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Kenne L, Hinman A, Holley S, Healy S, Sebolt T, Edmond M, Nelson DL, Valley K, Mueller RN, Schuessler B, Hanna B, Kobayashi T, Hartley P. Implementation of a hotline ("S-T-I-C-K") to expedite management of occupational bloodborne pathogen exposures at an academic medical center: A Process Improvement Initiative. Am J Infect Control 2024; 52:618-620. [PMID: 38211666 DOI: 10.1016/j.ajic.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
Previously, blood and body fluid exposures were managed by a visit to the University Employee Health Clinic during normal business hours and the Emergency Department after hours. We implemented the "S-T-I-C-K" program where health care personnel were evaluated immediately after exposure by a nurse-driven 24/7 hotline. Increasing accessibility to care and a simplified process for exposure management led to a significant decrease in Emergency Department utilization and time between the exposure and receipt of post-exposure prophylaxis.
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Affiliation(s)
- Lynnette Kenne
- Quality Improvement Program, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Ashley Hinman
- University Employee Health Clinic, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Stephanie Holley
- Quality Improvement Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Sarah Healy
- Quality Improvement Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Tamara Sebolt
- University Employee Health Clinic, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Michael Edmond
- Quality Improvement Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - David L Nelson
- Quality Improvement Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Kenneth Valley
- University Employee Health Clinic, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Rashmi N Mueller
- Quality Improvement Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Barbara Schuessler
- University Employee Health Clinic, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Beth Hanna
- Quality Improvement Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Takaaki Kobayashi
- Quality Improvement Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Patrick Hartley
- University Employee Health Clinic, University of Iowa Hospitals and Clinics, Iowa City, IA
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Yu X, Gan T, Zhu Y, Wang M, Qian L, Lu Y. Management of Occupational Bloodborne Pathogen Exposure among Medical Personnel: a 4-Year Prospective Study. Jpn J Infect Dis 2023; 76:289-294. [PMID: 37258178 DOI: 10.7883/yoken.jjid.2022.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study examined the management of occupational bloodborne pathogen exposure at a tertiary hospital in China. This prospective study was conducted at the Zhejiang Hospital of Traditional Chinese Medicine between January 2016 and December 2019. Data on bloodborne occupational exposure management were collected. In total, 460 exposures were reported. The majority of exposures (40.2 %) were from hepatitis B virus (HBV)-positive index patients. Of the 460 cases, 453 (98.5%) exposures were reported timeously, and 371 (80.7%) cases received emergency treatment response and management. Sixty-eight personnel (93.2%) received timely prophylaxis treatment. Only 82/113 (72.6%) personnel completed the recommended follow-up period. Outsourced personnel(P = 0.002) and interns (P = 0.011) were independent follow-up factors. Although adequate compliance was achieved with timely reporting and prophylactic medication, there is room for improvement in terms of emergency treatment response and follow-up compliance. Furthermore, HBV vaccination and improved follow-up with outsourced personnel are recommended.
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Affiliation(s)
- Xuxia Yu
- Department of Nosocomial Infection Management, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), China
| | - Tieer Gan
- Department of Nosocomial Infection Management, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), China
| | - Yuexian Zhu
- Department of Nosocomial Infection Management, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), China
| | - Minfang Wang
- Department of Nosocomial Infection Management, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), China
| | - Lili Qian
- Medical Laboratory, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), China
| | - Ye Lu
- Institute of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, China
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Investigation and Analysis of Sharp Injuries among Health Care Workers from 36 Hospitals in Shandong Province, China. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5698483. [PMID: 34195270 PMCID: PMC8214496 DOI: 10.1155/2021/5698483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/05/2021] [Indexed: 12/04/2022]
Abstract
Background This study investigated and analyzed the current situation of sharp injuries among health care workers (HCWs) in China's Shandong Province. Methods By means of questionnaire survey, the incidence of sharp injuries among HCWs from 36 hospitals in China's Shandong Province in October 2019 was investigated, and the results of this survey were compared with those of October 2012. Results A total of 48165 HCWs were investigated. 549 cases of sharp injuries occurred. The incidence of sharp injuries was 1.14%, which was significantly lower than that in October 2012 (9.71%). In the occupational distribution of sharp injuries among HCWs, the proportion of nurses was 58.65%, doctors 23.32%, and interns 12.02%. Among the distribution of sharp injury departments, general wards, operating rooms, intensive care units, disinfection supply centers, and outpatient clinics were the high-incidence sites of occupational exposure among HCWs. The main instruments causing sharp injuries in HCWs were syringes, scalp steel needles, surgical suture needles, vacuum blood collection needles, and glass slides. Drug administration, double-handed loop needle cap, blood extraction, surgical suture needle, and arteriovenous needle extraction were high-risk operations causing sharp instrument injuries in HCWs. Conclusion The incidence of sharp injuries among HCWs from 36 hospitals in Shandong Province in October 2019 was significantly lower than that in October 2012. Sharp injuries were a common type of occupational exposure for HCWs. The occurrence of sharp injuries should be effectively reduced by changing wrong habitual behavior and implementing standard protective measures.
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Sakr CJ, Alameddine R, Hoteit R, Daou C, Doudakian R, Kreidieh K, Musharrafieh U, Rahme DV. Occupational Exposure to Blood-Borne Pathogens among Healthcare Workers in a Tertiary Care Center in Lebanon. Ann Work Expo Health 2021; 65:475-484. [PMID: 33586765 DOI: 10.1093/annweh/wxaa117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Despite numerous initiatives, occupational exposure to blood-borne pathogens (BBP) caused by percutaneous injuries or mucosal contamination remain common among healthcare workers (HCWs). These exposures were decreasing at the American University of Beirut Medical Center (AUBMC) in the previous decades. Recently, the medical center activity has been increasing with higher number of interventions performed and shorter hospital stay. Our aim was to determine the trend of incidents resulting from BBP exposures at AUBMC from 2014 till 2018 and identify whether the increase in hospital activity affected the rate of these exposures. We also aimed to assess the risk factors associated with needle stick injuries (NSIs). METHODS A retrospective observational descriptive study of all exposures to BBPs among HCWs reported to the Environmental Health, Safety, and Risk Management department at the AUBMC between 2014 and 2018 was performed. RESULTS There were 967 exposures reported among which 84% were due to needlesticks. Residents (40%), followed by nurses (30%), and then by attending physicians (16%) were the top three most exposed occupational groups. Half of the participants injured themselves using either a syringe or a suture needle; and mostly during or after use. Occupation and incident location were associated with NSIs. The mean BBP exposure incidence rate was 5.4 per 100 full-time employees, 65.6 per 100 bed-years, and 0.48 admission-years. The BBP exposure rate per 100 occupied beds per year decreased between 2014 and 2017 then increased in 2018 (P < 0.001). The number of BBP exposures showed a strong, though non-significant negative correlation with the average length of hospital stay (Spearman correlation coefficient = -0.9, P = 0.083). CONCLUSIONS BBP exposure remains a serious occupational hazard. Our study shows that the BBP exposure rate per 100 occupied beds per year started decreasing during the study period before increasing again in 2018. Only the nursing department showed a consistent decrease of exposures. The occupation and incident location were found to be risk factors associated with NSIs. In addition to providing education and training, additional steps such as providing safety equipment and future interventions directed towards adjusting to higher workload should be all considered.
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Affiliation(s)
- Carine J Sakr
- Employee Health Unit, Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Reina Alameddine
- Employee Health Unit, Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Reem Hoteit
- Employee Health Unit, Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Carla Daou
- Employee Health Unit, Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rita Doudakian
- Employee Health Unit, Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khalil Kreidieh
- Office of Faculty Affairs, American University of Beirut Medical Center, Beirut, Lebanon
| | - Umayya Musharrafieh
- Employee Health Unit, Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Diana V Rahme
- Employee Health Unit, Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Ferrario MM, Veronesi G, Borchini R, Cavicchiolo M, Dashi O, Dalla Gasperina D, Martinelli G, Gianfagna F. Time Trends of Percutaneous Injuries in Hospital Nurses: Evidence of the Interference between Effects of Adoption of Safety Devices and Organizational Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084371. [PMID: 33924104 PMCID: PMC8074301 DOI: 10.3390/ijerph18084371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 01/14/2023]
Abstract
Few studies have focused on the combined effects of devices and work organization on needlestick injuries trends. The aim of the study was to estimate trends of percutaneous injury rates (IR) in nurses (N) and nurse assistants (NA) over a 10 year period, in which passive safety devices were progressively adopted. Percutaneous and mucocutaneous injuries registered in a University Hospital in Northern Italy in Ns and NAs in 2007–2016 were analyzed. Organizational data were also available on shift schedules, turnover, downsizing and age- and skill-mix. We estimated IRs per 100 full-time equivalent workers from Poisson models and their average annual percent changes (APC) from joinpoint regression model. In the entire period, monotonic decreases in percutaneous IRs occurred among day-shift Ns (APC = −20.9%; 95% CI: −29.8%, −12%) and NAs (APC = −15.4%; −32.9%, 2.2%). Joinpoint modeling revealed a turning point in 2012 for night-shift Ns, with a steady decline in 2007–2012 (APC = −19.4%; −27.9%, −10.9%), and an increase thereafter (APC = +13.5%; 1.5%, 25.5%). In comparison to 2008 and 2012, in 2016 night-shift Ns were 5.9 and 2.5 times more likely to be younger and less qualified or experienced than day-shift Ns. The observed declines in percutaneous injury rates occurred in a time period when safety devices were progressively implemented. The causal nature of multiple exposures and organizational procedures in affecting injury time trends should be further addressed by quasi-experimental studies.
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Affiliation(s)
- Marco M. Ferrario
- Department of Medicine and Surgery, School of Medicine, University of Insubria, 21100 Varese, Italy; (G.V.); (D.D.G.); (F.G.)
- Occupational, Preventive and Toxicology Unit, ASST Sette Laghi, 21100 Varese, Italy
- Correspondence:
| | - Giovanni Veronesi
- Department of Medicine and Surgery, School of Medicine, University of Insubria, 21100 Varese, Italy; (G.V.); (D.D.G.); (F.G.)
| | - Rossana Borchini
- Occupational and Preventive Medicine Unit, ASST Lariana, 22100 Como, Italy;
| | - Marco Cavicchiolo
- School of Specialization in Occupational Medicine, University of Insubria, 21100 Varese, Italy; (M.C.); (O.D.)
| | - Oriana Dashi
- School of Specialization in Occupational Medicine, University of Insubria, 21100 Varese, Italy; (M.C.); (O.D.)
| | - Daniela Dalla Gasperina
- Department of Medicine and Surgery, School of Medicine, University of Insubria, 21100 Varese, Italy; (G.V.); (D.D.G.); (F.G.)
| | | | - Francesco Gianfagna
- Department of Medicine and Surgery, School of Medicine, University of Insubria, 21100 Varese, Italy; (G.V.); (D.D.G.); (F.G.)
- Mediterranea Cardiocentro, 80122 Napoli, Italy
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Abstract
BACKGROUND Blood-borne pathogen infections (BPIs), caused by the human immunodeficiency virus, hepatitis C and hepatitis B viruses pose an occupational hazard to healthcare workers. Facial trauma reconstruction surgeons may be at elevated risk because of routine use of sharps, and a higher than average incidence of BPIs in the trauma patient population. METHODS The authors retrospectively reviewed health records of patients admitted to a level 1 trauma center with a facial fracture between January 2010 and December 2015. Patient demographics, medical history, mechanism of injury, type of fracture, and procedures performed were documented. The authors detemined the frequency of human immunodeficiency virus, hepatitis B, and hepatitis C diagnosis and utilized univariable/multivariable analyses to identify risk factors associated with infection in this population. RESULTS In total, 4608 consecutive patients were included. Infections were found in 4.8% (n = 219) of patients (human immunodeficiency virus 1.6%, hepatitis C 3.3%, hepatitis B 0.8%). 76.3% of BPI patients in this cohort were identified by medical history, while 23.7% were diagnosed by serology following initiation of care. 39.0% of all patients received surgical treatment during initial hospitalization, of whom 4.3% had a diagnosed BPI. History of intravenous drug use (odds ratio [OR] 6.79, P < 0.001), assault-related injury (OR 1.61, P = 0.003), positive toxicology screen (OR 1.56, P = 0.004), and male gender (OR 1.53, P = 0.037) were significantly associated with a BPI diagnosis. CONCLUSION Patients presenting with facial fractures commonly harbor a BPI. The benefit of early diagnosis and risk to surgical staff may justify routine screening for BPI in high risk facial trauma patients (male, assault-related injury, and history of intravenous drug use).
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Magnaghi C, Caruso R, Brioni E, Apuzzo L, Galli M, Massari C, Del Pin M, Magon A, Vezzoli G, Villa G, Manara D. Describing nurses' awareness of biological risk in delivering care for renal-dialysis patients: an Italian pilot survey. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021003. [PMID: 33855994 PMCID: PMC8138799 DOI: 10.23750/abm.v92is2.11203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF WORK Despite national descriptions of awareness, knowledge, and perceptions about the exposure to the biological risk among nurses employed in renal-dialysis care are pivotal to increase work safety, there is a paucity of data on these descriptions in the Italian context. This study aimed at describing Italian nurses' awareness and knowledge about biological risk in delivering care for renal-dialysis patients, and their experiences of biological accidents. METHODS A pilot survey using cross-sectional data collection and convenience sampling procedure. 124 nurses were enrolled receiving a 7-item questionnaire: Questions 1, 2, and 7 were referred to the awareness about educational learning needs, questions 3 and 4 explored nurses' knowledge about biological risk, questions 5 and 6 collected accident-related information. RESULTS Overall, nurses' awareness and knowledge about biological risk appeared almost limited. Surprisingly, 52% of the enrolled nurses experienced a biological accident, and 29.5% reported to know colleagues who developed work-related disease after a biological accident. We found positive significant associations between awareness and knowledge. CONCLUSIONS This pilot study highlighted the need to further describe Italian nurses' awareness and knowledge about biological risk in delivering care for renal-dialysis patients, as well as the need of up-to-date epidemiological description about biological accidents. Accordingly, future studies are highly recommended to provide robust evidence aimed at supporting policy makers, educators, clinicians, regulators, and managers.
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Affiliation(s)
| | - Rosario Caruso
- Head of Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - Elena Brioni
- Genomic of Renal Disease and Hypertension Unit, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Luigi Apuzzo
- Coronaric Intensive Care Unit, AORN S'Anna e San Sebastiano, Caserta, Italy. SIAN. Research Center, Bologna, Italy.
| | - Marilena Galli
- RN, Simple Training Structure, ASU Friuli Centrale, Palmanova, Italy. SIAN. Secretary, Bologna, Italy..
| | | | - Marco Del Pin
- Dialysis and Nephrology Unit, ASU Friuli Centrale, Palmanova; Italy, SIAN. Webmaster, Bologna, Italy..
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy.
| | - Giuseppe Vezzoli
- Nephrology and Dialysis Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
| | - Giulia Villa
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy..
| | - Duilio Manara
- School of Nursing, Vita-Salute San Raffaele University, Milan, Italy..
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Cole J, Gambone J, Barnard E. P.R.I.D.E.-preventing respiratory infectious disease exposures: An improvement project in a Northern Californian emergency room. Am J Infect Control 2021; 49:174-178. [PMID: 32768437 PMCID: PMC7406469 DOI: 10.1016/j.ajic.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/10/2020] [Accepted: 07/30/2020] [Indexed: 12/01/2022]
Abstract
Preventing occupational health exposures in the emergency room. Prompt isolation of infectious patients. Performance Improvement project to prevent disease transmission.
Background Preventing respiratory infectious disease exposures is a performance improvement project to reduce the incidence of occupational health exposures among health care workers. This project encouraged registered nurses to quickly identify and isolate potentially infectious patients in the emergency room, to prevent exposures to airborne and droplet transmitted communicable diseases, including meningitis, tuberculosis, and measles. Methods This pre- and postintervention model implemented a quasi-experimental designed project in the emergency room (ER). The Centers for Disease Control's empiric transmission-based isolation precautions were implemented to prevent occupational health exposures. Eighty registered nurses (RN's) received education on the new intervention. The assumption of this project was, the new process will decrease occupational health exposures. Results Eight ER RNs reported an occupational health exposure, preintervention in quarter 2 of 2019, compared to zero occupational health exposures, postintervention in quarter 3 of 2019. A χ² independence test was used to determine if the categorical variables of the capstone intervention and disease exposure were related in the same RN population. An association between the capstone intervention and disease exposure was observed, X2 (1) = 8.421, P = .004, indicating the result is statistically significant. Conclusions The preventing respiratory infectious disease exposures project effectively reduced occupational health exposures to airborne and droplet transmitted diseases in the emergency room by 100%. These results should encourage Infection Preventionists to adapt the Centers for Disease Control's empiric transmission isolation precautions in their emergency rooms and urgent cares to prevent airborne and droplet transmitted disease exposures.
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Affiliation(s)
- Jennifer Cole
- Infection Prevention at Avanti Hospitals, LLC, Los Angeles, CA.
| | | | - Emily Barnard
- Infection Preventionist at Keck Medicine of USC, Los Angeles, CA
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Katsevman GA, Sedney CL, Braca Iii JA, Hatchett L. Interdisciplinary differences in needlestick injuries among healthcare professionals in training: Improving situational awareness to prevent high-risk injuries. Work 2020; 65:635-645. [PMID: 32116282 DOI: 10.3233/wor-203118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Needlestick injuries among healthcare professionals continue to be an occupational hazard, frequently and incorrectly regarded as low-risk, and exacerbated by underreporting. We aimed to investigate rates of needlestick injury, reasons for underreporting, and how explicit announcements that patients are "high-risk" (i.e., human immunodeficiency virus, hepatitis, or intravenous drug abuse history) might affect the actions of those at risk of sustaining an injury. METHODS A cross-sectional survey was administered to medical students (MS), nursing students (NS), and residents. RESULTS 30/224 (13%) of MS, 6/65 (9%) of NS, and 67/126 (53%) of residents experienced needlestick injuries. 37% of MS, 33% of NS, and 46% of residents attributed "lack of concentration" as cause of injury. Residents had the lowest percentage of underreporting (33%), with rates of 40% and 83% among MS and NS, respectively. Top reasons for non-reporting included the injury being perceived as "trivial" (22%) and patient being "low-risk" (18%). A majority stated pre-operative "high-risk" announcements should be required (91%), and would promote "culture of safety" (82%), reporting of injuries (85%), and increased concentration during procedures (70%). CONCLUSIONS We recommend routine announcements during pre-operative time-out and nursing/resident hand-offs that state a patient is "high-risk" if applicable. We hypothesize such policy will promote a "culture of safety," situational awareness, and incident reporting.
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Affiliation(s)
- Gennadiy A Katsevman
- Department of Neurological Surgery, West Virginia University, Morgantown, WV, USA
| | - Cara L Sedney
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
| | - John A Braca Iii
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
| | - Lena Hatchett
- Neiswanger Institute for Bioethics and Health Policy, Loyola University Medical Center, Maywood, IL, USA
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Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Wang W, Vetter C, Czeisler CA, Barger LK. The Association Between Resident Physician Work-Hour Regulations and Physician Safety and Health. Am J Med 2020; 133:e343-e354. [PMID: 32061733 PMCID: PMC7469904 DOI: 10.1016/j.amjmed.2019.12.053] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety. METHODS All medical students matched to a US residency program from 2002 to 2007 and 2014 to 2017 were invited to participate in prospective cohort studies. Each month participants reported hours of work, extended duration shifts, and adverse safety outcomes, including motor vehicle crashes, percutaneous injuries, and attentional failures. The incidence of each outcome was compared before and after the 2011 ACGME work-hour limit. Hypotheses were tested using generalized linear models adjusted for potential confounders. RESULTS Of all first-year resident physicians nationwide, 13% participated in the study, with 80,266 monthly reports completed by 15,276 first-year resident physicians. Following implementation of the 16-h 2011 ACGME work-hour limit, the mean number of extended duration (≥24-h) shifts per month decreased from 3.9 to 0.2. The risk of motor vehicle crash decreased 24% (relative risk [RR] 0.76; 0.67-0.85), percutaneous injury risk decreased more than 40% (relative risk 0.54; 0.48-0.61), and the rate of attentional failures was reduced 18% (incidence rate ratio [IRR] 0.82; 0.78-0.86). Extended duration shifts and prolonged weekly work hours were associated with an increased risk of adverse safety outcomes independent of cohort. CONCLUSIONS The 2011 ACGME work-hour limit was associated with meaningful improvements in physician safety and health. Surveillance is needed to monitor the ongoing impact of work hours on physician safety, health, and well-being.
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Affiliation(s)
- Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass.
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass; Department of Medicine, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Conor S O'Brien
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Natalie Viyaran
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Céline Vetter
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Department of Integrative Physiology, University of Colorado, Boulder
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
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Cao W, Cao N, Gu M, Li P, Li M, Luo C, Liu H, Jiang F, Li C, Cao S. Prevalence of Percutaneous Injuries and Associated Factors Among a Sample of Midwives in Hunan Province, China. Workplace Health Saf 2020; 68:422-431. [PMID: 32469688 DOI: 10.1177/2165079920914923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Percutaneous injuries and blood-borne-related infections pose occupational hazards to healthcare professionals. However, the prevalence and associated factors for these hazards among midwives in Hunan Province, China are poorly documented. Methods: A cross-sectional study was conducted among a sample of 1,282 eligible midwives in the cities of Yongzhou, Chenzhou, Hengyang, and Changsha in Hunan Province, China, from January 2017 to July 2017. The association of selected independent variables with percutaneous injuries was investigated using binary logistic regression. Results: 992 participants responded (77.3%), and within the previous 12 months, 15.7% experienced percutaneous injuries. In multivariate analysis, hospital size, age, length of employment as a midwife, weekly working hours, and three aspects of Hospital Safety Climate Scale were associated with percutaneous injuries. The risk of percutaneous injuries among the midwives working in hospitals with ≤399 beds was higher than that among those working in hospitals with ≥400 beds by nearly 3 times. Furthermore, the percutaneous injury prevalence of midwives decreased as age increased. Moreover, the probability of percutaneous injuries among the midwives with weekly working hours of >40 was 4.35 times higher compared with that among midwives with weekly working hours of ≤40. Conclusion/Application to practice: The prevalence of percutaneous injuries among midwives in the study hospitals was substantial. Our results further proved that risk mitigation strategies tailored to midwives are needed to reduce this risk. These strategies include ensuring a positive organizational climate, providing highly safe devices, and reducing the workload.
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Affiliation(s)
| | - Nanlin Cao
- The Affiliated Hospital of Xiangnan University
| | | | | | - Min Li
- The Third Xiangya Hospital of Central South University
| | | | | | - Fuyun Jiang
- First Affiliated Hospital of University of South China
| | | | - Shunwang Cao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine
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Bouya S, Balouchi A, Rafiemanesh H, Amirshahi M, Dastres M, Moghadam MP, Behnamfar N, Shyeback M, Badakhsh M, Allahyari J, Al Mawali A, Ebadi A, Dezhkam A, Daley KA. Global Prevalence and Device Related Causes of Needle Stick Injuries among Health Care Workers: A Systematic Review and Meta-Analysis. Ann Glob Health 2020; 86:35. [PMID: 32346521 PMCID: PMC7181946 DOI: 10.5334/aogh.2698] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Healthcare workers (HCWs) suffer more than 2 million occupational needle-stick injuries (NSIs) annually. Goal To determine the global prevalence and causes of NSIs among HCWs. Methods In this systematic review and meta-analysis, three databases (PubMed, Web of science, and Scopus) were searched for reports from January 1, 2000 to December 31, 2018. The random effects model was used to determine the prevalence of NSIs among HCWs. Hoy et al.'s instrument was employed to evaluate the quality of the included studies. Findings A total of 87 studies performed on 50,916 HCWs in 31 countries worldwide were included in the study. The one-year global pooled prevalence of NSIs among HCWs was 44.5% (95% CI: 35.7, 53.2). Highest prevalence of NSIs occurred in the South East Asia region at 58.2% (95%, CI: 36.7, 79.8). By job category, prevalence of NSIs was highest among dentists at 59.1% (95% CI: 38.8, 79.4), Hypodermic needles were the most common cause of NSIs at 55.1% (95% CI: 41.4, 68.9). Conclusion The current high prevalence of NSIs among HCWs suggests need to improve occupational health services and needle-stick education programs globally.
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Affiliation(s)
- Salehoddin Bouya
- Internal Medicine and Nephrology, Clinical Immunology Research Center, Ali-Ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, IR
| | - Abbas Balouchi
- Student Research Committee, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, IR
| | - Hosien Rafiemanesh
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, IR
| | | | - Majid Dastres
- Nursing and Midwifery school, Zahedan University of Medical Sciences, Zahedan, IR
| | - Mahdieh Poodineh Moghadam
- Department of Nursing, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, IR
| | - Niaz Behnamfar
- Department of Nursing, Faculty of nursing and midwifery, Tehran medical sciences, Islamic Azad university, Tehran, IR
| | | | - Mahin Badakhsh
- Department of Nursing, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, IR
| | | | - Adhra Al Mawali
- Centre of Studies and Research, Oman Ministry of Health, Muscat, OM
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style institute, Baqiyatallah University of Medical Sciences, Tehran, IR
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR
| | - Asiyeh Dezhkam
- Department of Pediaterics, Iranshahr University of Medical Sciences, Iranshahr, IR
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Grimmond T, Good L. EXPO-S.T.O.P. 2016 and 2017 blood exposure surveys: An alarming rise. Am J Infect Control 2019; 47:1465-1470. [PMID: 31402068 DOI: 10.1016/j.ajic.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The annual Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.), conducted by the Association of Occupational Health Professionals in Healthcare, provides a U.S. national overview of sharps injuries (SIs) and mucocutaneous exposures (MCEs). This study presents the 2016 and 2017 surveys. METHODS An 18-item survey was distributed to Association of Occupational Health Professionals in Healthcare members and colleagues and requested total SIs and MCEs; SI in nurses, doctors, and surgery; staffed beds; teaching status; full-time equivalent staff (FTE), nurse FTE, and average daily census (ADC). RESULTS In 2016, 170 hospitals reported 10,271 exposures (72.9% SIs); in 2017, 224 hospitals reported 12,672 exposures (74.4% SIs). In 2016, SI rates were 27.0 per 100 ADC, 2.3 per 100 FTE, and 2.8 per 100 nurse FTE. Of the total SIs, 36.4% were nurses, 35.6% were doctors, and 39.0% occurred during surgery. In 2017, the respective SI rates were 27.7 per 100 ADC, 2.5 per 100 FTE, and 2.7 per 100 nurse FTE. Of the total SIs, 37.6% were nurses, 32.7% were doctors, and 39.9% occurred during surgery. In 2016, MCE rates were 11.2 per 100 ADC and 0.82 per 100 FTE, and in 2017, MCE rates were 9.6 per 100 ADC and 0.87 per 100 FTE. Teaching hospitals had higher rates than nonteaching hospitals. DISCUSSION EXPO-S.T.O.P. SI rates have risen year-on-year for 3 years and now match 2001-2005 levels. CONCLUSIONS There is an urgent need for aggressive SI-reduction strategies, including leadership support, safety-engineered devices (SED) training/education, and adoption of safer, less user-dependent SED. Further research on SI mechanisms, SED effectiveness, and reduction strategies is required.
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Lee JT, Gaertner WB. Workplace Exposures. Clin Colon Rectal Surg 2019; 32:435-441. [PMID: 31686995 DOI: 10.1055/s-0039-1693010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Workplace exposure in colorectal surgery is unique compared with other surgical specialties and generally underreported. Although the most common device-associated exposure in surgery is suture needle injury, colorectal surgeons are increasingly exposed to gastrointestinal-related infectious agents, radiation, and other hazards in multiple different clinical settings. Highlighting the unique workplace exposures in colorectal surgery may help increase awareness, improve education, and identify possible targets for early intervention in order to minimize these risks.
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Affiliation(s)
- Janet T Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Wolfgang B Gaertner
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Don't Get Stuck: A Quality Improvement Project to Reduce Perioperative Blood-Borne Pathogen Exposure. Jt Comm J Qual Patient Saf 2019; 45:329-336. [PMID: 30733139 DOI: 10.1016/j.jcjq.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Blood-borne pathogen exposure (BBPE) represents a significant safety and resource burden, with more than 380,000 events reported annually across hospitals in the United States. The perioperative environment is a high-risk area for BBPE, and efforts to reduce exposures are not well defined. A multidisciplinary group of nurses, surgical technologists, surgeons, and employee health specialists created a BBPE prevention bundle to reduce Occupational Safety and Health Administration (OSHA) recordable cases. METHODS Mandatory double gloving, a safety zone, engineered-sharps injury prevention devices, and clear communication when passing sharps were implemented in an evidence-based fashion at one institution. Days between exposures and total number of exposures were monitored. Analysis by specialty, role, location, type of injury, and timing was performed. RESULTS During fiscal year (FY) 2015, 45 cases were reported. During the first year of implementation, cases decreased to 38 (a 15.6% decrease; p < 0.65). In the postimplementation period (FY 2017), only 21 cases were reported (an additional 44.7% decrease; p < 0.12), for a total decrease of 53.3% (p < 0.01). The mean number of days between injuries significantly increased (2.5 to 16.3) over the study period. For FY 2017, the main cause of BBPE was needlestick while suturing (47.6%); fellows and attendings combined had the most injuries (52.4%); among divisions, pediatric surgery (19.0%), operating room staff (19.0%), and orthopedics (19.0%) had the most events. CONCLUSION A comprehensive and multidisciplinary approach to employee safety, focused on reduction of BBPE resulted in a significant progressive annual decrease of injuries among perioperative staff.
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Du G, Woythe L, van der Maaden K, Leone M, Romeijn S, Kros A, Kersten G, Jiskoot W, Bouwstra JA. Coated and Hollow Microneedle-Mediated Intradermal Immunization in Mice with Diphtheria Toxoid Loaded Mesoporous Silica Nanoparticles. Pharm Res 2018; 35:189. [PMID: 30105542 PMCID: PMC6096895 DOI: 10.1007/s11095-018-2476-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To examine the immunogenicity of diphtheria toxoid (DT) loaded mesoporous silica nanoparticles (MSNs) after coated and hollow microneedle-mediated intradermal immunization in mice. METHODS DT was loaded into MSNs and the nanoparticle surface was coated with a lipid bilayer (LB-MSN-DT). To prepare coated microneedles, alternating layers of negatively charged LB-MSN-DT and positively charged N-trimethyl chitosan (TMC) were coated onto pH-sensitive microneedle arrays via a layer-by-layer approach. Microneedle arrays coated with 5 or 3 layers of LB-MSN-DT were used to immunize mice and the elicited antibody responses were compared with those induced by hollow microneedle-injected liquid formulation of LB-MSN-DT. Liquid DT formulation with and without TMC (DT/TMC) injected by a hollow microneedle were used as controls. RESULTS LB-MSN-DT had an average size of about 670 nm and a zeta potential of -35 mV. The encapsulation efficiency of DT in the nanoparticles was 77%. The amount of nano-encapsulated DT coated onto the microneedle array increased linearly with increasing number of the coating layers. Nano-encapsulated DT induced stronger immune responses than DT solution when delivered intradermally via hollow microneedles, but not when delivered via coated microneedles. CONCLUSION Both the nano-encapsulation of DT and the type of microneedles affect the immunogenicity of the antigen.
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Affiliation(s)
- Guangsheng Du
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Laura Woythe
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Koen van der Maaden
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Mara Leone
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Stefan Romeijn
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Alexander Kros
- Department of Supramolecular & Biomaterials Chemistry, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Gideon Kersten
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
- Institute for Translational Vaccinology (Intravacc), Bilthoven, The Netherlands
| | - Wim Jiskoot
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Joke A Bouwstra
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
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Mini-Review: Assessing the Potential Impact of Microneedle Technologies on Home Healthcare Applications. MEDICINES 2018; 5:medicines5020050. [PMID: 29890643 PMCID: PMC6023334 DOI: 10.3390/medicines5020050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 01/01/2023]
Abstract
The increasing devolution of healthcare towards community care has meant that the management of many conditions is conducted within the home either by community nurses or by the patients themselves. The administration of medicines within home healthcare scenarios can however be problematic—especially when considering the delivery of medicines through injection. The possibility of needlestick injury (NSI) has become an ever-present hazard within healthcare settings, with a significant proportion of percutaneous injuries occurring during the handling and disposal of the needle. The emergence of transdermal microneedle systems, however, offers a potentially revolutionary advance and could dramatically improve safety—particularly within home healthcare where there are mounting concerns over the use and disposal of sharps. A mini-review of the advantages proffered by microneedle drug delivery technologies is presented and the potential impact on delivery of medicines within the home is critically appraised.
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Reddy VK, Lavoie M, Verbeek JH, Pahwa M. Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel. Cochrane Database Syst Rev 2017; 11:CD009740. [PMID: 29190036 PMCID: PMC6491125 DOI: 10.1002/14651858.cd009740.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Percutaneous exposure injuries from devices used for blood collection or for injections expose healthcare workers to the risk of blood borne infections such as hepatitis B and C, and human immunodeficiency virus (HIV). Safety features such as shields or retractable needles can possibly contribute to the prevention of these injuries and it is important to evaluate their effectiveness. OBJECTIVES To determine the benefits and harms of safety medical devices aiming to prevent percutaneous exposure injuries caused by needles in healthcare personnel versus no intervention or alternative interventions. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, Nioshtic, CISdoc and PsycINFO (until 11 November 2016). SELECTION CRITERIA We included randomised controlled trials (RCT), controlled before and after studies (CBA) and interrupted time-series (ITS) designs of the effect of safety engineered medical devices on percutaneous exposure injuries in healthcare staff. DATA COLLECTION AND ANALYSIS Two of the authors independently assessed study eligibility and risk of bias and extracted data. We synthesized study results with a fixed-effect or random-effects model meta-analysis where appropriate. MAIN RESULTS We included six RCTs with 1838 participants, two cluster-RCTs with 795 participants and 73,454 patient days, five CBAs with approximately 22,000 participants and eleven ITS with an average of 13.8 data points. These studies evaluated safe modifications of blood collection systems, intravenous (IV) systems, injection systems, multiple devices, sharps containers and legislation on the implementation of safe devices. We estimated the needlestick injury (NSI) rate in the control groups to be about one to five NSIs per 1000 person-years. There were only two studies from low- or middle-income countries. The risk of bias was high in 20 of 24 studies. Safe blood collection systems:We found one RCT that found a safety engineered blood gas syringe having no considerable effect on NSIs (Relative Risk (RR) 0.2, 95% Confidence Interval (95% CI) 0.01 to 4.14, 550 patients, very low quality evidence). In one ITS study, safe blood collection systems decreased NSIs immediately after the introduction (effect size (ES) -6.9, 95% CI -9.5 to -4.2) but there was no further decrease over time (ES -1.2, 95% CI -2.5 to 0.1, very low quality evidence). Another ITS study evaluated an outdated recapping shield, which we did not consider further. Safe Intravenous systemsThere was very low quality evidence in two ITS studies that NSIs were reduced with the introduction of safe IV devices, whereas one RCT and one CBA study provided very low quality evidence of no effect. However, there was moderate quality evidence produced by four other RCT studies that these devices increased the number of blood splashes when the safety system had to be engaged actively (relative risk (RR) 1.6, 95% CI 1.08 to 2.36). In contrast there was low quality evidence produced by two RCTs of passive systems that showed no effect on blood splashes. Yet another RCT produced low quality evidence that a different safe active IV system also decreased the incidence of blood leakages. Safe injection devicesThere was very low quality evidence provided by one RCT and one CBA study showing that introduction of safe injection devices did not considerably change the NSI rate. One ITS study produced low quality evidence showing that the introduction of safe passive injection systems had no effect on NSI rate when compared to safe active injection systems. Multiple safe devicesThere was very low quality evidence from one CBA study and two ITS studies. According to the CBA study, the introduction of multiple safe devices resulted in a decrease in NSI,whereas the two ITS studies found no change. Safety containersOne CBA study produced very low quality evidence showing that the introduction of safety containers decreased NSI. However, two ITS studies evaluating the same intervention found inconsistent results. LegislationThere was low to moderate quality evidence in two ITS studies that introduction of legislation on the use of safety-engineered devices reduced the rate of NSIs among healthcare workers. There was also low quality evidence which showed a decrease in the trend over time for NSI rates.Twenty out of 24 studies had a high risk of bias and the lack of evidence of a beneficial effect could be due to both confounding and bias. This does not mean that these devices are not effective. AUTHORS' CONCLUSIONS For safe blood collection systems, we found very low quality evidence of inconsistent effects on NSIs. For safe passive intravenous systems, we found very low quality evidence of a decrease in NSI and a reduction in the incidence of blood leakage events but moderate quality evidence that active systems may increase exposure to blood. For safe injection needles, the introduction of multiple safety devices or the introduction of sharps containers the evidence was inconsistent or there was no clear evidence of a benefit. There was low to moderate quality evidence that introduction of legislation probably reduces NSI rates.More high-quality cluster-randomised controlled studies that include cost-effectiveness measures are needed, especially in countries where both NSIs and blood-borne infections are highly prevalent.
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Affiliation(s)
- Viraj K Reddy
- Finnish Institute of Occupational HealthCochrane Work Review GroupNeulaniementie 4KuopioFinland70101
| | - Marie‐Claude Lavoie
- University of Maryland Baltimore110 South Paca Street4th Floor, RM 4‐100BaltimoreMarylandUSA21201
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Work Review GroupNeulaniementie 4KuopioFinland70101
| | - Manisha Pahwa
- University of TorontoDalla Lana School of Public Health155 College Street, 6th floorTorontoONCanadaM5T 3M7
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