Sharps injuries in ophthalmic practice

Bloodborne viral infections: Seroprevalence and relevance of preoperative screening in Indian eye care system - A retrospective study

PURPOSE

To report the seroprevalence of bloodborne viral infection (BBVI) in patients undergoing ophthalmic surgeries and assess the utility and feasibility of preoperative screening for BBVI in India's current eye care system.

METHODS

This retrospective, hospital-based, descriptive study included data from patients undergoing preoperative screening for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and human immunodeficiency virus (HIV) at a tertiary eye care institute from 2018 to 2022. Rapid diagnostic tests (RDTs) were performed on the blood samples after obtaining informed consent from the patients. Seroreactive patients underwent surgery with additional safety precautions. The demographic data and surgical details of these patients were collected and analyzed. ANOVA was used to carry out statistical analysis between groups. During the study period, the number of healthcare workers (HCWs) sustaining needle stick injury (NSI) and accidental sharp injury (ASI) in the operating theater (OT) and details of these injuries were recorded.

RESULTS

Samples from 28,563 patients were included. The seroprevalence of BBVI was 1.87% (536/28563). Hepatitis B virus (322, 60.1%) was the most commonly detected infection, and HIV (59, 11%) was the least detected infection. The mean age of the seroreactive patients was 60.3 ± 30.8 years. The incidence of NSI was 0.49/1000 surgeries. Nurses (11) and technicians (4) in the OT sustained maximum NSI. None of the HCWs had seroconversion after NSI.

CONCLUSION

The overall seroprevalence of BBVI in the current study is lower than that reported in previously published studies from eye care organizations. Currently, mandatory preoperative screening for BBVI to prevent transmission of these infections to HCWs working in the eye care sector in India appears to be less cost-effective.

Sharps injuries within the healthcare student population: a narrative review

BACKGROUND

Studies have reported evidence on sharps injuries among nursing, medical and dental students but little is known about the amount, type and causes of sharps injuries affecting other healthcare students.

AIM

The aim of the narrative review was to identify the extent, type and causes of sharps injuries sustained by healthcare students, especially those not in those fields.

METHOD

Eight databases were searched using keywords to identify studies published between 1980 and March 2023.

FINDINGS

This narrative review highlights that some groups of healthcare students, including those studying pharmacy, physiotherapy and radiography, sustain sharps injuries from similar devices as reported in research on such injuries in nursing, medical and nursing students. Sharps injuries happen in a range of healthcare environments, and many were not reported by students. The main cause of a sharps injury identified was a lack of knowledge.

CONCLUSION

More research is needed on the extent of sharps injuries in healthcare students in European countries and the UK as well as on their physical and psychological effects. Education and training in sharps use and disposal are essential.

Needle-Stick Injuries in Ophthalmic Practice

Purpose

Needle-stick injuries (NSI) are a prominent route by which blood-borne infections are transmitted. The unique microsurgical nature of ophthalmic practice constitutes an additional risk to sustain injury. This study aimed to identify the epidemiological profile of needle-stick injuries in a tertiary eye center and to evaluate the implemented safety policy in preventing sharp injuries.

Methods

This was a retrospective cross-sectional study of all sharp injuries that occurred at King Khalid Eye Specialist Hospital (KKESH). Data on all reported sharp injury incidents from 2013 to 2021 were collected. The mechanisms of injury, context, location, and type of prick were collected and analyzed. Also, this study involved an institution-based survey for all ophthalmic staff.

Results

Two hundred and one sharp injury incidents were reported over 9 years. Physicians sustained 46.8% (n=94) of injuries, followed by nurses and ophthalmic technicians, 40.8% (n=82) and 7% (14); respectively. Operating and treatment rooms were the locations of 60.7% of incidents, whereas outpatient clinics and emergency rooms accounted for 19.4% and 13.4% of injuries, respectively.

Conclusion

The current findings add to the growing body of literature on the importance of NSI prevention and reporting strategies. In the present study, sharp injuries were most commonly encountered by ophthalmic staff in the operating rooms. Continuous staff education on handling sharp instruments, encouraging anonymous reporting, and up-to-date revisions of guidelines and policies are of paramount importance to lessen the burden of sharp injuries.

Incidence of sharps injuries in surgical units, a meta-analysis and meta-regression

BACKGROUND

Sharps injuries occur often among surgical staff, but they vary considerably.

METHODS

We searched PubMed and Embase for studies assessing the incidence of sharps injuries. We combined the incidence rates of similar studies in a random effects meta-analysis and explored heterogeneity with meta-regression.

RESULTS

We located 45 studies of which 11 were randomized control trials, 15 were follow-up studies, and 19 were cross-sectional studies. We categorized injuries as self-reported, glove perforations, or administrative injuries. We calculated the population at risk as person-years and as person-operations (po). Meta-analysis of the incidence rate based on the best outcome measure resulted in 13.2 injuries per 100 time-units (95% confidence interval [CI], 4.7-37.1; I² = 100%). Per 100 person-years, the injury rate was 88.2 (95% CI, 61.3-126.9; 21 studies) for self-reported injuries, 40.0 for perforations (95% CI, 19.2-83.5; 15 studies), and 5.8 for administrative injuries (95% CI, 2.7-12.2; 5 studies). Per 100 po, the respective figures were 2.1 (95% CI, 0.8-5.0; 4 studies), 11.1 (95% CI, 6.6-18.9, 15 studies), and 0.1 (95% CI, 0.05-0.21). I² values were all above 90%. Meta-regression indicated lower incidence rates in studies that used perforations per po.

CONCLUSIONS

A surgeon will have a sharps injury in about 1 in 10 operations . Reporting of sharps injuries in surgical staff should be standardized per 100 po and be assessed in prospective follow-up studies.

Practice pattern of cataract surgeons when operating on seropositive patients

Purpose

The aim of this study is to know practice pattern of cataract surgeons when operating on patients, positive for blood-borne viral infections (BBVIs), namely, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. We also studied their awareness, knowledge, and attitude toward universal precautions and guidelines.

Methods

The telephonic survey enrolled practicing cataract surgeons, who were interviewed to record responses pertaining to their practice using an open-ended questionnaire. We studied statistical significance of difference of frequency of prick injuries in topical versus peribulbar anesthesia, and phacoemulsification versus manual small incision cataract surgery by employing Chi-square test. Significance of proportion was calculated using z-test. For all statistical calculations, significance level was set at 0.05%.

Results

Of 623 ophthalmologists contacted, responses of 479 (79%) ophthalmologists were analyzed. Maximum participants were in private practice (48%). During whole practicing carrier, 313 (65%; 95% confidence interval [CI]: 61-70) participants admitted having suffered injury with needle or sharp instruments; of these, 204 (65%; 95% CI: 60-70) participants did not report their injury. Wearing "double gloves" during cataract surgery was the most common barrier adopted by participants.

Conclusion

We found high prevalence of occupational-related sharp injuries among ophthalmologists in this survey. Majority of them were aware of universal precautions, but adherence to postexposure prophylaxis was lacking.

Needle stick injuries in a tertiary eye-care hospital: Incidence, management, outcomes, and recommendations

Purpose:

The purpose of this study is to assess the incidence, management, and outcomes for needle stick injuries (NSIs) in a tertiary eye-care hospital and provide appropriate recommendations for its prevention.

Methods:

This was a retrospective database review of NSI recorded between 2010 and 2015 at a tertiary eye care center. All staff members who had NSI were managed with standard treatment protocol. The mode, location, health-care workers affected and/or at risk for NSI were analyzed.

Results:

One hundred and forty NSI were reported between 2010 and 2015, with ophthalmic fellows under training encountering maximum needle pricks (n = 33; 24%), followed by nursing staff (n = 32; 23%), and consultants (n = 30; 21%). Location wise, the highest incidence of NSI was found in the operating room (n = 94; 67%), followed by the laboratory (n = 17; 12%), and patients’ ward (n = 14; 10%). Maximum pricks (n = 10; 20%) occurred while passing sharp instruments, anterior segment surgeons (n = 23; 79%) being affected more than posterior segment surgeons (n = 6; 21%). None of the NSI incidents was attributed to anti-VEGF injections. None of the subjects with NSI had seroconversion to hepatitis B surface antigen, human immunodeficiency virus, or hepatitis C virus in the 5-year study period.

Conclusions:

NSI is the most commonly encountered in the operating room among training personnel while passing sharp instruments, especially anterior segment surgeons. A proper needle/sharp disposal mechanism, documentation of adverse event, on-going staff training, and prompt prophylactic treatment are essential components of the protocol for NSI management.