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Grisel B, Kaur K, Swain S, Gorenshtein L, Chime C, O'Callaghan E, Vasireddy A, Moore L, Shin C, Won M, Ebangwese S, Tripoli T, Lumpkin S, Ginsberg Z, Cantrell S, Freeman J, Agarwal S, Haines K. The Ethical Obligation to Treat Infectious Patients: A Systematic Review of Reasons. Clin Infect Dis 2024; 79:339-347. [PMID: 39149937 DOI: 10.1093/cid/ciae162] [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] [Received: 03/04/2024] [Indexed: 08/17/2024] Open
Abstract
During pandemics, healthcare providers struggle with balancing obligations to self, family, and patients. While HIV/AIDS seemed to settle this issue, coronavirus disease 2019 (COVID-19) rekindled debates regarding treatment refusal. We searched MEDLINE, Embase, CINAHL Complete, and Web of Science using terms including obligation, refusal, HIV/AIDS, COVID-19, and pandemics. After duplicate removal and dual, independent screening, we analyzed 156 articles for quality, ethical position, reasons, and concepts. Diseases in our sample included HIV/AIDS (72.2%), severe acute respiratory syndrome (SARS) (10.2%), COVID-19 (10.2%), Ebola (7.0%), and influenza (7.0%). Most articles (81.9%, n = 128) indicated an obligation to treat. COVID-19 had the highest number of papers indicating ethical acceptability of refusal (60%, P < .001), while HIV had the least (13.3%, P = .026). Several reason domains were significantly different during COVID-19, including unreasonable risks to self/family (26.7%, P < .001) and labor rights/workers' protection (40%, P < .001). A surge in ethics literature during COVID-19 has advocated for permissibility of treatment refusal. Balancing healthcare provision with workforce protection is crucial in effectively responding to a global pandemic.
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Affiliation(s)
- Braylee Grisel
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kavneet Kaur
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Sonal Swain
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura Gorenshtein
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Chinecherem Chime
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Ellen O'Callaghan
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Avani Vasireddy
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren Moore
- Department of Surgery, Texas Christian University, Fort Worth, Texas, USA
| | - Christina Shin
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michelle Won
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Santita Ebangwese
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Todd Tripoli
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Stephanie Lumpkin
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Zachary Ginsberg
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Sarah Cantrell
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer Freeman
- Department of Surgery, Texas Christian University, Fort Worth, Texas, USA
| | - Suresh Agarwal
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Krista Haines
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Kahveci Z, Kilinc-Balci FS, Yorio PL. Evaluation of fluid leakage at the coverall and glove interface in single and double glove conditions. Am J Infect Control 2023; 51:1145-1150. [PMID: 36931507 DOI: 10.1016/j.ajic.2023.02.018] [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] [Received: 12/27/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Fluid leakage through the glove-protective clothing interface is an area of concern for many health care personnel, including emergency medical service providers, who may wear coveralls to protect themselves from multiple types of hazards. There is currently no established standard test method to specifically evaluate the barrier performance of the glove-protective clothing interface region for any personal protective equipment ensemble. OBJECTIVE This study quantifies the fluid leakage at the coverall and glove interface using single and double gloving. METHODS A robotic arm, which can simulate upper extremity movements of health care personnel, was used to test 5 coverall models and an extended examination glove model in single and double glove conditions. RESULTS The results show that there was a significant difference in fluid leakage amounts between some of the coverall models and the number of glove layers studied. Findings also highlight that there is a high correlation between basis weight and stiffness of the coverall fabrics and the fluid leakage amounts. CONCLUSIONS These results underline that coverall constructed from thin and less stiff fabrics can result in lower fluid leakage levels. Also, there was no significant difference in fluid leakage amounts between single and double gloves when tested with each of the coverall models, with the exception of the coveralls with the highest basis weight and stiffness.
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Affiliation(s)
- Zafer Kahveci
- US Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA
| | - F Selcen Kilinc-Balci
- US Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA.
| | - Patrick L Yorio
- US Centers for Disease Control and Prevention, Office of the Director (OD), Human Resources Office (HRO), Office of the Chief Operating Officer (OCOO), Atlanta, GA
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Seyoum MA, Belachew MT, Dessale MB, Adugna MW, Keto TY, Wassie YG, Dobamo HA, Getaneh MU, Nemomssa HD. Development of a low-cost device for testing glove and condom leakage. Ann Med Surg (Lond) 2022; 78:103791. [PMID: 35620039 PMCID: PMC9127158 DOI: 10.1016/j.amsu.2022.103791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mekides Abera Seyoum
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
| | - Menen Teshome Belachew
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
| | - Meron Berihun Dessale
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
| | - Meti Wakjira Adugna
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
- Gilando Biomedical Solution Plc, Addis Ababa, Ethiopia
| | - Tizita Yohannes Keto
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
| | - Yezbalem Getnet Wassie
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Melese Uma Getaneh
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
| | - Hundessa Daba Nemomssa
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
- Corresponding author.
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Cresswell F, Asanati K, Bhagani S, Boffito M, Delpech V, Ellis J, Fox J, Furness L, Kingston M, Mansouri M, Samarawickrama A, Smithson K, Sparrowhawk A, Rafferty P, Roper T, Waters L, Rodger A, Gupta N. UK guideline for the use of HIV post-exposure prophylaxis 2021. HIV Med 2022; 23:494-545. [PMID: 35166004 DOI: 10.1111/hiv.13208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual-level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow-up blood-borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre-exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.
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Affiliation(s)
- Fiona Cresswell
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,Clinical Research Department, London School of Hygiene and Tropical Medicine, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Kaveh Asanati
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Sanjay Bhagani
- Royal Free Hospital, London, UK.,Institute for Global Health, University College London, London, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - Valerie Delpech
- Department of Epidemiology, Public Health England, London, UK
| | - Jayne Ellis
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,University College London, Hospitals NHS Foundation Trust, London, UK
| | - Julie Fox
- HIV Medicine and Clinical Trials, Guy's and St Thomas' Hospital, London, UK.,Kings College London, London, UK
| | | | - Margaret Kingston
- British Association of Sexual Health and HIV Clinical Effectiveness Group, Macclesfield, UK.,Manchester Royal Infirmary, Manchester, UK.,Manchester University, Manchester, UK
| | - Massoud Mansouri
- Occupational Health, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Paul Rafferty
- Belfast Health and Social Care Trust, Belfast, UK.,HIV Pharmacy Association Representative, Newcastle upon Tyne, UK
| | | | | | - Alison Rodger
- Royal Free Hospital, London, UK.,Institute for Global Health, University College London, London, UK
| | - Nadi Gupta
- British HIV Association Guideline Committee, London, UK.,Rotherham NHS Foundation Trust, Rotherham, UK
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Investigating surgical smoke in otolaryngology operating rooms. Sci Rep 2022; 12:1719. [PMID: 35110589 PMCID: PMC8810908 DOI: 10.1038/s41598-022-05701-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/10/2022] [Indexed: 01/02/2023] Open
Abstract
Surgical smoke is a common chemical hazard produced from the use of electrocautery, laser, or ultrasonic scalpels during surgery. It has been proved harmful to medical personnel. Thus, it is important to monitor surgical smoke concentrations in the operating room. In the past decade, many researches regarding surgical smoke were discussed in different professional healthcare fields, but few showed the correlation between surgical smoke and otolaryngology surgery. In this study, the concentrations of particulate matter and formaldehyde were measured during thirty cases of several types of otolaryngology surgery in a regional research hospital in Taiwan. The concentrations of 0.3 µm and 0.5 µm particulate matter raised rapidly in the main knife range at the beginning of the electrocautery knife used, and then decreased by half after 5-10 min of use. The concentrations of formaldehyde were ranged from 1 to 2 ppm during the surgery, which is higher than the permissible exposure limit. While many medical staffs are working in the operating room and are exposed to the smoke hazard, effective strategies for collecting and eliminating the smoke should be taken in all medical facilities.
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Kahveci Z, Kilinc-Balci FS, Yorio PL. A simulation study to assess fluid leakage through the glove-gown interface in isolation settings. Am J Infect Control 2021; 49:1481-1487. [PMID: 34428530 PMCID: PMC10124161 DOI: 10.1016/j.ajic.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isolation gowns are recommended to protect healthcare personnel, patients, and visitors from transfer of microorganisms and body fluids in patient isolation situations. Standards provide limited information about barrier performance of isolation gowns for possible exposure scenarios. One of the most vulnerable areas of the personal protective equipment ensemble is considered the glove-gown interface. However, current isolation gown classification standards do not consider the interface regions of the personal protective equipment system while assessing the level of protection. The purpose of this study was to quantitatively evaluate the fluid leakage through the glove-gown interface by simulating exposures and healthcare personnel arm movements in patient care for isolation settings. METHODS We tested fluid leakage of two examination gloves with different cuff lengths and seven isolation gown models designed with varying levels of barrier resistance and multiple cuff types. RESULTS Our results demonstrated that leakage through the glove-gown interface depends on multiple factors, including glove cuff length and gown cuff design. Gowns with the thumb loop design provided better protection than the elastic cuff design, and the elastic cuff design provided better protection compared to the knit cuff design for a given AAMI PB70 level. More importantly, a substantial penetration through gown fabrics was observed. CONCLUSIONS This research identifies a need to develop a standardized method to evaluate leakage at the glove-gown interface to improve worker protection.
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Affiliation(s)
- Zafer Kahveci
- U.S. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH), National Personal Protective Technology Laboratory (NPPTL), Pittsburgh, PA
| | - F Selcen Kilinc-Balci
- U.S. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH), National Personal Protective Technology Laboratory (NPPTL), Washington, DC.
| | - Patrick L Yorio
- U.S. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH), National Personal Protective Technology Laboratory (NPPTL), Pittsburgh, PA
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Lee Y, Salahuddin M, Gibson‐Young L, Oliver GD. Assessing personal protective equipment needs for healthcare workers. Health Sci Rep 2021; 4:e370. [PMID: 34522792 PMCID: PMC8425781 DOI: 10.1002/hsr2.370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/08/2021] [Accepted: 08/08/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Personal protective equipment (PPE) is critical for healthcare workers (HCWs) since it acts as a barrier to infection transmission; however, current PPE is not ideally suited to their needs due to limitations in protection and comfort. Thus, the purpose of this study was to identify major issues of current PPE for body protection and assess its needs within health care. METHODS An online survey was conducted with a convenience sample of 200 U.S. healthcare professionals who interact with patients. The survey was designed to identify the types of PPE that HCWs currently use, assess current PPE design features for body protection, examine the effect of PPE design features for body protection, and HCWs' years of work experiences on overall PPE acceptability, and explore current PPE maintenance practices. Both quantitative and qualitative data were used for analyses. RESULTS This study showed the need for current PPE improvement in terms of fit, comfort, mobility, and donning and doffing for HCWs' safety and health. Donning and doffing plays an important role in HCWs' overall acceptance of PPE for body protection. This study revealed that most HCWs dispose of their PPE in a trashcan in a healthcare unit and non-disposed PPE is laundered at home, which may expose their family members to a health risk if a proper precaution is not followed. CONCLUSION This study provides critical insights for the needs of (a) novel PPE design research and (b) proper donning and doffing training and its strict regulatory effort to ensure HCWs' safety and health.
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Affiliation(s)
- Young‐A Lee
- Department of Consumer and Design SciencesAuburn UniversityAuburnAlabamaUSA
| | - Mir Salahuddin
- Department of Consumer and Design SciencesAuburn UniversityAuburnAlabamaUSA
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Abstract
Cardiopulmonary resuscitation (CPR) is an emergency lifesaving endeavor, performed in either the hospital or outpatient settings, that significantly improves outcomes and survival rates when performed in a timely fashion. As with any other medical procedure, CPR can bear potential risks not only for the patient but also for the rescuer. Among those risks, transmission of an infectious agent has been one of the most compelling triggers of reluctance to perform CPR among providers. The concern for transmission of an infection from the resuscitated subject may impede prompt initiation and implementation of CPR, compromising survival rates and neurological outcomes of the patients. Infections during CPR can be potentially acquired through airborne, droplet, contact, or hematogenous transmission. However, only a few cases of infection transmission have been actually reported globally. In this review, we present the available epidemiological findings on transmission of different pathogens during CPR and data on reluctance of health care workers to perform CPR. We also outline the levels of personal protective equipment and other protective measures according to potential infectious hazards that providers are potentially exposed to during CPR and summarize current guidelines on protection of CPR providers from international societies and stakeholders.
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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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Cheserem JB, Esene IN, Mahmud MR, Kalangu K, Sanoussi S, Musara A, El-Ghandour NMF, Fieggen G, Qureshi M. A Continental Survey on the Impact of COVID-19 on Neurosurgical Training in Africa. World Neurosurg 2020; 147:e8-e15. [PMID: 33186788 PMCID: PMC7834456 DOI: 10.1016/j.wneu.2020.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
Background Containment measures for COVID-19 have affected surgical training globally. We sought to assess how neurosurgical training has been affected across Africa in April 2020. Methods A cross-sectional survey was distributed to African Neurosurgical trainees seeking to review demographics and effects of COVID on training. Results A total of 123 neurosurgery trainees responded from 23 African countries and a further 6 were abroad. A total of 91.80% were men, and 96.70% were training in public institutions. Only 41% had received training in COVID-19 with 61.79% worried that they would contract COVID-19 while performing their clinical duties. There was a marked reduction in clinical activities including a median reduction of elective surgery (−80%), clinics (−83%), and emergency surgery (−38.50%). A total of 23.58% of residents did not receive a formal salary, with 50% on less than $1000 USD gross per month. Conclusions This is the first continental survey of neurosurgery trainees in Africa. COVID-19 has significantly affected clinical and learning opportunities. There are concerns of the long-term effects on their training activities for an uncertain period of time during this pandemic. Although there has been a global increase in e-learning, there is need to evaluate if this is accessible to all trainees.
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Affiliation(s)
- Jebet Beverly Cheserem
- Department of Neurosurgery, Weill Cornell, New York, New York, USA; Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya.
| | - Ignatius N Esene
- Department of Neurosurgery, University of Bamenda, Bamenda, Cameroon
| | - Muhammad Raji Mahmud
- Neurosurgery Unit, Department of Surgery, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Kazadi Kalangu
- Department of Neurosurgery, University of Zimbabwe, Harare, Zimbabwe
| | - Samuila Sanoussi
- Department of Neurosurgery, Niamey National Hospital, Niamey, Niger Republic
| | - Aaron Musara
- Department of Neurosurgery, University of Zimbabwe, Harare, Zimbabwe
| | | | - Graham Fieggen
- Department of Neurosurgery, University of Cape Town, Cape Town, South Africa
| | - Mahmood Qureshi
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
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Yohe N, Swiggett SJ, Razi A, Bowman JR, Watson SL, Pearson JM, Hudson PW, Patt JC, Ames SE, Leddy LR, Khoury JG, Tubb CC, McGwin G, Ponce B. Acute Workplace Hazards in Orthopedic Surgery: Resident Survey Regarding Splash and Workplace Violence Events. JOURNAL OF SURGICAL EDUCATION 2020; 77:1638-1645. [PMID: 32505670 DOI: 10.1016/j.jsurg.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/27/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Orthopedic surgery residents are at risk for daily work-related hazards and exposures. Hazards related specific to this specialty includes radiation exposure, smoke inhalation (from electrocautery), and disease transmission through contact with surgical instruments or sharps during procedures. However, minimal research has been focused on other occupational hazard risks in orthopedic surgery including surgical splash events and workplace violence. This study focused on determining (1) whether or not use of protective eyewear in the workplace would be related to the availability of personal protective equipment (PPE); (2) resident education; and (3) the rate of workplace violence toward orthopedic surgery residents during their training. METHODS An invitation to participate in a web-based, anonymous survey to 46 US allopathic orthopedic surgery residency programs (1207 potential resident respondents). The survey was conceptually divided into the following areas: (1) demographics; (2) training and attitudes concerning occupational hazards; (3) PPE provision and use; (4) sharps injuries and reporting; and (5) general safety knowledge and violence in the workplace. Those who answered yes to having a splatter event or receiving a threat at the hospital were compared to those who did not. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between these outcomes and selected independent variables of interest. p-Values of <0.05 were considered statistically significant. RESULTS From January 18 to March 31, 2016, 518 surveys were received and included for analysis for a response rate of 42.9% (518/1207). One survey was excluded from analysis due to <50% completed response items. Self-reported program types were 64.5% (334/518) public university-affiliated, 23.2% (120/518) private university affiliated, 7.1% (37/518) community, and 5.2% (27/518) military. Residents were 83.0% = male and 17.0% = female. Overall, reported eye protection usage was 95% amongst all residents and 22% of residents reported experiencing a violent threat in the workplace. The risk of experiencing a splatter event was not statistically associated with residency type, gender, or geographic region. Senior residents were at an increased likelihood of experiencing a splatter event (OR 1.22, [95% CI 1.06-1.41], p = 0.006) when compared to PGY-1 residents. The risk of a violent experience at work was not statistically associated with residency type, year of residency training, or gender. Residents in the Northeast were more likely to have a violent experience (OR 2.78 [95% CI 1.41-5.49] p = 0.003). Overall, residents felt that they had adequate training to prevent occupational hazards (mean of 3.9/5 on Likert scale) and respond to hazards (mean of 3.7/5 Likert). CONCLUSIONS Occupational hazards are not uncommon in orthopedic surgery training with high rates of improper eyewear PPE use and poor awareness of Occupational Safety and Health Administration and AAOS guidelines. Violence in the workplace impacts over one in 4 residents and training programs and hospitals should improve education and report efforts. Continual yearly PPE training and awareness of AAOS guidelines could be intertwined with duty hour and/or case logs in order to ensure residents are exposed to this material on a regular basis.
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Affiliation(s)
- Nicholas Yohe
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, New York
| | - Samuel J Swiggett
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, New York.
| | - Afshin Razi
- Maimonides Medical Center, Department of Orthopedic Surgery, Brooklyn, New York
| | | | - Shawna L Watson
- Baylor University Medical Center, Department of Orthopedic Surgery, Dallas, Texas
| | - Jeffrey M Pearson
- University of Alabama at Birmingham, Department of Orthopedic Surgery, Birmingham, Alabama
| | - Parke W Hudson
- University of Alabama at Birmingham, Department of Orthopedic Surgery, Birmingham, Alabama
| | - Joshua C Patt
- Carolinas Medical Center, Department of Orthopedic Surgery, Charlotte, North Carolina
| | - S Elizabeth Ames
- University of Vermont Medical Center, Department of Orthopedics and Rehabilitation, Burlington, Vermont
| | - Lee R Leddy
- Medical University of South Carolina, Department of Orthopedics and Physical Medicine, Charleston, South Carolina
| | - Joseph G Khoury
- University of Alabama at Birmingham, Department of Orthopedic Surgery, Birmingham, Alabama
| | - Creighton C Tubb
- New Braunfels Orthopedic Surgery & Sports Medicine, New Braunfels, Texas
| | - Gerald McGwin
- University of Alabama at Birmingham, Department of Orthopedic Surgery, Birmingham, Alabama
| | - Brent Ponce
- University of Alabama at Birmingham, Department of Orthopedic Surgery, Birmingham, Alabama
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Tshering K, Wangchuk K, Letho Z. Assessment of knowledge, attitude and practice of post exposure prophylaxis for HIV among nurses at Jigme Dorji Wanghuck National Referral Hospital, Bhutan. PLoS One 2020; 15:e0238069. [PMID: 32857804 PMCID: PMC7454947 DOI: 10.1371/journal.pone.0238069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022] Open
Abstract
Nurses are managing huge number of patients infected with human immunodeficiency virus (HIV), which made them highly vulnerable to HIV infection through occupational exposure such as needle stick injuries and splashing of blood/bodily fluids on mucosal surface. This made the practice of post exposure prophylaxis (PEP) for HIV crucial among nurses. Therefore, our study aimed to assess knowledge, attitude and practice of PEP for HIV among nurses in Bhutan. A cross-sectional study was conducted among 221 registered nurses working at Jigme Dorji Wangchuck National Referral Hospital, Bhutan between April and June 2017. A structured self-administered questionnaire was used to collect data and analysed using SPSS version 21. Majority (80.1%) of our participants had poor knowledge regarding PEP for HIV. Although half (51.1%) of our participants had heard about PEP, only 3 (1.4%) attended a formal training on PEP for HIV. However, a significant proportion of nurses (92.3%) had positive attitude towards PEP for HIV. Out of 221 respondents, 95(43%) had been exposed to needle stick injuries and splashing of blood/bodily fluids while managing patients. Despite significant number of exposures, only 2 (2.1%) of them took PEP and completed 28 days of prophylaxis. Lack of protective barriers at work place (56.8%) and poor knowledge on personal protective equipment (14.7%) were major perceived causes of exposure among study participants. No PEP service (30.2%) and lack of support to report incidents (22.6%) were two major reasons leading to failure of PEP practice among exposed individuals. Despite positive attitude exhibited by majority of our respondents, the level of knowledge and practice of PEP for HIV among nurses was very low. Therefore, a formal training on PEP and 24 hours accessible PEP service with proper guidelines are recommended to improve the overall knowledge and practice of PEP against HIV among nurses.
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Affiliation(s)
- Kezang Tshering
- Department of Pharmacy, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- * E-mail:
| | - Kinzang Wangchuk
- Department of Community Health, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Zimba Letho
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Shintani T, Iwata T, Okada M, Nakaoka M, Yamasaki N, Fujii T, Shiba H. Clinical Outcomes of Post-exposure Prophylaxis following Occupational Exposure to Human Immunodeficiency Virus at Dental Departments of Hiroshima University Hospital. Curr HIV Res 2020; 18:475-479. [PMID: 32753017 PMCID: PMC8388063 DOI: 10.2174/1570162x18666200804151118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/22/2022]
Abstract
Background Dental professionals have so many opportunities to use injection needles and sharp instruments during dental treatment that they face an increased risk of needlestick injuries. This retrospective study reports the utilization and clinical outcomes of occupational post-exposure prophylaxis (PEP) with anti-retroviral agents after being potentially exposed to HIV at the dental departments of Hiroshima University Hospital. Objective This study reports the utilization and clinical outcomes of occupational post-exposure prophylaxis (PEP) with antiretroviral agents after being potentially exposed to HIV at dental departments of Hiroshima University Hospital. Methods Data on the clinical status of HIV-infected source patients and information on HIV-exposed dental professionals from 2007 to 2018 were collected. Results Five dentists with an average experience of 5.6 years (1-15 years) were exposed. The averaged CD4-positive cell number and HIV-RNA load were 1176 (768-1898) /μl and less than 20 copies/ml, respectively, in all the patients. Two of the five HIV exposed dentists received PEP. Three months after the exposures, all of their results were negative in HIV antibody/antigen tests. Conclusion These data might support the concept of “undetectable equals untransmittable”, although HIV exposure in this study was not through sexual transmission.
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Affiliation(s)
- T Shintani
- Center of Oral Clinical Examination, Hiroshima University Hospital, Japan
| | - T Iwata
- Department of Periodontal Medicine, Graduate School of Biomedical & Sciences, Hiroshima University, Japan
| | - M Okada
- Division of Dental Hygiene, Department of Clinical Practice and Support, Hiroshima University Hospital, Japan
| | - M Nakaoka
- Division of Dental Hygiene, Department of Clinical Practice and Support, Hiroshima University Hospital, Japan
| | - N Yamasaki
- Division of Blood Transfusion, Hiroshima University Hospital, Japan,AIDS Care Unit, Hiroshima University Hospital, Japan
| | - T Fujii
- Division of Blood Transfusion, Hiroshima University Hospital, Japan,AIDS Care Unit, Hiroshima University Hospital, Japan
| | - H Shiba
- Center of Oral Clinical Examination, Hiroshima University Hospital, Japan,Department of Biological Endodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
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Minoyan N, Artenie AA, Zang G, Jutras-Aswad D, Turcotte MÈ, Bruneau J. Harm Reduction Coverage and Hepatitis C Incidence: Findings From a Cohort of People Who Inject Drugs. Am J Prev Med 2020; 58:845-853. [PMID: 32444003 DOI: 10.1016/j.amepre.2020.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Needle and syringe programs and opioid agonist therapy are essential for harm reduction among people who inject drugs. Few studies assess their combined potential in preventing hepatitis C virus infection. No studies have assessed whether they perform similarly among individuals at risk of primary and recurrent infection. This study aimed to estimate the rates of hepatitis C virus acquisition according to harm reduction coverage among hepatitis C virus-naive and previously infected people who inject drugs in Montreal, Canada. METHODS This prospective cohort study involved regular interviews and hepatitis C antibody and RNA testing (data collection: 2010-2017, analysis: 2018). Opioid agonist therapy coverage was defined by current dose: high (≥60 mg/day methadone, ≥16 mg buprenorphine), low, or none. Complete needle and syringe program coverage was defined as exclusively reporting safe needle and syringe sources (past 6 or 3 months). Combined coverage was defined as full (high-dose agonist/complete needle/syringe coverage), minimal (low-dose agonist/incomplete needle/syringe coverage), and partial (remaining combinations). Cox regression models were fit. RESULTS A total of 106 events were observed over 1,183.1 person-years for primary and recurrent incidence rates of 10.6 (95% CI=8.0, 13.8) and 7.6 (95% CI=5.6, 9.9) per 100 years, respectively. High-dose opioid agonist therapy was associated with a 77% reduction in hepatitis C virus acquisition (hazard ratio=0.23, 95% CI=0.10, 0.50) compared with not receiving opioid agonist therapy. Needle and syringe coverage was not associated with infection rates. Estimates considering their combination reflected opioid agonist therapy coverage. Associations were similar among hepatitis C virus-naive and previously infected people who inject drugs. CONCLUSIONS High-dose opioid agonist therapy seems particularly important to reduce drug-related harms among hepatitis C virus-naive and previously infected people who inject drugs in Montreal.
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Affiliation(s)
- Nanor Minoyan
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Andreea A Artenie
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Geng Zang
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Didier Jutras-Aswad
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Ève Turcotte
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Julie Bruneau
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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HOŞGÖR H. Assessment of the frequency of hepatitis A, B, C and HIV infections in dental patients of Kocaeli University, Faculty of Dentistry. ACTA ODONTOLOGICA TURCICA 2020. [DOI: 10.17214/gaziaot.612592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Rasoolinejad M, Abedinia N, Noorbala AA, Mohraz M, McMillan I, Moradmand B, Gilkison JH. Stigma and Dissatisfaction of Health Care Personnel in HIV Response in Iran: A Qualitative Study. J Int Assoc Provid AIDS Care 2020; 18:2325958219829606. [PMID: 30782052 PMCID: PMC6748510 DOI: 10.1177/2325958219829606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: With regard to the disease pandemics of HIV/AIDS, it is clear that there is need for
prevention, treatment, care, and support of HIV positive patients in the health care
system. In order to achieve these goals, job satisfaction should be a priority for
health care staff. This study examined the problems of health care personnel and the
behavior of patients undergoing HIV/AIDS counseling at Imam Khomeini Hospital in Tehran,
Iran. Methods: Interviews were conducted individually with 5 health care personnel who participated in
this study. Participants had 30 to 45 minutes each per session at the clinic, during
which they were able to discuss the problems they faced in their careers. All
conversations were officially recorded. Results: The most common problems mentioned by these health care workers included the lack of
safety and standardization of work conditions, the lack of appropriate equipment,
limited space, high numbers of patients, low staffing levels and financial and morale
problems compounded by the lack of support by hospital authorities. Conclusion: The authorities need to allocate more funds to provide facilities and appropriate
working conditions for health care staff in order to increase job satisfaction and
enable staff to provide the best services and care to HIV positive patients.
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Affiliation(s)
- Mehrnaz Rasoolinejad
- 1 Department of Infections, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran (TUMS)
| | - Nasrin Abedinia
- 1 Department of Infections, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran (TUMS)
| | - Ahmad Ali Noorbala
- 2 Department Psychiatric, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran (TUMS)
| | - Minoo Mohraz
- 1 Department of Infections, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran (TUMS)
| | | | - Banafsheh Moradmand
- 4 Department of Public Health, Faculty of Public Health, Flinders University, Flinders, Australia
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18
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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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Baladakis J, Perera M, Bolton D, Lawrentschuk N, Adam A. Is There an Optimal Curative Option in HIV-Positive Men with Localized Prostate Cancer? A Systematic Review. Curr Urol 2019; 12:169-176. [PMID: 31602182 DOI: 10.1159/000499309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/10/2017] [Indexed: 12/30/2022] Open
Abstract
Aims We aimed to compare the outcome of curative treatment options in localised Prostate Cancer (PCa) amongst HIV positive (HIV+) men. Methods A systematic search of the Cochrane Library of Systematic Reviews, the Scopus and PubMed databases was performed (January 1995 to November 2015) using pre-determined search terms. Outcome measures for comparison included the rate of biochemical failure (BCF), survival benefit and complications. Results A total of 14 eligible articles were identified for inclusion, representing a total of 202 HIV+ men with PCa. Radical Prostatectomy was performed in 40/153 compared to 109/153 patients undergoing alternative (non-surgical) treatments options. Only 3 studies compared outcomes within their respective study cohort. One study (n = 10) reported BCF results with 1/2 BCF patient in the surgical arm vs. 1/8 BCF positive patients in the non-surgical arm (mean 46 months follow-up), while two other studies reported no occurrences of BCF within both arms of their studies. Conclusion Due to paucity in the literature, there is insufficient evidence to support a certain treatment modality arm specifically for HIV+ men with localized PCa. An individualized management algorithm seems feasible within this cohort, until more definitive studies are performed.
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Affiliation(s)
- John Baladakis
- Department of Urology, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Division of Urology, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC.,Department of Surgery, University of Queensland, Brisbane, QLD
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC.,Olivia-Newton John Cancer Centre, University of Melbourne, Melbourne, VIC
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC.,Olivia-Newton John Cancer Centre, University of Melbourne, Melbourne, VIC.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ahmed Adam
- Department of Urology, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Division of Urology, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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20
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Al Wutayd O, AlRehaili A, AlSafrani K, Abalkhail A, AlEidi SM. Current Knowledge, Attitudes, and Practice of Medical Students Regarding the Risk of Hepatitis B Virus Infection and Control Measures at Qassim University. Open Access Maced J Med Sci 2019; 7:435-439. [PMID: 30834016 PMCID: PMC6390161 DOI: 10.3889/oamjms.2019.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/09/2019] [Accepted: 02/05/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND: Medical students are exposed to occupational health hazards in hospitals during their studies and lack sufficient education about infection control measures. Injury to medical students is a substantial problem and students have an increased risk of hepatitis B virus (HBV). To understand how medical students think about infection control, it is important to identify the strengths and weaknesses of their education. AIM: To assess current knowledge, attitudes, and practice of medical students regarding HBV infection and control measures at Qassim University, Saudi Arabia. MATERIAL AND METHODS: A cross-sectional study was conducted at a medical college. Participants completed a 39-item self-administered questionnaire assessing demographics, knowledge, attitudes, and practice. Item response frequencies were calculated. Responses were recorded into yes (strongly agree and agree) and no (neutral, disagree, and strongly disagree) answers. Correct responses were totalled and categorised as good or poor performance. A scale cut-off of less than 75% correct responses was considered poor, and 75% or more correct responses was considered good. Odds ratios and 95% confidence intervals were calculated, and the chi-square test was used for analysis. RESULTS: A total of 21%, 41%, and 8% of students expressed good knowledge, attitudes, and practice, respectively. There was no statistically significant difference between males and females on knowledge (p = 0.089), attitudes (p = 0.829), and practice (p = 0.248). There was a statistically significant difference between academic years on knowledge (p = 0.0001), attitudes (p = 0.0001), and practice (p = 0.0001). CONCLUSION: Most medical students have poor knowledge, attitudes, and practice regarding the risk of HBV infection. It is recommended that a policy is implemented for training on infection prevention for all medical students before they start clinical practice. Prevention programs about HBV infection should be instituted, and existing programs must be strengthened.
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Affiliation(s)
- Osama Al Wutayd
- Department of Family and Community Medicine, Unaizah College of Medicine, Qassim University, Saudi Arabia
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21
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Prevalence of Needlestick Injuries, Attitude Changes, and Prevention Practices Over 12 Years in an Urban Academic Hospital Surgery Department. Ann Surg 2019; 267:291-296. [PMID: 28221166 DOI: 10.1097/sla.0000000000002178] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Needlestick injury prevalence, protection practices, and attitudes were assessed. Current medical students were compared with 2003 data to assess any changes that occurred with engineered safety feature implementation. BACKGROUND Risk of occupational exposure to bloodborne pathogens is elevated in the operating room particularly with surgeons in training and nurses. METHODS A cross-sectional survey was distributed to medical students (n = 358) and Department of Surgery staff (n = 247). RESULTS The survey response rate was 24.8%. Needlestick injuries were reported by 38.7% of respondents (11% high risk), and the most common cause was "careless/accidental." Needlestick injury prevalence increased from medical students to residents and fellows (100%). Thirty-three percent of injured personnel had at least one unreported injury, and the most common reason was "inconvenient/too time consuming." Needlestick injury prevalence and double-glove use in medical students did not differ from 2003, and 25% of fellows reported always wearing double gloves. The true seroconversion rate for bloodborne pathogens was underestimated or unknown. The concern for contracting a bloodborne pathogen significantly decreased (65%) compared to 2003, and there were significantly less medical students with hepatitis B vaccinations (78.3%). Level of concern for contracting a bloodborne pathogen was predictive of needlestick injury. CONCLUSIONS Needlestick injury and occupational exposure to bloodborne pathogens are significant hazards for surgeons and nurses. Attitudes regarding risk are changing, and the true seroconversion risk is underestimated. Educational efforts focused on needlestick injury prevalence, seroconversion rates, and double-glove perforation rates may be effective in implementing protective strategies.
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Padmanabhan K, Barik D. Health Hazards of Medical Waste and its Disposal. ENERGY FROM TOXIC ORGANIC WASTE FOR HEAT AND POWER GENERATION 2019. [PMCID: PMC7152398 DOI: 10.1016/b978-0-08-102528-4.00008-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Medical waste is a source of generation of hazardous biomedical waste. Medical waste generation and disposal is an important aspect, especially in countries with poor hygiene and high population. Medical centers including hospitals, clinics, and places where diagnosis and treatment are conducted generate wastes that are highly hazardous and put people under risk of fatal diseases. Policies should be framed to avoid spread of infections by providing specification for handling waste for generation, segregation, collection, storage, transportation, and treatment. Awareness should be created at all levels of society through various means of communication and education, so that the risks of spreading the health hazards could be minimized. This chapter deals with medical waste, principles of waste management program, categories of health-care waste, parameters to be monitored in health-care waste, finances to be managed, and national plans for health-care waste.
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Affiliation(s)
- K.K. Padmanabhan
- Department of Automobile Engineering, Karpagam Academy of Higher Education, Coimbatore, India
| | - Debabrata Barik
- Department of Mechanical Engineering, Karpagam Academy of Higher Education, Coimbatore, India
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Reddon H, Marshall BDL, Milloy MJ. Elimination of HIV transmission through novel and established prevention strategies among people who inject drugs. Lancet HIV 2018; 6:e128-e136. [PMID: 30558843 DOI: 10.1016/s2352-3018(18)30292-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/01/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022]
Abstract
Despite the effectiveness of existing HIV prevention strategies for people who inject drugs (PWID), uncontrolled outbreaks of HIV among this group are common and occur around the world. In this Review, we summarise recent evidence for novel and established HIV prevention approaches to eliminate HIV transmission among PWID. Effective HIV prevention strategies include mobile needle and syringe programmes, pre-exposure prophylaxis, supervised injection facilities, and, to a lesser extent, some behavioural interventions. Studies have also shown the cost-effectiveness of long-standing HIV prevention strategies including needle and syringe programmes, opioid agonist therapy, and antiretroviral therapy for prevention. Although each individual intervention can reduce the risk of HIV acquisition among PWID, there is a consensus that a combination of approaches is required to achieve substantial and durable reductions in HIV transmission. Unfortunately, in many settings, the implementation of these interventions is often limited by public and political opposition that manifests as structural barriers to HIV prevention, such as the criminalisation of drug use. Given that there is ample evidence showing the effectiveness of several HIV prevention methods, social and political advocacy will be needed to overcome these barriers and integrate innovative HIV prevention approaches with addiction science to create effective drug policies.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada.
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Yi Y, Yuan S, Li Y, Mo D, Zeng L. Assessment of adherence behaviors for the self-reporting of occupational exposure to blood and body fluids among registered nurses: A cross-sectional study. PLoS One 2018; 13:e0202069. [PMID: 30256805 PMCID: PMC6157846 DOI: 10.1371/journal.pone.0202069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 07/27/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In China, register nurses (RNs) have a high risk of occupational exposure to blood/body fluids. The adherence behavior related to self-reporting of occupational exposure needs to be evaluated to protect RNs from healthcare-related infections. OBJECTIVES To assess adherence behaviors for self-reporting of occupational exposure to blood and body fluids among RNs and identify factors affecting self-reporting in Hunan Province, China for developing upgraded strategies. METHODS Study participants, randomly selected from six tertiary hospitals in Changsha City, completed a structured questionnaire. Frequencies and percentages were used to describe basic demographic data. One-way analysis of variance was performed to assess whether adherence behaviors were correlated to each other; the multivariate logistic regression analysis was performed to identify factors associated with reporting exposure to blood/body fluids. RESULTS In total, 548 RNs completed the questionnaire. All participants experienced sharp object injuries at least once during their career; 65.88% of participants were exposed to blood/body fluids thrice, and 31.2% experienced 1-5 occupational exposures in the past month. However, only 14.6% of participants submitted a blood/body fluid exposure report to a supervisor/official after every incident. Blood/body fluid exposure was associated with the non-usage of safety protocols. Only 10.2% of participants believed the employer paid more attention to needle-stick injuries (P<0.01) than to other injuries. Most participants (73.5%) reported the absence of psychological support after injuries (P<0.01). Nine personal and management factors were observed to be closely related to underreporting behavior. CONCLUSION The prevalence of exposure to blood/body fluids among RNs was high, and the underreporting rate was likely substantially underestimated. Safety-engineered devices must be adopted to decrease the prevalence of sharp object injuries. To encourage employees to report occupational exposure events, a series of hospital-wide actions need to be adopted.
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Affiliation(s)
- Yifang Yi
- Division of Otorhinolaryngology, Xiangya Hospital of Central South University, Changsha City, Hu’nan Province, China
| | - Sue Yuan
- Xianga Nursing School of Central South University, Changsha City, Hu’nan Province, China
- Department of Infectious Disease, Xianga Hospital of Central South University, Changsha City, Hu’nan Province, China
| | - Yinglan Li
- Department of Nursing Management, Xiangya Hospital of Central South University, Changsha City, Hu’nan Province, China
| | - Dan Mo
- Department of Infectious Disease, Xianga Hospital of Central South University, Changsha City, Hu’nan Province, China
| | - Li Zeng
- Department of Burns Surgery, Xiangya Hospital of Central South University, Changsha City, Hu’nan Province, China
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Libois A, Florence E, Derdelinckx I, Yombi JC, Henrard S, Uurlings F, Vandecasteele S, Allard SD, Demeester R, Van Wanzeele F, Ausselet N, De Wit S. Belgian guidelines for non-occupational HIV post-exposure prophylaxis 2017. Acta Clin Belg 2018; 73:275-280. [PMID: 29429390 DOI: 10.1080/17843286.2018.1428506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We present the updated Belgian guidelines for the use of non-occupational HIV post-exposure prophylaxis (NONOPEP). This document is inspired by UK guidelines 2015, adapted to the Belgian situation and approved by all AIDS reference centers in Belgium. When recommended, NONOPEP should be initiated as soon as possible, preferably within 24 h of exposure but can be offered up to 72 h. The duration of NONOPEP should be 28 days. These current guidelines include epidemiologic estimations, which can be used to calculate the risk of infection after a potential exposure and help to decide whether or not to start prophylaxis. We review which medications to use in the context of the last Belgian NONOPEP convention, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving NONOPEP.
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Affiliation(s)
- Agnès Libois
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Inge Derdelinckx
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine, Infectious Diseases and Tropical Medicine Unit, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Sophie Henrard
- Centre de Référence SIDA, Unité de Traitements des Immunodéficiences, Hôpital Erasme, Route de Lennik 808, Bruxelles, Belgium
| | - Françoise Uurlings
- Infectious Diseases Department, Liège University Hospital, Liège, Belgium
| | - Stefaan Vandecasteele
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, Belgium
| | - Sabine D. Allard
- Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Rémy Demeester
- Department of Internal Medicine and Infectious Diseases, CHU de Charleroi, Charleroi, Belgium
| | - Filip Van Wanzeele
- Department of General Internal Medicine, Infectious Diseases and Psychosomatics, Ghent University Hospital, Ghent, Belgium
| | | | - Stéphane De Wit
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Calderwood AH, Day LW, Muthusamy VR, Collins J, Hambrick RD, Brock AS, Guda NM, Buscaglia JM, Petersen BT, Buttar NS, Khanna LG, Kushnir VM, Repaka A, Villa NA, Eisen GM. ASGE guideline for infection control during GI endoscopy. Gastrointest Endosc 2018; 87:1167-1179. [PMID: 29573782 DOI: 10.1016/j.gie.2017.12.009] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 02/08/2023]
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Bowman JR, Razi A, Watson SL, Pearson JM, Hudson PW, Patt JC, Ames SE, Leddy LR, Khoury JG, Tubb CC, McGwin G, Ponce BA. What Leads to Lead: Results of a Nationwide Survey Exploring Attitudes and Practices of Orthopaedic Surgery Residents Regarding Radiation Safety. J Bone Joint Surg Am 2018; 100:e16. [PMID: 29406352 DOI: 10.2106/jbjs.17.00604] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Excessive radiation to health-care providers has been linked to risks of cancer and cataracts, but its negative effects can be substantially reduced by lead aprons, thyroid shields, and leaded glasses. Hospitals are required to provide education and proper personal protective equipment, yet discrepancies exist between recommendations and compliance. This article presents the results of a survey of U.S. orthopaedic surgery residents concerning attitudes toward radiation exposure and personal protective equipment behavior. METHODS An invitation to participate in a web-based, anonymous survey was distributed to 46 U.S. allopathic orthopaedic surgery residency programs (1,207 potential resident respondents). The survey was conceptually divided into the following areas: demographic characteristics, training and attitudes concerning occupational hazards, personal protective equipment provision and use, and general safety knowledge. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated for the association between these characteristics and compliance with thyroid shield or lead gown wear. RESULTS In this study, 518 surveys were received, with 1 survey excluded because of insufficient response, leaving 517 surveys for analysis (42.8% response rate). Ninety-eight percent of residents believed that personal protective equipment should be provided by the hospital or residency program. However, provision of personal protective equipment was not universal, with 33.8% reporting none and 54.2% reporting provision of a gown and thyroid shield. The prevalence of leaded glasses usage was 21%. Poor lead gown compliance and thyroid shield wear were associated with difficulty finding the corresponding equipment: PR, 2.51 (95% CI, 1.75 to 3.62; p < 0.001) for poor lead gown compliance and PR, 2.14 (95% CI, 1.46 to 3.16; p < 0.0001) for poor thyroid shield wear. Not being provided with personal protective equipment was also significantly associated with low compliance with both lead gowns (PR, 1.47 [95% CI, 1.04 to 2.08]; p = 0.03) and thyroid shields (PR, 1.69 [95% CI, 1.18 to 2.41]; p = 0.004). Respondents from the Southeast, West, or Midwest had lower compliance with lead gown usage. Forgetting was the number 1 reason to not wear a lead apron (42%). CONCLUSIONS Radiation exposure is associated with increased risk of serious health problems. Our findings identified that the availability of lead personal protective equipment leads to increased compliance among residents surveyed. In addition to yearly occupational hazard training specific to orthopaedic surgery, greater efforts by residency programs and hospitals are needed to improve access to lead personal protective equipment and compliance for orthopaedic residents.
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Affiliation(s)
- James R Bowman
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Afshin Razi
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | | | | | - Parke W Hudson
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Lee R Leddy
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Creighton C Tubb
- New Braunfels Orthopedic Surgery & Sports Medicine, New Braunfels, Texas
| | - Gerald McGwin
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Brent A Ponce
- University of Alabama at Birmingham, Birmingham, Alabama
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Oishi N, Bagán JV, Javier K, Zapater E. Head and Neck Lymphomas in HIV Patients: a Clinical Perspective. Int Arch Otorhinolaryngol 2017; 21:399-407. [PMID: 29018505 PMCID: PMC5629092 DOI: 10.1055/s-0036-1597825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022] Open
Abstract
Introduction Because of the many HIV-related malignancies, the diagnosis and treatment of lymphoma in patients infected with human immunodeficiency virus are challenging. Objective Here, we review current knowledge of the pathogenesis, epidemiology, symptomatology, diagnosis, and treatment of head and neck lymphomas in HIV patients from a clinical perspective. Data Synthesis Although Hodgkin's lymphoma is not an AIDS-defining neoplasm, its prevalence is ten times higher in HIV patients than in the general population. NHL is the second most common malignancy in HIV patients, after Kaposi's sarcoma. In this group of patients, NHL is characterized by rapid progression, frequent extranodal involvement, and a poor outcome. HIV-related salivary gland disease is a benign condition that shares some features with lymphomas and is considered in their differential diagnosis. Conclusion The otolaryngologist may be the first clinician to diagnose head and neck lymphomas. The increasing survival of HIV patients implies clinical and epidemiological changes in the behavior of this disease. Early diagnosis is important to improve the prognosis and avoid the propagation of HIV infection.
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Affiliation(s)
- Natsuki Oishi
- ENT Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
- ENT Department, Universitat de Valencia Facultat de Medicina i Odontologia, Valencia, Comunitat Valenciana, Spain
| | - José Vicente Bagán
- Department of Stomatology, Consorci Hospital General Universitari de Valencia, Valencia, Comunitat Valenciana, Spain
| | - Karla Javier
- Department of Haematology, Consorci Hospital General Universitari de Valencia, Valencia, Comunitat Valenciana, Spain
| | - Enrique Zapater
- ENT Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
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Ngatu NR, Kayembe NJM, Phillips EK, Okech-Ojony J, Patou-Musumari M, Gaspard-Kibukusa M, Madone-Mandina N, Godefroid-Mayala M, Mutaawe L, Manzengo C, Roger-Wumba D, Nojima S. Epidemiology of ebolavirus disease (EVD) and occupational EVD in health care workers in Sub-Saharan Africa: Need for strengthened public health preparedness. J Epidemiol 2017; 27:455-461. [PMID: 28416172 PMCID: PMC5602796 DOI: 10.1016/j.je.2016.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/02/2016] [Indexed: 02/01/2023] Open
Abstract
Ebolavirus disease (EVD) is a severe contagious disease in humans, and health care workers (HCW) are at risk of infection when caring for EVD patients. This paper highlights the epidemiologic profile of EVD and its impact on the health care workforce in Africa. A documentary study was conducted which consisted of a review of available literature regarding the epidemiology of EVD, occupational EVD (OEVD), and work safety issues in Sub-Saharan Africa; the literature findings are enriched by field experiences from the authors. EVD outbreaks have already caused 30,500 cases in humans of whom 12,933 died (as of September 9, 2015), and the number of infected HCW has dramatically increased. All eight HCW infected during the 2014 outbreak in Democratic Republic of the Congo died, whereas during the recent West African EVD epidemic more than 890 HCW were infected, with a case fatality rate of 57%. Occupational exposure to blood and other body fluids due to inadequate use of personal protective equipment and needle stick or sharp injuries are among factors that contribute to the occurrence of OEVD. Prevention of OEVD should be one of the top priorities in EVD outbreak preparedness and management, and research should be conducted to elucidate occupational and other factors that expose HCW to EVD. In addition to regularly training HCW to be adequately prepared to care for patients with EVD, it is critical to strengthen the general health care system and improve occupational safety in medical settings of countries at risk.
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Affiliation(s)
- Nlandu Roger Ngatu
- Graduate School of Health Sciences & Nursing, University de Kochi, Kochi, Japan.
| | - Ntumba Jean-Marie Kayembe
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Joa Okech-Ojony
- WHO-Ebolavirus Outbreak Response Team, WHO-Liberia, Moronvia, Liberia
| | - Masika Patou-Musumari
- Department of Global Health & Socioepidemiology, Kyoto University School of Public Health, Kyoto, Japan
| | - Mukunda Gaspard-Kibukusa
- Ministry of Social Affairs, Humanitarian Action and National Solidarity, Kinshasa, Democratic Republic of the Congo
| | - Ndona Madone-Mandina
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Lubogo Mutaawe
- WHO-Ebolavirus Outbreak Response Team, WHO-Liberia, Moronvia, Liberia
| | - Casimir Manzengo
- World Health Organization (WHO), Kinshasa, Democratic Republic of the Congo
| | - Dimosi Roger-Wumba
- Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Sayumi Nojima
- Graduate School of Health Sciences & Nursing, University de Kochi, Kochi, Japan
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Brewer JD, Elston DM, Vidimos AT, Rizza SA, Miller SJ. Managing sharps injuries and other occupational exposures to HIV, HBV, and HCV in the dermatology office. J Am Acad Dermatol 2017; 77:946-951.e6. [PMID: 28865865 DOI: 10.1016/j.jaad.2017.06.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/09/2017] [Accepted: 06/18/2017] [Indexed: 12/13/2022]
Abstract
Dermatologists and their staff are at risk for needlestick injuries and exposures to body fluids. Despite the availability of treatment to reduce the risk of blood-borne infection, many exposures go unreported. This paper identifies current recommendations and the specific details for response to occupational exposures to HIV, hepatitis B virus, and hepatitis C virus in the dermatology office. Issues surrounding each virus are discussed individually, and a summary step-by-step algorithm of how to proceed in the event of an occupational exposure is presented. In addition, a focused Practice Improvement Activity that is based on this paper and provides Maintenance of Certification credit has been developed. To view and participate, visit https://secure.dataharborsolutions.com/abdermorg/.
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Affiliation(s)
- Jerry D Brewer
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Dirk M Elston
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina
| | | | - Stacey A Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Stanley J Miller
- Department of Dermatology, Johns Hopkins Hospital, Baltimore, Maryland
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Seroconversion rate among health care workers exposed to HIV-contaminated body fluids: The University of Pittsburgh 13-year experience. Am J Infect Control 2017; 45:896-900. [PMID: 28449921 DOI: 10.1016/j.ajic.2017.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The studies enumerating the risk of HIV transmission to health care workers (HCWs) as 0.3% after percutaneous exposure to HIV-positive blood, and 0.09% after a mucous membrane exposure, are weakened by dated literature. Our study aims to demonstrate the seroconversion rate after exposure to HIV-contaminated body fluids in a major academic center in the United States. METHODS A prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at an academic medical center was analyzed. Data collected included the type of injury, injured body part, type of fluid, contamination of sharps, involvement of resident physicians, use of postexposure prophylaxis, and patients' HIV, hepatitis B virus, and hepatitis C virus status. RESULTS A total of 266 cases were included in the study. Most exposures were caused by percutaneous injuries (52.6%), followed by 43.2% mucocutaneous injuries. Of the injuries, 52.6% were to the hand and 33.5% to the face and neck. Blood exposure accounted for 64.3% of all cases. Of the patients, 21.1% received postexposure prophylaxis. None of the HCWs exposed to HIV-contaminated body fluids seroconverted (seroconversion rate, 0%). CONCLUSIONS HIV does not seem to be as easily transmitted by needlestick, laceration, or splash injuries as previously surmised. Further large-scale and multicenter studies are needed for a more accurate estimation of the risk of transmission of HIV in U.S. health care workers.
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DiGiacomo JC, Angus LG. Thoracotomy in the emergency department for resuscitation of the mortally injured. Chin J Traumatol 2017; 20:141-146. [PMID: 28550970 PMCID: PMC5473713 DOI: 10.1016/j.cjtee.2017.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/24/2017] [Accepted: 03/08/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Emergency department resuscitative thoracotomy is an intervention of last resort for the acutely dying victim of trauma. In light of improvements in pre-hospital emergency systems, improved operative strategies for survival such as damage control and improvements in critical care medicine, the most extreme of resuscitation efforts should be re-evaluated for the potential survivor, with success properly defined as the return of vital signs which allow transport of the patient to the operating room. METHODS A retrospective review of all patients at a suburban level I trauma center who underwent emergency department resuscitative thoracotomy as an adjunct to the resuscitation efforts normally delivered in the trauma receiving area over a 22 year period was performed. Survival of emergency department resuscitative thoracotomy was defined as restoration of vital signs and transport out of the trauma resuscitation area to the operating room. RESULTS Sixty-eight patients were identified, of whom 27 survived the emergency department resuscitative thoracotomy and were transported to the operating room. Review of pre-hospital and initial hospital data between these potential long term survivors and those who died in the emergency department failed to demonstrate trends which were predictive of survival of emergency department resuscitative thoracotomy. The only subgroup which failed to respond to emergency department resuscitative thoracotomy was patients without signs of life at the scene who arrived to the treatment facility without signs of life. CONCLUSION The patient population of the "potential survivor" has been expanded due to advances in critical care practices, technology, and surgical technique and every opportunity for survival should be provided at the outset. Emergency department resuscitative thoracotomy is warranted for any patient with thoracic or subdiaphragmatic trauma who presents in extremis with a history of signs of life at the scene or organized cardiac activity upon arrival. Patients who have no evidence of signs of life at the scene and have no organized cardiac activity upon arrival should be pronounced.
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Bhatia R. Emerging Challenges and Opportunities in Medical Microbiology. Indian J Med Microbiol 2017; 35:4-7. [DOI: 10.4103/ijmm.ijmm_17_88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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He L, Lu Z, Huang J, Zhou Y, Huang J, Bi Y, Li J. An Integrated Intervention for Increasing Clinical Nurses' Knowledge of HIV/AIDS-Related Occupational Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111094. [PMID: 27828002 PMCID: PMC5129304 DOI: 10.3390/ijerph13111094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 12/28/2022]
Abstract
Background: Approximately 35 new HIV (Human Immunodeficiency Virus, HIV) cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS) and HIV-related occupational safety. At this time, universal protection precautions are not strictly implemented in Chinese hospitals. Lack of training may place nurses at risk for occupational exposure to blood-borne pathogens. Objectives: To assess the effectiveness of integrated interventions on nurses’ knowledge improvement about reducing the risk of occupationally acquired HIV infection. Methods: We audited integrated interventions using 300 questionnaires collected from nurses at the Affiliated Hospital of Xiangnan University, a public polyclinic in Hunan Province. The intervention studied was multifaceted and included appropriate and targeted training content for hospital, department and individual levels. After three months of occupational safety integrated interventions, 234 participants who completed the program were assessed. Results: Of the subjects studied, 94.3% (283/300) were injured one or more times by medical sharp instruments or splashed by body fluids in the last year and 95.3% considered their risk of occupational exposure high or very high. After the intervention, awareness of HIV/AIDS-related knowledge improved significantly (χ2 = 86.34, p = 0.00), and correct answers increased from 67.9% to 82.34%. Correct answers regarding risk perception were significantly different between pre-test (54.4%) and post-test (66.6%) (χ2 = 73.2, p = 0.00). When coming into contact with patient body fluids and blood only 24.0% of subjects used gloves regularly. The pre-test knowledge scores on universal precautions were relatively high. Correct answers about universal precautions improved significantly from pre-test (83.71%) to post-test (89.58%; χ2 = 25.00, p = 0.00). After the intervention, nurses’ attitude scores improved significantly from pre-test (3.80 ± 0.79) to post-test (4.06 ± 0.75; t = 3.74, p = 0.00). Conclusions: Integrated educational interventions enhance nurses’ knowledge of risk reduction for occupationally acquired HIV infections and improve the observance of universal precautionary procedures. This enhancement allows nurses to assume a teaching role for prevention and management of HIV/AIDS.
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Affiliation(s)
- Liping He
- School of Public Health, Wuhan University, Wuhan 430072, China.
- School of Public Health, Xiangnan University, Chenzhou 423000, China.
| | - Zhiyan Lu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan 430072, China.
| | - Jing Huang
- The Affiliated Hospital of Xiangnan University, Chenzhou 423000, China.
| | - Yiping Zhou
- School of Public Health, Xiangnan University, Chenzhou 423000, China.
| | - Jian Huang
- Chenzhou City Center for Disease Control and Prevention, Chenzhou 423000, China.
| | - Yongyi Bi
- School of Public Health, Wuhan University, Wuhan 430072, China.
| | - Jun Li
- School of Public Health, Xiangnan University, Chenzhou 423000, China.
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Jaspal R, Nerlich B. A ‘morning-after’ pill for HIV? Social representations of post-exposure prophylaxis for HIV in the British print media. HEALTH RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2016.1222354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gańczak M, Milona M, Szych Z. Nurses and Occupational Exposures to Bloodborne Viruses in Poland. Infect Control Hosp Epidemiol 2016; 27:175-80. [PMID: 16465634 DOI: 10.1086/500333] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Accepted: 08/16/2004] [Indexed: 11/04/2022]
Abstract
Study Objective.To record descriptions of occupational exposures to blood, determine factors predictive of exposure, and identify interventions that might reduce the frequency of exposure.Design.An analytic, cross-sectional survey.Study Population.A total of 601 nurses from surgical wards, operating rooms, and emergency departments.Study Instrument.An anonymous questionnaire developed by the authors on the basis of previously published guidelines was distributed between January and March 2003.Sampling.Random, with 18 hospitals selected from 2 urban and rural locations.Results.Almost half of respondents reported having had at least 1 puncture injury during the preceding year, 1 in 5 had exposure via mucous membranes, and more than half had worked at least once with a recent abrasion or cut on their hands. The number of injuries was independent of age (P = .26), duration of practice (P = .21), and workplace setting (P = .78). The percentage of nurses without percutaneous exposure during the preceding year was significantly higher in the group that received special HIV/AIDS training than in the group that did not (95% confidence interval, 5.8-24.1%; P<.002). The most recent exposure was primarily caused by hollow-bore needles, involved the palm and fingers II-V, was self-inflicted, took place during an elective procedure, and was not reported to the hospital's infection control center by 74% of respondents. The most common reason for not reporting the exposure (38% of cases) was the conviction that the source patient was not infected.Conclusions.Because of the large number of occupational exposures to blood, especially those due to injuries with hollow-bore needles, nurses should adopt more adequate behavioral strategies to prevent the transmission of blood-borne pathogens. Policies for providing adequate education programs tailored to encourage nurses to report all exposures are urgently required.
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Affiliation(s)
- Maria Gańczak
- Department of Hygiene and Epidemiology, Pomeranian Medical University, Szczecin, Poland.
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Winkelmann M, Sorrentino JN, Klein M, Macke C, Mommsen P, Brand S, Schröter C, Krettek C, Zeckey C. Is there a benefit for health care workers in testing HIV, HCV and HBV in routine before elective arthroplasty? Orthop Traumatol Surg Res 2016; 102:513-6. [PMID: 27062330 DOI: 10.1016/j.otsr.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Occupational infection of clinical health care workers with blood-borne viruses (BBVs) like human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) is a current and often emotionally discussed issue. HCV and especially HIV are still stigmatized. The consequence is a broad and maybe irrational fear of professional health care workers being infected occupationally. Therefore, we assessed preoperative screening to: (1) answer whether this can detect not previously diagnosed blood-borne virus infections to a great extent, (2) calculate a cost-benefit ratio to find out, if the screening's potential ability to prevent occupational transmission of BBVs to health care workers faces unjustifiable high costs. HYPOTHESIS Preoperative routine screening is limited suitable for enhancement of detecting fomites compared to interview the patient. MATERIALS AND METHODS Retrospective cohort study of preoperative screening for HIV, HBV and HCV (HBsAg, anti-HCV and HIV-Ab/Ag-Combination) for every patient who was admitted to the traumatologic department for elective arthroplasty between 01/01/1997 and 31/12/2008. RESULTS Among the 1534 patients who underwent elective prosthetic surgery [total hip (879) and knee arthroplasty (508), followed by shoulder, elbow and upper ankle joint], 693 (45.2%) patients were male and 841 (54.8) female. Mean age was 64.2±13.8 years. Screening tests were available for 1373 patients (89.5%). Among all screened patients, we found 21 HCV, 10 HBV and 1 HIV infections. 5 HBV (0.5%) and 7 HCV infections (0.7%) were unknown before. Every newly detected infectious patient occasions screening costs about 7250€. Considering this data, the risk of HCV transmission from an index patient with unknown status of infectiousness to health care worker after percutaneous contact to blood is 0.08 ‰ and of HIV transmission is 0.00054 ‰ in our study population. DISCUSSION Routine preoperative screening for BBVs of patients undergoing elective arthroplasty, who were asked for HBV, HCV and HIV, should be reconsidered and is, in times of sparse funds, overpriced. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M Winkelmann
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - J-N Sorrentino
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - M Klein
- Department for Orthopedics and Traumatology, Sana Hospital Hameln, Saint-Maur-Platz 1, 31785 Hameln, Germany
| | - C Macke
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - P Mommsen
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - S Brand
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - C Schröter
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - C Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - C Zeckey
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Cresswell F, Waters L, Briggs E, Fox J, Harbottle J, Hawkins D, Murchie M, Radcliffe K, Rafferty P, Rodger A, Fisher M. UK guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure, 2015. Int J STD AIDS 2016; 27:713-38. [PMID: 27095790 DOI: 10.1177/0956462416641813] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/18/2016] [Indexed: 11/15/2022]
Abstract
We present the updated British Association for Sexual Health and HIV guidelines for HIV post-exposure prophylaxis following sexual exposure (PEPSE). This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE should and should not be considered. We also review which medications to use for PEPSE, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving PEPSE. Special scenarios, cost-effectiveness of PEPSE, and issues relating to service provision are also discussed. Throughout the document, the place of PEPSE within the broader context of other HIV prevention strategies is considered.
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Moorhouse M, Bekker LG, Black V, Conradie F, Harley B, Howell P, Maartens G, Papavarnavas T, Rebe K, Sorour G, Venter F, Wallis CL. Guideline on the management of occupational and non-occupational exposure to the human immunodeficiency virus and recommendations for post-exposure prophylaxis: 2015 Update. South Afr J HIV Med 2015; 16:399. [PMID: 29568597 PMCID: PMC5843151 DOI: 10.4102/sajhivmed.v16i1.399] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This guideline is an update of the post-exposure prophylaxis (PEP) guideline published by the Southern African HIV Clinicians Society in 2008. It updates the recommendations on the use of antiretroviral medications to prevent individuals who have been exposed to a potential HIV source, via either occupational or non-occupational exposure, from becoming infected with HIV. No distinction is made between occupational or non-occupational exposure, and the guideline promotes the provision of PEP with three antiretroviral drugs if the exposure confers a significant transmission risk. The present guideline aligns with the principles of the World Health Organization PEP guidelines (2014), promoting simplification and adherence support to individuals receiving PEP.
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Affiliation(s)
| | - Linda G Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - Vivian Black
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Francesca Conradie
- Right to Care and Clinical HIV Research Unit, University of Witwatersrand, South Africa
| | - Beth Harley
- City Health, City of Cape Town, South Africa
| | - Pauline Howell
- Wits Health Consortium, University of Witwatersrand, South Africa
| | - Gary Maartens
- Department of Medicine, University of Cape Town, South Africa
| | | | - Kevin Rebe
- Anova Health Institute, Johannesburg, South Africa
| | - Gillian Sorour
- Gauteng Department of Health, Gauteng, South Africa.,President's Emergency Plan for AIDS Relief, Wits Reproductive Health & HIV Institute, South Africa
| | - Francois Venter
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Carole L Wallis
- BARC, Johannesburg, South Africa.,Lancet Laboratories, Johannesburg, South Africa
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Tahir MA, Cheema A, Tareen S. Frequency of Hepatitis-B and C in patients undergoing cataract surgery in a tertiary care Centre. Pak J Med Sci 2015; 31:895-8. [PMID: 26430425 PMCID: PMC4590375 DOI: 10.12669/pjms.314.6771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To analyze the frequency of hepatitis B and C in patients undergoing cataract surgery. Methods: This descriptive study was conducted at department of Ophthalmology Jinnah Post Graduate Medical Centre. The duration of study was seven months from May 2013 to November 2013. After taking informed consent from the patient and hospital ethical committee all patients presenting with cataract and undergoing cataract surgery were evaluated for the existence of hepatitis C and B. Diagnosis of hepatitis C or B was made on the criteria that a patient must be positive for either Anti-HCV or HBsAg or both. Proformas were filled and data was collected and analysis was done. Pearson’s correlation coefficients were calculated to calculate the occurrence of hepatitis C and B in general population undergoing cataract surgery. Results: Six hundred and forty-eight patients were operated on for cataract surgery at Jinnah Post Graduate Medical Centre during the study period. Mean age of patients was 63 years, 300 (46.29%) were male and 348 (53.70%) female. Out of them 57 (8.79%) patients were carriers of either Hepatitis C or B. Hepatitis B accounted for 17 cases (2.62%) however Hepatitis C positive were 40 cases (6.17%). Nobody was simultaneously affected by both hepatitis C and B. Conclusion: Significant number of asymptomatic carriers of hepatitis C and B were found in preoperative cataract patients. It is recommended that preoperative screening of all cataract patients should be done so that asymptomatic carriers might not become a threat for spread of disease.
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Affiliation(s)
- Muhammad Ali Tahir
- Dr. Muhammad Ali Tahir, FCPS. Department of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Alyscia Cheema
- Dr. Alyscia Cheema, FCPS, FRCS. Department of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Saifullah Tareen
- Dr. Saifullah Tareen, FCPS. Department of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
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Agarwal J, Agarwal RS, Shrivastava A, Shrivastava S. Analysis of Information, Impact and Control of HIV amongst Dental Professionals of Central India. J Clin Diagn Res 2015; 9:ZC80-4. [PMID: 26393211 PMCID: PMC4573044 DOI: 10.7860/jcdr/2015/14300.6236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/08/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dental health care providers may be exposed to a variety of microorganisms via blood, oral or respiratory secretions. Though the risk of transmission of Human Immunodeficiency Virus (HIV) in dental settings is low, the consequences of being infected are life threatening. Therefore, high standards in infection control and waste management are required in controlling occupational contagion and cross infection. AIM To obtain comprehensive information about the HIV related information, its impact on the health care provider's attitude towards treating patients living with HIV/AIDS (PLWHA), infection control & waste disposal practices among dental professionals of Malwa region of Madhya Pradesh; situated in Central India. MATERIALS AND METHODS A cross-sectional survey was conducted among 320 private dental practitioners. Data was collected using a pretested, self administered 40 item questionnaire and statistically analysed. RESULTS The response rate was 81.25%. Over all 50.76% dentists were graded as having good knowledge of HIV. Unfortunately, their willingness to treat these patients remained low. In all 39.23% dentist were willing to render care to PLWHA. Junior dentists expressed less hesitation with regard to acceptance of risk patients than other dentists. Over 65% of the respondents reported adherence to universal precautions. The most alarming observation was that dentists were not following safe waste management practices. CONCLUSION Dental professionals continue to indicate a reluctance to treat patients with HIV/AIDS or those in high- risk groups. The results suggest need to have a comprehensive motivational program and implementing ways to ensure access and availability of safe dental care for PLWHA. The desire to get training on how to handle PLWHA illustrates that receptiveness to change exists.
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Affiliation(s)
- Jatin Agarwal
- Professor, Department of Prosthodontics, Sri Aurobindo college of Dentistry, Indore, India
| | - Rolly Shrivastava Agarwal
- Professor, Department of Conservative Dentistry and Endodontics, Sri Aurobindo college of Dentistry, Indore, India
| | - Asha Shrivastava
- Professor, Department of Physiology, GMC Medical College, Bhopal, India
| | - Sudha Shrivastava
- Professor, Department of Anatomy, MGMC Medical College, Indore, India
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Laramie AK, Pun VC, Fang SC, Kriebel D, Davis L. Sharps Injuries among Employees of Acute Care Hospitals in Massachusetts, 2002–2007. Infect Control Hosp Epidemiol 2015; 32:538-44. [DOI: 10.1086/660012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.Sharps with engineered sharps injury protections (SESIPs) have been found to reduce risk of sharps injuries (Sis). We examined trends in SI rates among employees of acute care hospitals in Massachusetts, including the impact of SESIPs on SI trends during 2002-2007.Design.Prospective surveillance.Setting.Seventy-six acute care hospitals licensed by the Massachusetts Department of Public Health.Participants.Employees of acute care hospitals who reported Sis to their employers.Methods.Data on Sis in acute care hospitals collected by the Massachusetts Sharps Injury Surveillance System were used to examine trends in SI rates over time by occupation, hospital size, and device. Negative binomial regression was used to assess trends.Results.During 2002-2007, 16,158 Sis among employees of 76 acute care hospitals were reported to the surveillance system. The annual SI rate decreased by 22%, with an annual decline of 4.7% (P< .001). Rates declined significantly among nurses (—7.2% per year;P< .001) but not among physicians (—0.9% per year;P= .553). SI rates associated with winged steel needles and hypodermic needles and syringes also declined significantly as the proportion of injuries involving devices with sharps injury prevention features increased during the same time period.Conclusion.SI rates involving devices for which SESIPs are widely available and appear to be increasingly used have declined. The continued use of devices lacking SI protections for which SESIPs are available needs to be addressed. The extent to which injuries involving SESIPs are due to flaws in design or lack of experience and training must be examined.
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Askarian M, Mirzaei K, Assadian O. Iranians' Attitudes About Possible Human Immunodeficiency Virus Transmission in Dental Settings. Infect Control Hosp Epidemiol 2015; 28:234-7. [PMID: 17265412 DOI: 10.1086/509860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Accepted: 06/30/2005] [Indexed: 11/03/2022]
Abstract
We conducted a cross-sectional survey from October through December 2004 of 8,312 residents of Shiraz, Iran, to investigate Iranians' perceptions about undergoing dental treatment in dental offices where other patients or the dentist and/or dental assistants are infected with human immunodeficiency virus (HIV). Most survey respondents (83%) had acceptable general knowledge about the mode of transmission of HIV and about acquired immunodeficiency syndrome (AIDS); however, many misconceptions were observed. A negative association was detected between the level of concern about contracting HIV/AIDS and the intention to continue treatment in services where patients with HIV/AIDS were also treated or where the dentist and/or dental assistants had HIV/AIDS.
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Affiliation(s)
- Mehrdad Askarian
- Department of Community Medicine, Shiraz Medical School, Shiraz, Iran.
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Green-McKenzie J, Shofer FS. Duration of Time on Shift Before Accidental Blood or Body Fluid Exposure for Housestaff, Nurses, and Technicians. Infect Control Hosp Epidemiol 2015; 28:5-9. [PMID: 17230381 DOI: 10.1086/510568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 04/14/2006] [Indexed: 11/04/2022]
Abstract
Background.Shift work has been found to be associated with an increased rate of errors and accidents among healthcare workers (HCWs), but the effect of shift work on accidental blood and body fluid exposure sustained by HCWs has not been well characterized.Objectives.To determine the duration of time on shift before accidental blood and body fluid exposure in housestaff, nurses, and technicians and the proportion of housestaff who sustain a blood and body fluid exposure after 12 hours on duty.Methods.This retrospective, descriptive study was conducted during a 24-month period at a large urban teaching hospital. Participants were HCWs who sustained an accidental blood and body fluid exposure.Results.Housestaff were on duty significantly longer than both nursing staff (P = .02) and technicians (P < .0001) before accidental blood and body fluid exposure. Half of the blood and body fluid exposures sustained by housestaff occurred after being on duty 8 hours or more, and 24% were sustained after being on duty 12 hours or more. Of all HCWs, 3% reported an accidental blood and body fluid exposure, with specific rates of 7.9% among nurses, 9.4% among housestaff, and 3% among phlebotomists.Conclusions.Housestaff were significantly more likely to have longer duration of time on shift before blood and body fluid exposure than were the other groups. Almost one-quarter of accidental blood and body fluid exposures to housestaff were incurred after they had been on duty for 12 hours or more. Housestaff sustained a higher rate of accidental blood and body fluid exposures than did nursing staff and technicians.
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O'Malley EM, Scott RD, Gayle J, Dekutoski J, Foltzer M, Lundstrom TS, Welbel S, Chiarello LA, Panlilio AL. Costs of Management of Occupational Exposures to Blood and Body Fluids. Infect Control Hosp Epidemiol 2015; 28:774-82. [PMID: 17564978 DOI: 10.1086/518729] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 12/15/2006] [Indexed: 11/04/2022]
Abstract
Objective.To determine the cost of management of occupational exposures to blood and body fluids.Design.A convenience sample of 4 healthcare facilities provided information on the cost of management of occupational exposures that varied in type, severity, and exposure source infection status. Detailed information was collected on time spent reporting, managing, and following up the exposures; salaries (including benefits) for representative staff who sustained and who managed exposures; and costs (not charges) for laboratory testing of exposure sources and exposed healthcare personnel, as well as any postexposure prophylaxis taken by the exposed personnel. Resources used were stratified by the phase of exposure management: exposure reporting, initial management, and follow-up. Data for 31 exposure scenarios were analyzed. Costs were given in 2003 US dollars.Setting.The 4 facilities providing data were a 600-bed public hospital, a 244-bed Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a 3,500-bed healthcare system.Results.The overall range of costs to manage reported exposures was $71-$4,838. Mean total costs varied greatly by the infection status of the source patient. The overall mean cost for exposures to human immunodeficiency virus (HIV)-infected source patients (n = 19, including those coinfected with hepatitis B or C virus) was $2,456 (range, $907-$4,838), whereas the overall mean cost for exposures to source patients with unknown or negative infection status (n = 8) was $376 (range, $71-$860). Lastly, the overall mean cost of management of reported exposures for source patients infected with hepatitis C virus (n = 4) was $650 (range, $186-$856).Conclusions.Management of occupational exposures to blood and body fluids is costly, the best way to avoid these costs is by prevention of exposures.
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Affiliation(s)
- Emily M O'Malley
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Camacho-Ortiz A. Failure of HIV Postexposure Prophylaxis after a Work-Related Needlestick Injury. Infect Control Hosp Epidemiol 2015; 33:646-7. [DOI: 10.1086/665718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Montufar Andrade FE, Villa Franco JP, Madrid Muñoz CA, Díaz Correa LM, Vega Miranda J, Vélez Rivera JD, Zuleta JJ. Infección por VIH posterior a exposición ocupacional de riesgo biológico en trabajadores de la salud. INFECTIO 2015. [DOI: 10.1016/j.infect.2014.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Utkarsha Lokesh, Srinidhi D, Sudhakara Reddy K. Post exposure prophylaxis to occupational injuries for general dentist. J Indian Prosthodont Soc 2014; 14:1-3. [PMID: 26199484 PMCID: PMC4501978 DOI: 10.1007/s13191-012-0176-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/21/2012] [Indexed: 11/30/2022] Open
Abstract
Occupational injuries which expose health-care professionals to blood-borne pathogens continue to be an important public health concern. Especially, dentists are at increased risk of exposure to Hepatitis B, Hepatitis C, and HIV. Dentists should remember and apply many precautions to prevent the broad spectrum of sharps and splash injuries that could occur during the delivery of dental care. This article updates and consolidates recommendations for the management of dental health-care personnel who have occupational exposure to blood and other body fluids.
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Affiliation(s)
- Utkarsha Lokesh
- />Department of Oral Maxillofacial Surgery, Sri Rajivgandhi College of Dental Sciences, Cholanagar, Hebbal post, Bangalore, India
| | - D. Srinidhi
- />Department of Oral Maxillofacial Surgery, Rajarajeshwari Dental College, Bangalore, India
| | - K. Sudhakara Reddy
- />Department of Oral Maxillofacial Surgery, Sri Rajivgandhi College of Dental Sciences, Bangalore, India
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Wu Q, Xue XF, Shah D, Zhao J, Hwang LY, Zhuang G. Knowledge, Attitude, and Practices Regarding Occupational HIV Exposure and Protection among Health Care Workers in China: Census Survey in a Rural Area. J Int Assoc Provid AIDS Care 2014; 15:363-9. [PMID: 25425637 DOI: 10.1177/2325957414558300] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health care workers (HCWs) seek, treat, and care for patients living with HIV/AIDS on a daily basis and thus face a significant risk to work-related infections. To assess the knowledge, attitude, and practices regarding occupational HIV exposure and protection among HCWs in low HIV prevalence areas of rural China. METHODS A cross-sectional questionnaire survey was carried out among all medical units in Pucheng County, Shaanxi, China. RESULTS Response rate of this study was 94%. The average overall knowledge score of HCWs was 10.9 of 21.0. Deficiencies in general, transmission, exposure, and protection knowledge were identified among HCWs at all levels. A high rate of occupational exposure (85%) and lack of universal precautions practice behavior were recorded. Significant predictors of universal precautions practice behavior were female sex, prior training, and greater knowledge about HIV/AIDS. CONCLUSION Health care workers at various levels have inadequate knowledge on HIV/AIDS and do not practice universal precautions. Nurses and medical technicians at the county level faced more occupation risk than other HCWs. The key of AIDS training for different levels of HCWs should be distinguished.
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Affiliation(s)
- Qian Wu
- Department of Epidemiology, Xi'an Jiaotong University School of Public Health, Shaanxi, People's Republic of China
| | - Xiao Fei Xue
- Pucheng County Hospital, Weinan, Shaanxi, People's Republic of China
| | - Dimpy Shah
- Division of Epidemiology, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Jian Zhao
- Pucheng County Hospital, Weinan, Shaanxi, People's Republic of China
| | - Lu-Yu Hwang
- Division of Epidemiology, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - GuiHua Zhuang
- Department of Epidemiology, Xi'an Jiaotong University School of Public Health, Shaanxi, People's Republic of China
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