was the most reported injury (in 60.3 % of cases), followed by needle stick (28.7 %) and cuts (10.9 %). Moreover, 43.6 % of victims were not vaccinated against HBV, 7.3 % were not wearing gloves during the accident and 41 % of splash occurs on injured skin. The majority of victims belong to the surgical Department [20 %, p = 0.2310]. None of these injuries had been reported in the registry of accidental exposure to blood.

Conclusions

There is a high rate of accidental exposure to blood and body fluid in the daily hospital routine. Preventives measures, including wearing of protective equipment’s during care and vaccination against HBV are not systematically done among health workers. Health institution should develop and provide standard operating procedures targeting surveillance of occupational risks, staff training, and supervision.

Prevalence of percutaneous injuries and associated factors among health care workers in Hawassa referral and adare District hospitals, Hawassa, Ethiopia, January 2014

Background

Accidental percutaneous injury and acquiring blood-borne diseases are common problems among health care workers (HCWs). However, little is known about the prevalence and associated factors for needle stick injury among HCWs in Ethiopia.

Methods

A cross sectional study was conducted by including 526 HCWs (physicians, nurses, laboratory technicians, midwives and others), working in two public hospitals (Hawassa Referral and Adare District hospitals), from January 1–30, 2014. Binary logistic regression was done to assess the association of selected independent variables with accidental percutaneous injury.

Results

The prevalence of at least one episode of percutaneous injury was about 46 % of which more than half (28 %) occurred within one year prior to the study period and only 24 % took prophylaxis for human immune deficiency virus (HIV) infection. The adjusted logistic regression analysis revealed that HCWs who recap needles were twice as likely to face a percutaneous injury. Chance of exposure to needle stick or sharp injuries also increased with increase in educational status. Having a previous history of needle stick or sharp injury was found as one of the risk factors for the occurrence of another injury. Nurses and cleaners were also at increased risk for the occurrence of percutaneous injuries.

Conclusion

Needle stick and sharp injuries were common among HCWs in the study hospitals, which warrants training on preventive methods.

The Frequency, Causes and Prevention of Needlestick Injuries in Nurses of Kerman: A Cross-Sectional Study

INTRODUCTION

The needlestick injuries can cause the transmission of infectious diseases. Compared to other members of the community of health care nurses are at great risk of needle stick injury because of their frequent performance with vein punctures and taking care of patients suffering from different infectious diseases.

AIM

The main aim of this study was to assess Prevalence, causes and preventive of Needle Sticks injuries among nurses in Kerman (south of Iran).

MATERIALS AND METHODS

This cross-sectional study was conducted from December 2014 to March 2015 on 240 nurses employed in two hospitals of Kerman. Sampling was performed through simple random sampling. Data gathered through a researcher made questioner. Data analysed by use descriptive analytical testes.

RESULTS

From the nurses' perspective the main physical and human causes of needlestick injuries were syringe needles (82) and crowded wards (74). The majority of the nurses believed the most effective method to prevent needlestick were training (82).

CONCLUSION

Due to the high prevalence of injuries caused by sharp objects in nurses, needlestick injuries are suggested to be recorded in special forms and their causes to be checked by the Infection Control Committee. Since syringe needle heads and angiocatheter are the main causes of needlestick injuries, providing safe medical equipment should also be emphasized.

Needle-Stick Injuries Among Healthcare Workers in a Teaching Hospital

Background:

Needle-Stick Injuries (NSIs) are among the hazards and problems that can expose health workers to infections.

Objectives:

This study aimed to determine the rate of NSIs in a teaching hospital in Tehran, Iran.

Materials and Methods:

This cross-sectional, analytical and descriptive study was conducted at one of the teaching hospitals in Tehran, Iran, in 2013. The study population was 344 employees in various occupational groups selected via census. Data were collected using a researcher-made questionnaire. The collected data were analyzed using some statistical tests, including independent-samples t-test with SPSS software version 21.0.

Results:

The results showed that only 50.2% of injuries had been reported; 67.8% of all participants (n = 211) had at least one NSI. Most NSIs had been reported in the emergency department (33.5%). Most participants mentioned the injection syringe needles as the main cause of their injuries (71.1% of all NSIs). Among NSIs, those caused by insulin syringe needles (6.2%) were the second cause. In this study, females had NSIs more than males. There was a statistically significant relationship between sex and the rate of NSIs (P < 0.05).

Conclusions:

Considering the high rate of occupational injuries, further preventive measures should be implemented to prevent these injuries from occurring. Providing initial and continuing training for employees is very important. Directing special attention to emergency department employees may be effective in reducing occupational injuries.

Reducing needlestick injuries through safety-engineered devices: results of a Japanese multi-centre study

BACKGROUND

Quantitative information on the effectiveness of safety-engineered devices (SEDs) is needed to support decisions regarding their implementation.

AIM

To elucidate the effects of SED use in winged steel needles, intravenous (IV) catheter stylets and suture needles on needlestick injury (NSI) incidence rates in Japan.

METHODS

Japan EPINet survey data and device utilization data for conventional devices and SEDs were collected from 26 participating hospitals between 1 April 2009 and 31 March 2014. The NSI incidence rate for every 100,000 devices was calculated according to hospital, year and SED use for winged steel needles, IV catheter stylets and suture needles. Weighted means and 95% confidence intervals (CI) were used to calculate overall NSI incidence rates.

FINDINGS

In total, there were 236 NSIs for winged steel needles, 152 NSIs for IV catheter stylets and 180 NSIs for suture needles. The weighted NSI incidence rates per 100,000 devices for SEDs and non-SEDs were as follows: winged steel needles, 2.10 (95% CI 1.66-2.54) and 14.95 (95% CI 2.46-27.43), respectively; IV catheter stylets, 0.95 (95% CI 0.60-1.29) and 6.39 (95% CI 3.56-9.23), respectively; and suture needles, 1.47 (95% CI -1.14-4.09) and 16.50 (95% CI 4.15-28.86), respectively. All devices showed a significant reduction in the NSI incidence rate with SED use (P < 0.001 for winged steel needles, P = 0.035 for IV catheter stylets and P = 0.044 for suture needles).

CONCLUSION

SED use substantially reduces the incidence of NSIs, and is therefore recommended as a means to prevent occupational infections in healthcare workers and improve healthcare safety.

Incidence of occupational exposure to blood and body fluids and measures taken by health care workers before and after exposure in regional hospitals of a developing country: a multicenter study

This cross-sectional study was conducted on 371 health care workers working in government hospitals in the Northern Khorasan province of Iran. Exposure to sharp objects was 44% and 31% of participants had a history of being in contact with blood or body fluids of patients. Among health care workers who had needlestick injuries, 82 had a positive hepatitis B surface antibody titer measured after injury.

Seroprevalence of hepatitis B virus infection and hepatitis B surface antibody status among laboratory health care workers in Isfahan, Iran

Background:

Laboratory health care workers (HCWs) may become infected through their occupation with blood-borne pathogens. The aims of this study were determining the seroprevalence of hepatitis B virus (HBV) and the protection offered by HBV vaccine in medical laboratory HCWs.

Materials and Methods:

A descriptive cross-sectional study was carried out on 203 employers of clinical laboratories. Participant data were obtained through a questionnaire, and the level of antigens and antibodies were measured by enzyme-linked immunosorbent assay (ELISA).

Results:

All of the subjects were negative for HBV infection. Forty-seven (23.2%) were not immune, 126 (62.0%) were relatively immune, and 30 (14.8%) were highly immune.

Conclusion:

Hepatitis B infection is infrequent in laboratory HCWs in Isfahan.

Occupational Risks of Health Professionals in Turkey as an Emerging Economy

BACKGROUND

Health services are one of the work areas that contain important risks in terms of the occupational health and safety of the laborer. Professionals in various areas of health services encounter biological, chemical, physical, ergonomic, and psychosocial risks, particularly in hospitals.

OBJECTIVES

This study has been performed to evaluate the impacts of the occupational risks on health of health professionals in Turkey.

FINDINGS

In Turkey, as an emerging economy, the history of studies on health professionals is not longstanding. There have been various regulations intended for the occupational health and safety of health professionals in line with the Regulation of the Provision on Patient and Staff Safety prepared in 2012. However, applications can differ from region to region, institution to institution, and person to person.

CONCLUSIONS

We believe that this review will lead health professionals to be aware of occupational risks and contribute to planning health services for health professionals.

Occupational injuries prone to infectious risks amongst healthcare personnel in Kuwait: a retrospective study

OBJECTIVE

The study aimed at determining the prevalence of incident occupational exposure to blood and other potentially infectious materials (OPIM) among healthcare personnel (HCP) during 2010 and at evaluating the factors associated with these incidents.

SUBJECTS AND METHODS

An epidemiological, retrospective, record-based study was conducted. All self-reported incidents of occupational exposure to blood and OPIM among HCP from all healthcare settings of the Kuwait Ministry of Health during 2010 were included.

RESULTS

The total number of the exposed HCP was 249. The prevalence of incident exposure was 0.7% of the HCP at risk. Their mean age was 32.31 ± 6.98 years. The majority were nurses: 166 (66.7%), followed by doctors: 35 (14.1%), technicians: 26 (10.4%) and housekeeping personnel: 22 (8.8%). Needle stick injury was the most common type of exposure, in 189 (75.9%), followed by sharp-object injury, mucous-membrane exposure and contact with nonintact skin. The majority of needle stick exposures, i.e. 177 (93.7%), were caused by hollow-bore needles. Exposure to blood represented 96.8%, mostly during drawing blood and the insertion or removal of needles from patients [88 (35.4%)] and when performing surgical interventions [56 (22.6%)]. Easily preventable exposures such as injuries related to 2-handed recapping of needles [24 (9.6%)] and garbage collection [21 (8.4%)] were reported. Exposures mainly occurred in the inpatient wards [75 (30.1%)] and operating theaters [56 (22.6%)]. Among the exposed HCP, 130 (52.2%) had been fully vaccinated against hepatitis B virus (HBV).

CONCLUSION

Needle stick injuries are the most common exposure among HCP in Kuwait, and nurses are the most frequently involved HCP category. A good proportion of exposures could be easily prevented. HBV vaccination coverage is incomplete.

Occupational exposure to blood and body fluids among health care professionals in bahir dar town, northwest ethiopia

Background

Health care professionals (HCPs) are at high risk of contracting blood-borne infections due to their occupational exposure to blood and body fluids (BBFs). The incidence of these infections among HCPs are higher in low income countries such as Ethiopia. The aim of the study was to investigate the extent of occupational exposure to BBFs and its associated factors among HCPs in Bahir Dar town, Ethiopia.

Methods

A cross-sectional study was used from October 1, 2012 to October 30, 2012. Three hundred and seventeen HCPs were included in the study using a simple random sampling technique. The data were collected using a structured questionnaire and analyzed using SPSS version 16. Bivariate and multivariate analyses were used to identify the factors related to exposure to BBFs.

Results

Two hundred and nine (65.9%) HCPs were exposed to BBFs in the past year, of which 29.0% were needlestick injuries. Work experience [adjusted odds ratio (AOR) 4.13, 95% confidence interval (CI) 1.56–10.91], inconsistent use of gloves (AOR 1.98, 95% CI 1.04–3.43), and not complying with standard precautions (AOR 1.80, 95% CI 1.00–3.22) were the factors associated with occupational exposure to BBFs.

Conclusion

A high proportion of HCPs was exposed to BBFs in this study. Occupational exposure to BBFs was determined by the use of gloves and not complying with standard precautions. Ensuring the availability of gloves, training about standard precautions, and motivation of HCPs to implement standard precautions should be emphasized to avoid such exposures.

Behavior of healthcare workers after injuries from sharp instruments

Background

Injuries with sharps are common occupational hazards for healthcare workers. Such injuries predispose the staff to dangerous infections such as hepatitis B, C and HIV.

Objectives

The present study was conducted to investigate the behaviors of healthcare workers in Kashan healthcare centers after needle sticks and injuries with sharps in 2012.

Materials and Methods

A cross-sectional study was conducted on 298 healthcare workers of medical centers governed by Kashan University of Medical Sciences. A questionnaire was used in this study. The first part included questions about demographic characteristics. The second part of the questionnaire consisted of 16 items related to the sharp instrument injuries. For data analysis, descriptive and analytical statistics (chi-square, ANOVA and Pearson correlation coefficient) SPSS version 16.0 software was used.

Results

From a total of 298 healthcare workers, 114 (38.3%) had a history of injury from needles and sharp instruments in the last six months. Most needle stick and sharp instrument injuries had occurred among the operating room nurses and midwifes; 32.5% of injuries from sharp instruments occurred in the morning shift. Needles were responsible for 46.5% of injuries. The most common actions taken after needle stick injuries were compression (27.2%) and washing the area with soap and water (15.8%). Only 44.6% of the injured personnel pursued follow-up measures after a needle stick or sharp instrument injury.

Conclusions

More than a half of the healthcare workers with needle stick or sharp instrument injury had refused follow-up for various reasons. The authorities should implement education programs along with protocols to be implemented after needle stick injuries or sharps.

Comparison of 2 techniques used to obtain sterile urine specimens from urethral catheters

OBJECTIVE

The objective of this study was to compare the rates of urine contamination and the frequencies of minor adverse events between the vacuum tube and injector techniques methods for the collection of sterile urine specimens.

DESIGN

This study was a cross-sectional study.

SAMPLE

The sample population was composed of patients who underwent a urodynamics procedure.

SETTING

This study was performed at the urodynamics unit of a rehabilitation and care center in Turkey.

METHODS

Sterile urine specimens (n = 576) were collected from 144 patients using the vacuum tube technique and the injector technique; the rates of urine contamination and minor adverse events were evaluated. χ2 Statistics and Fisher exact tests were used to assess the contamination rates and frequencies of minor adverse events during the collection of sterile urine specimens.

RESULTS

The contamination rate of urine specimens collected using an injector was 0.9% (P > .05). The rate of minor adverse events during specimen collection was lower when using the vacuum technique than when using an injector and sterile urine container (2 vs 36 events, P < .05).

CONCLUSION

The vacuum tube technique of urine specimen collection was not superior to the injector technique in regard to contamination. The use of the vacuum tube technique for the collection of sterile urine specimens can prevent minor adverse events related to spillage/leakage of urine.

IMPLICATIONS

More research from multiple settings and work environments is needed to strengthen the evidence base of vacuum tube technique of sterile urine specimen collection.

Needle stick injuries--risk and preventive factors: a study among health care workers in tertiary care hospitals in Pakistan

BACKGROUND

Health care workers (HCWs) are at substantial risk of acquiring blood borne infections such as HIV, Hepatitis-B and Hepatitis-C through needle stick injuries (NSIs). This study aimed to assess the proportion of NSIs and their associated factors among HCWs and also to identify the areas in which preventive efforts might be directed to protect against this occupational hazard.

METHODOLOGY

A cross-sectional study was conducted in two tertiary care hospitals of Pakistan representing both private and public health sector. A total of 497 HCWs (doctors and nurses) were interviewed using a structured questionnaire. Data was collected from January to May 2008.

RESULTS

Overall, 64% of the HCWs were exposed to at least one NSI during their career; among them 73% reported NSIs for two or more times. Factors found to be highly associated with NSIs were those practicing this occupation for more than five years (p < 0.001: OR = 5.92; 95% CI = 3.45-10.16) and working as nurse than doctor (p 0.001: OR = 2.12; 95% CI = 1.35-3.32). Having received booster dose of hepatitis B vaccine (p 0.02: OR = 1.85; 95% CI = 1.10-3.11), working in surgical specialty (p < 0.01: OR = 1.6; 95% CI = 1.09-2.51) and being a female (p 0.03: OR = 1.52; 95% CI = 1.04-2.22) were also found to be associated with NSIs. Most commonly reported reason for NSIs was injecting medicine and drawing blood (42%) followed by two-handed recapping of needle (37%). Only, 34% of study subjects were vaccinated against hepatitis B infection. Overall, HCWs had inadequate practices regarding standard precautions such as availability of gloves/protective cloths (40%) and infection control guidelines/protocols (10%) respectively in their working places.

CONCLUSION

In addition to very high rates of NSIs, low safety practices including inadequate vaccination coverage, unavailability of infection control guidelines and other preventive facilities were reported in this study. Prevention of occupational infections among HCWs should be a priority. Formal training, by health authorities in the local area, about safe practices and availability of preventive facilities should be ensured regarding NSIs among HCWs.

Healthcare workers' compliance with universal precautions in Turkey

Blood-borne pathogens (BBP) represent remarkable occupational risks for healthcare workers (HCWs). Avoiding occupational blood exposure is a basis of prevention of the blood-borne pathogens (BBP). The effectiveness of the prevention strategies depends on the compliance and adherence to the program by healthcare-facility personnel. The aim of this study was to evaluate Turkish HCWs' compliance with Universal Precautions (UP). An analytic, cross-sectional, countrywide survey study was performed in hospital settings, (n = 5145) in 30 hospitals in 19 cities. In total, 1726 of the 5143 (33.6%) participants' behaviors were accepted as satisfactory for compliance with UP. The hepatitis knowledge levels of 2,650 (51.5%) participants were found to be satisfactory. In the multivariate analysis, working at a surgical site (P = 0.004), living in a rich region (P = .007) and the existence of a health office for HCWs (p = .000) were found to be contributor factors for HCWs' compliance with UP. Conversely, being a nurse (P = .000) and HBV/HCV carrier status (P = .039) were significant preventing predictors for HCWs' compliance with UP. Along with the other well-known predictive factors, regional economic status and a health office for HCWs are contributors for compliance with UP.

Hepatitis B vaccination status and needlestick injuries among healthcare workers in syria

Background:

Although a majority of countries in the Middle East show intermediate or high endemicity of hepatitis B virus (HBV) infection, which clearly poses a serious public health problem in the region, the situation in the Republic of Syria remains unclear. The aim of this study is to determine the hepatitis B vaccination status, to assess the number of vaccinations administered, and to estimate the annual incidence of needlestick injuries (NSIs) among healthcare workers (HCWs) in Aleppo University hospitals.

Materials and Methods:

A cross-sectional design with a survey questionnaire was used for exploring details of NSIs during 2008, hepatitis B vaccination status, and HBV infection among a random stratified sample of HCWs in three tertiary hospitals in Aleppo (n = 321).

Results:

Two hundred and forty-six (76.6%) HCWs had sustained at least one NSI during 2008. Nine (2.8%) had HBV chronic infection and 75 HCWs (23.4%) were never vaccinated. Anesthesiology technicians had the greatest exposure risk when compared to office workers [OR = 16,95% CI (2.55-100), P < 0.01], doctors [OR = 10,95% CI (2.1 47.57), P < 0.01], and nurses [OR = 6.75,95% CI (1.56-29.03), P = 0.01]. HCWs under 25 and between the age of 25 and 35 years were at increased risk for NSI when compared to HCWs older than 45 years [OR = 3.12,95% CI (1.19-8.19), P = 0.02] and [OR = 3.05,95% CI (1.42-6.57), P < 0.01], respectively.

Conclusion:

HCWs at Aleppo University hospitals are frequently exposed to blood-borne infections. Precautions and protection from NSIs are important in preventing infection of HCWs. Education about the transmission of blood-borne infections, vaccination, and post-exposure prophylaxis must be implemented and strictly monitored.

Underreporting of blood and body fluid exposures among health care students and trainees in the acute care setting: a 2007 survey

BACKGROUND

It has been estimated that more than 8 million health care workers (HCWs) in the United States may be exposed to blood and body fluids via sharp and mucocutaneous exposures.

METHODS

An anonymous questionnaire was distributed among 505 HCWs. The target sample population included all the medical students; nursing professionals; dental professionals; and residents in internal medicine, emergency medicine, surgery, and obstetrics and gynecology at the University of Illinois Medical Center, Chicago, Illinois, a metropolitan tertiary care and referral center for Northern Illinois and Northwest Indiana. The sample was limited by the number of HCWs who were available to take the survey. The number and the characteristics of occupational exposures and reporting practices were recorded and compiled. Subsequently, a review of the English literature was performed using PubMed to analyze reasons for underreporting. Secondary and tertiary articles were located based on findings from the initial searches.

RESULTS

One hundred three of 455 (22.6%) HCWs reported a sharps exposure during their career, including their student years; thirty-four (33.0%) of these were not reported. One hundred five of 455 (23.1%) HCWs reported a mucocutaneous exposure during their career; 87 (82.9%) of these were not reported. The most common year of exposure was the intern year. The most common reason for not reporting was the belief that the exposure was not significant, followed by the combination of believing the exposure was not significant and being too busy.

CONCLUSION

Underreporting of blood and body fluid exposures is common because of a belief that most exposures are not significant. More education of HCWs is needed to change this perspective.

Acidente ocupacional por material perfurocortante entre profissionais de saúde de um Centro Cirúrgico

O acidente ocupacional por material perfurocortante constitui uma preocupação para instituições e trabalhadores de saúde, devido à elevada frequência de procedimentos invasivos, e a dinâmica do trabalho. Objetivou-se identificar a incidência dos acidentes, dos materiais envolvidos, dos fatores contribuintes e das condutas tomadas pós-acidente. Participaram de um estudo transversal 127 funcionários do centro cirúrgico. Registraram-se 23,6% (30/127) acidentes com envolvimento de agulha (73,3%), lâmina de bisturi (6,7%) e eletrocautério (6,7%). Os fatores contribuintes para o acidente foram: falta de atenção (36,7%), más condições de trabalho (20,0%), descuido (13,3%), pressa (10%) e acaso/azar (6,7%). Somente 15,4% dos acidentes foram registrados. A subnotificação deveu-se à irrelevância do acidente, desconhecimento do protocolo de rotina, displicência e sobrecarga de trabalho. Os resultados alertam para a importância de se implementar estratégias para adoção/revisão de protocolos pós-acidentes, visando a redução dos acidentes e de sua subnotificação.

Barriers to hepatitis B vaccine coverage among healthcare workers in the Republic of Georgia: An international perspective

BACKGROUND

While the Republic of Georgia has a high prevalence of hepatitis B virus (HBV) infection (3.4% of blood donors tested positive for HBV surface antigen [HBsAg]), relatively few healthcare workers (HCWs) are thought to be immunized.

OBJECTIVE

To measure rates of HBV vaccination coverage and identify predictors of vaccine acceptance among HCWs.

DESIGN

Cross-sectional survey.

METHODS

A study was conducted among full-time physicians and nurses at 2 large hospitals. Self-administered questionnaires included questions about demographic characteristics, HBV vaccine status, willingness to recommend vaccination to other HCWs, and barriers to vaccination. Laboratory tests were conducted for identification of HBsAg and antibody to hepatitis B core antigen.

RESULTS

A total of 297 (91%) of 325 randomly selected HCWs provided information for the study (124 physicians and 173 nurses). The rate of HBV vaccination coverage was 12%, and 54% of respondents indicated that they would recommend vaccination to other HCWs. Perception of vaccine safety was identified as the most important predictor for acceptance (prevalence ratio [PR], 3.3 [95% confidence ratio {CI}, 1.2-8.9]) and for willingness to recommend HBV vaccination to other HCWs (PR, 5.5 [95% CI, 3.1-9.4]). Vaccinated HCWs were more likely to recommend vaccination to other healthcare personnel (PR, 1.7 [95% CI, 1.5-2.1]), as were those younger than 40 years of age (PR, 6.0 [95% CI, 2.8-12.6]). Multivariate analyses identified 2 additional factors associated with vaccine acceptance and willingness to recommend vaccination: the hospital at which the HCW was employed and the perception of risk of infection for HCWs.

CONCLUSION

Georgia plans a major HBV vaccination campaign for HCWs in 2009. The campaign's success will depend on addressing vaccine safety concerns identified in this study and educating HCWs about risk factors for infection and benefits of immunization.

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.

Predictive factors for occupational bloodborne exposure in Turkish hospitals

BACKGROUND

This study was conducted to evaluate the epidemiology of percutaneous injury and/or mucosa exposure (PME) with blood or other body fluids that poses serious risks for health care workers (HCWs).

METHODS

An analytic, cross-sectional, countrywide survey study was conducted to describe the extent of and predictive factors for PME among HCWs in hospital settings in Turkey, with total of 5258 HCW participants from 30 hospitals in 19 cities throughout the country.

RESULTS

The respondent group included 41.3% nurses, 29.0% doctors, 9.3% laboratory workers, and 20.3% paramedics. The survey found that 50.1% of the participants reported at least 1 occupational PME in the previous year. Doctors (2.57/person/year) and nurses (2.56/person/year) had the highest PME incidents. In the multivariate analysis, working at a surgical site (P = .000), being a doctor (P = .000), being a nurse (P=.000), young age (P = .025), and living in a poor region (P = .005) were significant factors for high occupational exposure. The presence of a health office for HCWs at the hospital (P = .000) and working at a university hospital (P = .003) were significant predictors of less occupational exposure. Overall, the mean number of PME incidents was 2.16/person/year.

CONCLUSION

Along with the other well-known predictive factors, regional economic status and a health office for HCWs are preventive factors for PME exposure of HCWs.

Adesão às precauções padrão pela equipe do atendimento pré-hospitalar móvel de Belo Horizonte, Minas Gerais, Brasil

Estudo transversal com profissionais do Serviço de Atendimento Pré-hospitalar de Belo Horizonte, Minas Gerais, Brasil, com o objetivo de avaliar a adesão às precauções padrão. Instrumento constou de questões sobre conhecimento, atitude e fatores facilitadores à adesão das precauções. Para verificar a adesão considerou-se percentual de adequação: > 75% de respostas corretas. Condutores apresentaram menor e médicos maior grau de conhecimento. No relato das atitudes, profissionais não alcançaram adequação para uso de máscara facial, óculos e equipamento proteção individual (EPI), e, condutores relataram atitude inadequada para todos itens. Na análise univariada, categoria profissional, sexo e unidade de lotação foram associados à adoção das precauções. Já na multivariada, apenas categoria profissional (condutor e técnico/auxiliar enfermagem). Fatores facilitadores mais citados para melhorar adesão foram: treinamentos sobre infecções, riscos ocupacionais e uso de EPI; reuniões periódicas de equipe; e criação de central para limpeza, desinfecção e esterilização de material. Profissionais do Serviço de Atendimento Pré-hospitalar demonstraram atitudes compatíveis com conhecimento. No entanto, a profissão interferiu no conhecimento das medidas de precaução e no relato de atitudes adequadas.

Needlestick injuries among nurses of Fars province, Iran

PURPOSE

A prevalence survey was performed to estimate the magnitude and predictors for needlestick injury (NSI) in nurses of Fars province hospitals.

METHODS

Questionnaires were distributed in 52 hospitals to a stratified random sample of 2,118 (46.3%) nurses between April and September 2005 to collect self-reported NSI in the past 12- months.

RESULTS

Of the 1,555 nurses who returned a completed questionnaire, 49.6% (95% confidence interval [95 CI] 47.1%-52.1%) recalled at least one sharps injury, of which 52.6% were classified as NSI. Just over one fourth (26.3%; 95 CI 24.1%-28.6%, 409/1,555) of respondents sustained at least one NSI, 75.6% (95 CI 71.1%-79.6%) recalled having sustained between 1 and 4 injuries in the past 12-months, of which 72.2% involved a hollow-bore needle and 95.1% of injuries involved fingers. Predictors of NSI included being a registered nurse (odds ratio [OR] 1.6, 95% CI 1.1-2.3) or midwife (OR 2.4, 95% CI 1.4-3.9) compared with nurse managers, being employed in a hospital located in other cities smaller than Shiraz (OR 1.4, 95% CI 1.1-1.8). Nurses who reported a previous contaminated NSI were less likely to sustain a further injury (OR 0.3, 95% CI 0.2-0.4).

CONCLUSION

The prevalence of NSI in Iranian nurses is high, with the majority of injured staff having sustained up to 4 NSIs in a 12-month period. Nearly all NSIs were high-risk injuries involving a hollow-bore needle. Providing nursing staff with safety-engineered devices, including retractable syringes when hollow-bore needles are to be used, will be an important step toward reducing our NSI epidemic.

Needlestick and sharps injuries among a cross-section of physicians in Mainland China

BACKGROUND

Although needlestick and sharps injuries (NSI) represent a significant occupational hazard for physicians worldwide, their epidemiology has not been previously examined in Mainland China. This study describes the prevalence, distribution, and risk factors for NSI among a cross-section of Chinese physicians.

METHODS

Data was obtained by an anonymous, self-reporting survey administered to all 361 physicians at a university teaching hospital, during 2004.

RESULTS

Seventy-nine percent of the physicians responded. Among them, 64% had experienced an NSI in the previous 12 months, 50.3% of which involved contaminated devices. By device, 22.8% were caused by hollow-bore syringe needles, 19.1% by suture needles, and 12.1% by scalpel blades. Surgical procedures accounted for 27.9% of all injuries. Only 15.3% of physicians had officially reported their NSI to management, of which 10% went unreported because the individual felt they were not unlucky enough to get a disease. A statistically significant correlation was demonstrated between NSI and working in the intensive care unit (adjusted odds ratio: 5.3, 95% CI: 1.7-23.4).

CONCLUSIONS

Although this study suggests that NSI are an important workplace hazard for Chinese physicians, future measures should consider the unique cultural beliefs of Chinese people and its effect on preventive behaviors. The concept of "luck," and its relationship with NSI reporting in particular, may also need to be addressed.