Needlestick and sharps injuries among health-care workers in Taiwan

Effect of the Automatic Needle Destroyer on Healthcare Providers’ Work in an Emergency Department: A Mixed-Methods Study

Objectives: This study introduced a novel Automatic Needle Destroyer (AND) to an emergency department (ED) and assessed its effect on healthcare providers’ work.Methods: Between August and September 2019, in the ED of a tertiary hospital in Seoul, we conducted a mixed-methods study to evaluate the efficiency, safety, and usability of the AND using video analysis, surveys, and in-depth interviews, wherein participants described the advantages and disadvantages of the AND.Results: Compared to the existing method, introducing the AND significantly reduced the operating time from 2.32 ± 1.14 seconds to 1.77 ± 3.71 seconds (<i>p</i> < 0.001). The normal operation rate was 90.6%. The rate of needle-stick injuries (NSIs) and the mean system usability scale (SUS) showed no significant differences. The in-depth interviews indicated that the disadvantages of the AND were mostly operational. The advantages were related to profit, reduced direct contact with hazardous waste, and behavioral changes, such as not having to recap syringes.Conclusions: We introduced the AND to an ED environment, where NSIs occur frequently and many syringes are used, to evaluate its effect on providers’ work. The AND reduced the time for needle disposal, but the normal operation rate was low. No significant differences were found in the SUS score or the rate of NSIs. Although there are some restrictions on introducing the AND immediately, this study’s results showed its potential usefulness. Efforts to improve the operation of the device and a longer study period are needed to fully achieve safety and efficiency.

Factors Associated with Needle Stick and Sharp Injuries Among Healthcare Workers in North East Ethiopia

BACKGROUND

Percutaneous exposure to blood and body fluids through contaminated needle sticks and sharps are serious occupational hazards for morbidity and mortality from infections from blood-borne pathogens among healthcare workers. However, limited studies have been conducted to identify factors associated with needle stick and sharp injuries among healthcare workers in the study area. Therefore, this study aimed at identifying factors associated with needle stick and sharp injuries among healthcare workers.

METHODS

Institution-based cross-sectional study was conducted among healthcare workers at health facilities in Dessie from January to March 2018. A simple random sampling technique was used to recruit 362 healthcare workers. Data were collected using a structured self-administered questionnaire. The association between dependent and independent variables was checked using binary logistic regression and p-value ≤0.05 was used as a cut-off point for significance.

RESULTS

The entire work time and one-year prevalence of needle stick and sharp injury among healthcare workers were 60.2% and 40.1%, respectively. Working in private hospital (AOR = 9.619, 95% CI: 2.476, 27.373), working in private clinic (AOR = 3.308, 95% CI: 1.038, 8.506), less work experience (AOR = 2.762, 95% CI: 1.381, 4.521), higher workload (AOR = 3.794, 95% CI: 2.268, 6.346) and all-time availability of sharp storage and disposal containers (AOR = 0.435, 95% CI: 0.215, 0.879) were significant predictors of needle stick and sharp injuries.

CONCLUSION

Prevalence of needle stick and sharp injury was high. Working in private health institutions, less work experience, higher workload and all-time availability of sharp storage and disposal containers were significant predictors of needle stick and sharp injuries. Therefore, efforts have to be made to reduce the workload of healthcare workers and to available sharp storage and disposal containers all the time in the workplaces.

Use of Oral Vitamin-D Glass ampoule and tablet: Experience of patients and physicians

Objective:

To ascertain patients and physician views regarding hazard and compliance of oral liquid Vitamin D glass ampoule and tablets.

Methods:

This cross sectional survey was conducted from November 1^st 2016 to 15^th December 2016. Patients who were prescribed Vitamin D glass ampoule from oral route in last three months were included along with physicians who routinely prescribe vitamin D after taking informed consent. The participants were asked about injuries related to the use of glass ampoule, ease of using this from, after taste preference of tablet or injectable form as well as demography. Data was analysed with SPSS version 24.0.

Results:

Total 182 patients were included in the study with mean ± SD age of 39.4 ± 12.4 years. Majority of patients, 80.2% (142) said they prefer oral tablet in preference to injectable ampule in oral form if given choice while prescribing Vitamin D. Moreover 66.7% (64) doctors prefer to prescribe tablet form of Vitamin D instead of injection as oral form for vitamin D deficiency among their patients. One third of patients, 33% (n=59) sustained injury while breaking the ampule which included minor self-controlled bleeding by glass particles in 50% (n=35). Less than half of doctors 46.9% (n=45) said they taught their patients about usage of injectable Vitamin D ampules.

Conclusion:

Majority of patients prefer Vitamin D tablet instead of Oral liquid in glass ampoule if they got the choice among two. The results of this study provide important implications for our doctors about patients concern of hazard, after taste and compliance with orally administered Vitamin D glass ampoules.

Continuous-wave laser generated jets for needle free applications

We designed and built a microfluidic device for the generation of liquid jets produced by thermocavitation. A continuous wave (CW) laser was focused inside a micro-chamber filled with a light-absorbing solution to create a rapidly expanding vapor bubble. The chamber is connected to a micro-channel which focuses and ejects the liquid jet through the exit. The bubble growth and the jet velocity were measured as a function of the devices geometry (channel diameter D and chamber width A). The fastest jets were those for relatively large chamber size with respect to the channel diameter. Elongated and focused jets up to 29 m/s for a channel diameter of [Formula: see text] and chamber size of [Formula: see text] were obtained. The proposed CW laser-based device is potentially a compact option for a practical and commercially feasible needle-free injector.

Glass injuries seen in the emergency department of a South African district hospital

BACKGROUND

The emergency department of Embhuleni Hospital frequently manages patients with glass-related injuries. This study assessed these injuries and the glass that caused them in more detail.

AIM

The objectives of our study included determining the type of glass causing these injuries and describing the circumstances associated with different types of glass injuries.

SETTING

The emergency department of Embhuleni Hospital in Elukwatini, Mpumalanga province, South Africa.

METHODS

This was a cross-sectional study with a sample size of 104 patients. Descriptive statistics were used to assess the characteristics of the glass injuries.

RESULTS

Five different types of glass were reported to have caused the injuries, namely car glass (7.69%), glass ampoules (3.85%), glass bottles (82.69%), glass windows (3.85%) and street glass shards (1.92%). Glass bottle injuries were mainly caused by assaults (90.47%) and most victims were mostly young males (80.23%). The assaults occurred at alcohol-licensed premises in 65.11% of cases. These injuries occurred mostly over weekends (83.72%), between 18:00 and 04:00. The face (34.23%) and the scalp (26.84%) were the sites that were injured most often.

CONCLUSION

Assault is the most common cause of glass injuries, usually involving young men at alcohol-licensed premises. Glass injuries generally resulted in minor lacerations, with few complications (2.68%).

Needle-Free Dermal Delivery of a Diphtheria Toxin CRM197 Mutant on Potassium-Doped Hydroxyapatite Microparticles

Injections with a hypodermic needle and syringe (HNS) are the current standard of care globally, but the use of needles is not without limitation. While a plethora of needle-free injection devices exist, vaccine reformulation is costly and presents a barrier to their widespread clinical application. To provide a simple, needle-free, and broad-spectrum protein antigen delivery platform, we developed novel potassium-doped hydroxyapatite (K-Hap) microparticles with improved protein loading capabilities that can provide sustained local antigen presentation and release. K-Hap showed increased protein adsorption over regular hydroxyapatite (P < 0.001), good structural retention of the model antigen (CRM197) with 1% decrease in α-helix content and no change in β-sheet content upon adsorption, and sustained release in vitro. Needle-free intradermal powder inoculation with K-Hap-CRM197 induced significantly higher IgG1 geometric mean titers (GMTs) than IgG2a GMTs in a BALB/c mouse model (P < 0.001) and induced IgG titer levels that were not different from the current clinical standard (P > 0.05), namely, alum-adsorbed CRM197 by intramuscular (i.m.) delivery. The presented results suggest that K-Hap microparticles may be used as a novel needle-free delivery vehicle for some protein antigens.

Incidence of ambulatory care visits after needlestick and sharps injuries among healthcare workers in Taiwan: a nationwide population-based study

Healthcare professionals have a high risk of needlestick and sharps injuries (NSIs), which have a high potential for disease transmission. Ambulatory care follow up is essential, but is usually overlooked. This study aimed to investigate the annual and cumulative (age-, sex-, and subtype-specific) incidences of ambulatory care visits after NSIs. This study was also designed to evaluate the incidences of blood-borne diseases associated with NSIs among Taiwanese health professionals in Taiwan between 2004 and 2010. Data were obtained from the National Health Insurance Research Database, which contains anonymized records representing approximately 99% of the Taiwan population. A total of 4443 nurse healthcare workers (NHCWs) and 3138 non-nurse healthcare workers (NNHCWs), including physicians, medical technologists, and other health professionals were included in this longitudinal study. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Mantel-Haenszel method was used to adjust for sex, age, and type of affiliation. Results showed that the annual incidence of ambulatory care visits of NHCWs increased from 0.7% in 2004 to 1.9% in 2010; this incidence was significantly higher than that of NNHCWs (from 0.3% in 2004 to 0.5% in 2010) in any yearly comparison (p < 0.05). The sex-adjusted 7-year cumulative incidence rate was 3.23 (95% CI = 1.23-8.45) in males and 3.92 (95% CI = 2.70-5.69) in females (p < 0.05). The age-adjusted 7-year cumulative incidence rate was 2.74 (95% CI = 1.99-3.77) and 2.14 (95% CI = 1.49-3.07) in subjects ≤ 30 and ≥31 years old, respectively (p < 0.0005). The affiliation-adjusted 7-year cumulative incidence rate was 1.89 (95% CI = 1.21-2.94) in medical centers and 3.33 (95% CI = 2.51-4.41) in nonmedical centers (p < 0.01). In conclusion, NSIs increased steadily from 2004 to 2010 in Taiwan with NHCWs having higher NSIs incidences than NNHCWs. A routine ambulatory care visit after NSIs can prevent blood-borne transmission, especially for NHCWs. Educational programs may be helpful for reducing the incidence of NSIs and increasing ambulatory care visit ratios after NSIs.

Association of the dominant hand and needle stick injuries for healthcare workers in Taiwan

BACKGROUND

Healthcare workers face the risk of acquiring blood-borne infections from patients through needle stick injuries. Understanding the factors that are associated with increased risk, for example, the role of the dominant hand, is important so that preventive measures can be focused.

METHODS

The EPINet (Exposure Prevention, Information Network--a trade mark of Virginia University) questionnaire was used to collect the data. The EPInet system started 2003 in Taiwan under C-MESH. When healthcare workers sustain sharp injury, they complete the injury report form, and report to infection control personnel, who then transmitted the data to EPINet website monthly.

RESULTS

93.5% of the healthcare workers reported being right handed and only 6.5% reported being left handed. About two-thirds (65%) of the reported injuries were by self, 30% injuries were by others and 5% were reported as injured by unknown.There was an association between the dominant hand injury and the needle stick original HCW user, p<0.0001. There is a significant difference between the dominant hand and the needlestick original HCW user. HCW whose dominant hand was the right hand were most likely at risk to be injured by "others" than "self" or "unknown HCW"; OR≤ 18.39; CI (0.42 ± 2.33).

CONCLUSION

Needlestick injuries among health care workers in Taiwan continue to pose a serious occupational problem. Historically, prevention has focused on the use of protective wear than assessment of which hand may be at greater risk than the other. There is a greater need to prevent hand injuries as the dominant hand remains the most used and injured in process of patient care.

Factors affecting occupational exposure to needlestick and sharps injuries among dentists in Taiwan: a nationwide survey

Background

Although the risks of needlestick and sharps injuries (NSIs) for dentists are well recognized, most papers published only described the frequency of occupational exposure to NSIs. Less has been reported assessing factors contributing to exposure to NSIs. The purpose of this study was to update the epidemiology of NSIs among dentists in Taiwan and identify factors affecting NSIs in order to find preventive strategies.

Methodology/Principal Findings

A nationwide survey was conducted in dentists at 60 hospitals and 340 clinics in Taiwan. The survey included questions about factors supposedly affecting exposure to NSIs, such as dentist and facility characteristics, knowledge and attitudes about infectious diseases, and practices related to infection control. Univariate and multivariate logistic regression analyses were conducted to determine the association between risk factors and exposure to NSIs. In total, 434 (74.8%) of 580 dentists returned the survey questionnaires, and 100 (23.0%) reported that they had experienced more than one NSI per week. Our data showed that the risk of occupational NSIs is similarly heightened by an older age (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.62–6.25), more years in practice (OR, 2.57; 95% CI, 1.41–4.69), working in clinics (OR, 1.73; 95% CI, 1.08–2.77), exhibiting less compliance with infection-control procedures (OR, 1.82; 95% CI, 1.04–3.18), having insufficient knowledge of blood-borne pathogens (OR, 1.67; 95% CI, 1.04–2.67), and being more worried about being infected by blood-borne pathogens (OR, 1.82; 95% CI, 1.05–3.13).

Conclusions/Significance

High rates of NSIs and low compliance with infection-control procedures highly contribute to the chance of acquiring a blood-borne pathogen infection and threaten occupational safety. This study reveals the possible affecting factors and helps in designing prevention strategies for occupational exposure to NSIs.

Unexpected injury of the orthopaedic surgeon: a case report of a hammer splinter

Sharps injuries have become one of the most important occupational injuries and they are common during surgery, with rates between 1.7 and 6.9% of all surgical procedures. This case report, however, revealed an extremely rare and unexpected condition, which could not be prevented by the reasonable safety precautions against injury. Closed reduction and closed intramedullary fixation was planned for the patient with humeral shaft fracture. While advancing the nail by hammering a piece of metal detached. A short time following the commencement of the procedure, the surgeon who was performing the operation felt a sudden severe pain in the neck. A radio-opaque intensity in the cervical region was detected on X-rays. There was a piece of metal from the hammer. The risk encountered in the present case comprises a condition, the prevention of which is probably impossible with the frequently utilized preventive measures against injuries. For this reason, the operating room team and in particular, the surgeon, should be careful about possible expected injuries, as well as the unexpected ones. Sharps injuries continue to be a serious concern for all healthcare workers. In some studies however, reporting of sharps injuries by healthcare workers remains a problem with reporting levels cited as low as 15% and as high as 90% (Kerr H-L, Stewart N Ann R Coll Surg Engl 91:430-432, [6]). Guo et al. pointed out the most recent sharps injuries at work, and syringe needles was by far the most important items causing injuries, followed by glass products, suture needles, and intravenous catheters.

Occupational injury history and universal precautions awareness: a survey in Kabul hospital staff

Background

Health staff in Afghanistan may be at high risk of needle stick injury and occupational infection with blood borne pathogens, but we have not found any published or unpublished data.

Methods

Our aim was to measure the percentage of healthcare staff reporting sharps injuries in the preceding 12 months, and to explore what they knew about universal precautions. In five randomly selected government hospitals in Kabul a total of 950 staff participated in the study. Data were analyzed with Epi Info 3.

Results

Seventy three percent of staff (72.6%, 491/676) reported sharps injury in the preceding 12 months, with remarkably similar levels between hospitals and staff cadres in the 676 (71.1%) people responding. Most at risk were gynaecologist/obstetricians (96.1%) followed by surgeons (91.1%), nurses (80.2%), dentists (75.4%), midwives (62.0%), technicians (50.0%), and internist/paediatricians (47.5%). Of the injuries reported, the commonest were from hollow-bore needles (46.3%, n = 361/780), usually during recapping. Almost a quarter (27.9%) of respondents had not been vaccinated against hepatitis B. Basic knowledge about universal precautions were found insufficient across all hospitals and cadres.

Conclusion

Occupational health policies for universal precautions need to be implemented in Afghani hospitals. Staff vaccination against hepatitis B is recommended.

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

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

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

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

National incidence of percutaneous injury in Taiwan healthcare workers

We established a standardized surveillance system using the Chinese Exposure Prevention Information Network to estimate the frequency of percutaneous injuries (PCIs) in Taiwanese healthcare workers (HCWs). Fourteen hospitals employing 8,132 HCWs participated and a total of 583 PCIs were reported. The annual number was estimated to be 8,058 PCIs per hospital size, 8,100 per HCWs, and 8,286 per inpatient-day; indicating similar estimates using different denominators. The estimated annual frequency of pathogen-specific PCIs was 1,168 for hepatitis B, 1,263 for hepatitis C, and 59 for HIV. This study documents the annual incidence of PCI among HCWs showing important potential exposure to viral hepatitis and HIV in Taiwan.

Sharps Injury and Body Fluid Exposure Among Health Care Workers in an Australian Tertiary Hospital

To examine sharps injury and body fluid exposure among health care workers, a descriptive epidemiological study was conducted in a 1000-bed tertiary hospital between 2000 and 2003 using surveillance data of all reported sharps injuries and body fluid exposures. A total of 640 sharps injuries and body fluid exposures were reported from hospital and nonhospital staff, although no seroconversions to HIV, hepatitis B virus, or hepatitis C virus were observed during the study period. Nurses reported 47% of sharps injuries and 68% of body fluid exposures, medical staff reported 38% and 16%, and other nonmedical staff notified 5% and 4%, respectively, while nonhospital staff reported the rest. Hollow-bore needles accounted for 56% of sharps injuries, while 11% of the incidents were sustained during recapping and inappropriate disposal. Further research into Australian work practices, disposal systems, education strategies, and the use of safety sharps should be emphasized to implement strategies to reduce work-related injuries among health care workers.

Healthcare waste management in the capital city of Mongolia

Inconsistencies are present in the management options for healthcare wastes in Mongolia. One of the first critical steps in the process of developing a reliable waste management plan requires the performance of a waste characterization analysis. The objectives of this study were an assessment of the current situation of healthcare waste management (HCWM) and characterization of healthcare wastes generated in Ulaanbaatar. A total about 2.65 tonnes of healthcare wastes are produced each day in Ulaanbaatar (0.78 tons of medical wastes and 1.87 tons of general wastes). The medical waste generation rate per kg/patient-day in the inpatient services of public healthcare facilities was 1.4-3.0 times higher than in the outpatient services (P<0.01). The waste generation rate in the healthcare facilities of Ulaanbaatar was lower than in some other countries; however, the percentage of medical wastes in the total waste stream was comparatively high, ranging from 12.5% to 69.3%, which indicated poor waste handling practices. Despite the efforts for the management of wastes, the current system of healthcare waste management in Ulaanbaatar city of Mongolia is under development and is in dire need of immediate attention and improvement. It is essential to develop a national policy and implement a comprehensive action plan for HCWM providing environmentally sound technological measures to improve HCWM in Mongolia.

The impact of self-perceived job stress on menstrual patterns among Taiwanese nurses

The purpose of this study was to assess the impact of self-reported job stress on menstrual patterns among nurses. We conducted a cross-sectional survey of nursing staff from five psychiatric institutions and four general hospitals in Taiwan. A total of 746 participants were eligible for the final analysis, among whom, 72.3% were ascertained as having a self-perceived high level of job stress. Self-perceived high job stress was significantly associated with irregular menstrual cycles [Adjusted odds ratio (AOR): 4.8, 95% confidence interval (CI): 3.3-7.2] and longer menstrual bleeding periods (more than 7 d) [AOR: 2.5, 95% CI: 1.7-3.7], but was not significantly related to long or short menstrual cycles. Overall, this study suggests that nurses' self-perceived job stress may be associated with certain aspects of menstrual dysfunction. Further investigations with prospective follow-up studies and urine hormonal measurements are now recommended to provide additional insight into the pathophysiological mechanisms of our findings.

Factors predicting nurses' consideration of leaving their job during the SARS outbreak

Taiwan was affected by an outbreak of severe acute respiratory syndrome (SARS) in early 2003. A questionnaire survey was conducted to determine (1) the perceptions of risk of SARS infection in nurses; (2) the proportion of nurses considering leaving their job; and (3) work as well as non-work factors related to nurses' consideration of leaving their job because of the SARS outbreak. Nearly three quarters (71.9%) of the participants believed they were 'at great risk of exposure to SARS', 49.9% felt 'an increase in workload', and 32.4% thought that people avoided them because of their job; 7.6% of the nurses not only considered that they should not care for SARS patients but were looking for another job or considering resignation. The main predictors of nurses' consideration of leaving their job were shorter tenure, increased work stress, perceived risk of fatality from SARS, and affected social relationships. The findings are important in view of potential impending threats of pandemics such as avian influenza.

Epidemiology of needlestick and sharps injuries among professional Korean nurses

Although needlestick and sharps injuries (NSI) are known to affect professional nurses at high rates, most studies depend on officially reported data and few have been undertaken in Korea. Thus, we surveyed a large cross-section of nurses from a hospital in Gangneung (response rate, 97.9%). Four hundred thirty-two incidents of NSI were reported by 263 nurses (79.7%) in the previous 12-month period (average, 1.31 events/nurse/year). Syringe needles were the most common devices, affecting 67.3% and comprising 52% of all NSI events. Sixty percent of all NSI events involved contaminated devices. Opening an ampoule or vial was the most common cause (affecting 35.2% of all nurses and accounting for 15.9% of all NSI events). Logistic regression indicated that nurses working in "other" departments were 5.4 times more likely to suffer any NSI (odds ratio [OR] = 5.4; 95% confidence interval [95% CI] = 2.0-15.2; P < .05) and 4.7 times more likely to incur a syringe-needle injury than nurses in intensive care units or inpatient departments (OR = 4.7; 95% CI = 2.0-11.6; P < .05). Younger-than-average nurses (< 27 years) were 4.5 times more likely to suffer NSI (OR = 4.5; 95% CI = 1.7-12.6; P < .05) and 3.1 times more likely to incur a syringe-needle injury (OR = 3.1; 95% CI = 1.4-7.0; P < .05). Working mixed shifts also increased the risk of any NSI (OR = 4.0; 95% CI = 1.7-10.4; P < .05) or syringe-needle NSI (OR = 4.4; 95% CI = 2.0-10.1; P < .05). Overall, our study suggests that NSI are common among Korean hospital nurses and represent a significant occupational burden for this large Asian demographic. Intervention and preventive strategies to help reduce their NSI exposures are urgently required in this country.

The health beliefs of hospital staff and the reporting of needlestick injury

AIM

The aim of this study is to examine the connection between the health beliefs of hospital staff (doctors, nurses and auxiliary staff) and their failure to report needlestick injuries.

BACKGROUND

Needlestick injury to hospital staff is quite frequent and can result in infections and disease, but staff frequently do not report the injury despite their awareness of the risk of blood-borne pathogens.

METHODS

Five questionnaires were constructed based on three existing research tools and were tested for validity and reliability. Two hundred and forty questionnaires were distributed to eight randomly chosen departments of a single Israeli hospital. Seventy-six percent of the questionnaires were anonymously completed and returned.

RESULTS

Nurses had the highest rate of needlestick injury, followed by auxiliary staff and doctors. Auxiliary staff showed the highest rate of compliance with the duty to report such injuries, while doctors showed the lowest. Perceived severity of contractable disease, the perceived efficacy of reporting injuries and overall motivation to maintain health were the best predictors of reporting compliance. Non-compliers emphasized the negative aspects of reporting the injuries, primarily that it took up too much time.

CONCLUSIONS

The solution to non-compliance with the duty to report must be a targeted investment in training and education. Relevance to clinical practice. Finding the reasons for compliance and non-compliance with the duty to report needlestick injuries will help in designing educational programmes for hospital staff and in determining a strategy for improving health behaviour.

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

The epidemiology of needlestick and sharps injuries (NSIs) was investigated among a complete cross-section of 1,162 nurses from a large hospital in southern Japan (response rate 74.0%). Forty-six percent had experienced an NSI in the previous year. Most were caused by ampoules or vials, which injured 32.3% of all nurses and accounted for 42.9% of all NSI events. Twenty-two percent of all NSIs involved a device that had been used on a patient prior to the NSI (contaminated device), while the usage status of a further 2.8% of devices was unknown. Logistic regression indicated that nurses younger than 25 years of age were 2.18 times more likely to have sustained a single NSI in the past 12 months [odds ratio (OR) 2.18, 95% confidence intervals (CI) 1.15-4.17] and 2.39 times more likely to have sustained multiple NSIs (OR 2.39, 95% CI 1.08-5.34). Working mixed shifts (rotating day and night, as opposed to day shifts alone) was associated with a 1.67-fold increased risk of sustaining any NSI (OR 1.67, 95% CI 1.01-2.85) and a 2.72 times greater risk of sustaining an NSI from a contaminated device (OR 2.72, 95% CI 1.71-4.44). Nurses who reported significant fatigue after work were 1.87 times more likely to sustain multiple NSIs (OR 1.87, 95% CI 1.13-3.13) and 1.94 times more likely not to report their NSIs (OR 1.94, 95% CI 1.03-3.71). Perceived high mental pressure was associated with a 1.75-fold increased risk of sustaining an NSI from a contaminated device (OR 1.75, 95% CI 1.07-2.88). Nurses who reported suboptimal staffing levels in their wards were 2.21 times more likely not to report any NSIs they sustained in the previous year (OR 2.21, 95% CI 1.06-4.89). Overall, this study suggests that NSIs represent a complex and multi-faceted problem for Japanese nurses. Intervention strategies should consider the emerging complicity of psychosocial factors on NSI among hospital staff in Japan, as elsewhere.

Needlestick and sharps injuries among nurses in a tropical Australian hospital

Although needlestick and sharps injuries (NSI) represent a major hazard in nursing practice, most studies rely on officially reported data and none have yet been undertaken in tropical environments. Therefore, we conducted a cross-sectional NSI survey targeting all nurses within a tropical Australian hospital, regardless of whether they had experienced an NSI or not. Our overall response rate was 76.7%. A total of 39 nurses reported 43 NSI events in the previous 12 months. The most common causative device was a normal syringe needle, followed by insulin syringe needles, i.v. needles or kits and blood collection needles. Half of the nurses' NSI events occurred beside the patient's bed: drawing up medication was the most common reason. Nurses working in the maternity/neonatal wards were only 0.3 times as likely to have experienced an NSI as their counterparts in the medical or surgical wards. Overall, our study has shown that NSI events represent an important workplace issue for tropical Australian nurses. Their actual rate might also be higher than official reports suggest.

Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers

BACKGROUND

The global burden of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infection due to percutaneous injuries among health care workers (HCWs) is estimated.

METHODS

The incidence of infections attributable to percutaneous injuries in 14 geographical regions on the basis of the probability of injury, the prevalence of infection, the susceptibility of the worker, and the percutaneous transmission potential are modeled. The model also provides the attributable fractions of infection in HCWs.

RESULTS

Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIV infections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries. The fraction of infections with HCV, HBV, and HIV in HCWs attributable to occupational exposure to percutaneous injuries fraction reaches 39%, 37%, and 4.4% respectively.

CONCLUSIONS

Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs). These infections are highly preventable and should be eliminated.

Occupational stress in nurses in psychiatric institutions in Taiwan

Nurses are known to be exposed to occupational stress. However, occupational stress is not well documented for nurses in psychiatric institutions in Taiwan. A cross-sectional study was conducted to explore the work-related stress and risk factors of nurses in psychiatric institutions in Taiwan. A structured questionnaire was distributed to nurses at five state-owned psychiatric hospitals in Taiwan in 2001. Demographic information, working environment, and personal health status were inquired. Occupational stress was assessed based on the Chinese version of Job Content Questionnaire (JCQ). General health status and mental health were evaluated by the International Quality of Life Assessment Short Form-36 (IQOLA SF-36). A total of 573 questionnaires were disseminated to nurses and 518 (90.4%) were satisfactorily completed by nurses, including 408 female full-time nurses who had been in their current work for more than 6 months. In the past one month, 17.2% of nurses reported being under significant stress often or always. Assault episodes were reported by 45.1% of nurses in the past 6 months. Among the nurses, 16.9%, 25.2%, 50.0%, and 7.8% belong to the "High strain", "Low strain", "Active", and "Passive" groups, respectively. Perceived occupational stress was associated with young age, widowed/divorced/separated marital status, high psychological demand, low workplace support, and threat of assault at work. Lower general health score was associated with low job control, high psychological demand, and perceived occupational stress. A lower mental health score was associated with low job control, high psychological demand, low workplace support, and perceived occupational stress. We concluded that nurses in psychiatric institutions are under significant stress related to work factors.

Needlestick/sharps injuries among vocational school nursing students in southern Taiwan

BACKGROUND

Although most needlestick/sharps injuries (NSIs/SIs) research focuses on health care workers (HCWs), students in hospital internships are also at risk. Investigations that examined NSIsS/SIs in student populations generally studied medical rather than nursing students (NSs). In 1999, approximately 17,000 Taiwanese nursing graduates were exposed to the hazard of NSIs/SIs. We examined the frequency and mechanism of NSIs/SIs among vocational school NSs in southern Taiwan.

METHODS

Between July and December of 1999, within 1 week after the NSs completed their internship training, one of the researchers, who was a teacher in this vocational school, asked them to fill out questionnaires.

RESULTS

Five hundred twenty-seven of 550 (92.6%) questionnaires were considered valid. Two hundred sixty-four of 527 (50.1%) responders sustained one or more NSIs/SIs. Ninety-six of 527 (18.2%) responders suffered contaminated NSIs/SIs. The average number of NSIs/SIs per student was 8.0 times/year (4.9 times/student/year for NSIs and 3.1 times/student/year for SIs). NSIs/SIs rates for NSs in 10-week and 4-week internships were significantly different ( P = .039): 53.3% versus 43.7%, respectively. The NSIs/SIs frequencies were influenced by length of internship: 7.3 times/student/year in 10-week internship and 11.7 times/student/year in 4-week internship. Logistic regression analysis indicated that length of internship rotation was statistically significant with respect to contaminated NSIs/SIs (OR = 1.682; 95% CI: 1.005-2.81; P = .048).

CONCLUSIONS

The NSIs/SIs frequencies of NSs were higher than those for HCWs. We found that frequency of NSIs/SIs for vocational school NSs is above average. Whether the young age of these NSs put them at greater risk for NSIs/SIs warrants further inquiry.

Needlestick and sharps injuries among nurses in the healthcare sector in a city of western Turkey

The aims of this study were to determine the rate of bloodborne infections after needlestick and sharps injuries in nurses at work, to estimate the number of vaccinations administered, and to assess whether universal precautions were being followed. The study involved 289 nurses working in five hospitals and six primary healthcare centres. Between 1 April 2002 and 31 June 2002, a total of 139 practising nurses were included in the study following a needlestick or sharps injury. The results of completed questionnaires were collated, and Chi-squared test was used for analysis. The rate of hollow-bored needle-related injuries was 76.2% (106/139). Most nurses (69.1%) did not report any details of their injuries and 32.4% (45/139) of nurses had not been vaccinated against hepatitis B virus (HBV). Only 5.3% of the nurses who responded to the compliance question indicated that they always complied with universal precautions. Of 139 nurses, 1.4% and 7.9% showed evidence of HBV infection and hepatitis C virus (HCV) infection, respectively. All those who had hepatitis B were aged 30 years or under, whereas most of those who were anti-HCV positive (81.8%) were over 30 years old (P < 0.05). Nurses working in the Turkish healthcare sector are frequently exposed to bloodborne infections. Precautions and protection from needlestick and sharps injuries are important in preventing infection of nurses. Education about the transmission of bloodborne infections, vaccination and post-exposure prophylaxis must be implemented. Further investigations are warranted to elucidate the risk to nurses of contracting these potentially serious infections.

Some epidemiological aspects of needle stick injuries among the hospital health care workers: Eastern Province, Saudi Arabia

This study was conducted to provide some epidemiological aspects of needle stick injuries among health care workers in the eastern province in Saudi Arabia. Data about 282 injuries reported from the hospitals of the Eastern Province of Saudi Arabia were collected through specially designed questionnaire retrospectively from 1995 to 1997. Results showed that 50% of injuries occurred in the first 3 years of employment. Workers in medical and surgical specialties suffered an equal degree of reported exposure. The highest percentage (46.8%) of injuries occurred during syringe related actions. Patients' wards were the major location of incidents (48.5%) followed by ICUs and dialysis units (17.7%), theatres (15.6%) and accidents and emergency departments (13.8%). There was no significant association between injuries and type of shifts. The middle hours of the shifts showed a significant association with injuries. The pattern of injuries was significantly associated with over loaded periods of medical practices. Deficiencies in implementing the standard recommendations for prevention and control of needle stick injuries were noted in the studied hospitals.

Student nurses in Taiwan at high risk for needlestick injuries

PURPOSE

To describe the prevalence and characteristics of needlestick injuries (NSI) in student nurses in Taiwan.

METHODS

A self-administered questionnaire was completed by 931 student nurses from 16 hospitals randomly selected from the 132 accredited hospitals.

RESULTS

The questionnaire was completed by 708 of 931 students who were contacted for participation in this study. NSI during internship was reported by 61.9% (438/708) of students, of whom 14.2% (62/438) made a formal report. The majority (70.1%) of NSI occurred in the patient's room. Hollow-bored needles contributed to half (219/438) of the NSIs of which 86.8% were syringe needles. Just over half (53.2%) of those items involved in NSIs had been used on patients. Of the hollow-bored needles involved in NSIs, 21.5% had been used on a patient with an infectious disease. Vaccination against hepatitis B virus (HBV) was lacking in 47.6% of students.

CONCLUSIONS

NSIs and non-reporting of NSIs were highly prevalent in nursing students. More intensive education programs should be directed at students to increase their awareness of and compliance with Universal Precautions (UP) before commencing their practical work experience. Students need to practice prompt post-exposure evaluation so that the need for early intervention can be assessed. In addition, any public health and infection control strategy should include a universal catch-up HBV vaccination program among students before commencement of internship.

Estimation of the risk of bloodborne pathogens to health care workers after a needlestick injury in Taiwan

OBJECTIVES

To estimate the number of health care workers (HCWs) in Taiwan at risk annually for contracting hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV after a needlestick and sharps injury (NSI) with a used hollow-bore needle.

METHODS

All patients hospitalized in 1 tertiary hospital between September 1997 and June 1998 had routine pathological work-ups. On the first day of the months of September 1997, December 1997, March 1998, and June 1998, 1805 samples of deidentified residual sera randomly sampled from 18,474 inpatients older than 6 years were serologically tested for antigens to HBV (HBsAg and HBeAg) and antibodies to HCV (anti-HCV) and HIV (anti-HIV) with enzyme-linked immunosorbent assay reagents. The frequency of NSIs with contaminated devices in HCWs from 16 public teaching hospitals between July 1996 and June 1997 and the serologic results were used to extrapolate the estimated annual rate of seroconversion in HCWs after an NSI.

RESULTS

Of the 1805 samples tested, 16.7% were seropositive for HBsAg (of which 1.7% were positive for HBeAg), 12.7% were positive for anti-HCV, and 0.8% were positive for anti-HIV. Of the 7550 NSIs reported by 8645 HCWs, 66.7% involved a contaminated hollow-bore needle. From these data, 308 to 924 HCWs were estimated to be at risk for contracting HBV; 334 to 836 were at risk for contracting HCV; and, at the most, 2 were at risk for contracting HIV. The estimated annual number of contaminated NSIs sustained by 4 categories of HCWs ranged from 0.3 to 0.7, resulting in 543 nurses, 113 technicians, 80 physicians, and 66 supporting staff to be at risk annually of acquiring HBV infection. The numbers of HCWs estimated to be at risk of acquiring HCV were 596 nurses, 90 physicians, 84 technicians, and 30 supporting staff. The risk of acquiring HIV was low, with 1 nurse and possibly 1 other staff potentially exposed annually.

CONCLUSIONS

Our estimates of the risk for seroconversion after an NSI have demonstrated that an occult risk can be formulated into a quantifiable risk. The number of susceptible HCWs at risk for seroconversion is as many as 1762 annually. With the number of nurses employed and the frequency with which they use sharps and sustain an NSI, 64.7% of all possible seroconversions will be in the nursing staff. This is a salient reminder of the importance of the introduction of early training in safe-needle-handling techniques before nurses enter their internship in countries where safety equipment, safety instructions, and staff vaccination programs are absent.

Sharps injuries among hospital support personnel

Sharps injuries (SIs) among support personnel in hospitals have received little attention in the scientific literature. A cross-sectional study was undertaken to measure the incidence of SIs in Taiwanese support personnel. All support personnel, including laundry workers, cleaners, porters and central supply workers, from 16 hospitals were surveyed for SIs, sustained between June 1996 and July 1997. Either a questionnaire or face-to-face interviews, for those staff with a literacy problem, were used. Of the 862 persons eligible for study, 79.4% (684) were evaluable. Few staff (30.4%) had attended a prevention programme and 61% had suffered an SI in the past year. Few (25.4%) reported their injury. Hollow-bore needles, of which 72.2% had been used, were associated with 42.2% of injuries. Cleaners sustained the majority (65.7%) of injuries, and inappropriate disposal was associated with 54.7% of all injuries. For those staff employed for more than four years, the risk of sustaining an injury increased significantly with length of employment (P<0.001). Most of the injuries were sustained by cleaners handling sharps inappropriately disposed of by clinical staff. A safer environment for support staff could be achieved with the co-operation of clinical staff to correctly dispose of sharps to ensure single handling of sharps. A formal orientation of support staff in the reporting of SIs would enable clinical assessment and management of injuries, as well as an evaluation of needle and sharps safety in the healthcare setting.

Vaccination against hepatitis B in health care workers

Hepatitis B is the most important infectious occupational disease for health care workers. The high risk of being infected is the consequence of the prevalence of virus carriers in the assisted population, the high frequency of exposure to blood and other body fluids and the high contagiousness of hepatitis B virus (HBV). Vaccination is able to prevent the most threatening consequences of the infection (acute disease and chronic carriage) in responders, even after loss of detectable antibodies. Non-responders to the primary series may benefit from administration of up to three more doses of vaccine (40-70% of initial non-responders show seroconversion to the new series). However, newly developed vaccines that seem more immunogenic are presently under evaluation and should further decrease the number of non-immune workers in the near future. In the mean time, coverage with standard vaccines should be improved also by supplying complete information on the risks of hepatitis B and on the safety and efficacy of active immunisation.

Prevalence of nonreporting behavior of sharps injuries in Taiwanese health care workers

BACKGROUND

Health care workers (HCWs) were surveyed to identify factors associated with nonreporting behavior of sharps injuries (SIs) in Taiwan.

METHODS

We surveyed 10,469 full-time medical, nursing, technical, and supporting personnel employed at 16 randomly selected hospitals from 132 available accredited teaching hospitals in Taiwan. Information about the most recent injury and reporting behavior after an SI were collected from July 1996 to June 1997 by using a pretested structured questionnaire. Eleven categories, including an open-ended option, were provided for participants to explain their nonreporting behavior.

RESULTS

Questionnaires were completed by 82.6% (8645) of our sample, of whom 87.3% reported to have experienced a recent SI. A used item was the most commonly (P <. 001) involved item in an SI, and SIs with a used item were significantly more likely (odds ratio 3.6; CI 95%, 3.03-4.26; P <. 001) to be reported compared with an SI that involved unused items. A total of 81.8% of injuries were not reported, with job category significantly affecting reporting behavior (P <.001). Medical staff had the highest nonreporting rate (85.2%). Although attendees of a prevention program were statistically more likely (P <.001) to report an injury compared with nonattendees, the level of reporting in both groups was not encouraging (21.3% and 17.2%, respectively). All reasons given for nonreporting were disconcerting, but none more so than the use of subjective assessment of risk by 21.7% of HCWs who did not report their injuries. Other reasons for not reporting SIs included that the item was unused (34%) and that the HCW was too busy to report the SI (14.9%), unaware of reporting requirements (14. 4%), or immune to hepatitis B virus (12.4%).

CONCLUSIONS

With 82% of SIs in Taiwanese HCWs going unreported, the expected national incidence will be seriously underestimated and impact the appropriateness of prevention programs. The very low rate of reporting suggests that the current reporting system requires simplification. Because most injuries involved used items, the reporting systems also should include a more responsive management component. The results also suggest that the current prevention programs, currently provided by the general nursing department, require expert content knowledge in infection control if nonreporting and SIs are to be reduced.