Causes of needlestick injuries in three healthcare settings: analysis of accident notifications registered six months after the implementation of EU Directive 2010/32/EU in Germany

Occupational protection behavior and its influencing factors of newly recruited nurses

AIM

Aim The objective of this study was to understand the occupational protective behaviors of newly recruited nurses and explore the influencing factors.

METHODS

A convenience sampling method was used to select newly recruited nurses in our hospital from July 2018 to November 2019. The survey was conducted using the general information questionnaire, work attitude scale (Wa), and occupational protective behavior scale.

RESULTS

The total score of occupational protective behaviors of 150 newly enrolled nurses was 18.94 ± 3.59. There was a significant negative correlation between work attitude score and occupational protective behaviors (r = -0.324, p < 0.001). Multiple linear regression analysis showed that gender, previous participation in nursing skill-based competitions, experience of needlestick injuries before recruit, work attitude score, average daily sleep time (p < 0.05) were independent factors influencing occupational protective behaviors.

CONCLUSIONS

The overall occupational protective awareness of newly enrolled nurses is relatively weak and needs to be further improved. The group's ability to improve occupational protective behaviors may be positively impacted through increased adaptability, improved sleep, active participation in nursing skill-based competitions, strengthening guidance and education on occupational protection.

Disposal of Waste from Tattoo and Beauty Parlors in Poland: A Survey-Based Analysis on Epidemiological Safety

Appropriate waste management is increasingly relevant due to environmental and infectious disease transmission concerns. An anonymous observational cross-sectional study was conducted from 2013-2017 of 262 tattooists and 824 beauticians throughout Poland. Knowledge, attitudes, behavior, and compliance with blood-borne infection controls and correct waste disposal were assessed. Tattooists correctly addressed hazardous waste significantly more often than did beauticians (83.3% vs. 44.8%). Medical waste was collected by a specialist company in 90.1% of tattoo parlors and 63.3%of beauty parlors. Tattooists correctly used and disposed of sharps more frequently than beauticians (93.1% vs. 68.9%); however, 46.4% of beauticians and 12.4% of tattooists discarded waste into municipal trash, including sharps (27.1% and 2.6%, respectively). Incorrect collection and labeling of biological waste present occupational risk to waste disposal personnel. Education and instructional controls could improve health safety in this industry. Biological waste management processes are restrictive for medical services and liberal for beauty services, an industry for which they should also be applied more comprehensively.

Sharp injuries and their relationship with stress among nurses working in acute care settings

BACKGROUND

Sharp injuries are common reasons for the transmission of blood-borne diseases in acute care settings. Fear of sharp injuries and their consequences can expose nurses to high levels of stress (sharp injuries stress).

AIM

To examine the occurrence of sharp injuries and to assess their relationship with stress among nurses working in acute care settings.

DESIGN

This was a cross-sectional study.

METHODS

A total of 150 nurses working in 10 acute care settings in two selected hospitals in Alexandria, Egypt, were selected as the population of this study. Data on the occurrence of sharp injuries were collected using a sharp injuries circumstances questionnaire (including questions regarding number, instrument and reasons/procedures that caused sharp injuries, etc.), and two scales were used to measure sharp injuries stress (the Impact of Event Scale-Revised and the Post-Traumatic Stress Syndrome Questions Inventory).

RESULTS

More than 13% of nurses experienced sharp injuries, and 25% of injuries were caused by contaminated instruments. Sharp injuries stress scores were high in nurses, with 65% of nurses experiencing sharp injuries and 30.8% of nurses who did not experience sharp injuries having high Impact of Event Scale-Revised scores. In addition, 45% of nurses who experienced sharp injuries and 15.39% of nurses who did not experience sharp injuries had high Post-Traumatic Stress Syndrome Questions Inventory (PTSSQI) scores. There was a significant relationship between the occurrence of sharp injuries and stress scales at P < .05.

CONCLUSIONS

Nurses are exposed to sharp injuries, leading to sharp injury stress pre- and post-occurrence of injuries. Sharp injuries stress can make nurses prone to Post-Traumatic Stress Syndrome (PTSS).

RELEVANCE TO CLINICAL PRACTICE

Factors that lead to the occurrence of sharp injuries and sharp injuries stress should be investigated, and a psychological rehabilitation unit should be instituted to help nurses working in acute care settings deal with the sharp injuries-related stressors they are facing.

Causes of Needlestick and Sharps Injuries When Using Devices with and without Safety Features

Safety-engineered devices (SEDs) have been developed to protect healthcare personnel (HCP) from needlestick and sharps injuries (NSIs). The aim of this study was to analyze NSIs associated with SEDs and non-SEDs among HCP in hospitals, medical offices and care facilities. Records from online questionnaires on NSIs were used. Causes of NSIs were compared for SED use and healthcare setting. A sample of 835 files was included. Injuries with SEDs accounted for 35.0% of all NSIs, whereas the proportions were higher in medical offices and lower in care facilities. NSIs in nurses were more often associated with SEDs than NSIs in physicians. NSIs from intravenous needles were associated with SEDs in more than 60% of cases in hospitals and medical offices and in about 30.0% of cases in care facilities. In contrast, suturing was associated with every fourth NSI in hospitals, of which fewer than 10.0% were associated with SEDs. In care facilities, SEDs were involved in 36.1% of NSIs during subcutaneous injections. NSIs during disposal accounted for 29.2% of total NSIs, of which 36.1% were associated with SEDs. Frequent reasons for SED-associated NSIs were technical problems, unexpected patient movement and problems during disposal. Our analysis shows that many NSIs are associated with SEDs. Continuous training is necessary in the handling and disposal of SEDs.

Needlestick injuries: the role of safety-engineered devices in prevention

The first documented mention of a needlestick injury (NSI) in the medical literature appeared in 1906. Despite growth in academic and clinical interest for NSI prevention, a global report identified that approximately 3 million healthcare workers have suffered percutaneous exposure to blood-borne pathogens. Legislation is an important component of NSI prevention. Unfortunately, the impact of legislation may not always reduce the incidence of NSI as much as expected. Safety-engineered device (SED) implementation has demonstrated a substantial reduction in NSI rates compared with non-SEDs. More importantly, passive SEDs are 10 times less likely to be connected with an NSI incident.

Needlestick injuries among Malaysian healthcare workers

BACKGROUND

Needlestick injury (NSI) is a significant occupational health issue among healthcare workers (HCWs).

AIMS

To determine the national self-reported incidence and risk factors for NSI among Malaysian Ministry of Health (MOH) HCWs.

METHODS

Using data from the MOH national sharps injury surveillance programme, information on reported NSIs over a 1-year period (2016) for different HCW subgroups were extracted and analysed.

RESULTS

A total of 1234 NSI cases were reported in 2016, giving an overall incidence of 6 injuries per 1000 HCWs. Medical doctors recorded the highest incidence (21.1 per 1000 HCWs) followed by dental staff (7.5), pharmacy staff (4.2), nurses (3.7), medical assistants (3.4) and allied and auxiliary staff (1.0). Doctors had significantly increased risk of NSI compared with allied and auxiliary staff (relative risk [RR] = 20.7, 95% confidence interval [CI] 15.5-27.5), medical assistants (RR = 6.1, 95% CI 4.5-8.2), nurses (RR = 5.7, 95% CI 5.0-6.6), pharmacy staff (RR = 5.0, 95% CI 3.7-6.6) and dental staff (RR = 2.8, 95% CI 2.2-3.5). Significant differences were found in age and sharps- handling experience between occupational subgroups (P < 0.001 for both variables). Male employees had higher risk than females (RR = 1.33, 95% CI 1.18-1.50), with a significant difference seen in their sharps-handling experience (P < 0.01). Important risk factors included unsafe practices such as recapping of needles and their improper disposal.

CONCLUSIONS

The national incidence of NSI amongst Malaysian HCWs was lower compared with other countries, but unsafe practices remain an important concern. There is a need to formulate, implement and monitor safe and consistent practices for the different healthcare professionals.

Understanding sharps use in an Australian Emergency Department: A mixed methods organisational case study

BACKGROUND

Despite the introduction of a range of safety policies and sharps equipment designed to protect healthcare workers, rates of percutaneous injuries from occupational exposure to sharps remains high. This study examined the availability and use of various types of sharps devices in a tertiary hospital emergency department, to understand clinician choice between non-safety and safety devices; and to document their safe and unsafe use of sharps.

METHODS

This mixed methods study consisted of areview of stock levels, a survey of staff usage, and a content analysis of semi-structured interview data to explore factors which impact on staff preferences for different sharps devices.

RESULTS

Staff identified a range of sharps risks, as well as barriers and enablers to the use of safety devices. Availability of, and preference for, familiar devices influenced choice of devices used in clinical practice, despite awareness of associated risks.

CONCLUSIONS

This understanding of equipment use and the factors that motivate such use have informed the first stage of the knowledge-to-action cycle. Knowledge translation, should include the development of policies to help reduce the risk of sharps injury. Culture change and ongoing skills development might help to overcome entrenched procedures and increase voluntary engagement with safer sharps.

Do training and needle-safety devices prevent needlestick injuries? A systematised review of the literature

This systematised review was undertaken to appraise research on the effects of training and the use of needle-safety devices (NSDs) on the prevention of needlestick injuries (NSIs) among health workers, focusing on a European perspective. A literature search from 2007 to 2017 was performed, which identified six studies that investigated the introduction of training and NSDs and their affect on NSIs. The six chosen studies identified that training, as well as the adoption of NSDs, has an impact on preventing NSIs. However, further information is required on the content and mode of delivery of training and on which types of NSDs are most effective at preventing injuries. This will help healthcare workers to understand and implement the most effective strategies to prevent injuries. This article provides a critique of the research approaches used in the six studies.

Infections in Healthcare Workers in Germany-22-Year Time Trends

Health workers (HWs) run an increased risk of infection. The standardised data set of an accident insurer was used to analyse the time trends of infection-related claims and confirmed occupational diseases (ODs) in HWs. The numbers of claims and confirmed claims for different infections were analysed for the years 1996 to 2017. The rate of claims and confirmed ODs were calculated per 100,000 full-time workers. The number of claims was relatively stable over time. However, the rate per 100,000 full-time workers decreased from 25.2 to 15.4. The decrease was most pronounced for hepatitis B and hepatitis C infections, which were the most frequent infections for which claims were made at the start of the period. In 2017, tuberculosis (TB)-related claims were more frequent than those related to blood-borne virus infections. However, the growing number of TB claims does not reflect an increased infection risk, but rather improved methods for the diagnosis of latent TB infection (LTBI). Measures to prevent blood-borne virus infections in HWs were successful in the last 22 years, but attention should be paid to newly emerging infections.

Seroconversion after needlestick injuries - analyses of statutory accident insurance claims in Germany

Objective: After a needlestick injury (NSI) with contaminated blood, there is a risk of seroconversion. Statutory accident insurance (SAI) claims data were used to determine the numbers of seroconversions for hepatitis B and C viruses (HBV, HCV) and for HIV.

Materials and methods: Cases of HBV, HCV or HIV infection recognised as occupational diseases between 2006 and 2015 were selected from the BGW (Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege) database. Cases where an NSI was reported to the accident insurer before the diagnosis of the infectious disease was made were included in the analysis. The causal link between the infection and the NSI identified was estimated based on diagnostic findings in medical case files.

Results: In total, 566 cases with an occupation-related HBV, HCV or HIV infection were identified, including 44 cases where an NSI had been reported before diagnosis. Data on file indicated a possible causal link in 34 cases. In 16 of the 34 cases, seroconversion after the NSI was proven by diagnostic findings; in 13 of the 34 cases, seroconversion was possible but not proven because of the lack of initial findings. The index case was known in 23 of the 34 cases. The injuries occurred most often during waste disposal and high-risk procedures such as taking blood samples. The injuries were most often caused by cannulas for intravenous puncture. Subcutaneous devices were involved in two NSIs but there was no information on the initial serology or known index case.

Conclusions: It is possible to identify seroconversion in SAI claims data. However, data on the injured person’s initial infection status is often incomplete and this makes it difficult to assess any causal link. The incidence of seroconversions resulting from injuries from subcutaneously applied devices is apparently low; this is consistent with the literature.

Do safety engineered devices reduce needlestick injuries?

BACKGROUND

Needlestick injuries (NSIs) are one of the most common health hazards facing healthcare workers (HCWs) across the globe. Needles with safety engineered devices (SEDs) have been developed to minimize the risk of exposure to blood-borne infections, such as hepatitis B virus, hepatitis C virus and human immunodeficiency virus, associated with NSIs.

AIM

To assess the effect of the introduction of SEDs in preventing NSIs among HCWs at Jeroen Bosch Hospital, the Netherlands.

METHODS

The incidence rates of reported NSIs before and after the introduction of SEDs were compared. All HCWs who reported an NSI with an SED were interviewed in order to understand the underlying causes of the NSIs.

FINDINGS

Despite the introduction of SEDs, the incidence of NSIs increased from 1.9 per 100 HCWs before the introduction of SEDs to 2.2 per 100 HCWs after the introduction of SEDs. The registration of reported SED-related NSIs showed a significant decrease in the number of NSIs related to injection needles and blood sugar needles, while an unexpected significant increase in NSIs with nadroparin calcium needles and infusion needles was found. The most common causes reported for NSIs were unsafe disposal of the needles and problems with the safety feature.

CONCLUSION

The application of SEDs has not led to a reduction in NSIs. The majority of NSIs caused by a needle with an SED can be prevented by stimulation of safe needle disposal, proper use of SEDs, and provision of feedback to manufacturers to keep improving product design.

Comparing non-safety with safety device sharps injury incidence data from two different occupational surveillance systems

The United States Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard as amended by the Needlestick Safety and Prevention Act requiring the use of safety-engineered medical devices to prevent needlesticks and sharps injuries has been in place since 2001. Injury changes over time include differences between those from non-safety compared with safety-engineered medical devices. This research compares two US occupational incident surveillance systems to determine whether these data can be generalized to other facilities and other countries either with legislation in place or considering developing national policies for the prevention of sharps injuries among healthcare personnel.