A training programme for prevention of occupational exposure to bloodborne pathogens: impact on knowledge, behaviour and incidence of needle stick injuries among student nurses in Changsha, People's Republic of China

Interventions to Enhance Nursing Student Compliance With Infection Control: A Systematic Review

AIM

The purpose of this review was to identify effective strategies for improving infection control practices among prelicensure nursing students.

BACKGROUND

Infection control practices are fundamental skills taught to prelicensure nursing students. The most effective teaching strategy to support infection control behaviors has yet to be determined.

METHOD

A systematic search of peer-reviewed English literature published before October 2021 was conducted in three databases, followed by critical appraisal. Outcomes included either observed or self-reported infection control behaviors.

RESULTS

Twelve eligible studies met inclusion criteria for qualitative synthesis. Studies with integrated simulation or multimodal interventions generally achieved higher infection control compliance than those with greater emphasis on traditional education. The appraisal noted intervention/instrument heterogeneity and limited control.

CONCLUSION

Didactic infection control education should be supplemented with other modalities, but further controlled studies are needed to identify which specific approach is most effective.

Safety interventions for the prevention of accidents at work: A systematic review

Background

Limited knowledge regarding the relative effectiveness of workplace accident prevention approaches creates barriers to informed decision-making by policy makers, public health practitioners, workplace, and worker advocates.

Objectives

The objective of this review was to assess the effectiveness of broad categories of safety interventions in preventing accidents at work. The review aims to compare effects of safety interventions to no intervention, usual activities, or alternative intervention, and if possible, to examine which constituent components of safety intervention programs contribute more strongly to preventing accidents at work in a given setting or context.

Date Sources

Studies were identified through electronic bibliographic searches, government policy databanks, and Internet search engines. The last search was carried out on July 9, 2015. Gray literature were identified by searching OSH ROM and Google. No language or date restrictions were applied. Searches done between February and July of 2015 included PubMed (1966), Embase (1980), CINAHL (1981), OSH ROM (NIOSHTIC 1977, HSELINE 1977, CIS-DOC 1974), PsycINFO (1806), EconLit (1969), Web of Science (1969), and ProQuest (1861); dates represent initial availability of each database. Websites of pertinent institutions (NIOSH, Perosh) were also searched.

Study Eligibility Criteria Participants and Interventions

Included studies had to focus on accidents at work, include an evaluation of a safety intervention, and have used injuries at work, or a relevant proxy, as an outcome measure. Experimental, quasi-experimental, and observational study designs were utilized, including randomized controlled trials (RCTs), controlled before and after (CBA) studies, and observational designs using serial measures (interrupted time series, retrospective cohort designs, and before and after studies using multiple measures). Interventions were classified by approach at the individual or group level, and broad categories based on the prevention approach including modification of: Attitudes (through information and persuasive campaign messaging).Behaviors (through training, incentives, goal setting, feedback/coaching).Physiological condition (by physical training).Climate/norms/culture (by coaching, feedback, modification of safety management/leadership).Structural conditions (including physical environment, engineering, legislation and enforcement, sectorial-level norms). When combined approaches were used, interventions were termed "multifaceted," and when an approach(es) is applied to more than one organizational level (e.g., individual, group, and/or organization), it is termed "across levels."

Study Appraisal and Synthesis Methods

Narrative report review captured industry (NACE), work setting, participant characteristics, theoretical basis for approach, intervention fidelity, research design, risk of bias, contextual detail, outcomes measures and results. Additional items were extracted for studies with serial measures including approaches to improve internal validity, assessments of reasonable statistical approaches (Effective Practice of Organization of Care [EPOC] criteria) and overall inference. Random-effects inverse variance weighted meta-analytic methods were used to synthesize odds ratios, rate ratios, or standardized mean differences for the outcomes for RCT and CBA studies with low or moderate levels of heterogeneity. For studies with greater heterogeneity and those using serial measures, we relied on narrative analyses to synthesize findings.

Results

In total 100 original studies were included for synthesis analysis, including 16 RCT study designs, 30 CBA study designs, and 54 studies using serial measures (ITS study designs). These studies represented 120 cases of safety interventions. The number of participants included 31,971,908 individuals in 59 safety interventions, 417,693 groups/firms in 35 safety interventions, and 15,505 injuries in 17 safety interventions. Out of the 59 safety interventions, two were evaluating national prevention measures, which alone accounted for 31,667,110 individuals. The remaining nine safety interventions used other types of measures, such as safety exposure, safety observations, gloves or claim rates. Strong evidence supports greater effects being achieved with safety interventions directed toward the group or organization level rather than individual behavior change. Engineering controls are more effective at reducing injuries than other approaches, particularly when engineered changes can be introduced without requiring "decision-to-use" by workplaces. Multifaceted approaches combining intervention elements on the organizational level, or across levels, provided moderate to strong effects, in particular when engineering controls were included. Interventions based on firm epidemiologic evidence of causality and a strong conceptual approach were more effective. Effects that are more modest were observed (in short follow-up) for safety climate interventions, using techniques such as feedback or leadership training to improve safety communication. There was limited evidence for a strong effect at medium-term with more intense counseling approaches. Evidence supports regulation/legislation as contributing to the prevention of accidents at work, but with lower effect sizes. Enforcement appears to work more consistently, but with smaller effects. In general, the results were consistent with previous systematic reviews of specific types of safety interventions, although the effectiveness of economic incentives to prevent accidents at work was not consistent with our results, and effectiveness of physiological safety intervention was only consistent to some extent.

Limitations

Acute musculoskeletal injuries and injuries from more long-time workplace exposures were not always clearly distinguished in research reports. In some studies acute and chronic exposures were mixed, resulting in inevitable misclassification. Of note, the classification of these events also remains problematic in clinical medicine. It was not possible to conduct meta-analyses on all types of interventions (due to variability in approach, context, and participants). The findings presented for most intervention types are from limited sources, and assessment of publication bias was not possible. These issues are not surprising, given the breadth of the field of occupational safety. To incorporate studies using serial measures, which provide the only source of information for some safety interventions such as legislation, we took a systematic, grounded approach to their review. Rather than requiring more stringent, specific criteria for inclusion of ITS studies, we chose to assess how investigators justified their approach to design and analyses, based on the context in which they were working. We sought to identify measures taken to improve external validity of studies, reasonable statistical inference, as well as an overall appropriate inferential process. We found the process useful and enlightening. Given the new approach, we may have failed to extract points others may find relevant. Similarly, to facilitate the broad nature of this review, we used a novel categorization of safety interventions, which is likely to evolve with additional use. The broad scope of this review and the time and resources available did not allow for contacting authors of original papers or seeking translation of non-English manuscripts, resulting in a few cases where we did not have sufficient information that may have been possible to obtain from the authors.

Conclusions and Implications of Key Findings

Our synthesis of the relative effectiveness of workplace safety interventions is in accordance with the Public Health Hierarchy of Hazard Control. Specifically, more effective interventions eliminate risk at the source of the hazard through engineering solutions or the separation of workers from hazards; effects were greater when these control measures worked independently of worker "decision-to-use" at the worksite. Interventions based on firm epidemiological evidence of causality and clear theoretical bases for the intervention approach were more effective in preventing injuries. Less effective behavioral approaches were often directed at the prevention of all workplace injuries through a common pathway, such as introducing safety training, without explicitly addressing specific hazards. We caution that this does not mean that training does not play an essential function in worker safety, but rather that it is not effective in the absence of other efforts. Due to the potential to reach large groups of workers through regulation and enforcement, these interventions with relatively modest effects, could have large population-based effects.

Healthcare workers' knowledge for safe handling and moving of the patient

Objectives. Healthcare workers are at risk of injury during patient handling activities. There is a lack of research in safe patient handling. The objective of this study was to examine the knowledge level of safe patient handling among Brazilian healthcare workers and to analyze its associated factors. Methods. This cross-sectional study was performed in two hospitals and 47 outpatient facilities with 644 participants in Brazil. Healthcare workers completed a self-administered questionnaire about their working characteristics, history of lower back pain and knowledge of safe patient handling. Results. The mean score of safe patient handling knowledge was 11.89 out of 22 maximum points. More than half (59%) of the participants did not see the risk of their activity. Educational level, type of healthcare facility and outpatient clinics were associated with safe patient handling knowledge in the logistic regression model. Conclusion. There was a substantial deficit in safe patient handling knowledge. There is a need for courses and textbooks to move beyond ineffective preventive strategies and minimize the risk of manual patient handling. Healthcare workers are at risk of injury during patient handling activities. Nursing schools in developing countries must focus on researching this topic to ensure safe patient handling.

Education and training for preventing sharps injuries and splash exposures in healthcare workers

BACKGROUND

In healthcare settings, health care workers (HCWs) are at risk of acquiring infectious diseases through sharps injuries and splash exposures to blood or bodily fluids. Education and training interventions are widely used to protect workers' health and safety and to prevent sharps injuries. In certain countries, they are part of obligatory professional development for HCWs.

OBJECTIVES

To assess the effects of education and training interventions compared to no intervention or alternative interventions for preventing sharps injuries and splash exposures in HCWs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, NHSEED, Science Citation Index Expanded, CINAHL and OSH-update (from all time until February 2016). In addition, we searched the databases of Global Health, AustHealth and Web of Science (from all time until February 2016). The original search strategy was re-run in November 2019, and again in February 2020. In April 2020, the search strategy was updated and run in CINAHL, MEDLINE, Scopus and Web of Science (from 2016 to current).

SELECTION CRITERIA

We considered randomized controlled trials (RCTs), cluster-randomized trials (cluster-RCTs), controlled clinical trials (CCTs), interrupted time series (ITS) study designs, and controlled before-and-after studies (CBA), that evaluated the effect of education and training interventions on the incidence of sharps injuries and splash exposures compared to no-intervention.

DATA COLLECTION AND ANALYSIS

Two authors (SC, HL) independently selected studies, and extracted data for the included studies. Studies were analyzed, risk of bias assessed (HL, JL) , and pooled using random-effect meta-analysis, where applicable, according to their design types. As primary outcome we looked for sharps injuries and splash exposures and calculated them as incidence of injuries per 1000 health care workers per year. For the quality of evidence we applied GRADE for the main outcomes.

MAIN RESULTS

Seven studies met our inclusion criteria: one cluster-RCT, three CCTs, and three ITS studies. The baseline rates of sharps injuries varied from 43 to 203 injuries per 1000 HCWs per year in studies with hospital registry systems. In questionnaire-based studies, the rates of sharps injuries were higher, from 1800 to 7000 injuries per 1000 HCWs per year.  The majority of studies utilised a combination of education and training interventions, including interactive demonstrations, educational presentations, web-based information systems, and marketing tools which we found similar enough to be combined. In the only cluster-RCT (n=796) from a high-income country, the single session educational workshop decreased sharps injuries at 12 months follow-up, but this was not statistically significant either measured as registry-based reporting of injuries (RR 0.46, 95% CI 0.16 to 1.30, low-quality evidence) or as self-reported injuries (RR 0.41, 95% CI 0.14 to 1.21, very low-quality evidence) In three CCTs educational interventions decreased sharps injuries at two months follow-up (RR 0.68, 95% CI 0.48 to 0.95, 330 participants, very low-quality evidence). In the meta-analysis of two ITS studies with a similar injury rate, (N=2104), the injury rate decreased immediately post-intervention by 9.3 injuries per 1000 HCWs per year (95% CI -14.9 to -3.8). There was a small non-significant decrease in trend over time post-intervention of 2.3 injuries per 1000 HCWs per year (95% CI -12.4 to 7.8, low-quality evidence). One ITS study (n=255) had a seven-fold higher injury rate compared to the other two ITS studies and only three data points before and after the intervention. The study reported a change in injury rate of 77 injuries per 1000 HCWs (95% CI -117.2 to -37.1, very low-quality evidence) immediately after the intervention, and a decrease in trend post-intervention of 32.5 injuries per 1000 HCWs per year (95% CI -49.6 to -15.4, very low quality evidence). None of the studies allowed analyses of splash exposures separately from sharps injuries. None of the studies reported rates of blood-borne infections in patients or staff. There was very low-quality evidence of short-term positive changes in process outcomes such as knowledge in sharps injuries and behaviors related to injury prevention.  AUTHORS' CONCLUSIONS: We found low- to very low-quality evidence that education and training interventions may cause small decreases in the incidence of sharps injuries two to twelve months after the intervention. There was very low-quality evidence that educational interventions may improve knowledge and behaviors related to sharps injuries in the short term but we are uncertain of this effect. Future studies should focus on developing valid measures of sharps injuries for reliable monitoring. Developing educational interventions in high-risk settings is another priority.

Magnitude of Needlestick and Sharp Injury and Its Associated Factors Among Nurses Working at Health Institutions in Western Ethiopia, 2020

Background

Needlestick and sharp injury represent a major occupational hazard in the healthcare environment with nurses experiencing a large proportion of the burden. It is a potential for transmission of bloodborne pathogens including the human immunodeficiency virus, hepatitis B and C virus. Needlestick and sharp injuries are neglected and are often not reported. Few studies have been conducted in Ethiopia, and no study was conducted particularly in the Western part of a country. Therefore, this study aimed to assess needlestick and sharp injuries and associated factors among nurses working at health institutions in western Ethiopia, 2020.

Methods

An institutional based cross-sectional study was conducted on 297 nurses, from January 15 to 30, 2020. The study participants were selected by a simple random sampling method and data were collected using a self-administered questionnaire. Multivariable logistic regression was used to identify associated factors of needlestick and sharp injury. The association between needle stick and sharp injury and associated factors were measured using the odds ratio at a 95% confidence interval. The statistical significance was made at a p-value of less than 0.05.

Results

Out of 297 nurses who participated in the study, 100 (33.7%) had encountered needlestick and sharp injury in the past 12 months. Recapping the needle (AOR=3.99 95% CI: 2.20, 7.21), non-utilization of infection prevention guideline (AOR= 2.69, 95% CI: 1.29, 5.60), not taking injection safety training (AOR = 2.25, 95% CI: 1.22, 4.13) and having job-related stress (AOR= 1.93, 95% CI: 1.10, 3.41) were significantly associated with the needlestick and sharp injury.

Conclusion

In this study, the magnitude of needlestick and the sharp injury was high. The nurse should not recap the needles, should utilize infection prevention guidelines, should minimize stress, and routine injection safety training should be given to minimize needlestick and sharp injuries.

Hepatitis B virus infections among health professional students in Mwanza city,Tanzania in 2016

Background

The World Health Organisation (WHO) recommends the vaccination against Hepatitis B virus in all infants and children up to the age of 18 years. In addition, adults in high-risk groups should also be vaccinated. This study investigated the prevalence and factors associated with Hepatitis B Virus (HBV) infections among health professional students in the city of Mwanza, Tanzania in order to provide data that can assist in devising prevention and control strategies in this special group.

Methods

A cross-sectional study involving health professional students of the Catholic University of health and Allied Sciences was conducted between April and July 2016. Hepatitis B surface antigen was detected using rapid antigen test while the anti-hepatitis B surface antibodies(anti-HBs) were quantified using Enzygnost Anti-HBs II assay and anti-HBV core antibodies tested using enzyme immunoassay.

Results

A total of 1211 health professional students with median age of 22 interquartile range (IQR):21–24 years were enrolled. The slighlty majority (57.5%) of these students were males and 475(39.2%) were in clinical practices. Out of 1211 students, 37 (3.1%) were Hepatitis B surface antigen positive. Of 1174 students tested for anti-HBs, 258 (22%) had titres > 10 IU/L indicating HBV immunity. The median anti-HBs titres was 47.7 IU/L(IQR:16–3-113). A total of 230(89.2%) students among those who were positive for anti-HBs were also positive for HBV core antibodies indicating HBV natural infections. Male sex (adjusted odd ratio(AOR):1.77, p < 0.000), being married (AOR:1.82, p = 0.002) and being in clinical practices (AOR:1.39, p = 0.028) independenlty predicted anti-HBs positivity.

Conclusion

A significant proportion of health professional students was naturally immune to Hepatitis B virus. There is a need to measure anti-HBs in order to reduce the cost of unnecessary vaccination especially in the countries with high endemicity of HBV.

The Unmet Medical Needs of Current Injectable Antidiabetic Therapies in China: Patient and Health Care Professional Perspectives

PURPOSE

Patients with diabetes and health care professionals (HCPs) play important roles in effective application of injectable antidiabetic therapies (IATs). However, their concerns and opinions on IATs are rarely investigated in China. This study aims to assess unmet medical needs of IATs regarding patient concerns, patient satisfaction, aspects that need improvement, and training burden from patient and HCP perspectives.

METHODS

This cross-sectional survey was conducted in 12 representative Chinese cities from December 2018 to January 2019. Patients with adult type 2 diabetes who were receiving IAT currently and had received IAT continuously for at least 1 month before the survey, endocrinologists with ≥5 years of experience and prescribing IAT in the past 1 month, and nurses with ≥3 years of experience and providing IAT training in the past 1 month were eligible participants. The patient survey assessed concerns of initiating IAT, satisfaction with IAT, aspects of IAT that need improvement, and IAT training received. The HCP survey evaluated patient concern of initiating IAT, aspects of IAT that need improvement, experience of providing IAT training, and self-reported burden of training. Descriptive statistical analysis was performed.

FINDINGS

In total, 500 patients, 200 endocrinologists, and 100 nurses were surveyed. The mean (SD) age of patients was 55.1 (11.8) years, with a disease duration of 7.6 (6.4) years. Of all patients, 391 (78.2%) were insulin users and 109 (21.8%) were glucagon-like peptide 1 receptor agonist users. Of the top 4 concerns about initiating IAT, both patients and endocrinologists reported inconvenience of daily injection (58.0% of patients and 68.5% of endocrinologists), worries about insulin dependence (42.6% of patients and 62.5% of endocrinologists), and fear of injection (37.0% of patients and 66.5% of endocrinologists). Medical expenses, convenience of drug portability and storage, and injection site reactions were the top 3 aspects that need improvement according to both patients and HCPs. High injection frequency was also one of the most urgent aspects for improvement (mean urgency score, 3.8 for physicians and 4.0 for nurses). A typical IAT training session took a mean (SD) of 14.1 (9.7) minutes. Both patients and HCPs considered injection operation after dose is set and symptoms and treatment for adverse effects as the 2 most time-consuming training contents. In addition, 97.1% of endocrinologists who provided training and 97.0% of nurses thought a more user-friendly IAT would reduce their training burden.

IMPLICATIONS

Study results indicate that the IATs with more convenient drug portability and storage, fewer injection site reactions and adverse events, less injection frequency, more user-friendly design, and fewer steps for injection might help improve patient experience with self-injection and reduce HCPs' training burden.

Sharps and needle-stick injuries among medical residents and healthcare professional students: pattern and reporting in Italy-a cross-sectional analytical study

OBJECTIVES

Healthcare workers, in the course of their professional activity, are potentially exposed to chemical, physical and above all biological risks. The aims of our study were to investigate the extent and distribution of needle-stick and sharp injuries (NSIs) in healthcare students, the behaviours and circumstances most frequently associated with NSIs, the frequency of NSI reporting and the adherence to the post-exposure protocols.

METHODS

This study involved, through an interviewer-administered structured questionnaire, undergraduate and postgraduate students attending postgraduate medical schools and healthcare professional schools who underwent occupational health visits between January 2015 and July 2018.

RESULTS

Of the 642 students that participated in the study, 95 (14.8%) sustained an NSI during the traineeship and, of these, 59 (62.1%) reported the NSI to the occupational health service. NSIs were significantly more frequent in older subjects (χ²=9.853, p=0.020) and, among medical residents, in surgical residents (χ²=31.260, p<0.0001); moreover, occurrence of NSIs increased with increasing duration of traineeship (t=-2.051, p=0.041). Reporting of NSIs significantly increased with increasing age (χ²=12.543, p=0.006), with medical residents significantly under-reporting NSIs compared with undergraduate healthcare professional students (χ²=10.718, p=0.001) and among medical residents, those attending critical care units had the highest under-reporting (χ²=7.323, p=0.026).

CONCLUSIONS

The study showed remarkable under-reporting, as well as a lack of preparedness of students for NSI preventive and post-exposure effective measures. Our findings underline that healthcare student education should be reinforced to ensure that safe practices are carried out when needles and sharps are involved, as well as stressing the importance of NSI reporting and adherence to post-exposure prophylaxis protocols.

Occupational Exposure to Potentially Infectious Biological Material Among Physicians, Dentists, and Nurses at a University

Objective

The objective of this study was to evaluate the prevalence and incidence of accidents with biological material, the level of knowledge, and compliance to standard precautions (SPs) among dentists, physicians, nurses, and dental and medical students.

Methods

A closed cohort study with a prospective and retrospective component was conducted between August 2014 and September 2015. The participants were contacted in two moments during the follow-up period, during which a structured questionnaire divided into six sections was used; the interviews were conducted during the follow-up period (Month 6) and at the end of the observation period (Month 12).

Results

The global prevalence of accidents in the previous 12 months was 10.2%, with a difference between professionals and students (13.0% vs. 5.1%, respectively; p < 0.003). The incidence rate was 6.49 per 100 person/year, with difference between the groups (6.09 per 100 person/year in professionals and 7.26 per 100 person/year in students), type of specialization (hazard ratio, 3.27), and hours worked per week (hazard ratio, 2.27). The mean of compliance to SP was 31.99 (±3.85) points, with a median of 33 (30, 35) points against the expected 27.75 points. Adherence to SP was associated with the accident report (p < 0.020).

Conclusion

We conclude that the proportion/incidence rate of accidents with biological material was high in relation to that in the literature, being higher in professionals and especially among physicians. The levels of knowledge and adherence to SP were good, with the best found in dentists and dental students.

Validation of the educational effectiveness of a mobile learning app to improve knowledge about MR image quality optimisation and artefact reduction

Aim

The aim was to design an app-based eLearning tool to provide radiographers with information about the physical basis of MR artefacts and practical elimination or/and minimisation strategies to optimise image quality, and to evaluate the impact of a smartphone app on radiographers’ knowledge.

Methods

The study used the comparison-experimental approach (pre- and post-test). Thirty-five MR radiographers independently reviewed a prepared series of MR images (n = 25). The participants were requested to identify image quality related errors, to specify error-correction strategies and to score how confident they were in their responses. Participants were then divided into experimental (n = 19) and control cohorts (n = 16). The app was provided to the experimental cohort for 3 months; after this period both cohorts re-reviewed the MR image datasets and repeated their identification of image quality errors.

Results

The results showed a statistically significant difference between control and experimental cohorts relative to participants’ pre- to post-test knowledge level. For the experimental cohort, years of experience, qualification and type of hospital were not associated with radiographer knowledge level and confidence in recognising the presence of an image quality error, naming the error and specifying appropriate correction strategies (p > 0.05).

Conclusion

The study identified the potential of the smartphone app as an effective educational tool to support MR radiographers’ knowledge in recognising and characterising MR image quality errors.

Key Points

• A high level of knowledge to optimise MR image quality is crucial.

• Ongoing education in image quality optimisation is required.

• The potential role of app as an effective educational tool is identified.

Evaluating the Effectiveness of a Continuing Education Program for Prevention of Occupational Exposure to Needle Stick Injuries in Nursing Staff Based on Kirkpatrick's Model

BACKGROUND

Nurses are the most vulnerable group that are faced with occupational injuries caused by exposure to needle stick injuries. This study evaluated the effectiveness of a continuing education program about the prevention of occupational exposure to needle stick injuries in the nursing staff, based on the Kirkpatrick model.

METHODS

In this study, 120 nurses were selected in the experimental and control groups. A continuing education program for experimental group was performed. After the education program, its effectiveness has been evaluated across four levels (Reaction, Learning, Behavior, Results) of the Kirkpatrick model. Data analysis was conducted using Pearson's correlation coefficient, chi-square test, paired t-test, independent samples t-test, and descriptive statistics. The data were analyzed using the SPSS statistical software (V. 22).

RESULTS

The mean score for knowledge in the experimental group improved significantly from 8.32 ± 2.17 to 13.98 ± 1.2 (p < 0.05). The experimental group of 24 nurses (40%) were exposed to needle stick injury before education, but this number was reduced to 9 (15%) after intervention. The chi-square test showed a significant difference (P = 0.013). However in the experimental group, 15 nurses (25%) were exposed to blood and body fluids before intervention, but again it was reduced to 6 (10%) after education. The chi-square test showed a significant difference (P = 0.002).

CONCLUSION

The results from the execution of continuing education program showed that through designing training programs and raising awareness in nursing personnel, we can reduce occupation exposure to needle stick injuries.

Needle-Stick Injuries in the National Health Service: A Culture of Silence

Injury by contaminated sharp instruments and needles constitutes a major occupational hazard for healthcare workers. In a confidential survey at a district general hospital, 300 healthcare professionals were asked about their personal experience of needle-stick injury and their attitudes to reporting. 279 individuals responded, of whom 38% had experienced at least one needle-stick (mean 1.8) in the past year and 74% had sustained such an injury during their careers (mean 3.0). Although 80% of respondents were aware that such incidents should be notified, only 51% of those affected had reported all needle-stick injuries. Doctors were less likely to report than nurses, despite a higher liability to injury. This survey adds to evidence of a culture of silence pertaining to needle-stick injuries. The consequent risks to health, and the ethical and financial implications, remain uncertain.

Needlestick and Sharps Injuries Among Nursing Students in Nanjing, China

Needlestick and sharps injuries (NSIs) are a major cause of occupational injuries for health care workers worldwide. In this study, the authors report the prevalence of and risk factors for NSIs among Chinese nursing students. A cross-sectional survey was distributed to 442 nursing students; 393 completed questionnaires were submitted. A total of 237 (60.3%) nursing students reported NSIs, which were more commonly reported by female students, younger students, students who worked frequent night shifts, students without safety training, and students who did not use personal protective equipment. Among those injured, 59.9% were injured by syringe needles, 21.9% by glass items, and 3.4% by scissors. Of those needles and sharps causing injuries, 36.3% of devices had been used on patients, 41% were unused, and 22.7% were unknown. Opening ampoules or vials was the most common injury agent. A total of 86.9% of NSIs were not reported to hospital infection control. Nursing students are at high risk of NSIs in China. Occupational safety training should be developed and implemented to prevent NSIs among this vulnerable population.

Compliance with infection control standard precautions guidelines: a survey among dental healthcare workers in Hail Region, Saudi Arabia

BACKGROUND

The concept of standard precautions (SP) has been a cornerstone of dental infection control (IC) practice. Full adherence with SP guidelines is still a matter of concern in many institutions. The objectives of the present study were to assess and characterise compliance with SP guidelines among dental healthcare workers (DHCWs) and to analyse factors that affect compliance.

METHODS

A regional cross-sectional questionnaire survey among DHCWs in all health facilities was carried out from August to November 2014.

RESULTS

A total of 307 returned valid self-report questionnaires with a response rate of 73.1%. Most participants (86.3%) were aware of the SP guidelines, 84.4% received IC training and 88.9% received hepatitis B vaccination. Compliance with SP was found to be high; the majority (90.1%) attained 75% on the compliance scale. In the multivariate logistic regression model, perceived higher institutional commitment as regard IC requirements (odds ratio [OR], 4.34; P <0.001), perceived training as adequate (OR, 3.51; P = 0.003), dentist job (OR, 2.99; P = 0.035) and younger age (OR, 0.59; P = 0.041) were independently predicted as good compliant behaviour.

CONCLUSIONS

This survey revealed high self-reported compliance with SP guidelines. Institutional factors appear to have an important role. Attention should be paid to dental assistants and private DHCWs.

Occupational Exposure to Needle Stick and Sharp Injuries and Associated Factors among Health Care Workers in Awi Zone, Amhara Regional State, Northwest Ethiopia, 2016

BACKGROUND

Needle stick and sharp injuries were one of the major risk factors for blood and body fluid borne infections at health care facilities.

OBJECTIVE

To assess occupational exposure to needle stick and sharp injuries and associated factors among health care workers in Awi zone, 2016.

METHODS

institutional based cross-sectional study was conducted among 193 health care workers. Study participants were selected using systematic random sampling technique.

RESULT

When queried, 18.7% of the respondents' encountered needle stick and sharp injury in the last 1 year. Participants who practiced needle recapping and had job related stress were 21.3 and 7.3 times more likely to face needle stick and sharp injury, respectively. However, those who apply universal precautions and acquire the required skill were 99% and 96% times less likely to face needle stick and sharp injury, respectively, than their counterparts.

CONCLUSION AND RECOMMENDATION

The prevalence of needle stick and sharp injury was relatively low as compared to previous studies. Recapping of needle after use, job related stress, not applying universal precautions, and lack of the required skill were associated with needle stick and sharp injuries. Therefore, health care providers should apply universal precaution.

The impact of sharps injuries on student nurses: a systematic review

AIMS AND OBJECTIVES

The purpose of this review was to discover the impact of sharps injuries in the student nurse population.

BACKGROUND

Much is known and reported about sharps injuries in registered nurses, but there has been a lack of published evidence regarding sharps injuries within the student nurse population.

METHOD

A systematic review of nursing, health and psychology databases was conducted. The limits set were publications between 1980 and 2014 in the English language. Studies were identified then, following a rigorous critical and quality appraisal with validated tools, were selected for the systematic review.

RESULTS

A total of 40 articles met the inclusion criteria, reporting studies conducted in 18 countries. Psychological and physical impacts of sharps injuries in student nurses were reported, such as fear, anxiety and depression, although these impacts were not quantified using a validated instrument.

CONCLUSION

The impact of sharps injuries can be severe, both psychological and physical. This systematic review shows that further research is needed into this, especially in under-researched areas such as the UK, to establish the impact of sharps injuries within this population. Further research would also aid the education and prevention of this harmful problem. The review also emphasises the psychological issues relating to sharps injuries, the impact these can have on individuals and the support and counselling that student nurses require after injury.

RELEVANCE TO PRACTICE

These findings highlight the potential psychological issues that can result from sharps injuries in this population.

Universal precautions

The purpose of this literature review is to consider key themes from empirical research relating to the knowledge and compliance of universal precautions amongst healthcare practitioners. Utilising international studies, strategies to improve universal precautions are analysed. The review identifies areas of limited knowledge, synthesises existing research and suggests aspects of universal precautions that need to be studied further.

A literature search of studies listed in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database was conducted from 1990–2003, using a number of key words. Review, analysis and synthesis of selected studies were performed.

The findings of this review showed that universal precautions are considered an effective means of protecting patients and staff and controlling infection. The consensus from this body of evidence is that, globally, knowledge of universal precautions is inadequate and compliance low. Studies from many countries have shown that specific intervention strategies, such as education, are influential in improving knowledge and compliance.

This review concludes that it is imperative that future research examines how the attitudes and beliefs of practitioners can be influenced and changed to reenforce adherence to universal precautions within the clinical practice setting. There remains a lack of evidence on the long-term benefits of practice interventions to improve compliance, and what specific barriers are influential in affecting how healthcare practitioners adopt universal precautions more effectively in their practice.

Implementation of infection control in health facilities in Arua district, Uganda: a cross-sectional study

Background

At least 1.4 million people are affected globally by nosocomial infections at any one time, the vast majority of these occurring in low-income countries. Most of these infections can be prevented by adopting inexpensive infection prevention and control measures such as hand washing. We assessed the implementation of infection control in health facilities and determined predictors of hand washing among healthcare workers (HCWs) in Arua district, Uganda.

Methods

We interviewed 202 HCWs that included 186 randomly selected and 16 purposively selected key informants in this cross-sectional study. We also conducted observations in 32 health facilities for compliance with infection control measures and availability of relevant supplies for their implementation. Quantitative data underwent descriptive analysis and multiple logistic regressions at 95 % confidence interval while qualitative data was coded and thematically analysed.

Results

Most respondents (95/186, 51 %) were aware of at least six of the eight major infection control measures assessed. Most facilities (93.8 %, 30/32) lacked infection control committees and adequate supplies or equipment for infection control. Respondents were more likely to wash their hands if they had prior training on infection control (AOR = 2.71, 95 % CI: 1.03–7.16), had obtained at least 11 years of formal education (AOR = 3.30, 95 % CI: 1.44–7.54) and had reported to have acquired a nosocomial infection (AOR = 2.84, 95 % CI: 1.03–7.84).

Conclusions

Healthcare workers are more likely to wash their hands if they have ever suffered from a nosocomial infection, received in-service training on infection control, were educated beyond ordinary level, or knew hand washing as one of the infection control measures. The Uganda Ministry of Health should provide regular in-service training in infection control measures and adequate necessary materials.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-015-0999-4) contains supplementary material, which is available to authorized users.

Predictors for compliance of standard precautions among nursing students

BACKGROUND

We aimed to investigate the frequency of standard precautions (SPs) compliance and the factors affecting the compliance among nursing students (NSs).

METHODS

A cross-sectional survey study guided by the health belief model was conducted in 2009. The study questionnaire is valid (content validity index, 0.81) and reliable (Cronbach α range, 0.65-0.94).

RESULTS

There were 678 questionnaires analyzed, with a response rate of 68.9%. The mean frequency score of SPs compliance was 4.38 ± 0.40 out of 5. Tukey honest significant difference post hoc test indicated that year 2 and year 4 students had better SPs compliance than year 3 students. Further analysis using a univariate general linear model identified an interaction effect of perceived influence of nursing staff and year of study (F1,593 = 3.72; P < .05). The 5 following predictors for SPs compliance were identified: knowledge of SPs, perceived barriers, adequacy of training, management support, and influence of nursing staff.

CONCLUSION

Although the SPs compliance among NSs was high, the compliance varied by year of study and was affected by the nursing staff. Furthermore, SPs compliance among NSs can be enhanced by increasing SPs knowledge, providing more SPs training, promoting management support, reducing identified SPs barriers, and improving nursing staff compliance to SPs.

[Knowledge of and compliance with universal precautions: students dealing with biohazards in Brazil and Colombia]

Objective To assess scales of adherence to universal precautions and means of knowledge transmission among healthcare students in Brazil and Colombia. Methods We conducted a pilot study to validate the questionnaire that started a cohort study. Twenty-six students in Colombia and 25 in Brazil were intentionally selected. The participants were comparable in number and sociodemographic characteristics in both countries and studied the health professions (medicine, nursing and dentistry). The program SPSS version 18.0 was used to create the database and to carry out statistical analysis. Results We evaluated a total of 51 students. They had a a mean (SD) age of 21.78 (2.33), 84.3 % were women, 66.7 % had white skin, 47.1 % were medical students, and 70,6 % were in their 4th year. They answered about sexual habits reporting that 45.1 had only one partner% in the last year, 23.5 % did not use protection, and, of those who were protected, 45.1 % used a condom. The mean knowledge was 10.88 (±0.952) points to an expected 9 points; Cronbach's Alpha (α) was 0.823. The mean adherence to universal precautions (UPs) was 33.69 (±3.36) points to an expected 30.75; α was 0.741. We found a significant difference in knowledge levels (p<0.007) between the two countries and in the adherence to PUs by year of study (p<0.001). Conclusions Knowledge about means of transmission was good. Adherence to universal precautions was acceptable, but low in terms of the use of glasses, face masks, and discarding sharp objects. Dentistry students showed the best adherence.

Sharp Injuries Among Medical Students

Introduction:

Sharp injuries threaten the health of healthcare employees. They cause the transmission of many diseases such as hepatitis B and C, AIDS, etc., which can increase the associated costs associated with them. The aim of this study was to investigate the frequency of sharp injuries among the students of Hormozgan University of Medical Sciences.

Method:

This cross-sectional study was conducted during 2012-2013 in Hormozgan University of Medical Sciences, IR Iran. The target population consisted of the medical, nursing, midwifery, operating room technician, and medical laboratory students in the 2012-2013 academic year. Census sampling was conducted, and accordingly, 500 students participated in the study Data was collected using modified questionnaire of the University of San Diego’s injury report form. The collected data were entered into SPSS V.19 and analyzed using descriptive statistical tests.

Findings:

Finally 377 students (75.4%) returned the questionnaire. Among the studied students, 184 students (39.3%) had had sharp injuries. The frequency of damaging Vein puncture was the most common mechanism of injury

Discussion and Conclusion:

The prevalence of sharp injuries is high among students which can increase the risk of disease and its subsequent risks, and thus, increase the cost and stress among students. It seems that holding workshops and increasing students’ awareness and skills to face these risks can be effective in mitigating them.

Epidemiology of exposure to HIV/AIDS risky conditions in healthcare settings: the case of health facilities in Gondar City, North West Ethiopia

BACKGROUND

It has been estimated that every year more than quarter a million health care workers exposed to HIV risky conditions in health care settings, more so in developing countries, with high incidence of HIV/AIDS and unsafe practices. Particularly, Sub-Saharan African countries share at least half of these occupational exposures to HIV risky conditions among health care workers. The aim of this study was to determine the epidemiology of health care workers' exposure to HIV/AIDS risky conditions and associated factors in the healthcare settings in Gondar city.

METHODS

Institution based quantitative cross sectional study was conducted from April 1-20, 2014. The study included 401 health care workers who were selected from the source population by simple random sampling technique. Data were collected by interviewing health care workers using structured and pretested questionnaire. After the collected data entered to EPI INFO version 3.5.3 statistical software and exported to SPSS version 20.0 for analysis, both binary and multivariable logistic regressions were done to identify factors associated with exposure to HIV/AIDS risky conditions.

RESULTS

From a total of 401 health care workers involved in this study, 162(40.4%) reported at least one history of occupational exposure to HIV/AIDS risky conditions in the last one year. More than half (52.31%) of physicians and 47.62% of anesthetists were exposed to HIV/AIDS risky conditions within one year. Lack of training on infection prevention, 5-10 years work experience, long working hours per week, absence of work guidelines, and dissatisfaction with current job were significantly associated with accidental occupational exposure to HIV/AIDS risky conditions.

CONCLUSION

This study found quite high prevalence of health care workers exposure to HIV/AIDS risky conditions in the health care settings in Gondar city. Therefore, effective and goal oriented educational programmes targeting at health care workers and establishment of surveillance systems for registering, reporting and management of occupational exposures in health care settings are quite important.

Knowledge, Attitude, and Practices Regarding Occupational HIV Exposure and Protection among Health Care Workers in China: Census Survey in a Rural Area

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.

Occupational exposures to body fluids and behaviors regarding their prevention and post-exposure among medical and nursing students at a Brazilian public university

A cross-sectional study was conducted to assess the frequencies and characteristics of occupational exposures among medical and nursing students at a Brazilian public university, in addition to their prevention and post-exposure behavior. During the second semester of 2010, a self-administered semi-structured questionnaire was completed by 253/320 (79.1%) medical students of the clinical course and 149/200 (74.5%) nursing students who were already performing practical activities. Among medical students, 53 (20.9%) suffered 73 injuries, which mainly occurred while performing extra-curricular activities (32.9%), with cutting and piercing objects (56.2%), in the emergency room (39.7%), and as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%) in the operating room or wards (72.2%), and as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instructions on previously received exposure prevention; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 49.3% and 35.1% did not bother to find out the source patient's serological results post-exposure; and 1.4% and 18.9% officially reported injuries. In conclusion, this study found high frequencies of exposures among the assessed students, inadequate practices in prevention and post-exposure, and, consequently, the need for training in “standard precautions” to prevent such exposures.

Infection control and practice of standard precautions among healthcare workers in northern Nigeria

Background:

Healthcare-associated infections (HAIs) have been reported to be a serious problem in the healthcare services as they are common causes of illness and mortality among hospitalized patients including healthcare workers (HCWs). Compliance with these standard precautions has been shown to reduce the risk of exposure to blood and body fluids.

Aims:

This study therefore assesses the level of knowledge and compliance with standard precautions by the various cadre of HCWs and the factors influencing compliance in hospital environment in Nasarawa State, Northern Nigeria.

Settings and Design:

Nasarawa State has a current human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevalence rate of 10.0%, which was higher than most states in Nigeria with a high level of illiteracy and ignorance. Majority of the people reside in the rural areas while a few are found in the towns, informal settlements with no direct access to healthcare facilities are common.

Materials and Methods:

This study is an analytical, cross-sectional study. Proportional sampling technique was used to obtain a representative sample and a structured self-administered questionnaire was used to collect relevant information from the healthcare providers working in Nasarawa State from January to February 2009.

Statistical analysis used:

To describe patient characteristics, we calculated proportions and medians. For categorical variables, we compared proportions using chi-square tests. A logistic regression model was produced with infection control as outcome variable to identify associated factors.

Results:

A total of 421 HCWs were interviewed, Majority (77.9%) correctly describe universal precaution and infection control with 19.2, 19.2, and 28.0%, respectively unable to recognize vaccination, postexposure prophylaxis, and surveillance for emerging diseases as standard precaution for infection control. About 70.1% usually wear gloves before handling patients or patients’ care products, 12.6% reported wash their hand before wearing the gloves, 10.7% washed hands after removal of gloves, and 72.4% changed gloves after each patient. Only 3.3% had a sharp disposal system in their various workplaces. Majority (98.6%) of the respondents reported that the major reason for noncompliance to universal precautions is the nonavailability of the equipments. There was a statistically significant difference in the practice of standard precaution among those that were exposed to blood products and body fluid compared to those that had not been exposed in the last 6 months (χ² = 3.96, P = 0.03), public healthcare providers when compared to private health workers (χ² = 22.32, P = 0.001), among those working in secondary and tertiary facilities compared to primary healthcare centers (χ² = 14.64, P = 0.001) and urban areas when compared to rural areas (χ² = 4.06, P = 0.02). The only predictor of practice of standard precaution was exposure to blood and body fluid in the last 6 months odds ratio (OR) = 4.56 (confidence interval (CI) = 1.00-21.28).

Conclusions:

This study implies that inadequate workers’ knowledge and environment related problems, including the lack of protective materials and other equipments and utilities required to ensure safety of HCWs is a crucial issue that need urgent attention. Institution of a surveillance system for hospital acquired infection to improve consistent use of standard precautions among health workers is recommended in Nigeria and other low income countries in Africa.

How do university education and clinical experience influence pre-registration nursing students' infection control practice? A descriptive, cross sectional survey

AIMS

This study aims to explore nursing students' knowledge of infection control and investigate how university education and clinical experience influence their infection control practice.

BACKGROUND

In order to prevent and control healthcare associated infections all healthcare staff must be knowledgeable about infection control. However, knowledge and practice of infection control are often sub-optimal. Education has had variable results in improving the infection control knowledge of healthcare professionals yet, there have been few studies examining this issue in relation to pre-registration nursing students in the United Kingdom.

METHODS

This descriptive cross-sectional survey employed a questionnaire composed of predominantly closed questions for data collection. A non-probability, purposive sample of 354/444 (79.7%) nursing students from one university participated in the study.

FINDINGS

Knowledge was generally adequate in questions related to pathogen transmission, hand hygiene principles, glove use, immediate action following sharps' injuries, and risk reduction in relation to sharps and waste management. Topics that received less positive results related to the chain of infection, the use of alcohol gel and Clostridium difficile and the definition of inoculation injury. University education was the main influence on knowledge and practice (340/353, 96.3%), but mentors (322/354, 91.2%), nurses (316/353, 89.3%), doctors (175/353, 49.4%) and other members of the multi-disciplinary team (213/352, 60.2%) were also deemed influential. Workload, time, and availability of facilities and equipment also contributed to the adoption of infection control precautions. The findings illustrated the importance of both theoretical and practical knowledge, supported by competent role models.

CONCLUSION

The study identified the complexities of knowledge acquisition and application in a practice based discipline. The support of a competent role model to assist in applying theory to practice is vital. The study has identified that there are many variables that affect IPC practice, both positively and negatively.

Impact of infection control educational activities on rates and frequencies of percutaneous injuries (PIs) at a tertiary care hospital in Saudi Arabia

OBJECTIVE

To study the impact of educational activities on the rates and frequencies of percutaneous injuries (PIs) at a tertiary care hospital in Saudi Arabia.

METHODS

PI surveillance is a routine activity in King Abdulaziz Medical City (a 900-bed teaching tertiary health care hospital) in Riyadh using the Exposure Prevention Information Network (EPINet) data collection tool. From 2001 through 2003, educational activities were conducted for health care workers (HCWs) to prevent PIs. The education included lectures on the risk of unsafe practices that may lead to PIs and how to avoid them. Data from before (1997-2000) and after (2004-2008) the intervention were imported from our surveillance system and statistically analyzed.

RESULTS

The total overall rate of PIs per 1000 HCWs was significantly lower in the post-intervention period than in the pre-intervention period (14 vs. 32.8/1000 HCWs, respectively). The rates of PIs among nurses and housekeepers showed a significant decrease (15 vs. 37.6/1000 HCWs and 10 vs. 34.5/1000 HCWs, respectively). The frequency of PIs in the emergency department (ED) and intensive care units (ICUs) showed a significant decrease (3.4% for both vs. 12.4% and 13.7%, respectively). PIs associated with devices, such as needles on IV lines, IV catheters, lancets and suture needles, showed a significant decrease. PIs occurring during device disassembly and from inappropriately discarded devices also decreased significantly.

CONCLUSION

The educational program reduced some categories of PIs, including the overall rate, the rate among nurses and housekeepers, the frequency in the ED and ICUs and the frequency among needles on IV lines, IV catheters, lancets and suture needles. Other PI categories did not change significantly.

Prion disease risk perception in Canadian medical laboratories

BACKGROUND

There are no national guidelines specific for handling prion-associated specimens in Canadian medical laboratories. Medical laboratory workers may perceive themselves at risk of prion transmission and, on occasion, decline to process such specimens.

OBJECTIVE

To examine the knowledge, attitudes and reported behaviours of medical laboratory workers in relation to prion disease to understand their risk perception and the need for national laboratory guidelines on prion infection control.

DESIGN

Survey development and cross-sectional web-based administration.

METHODS

The survey was developed through key informant interviews and a modified Delphi process. Medical laboratory workers across Canada were invited by laboratory managers and national organizations to complete the web-based survey.

RESULTS

Twelve key informant interviews were performed. Consensus for questionnaire content was reached through two rounds of the Delphi process. Responses were received from 426 Canadian medical laboratory workers; 37% of medical laboratory staff reported processing prion-associated specimens. Different protocols for specimen processing were followed, and 18% believed they were at risk when processing these specimens. Less than one-third of those receiving specimens believed they were adequately trained. The mean (±SD) knowledge score was 9.25±4.5/24; individuals who had received training scored significantly higher than those who were untrained (P<0.01). Eighty-one per cent of respondents would be more comfortable processing specimens if national guidelines existed and were used in their laboratory.

CONCLUSION

There is a high perception of risk and few perceived benefits of processing prion-associated specimens. National guidelines for prion infection control in medical laboratories and adequate training would enable medical laboratory workers to process these specimens efficiently and confidently.

Acidentes com material biológico em trabalhadores de enfermagem do Hospital Geral de Palmas (TO)

RESUMO OBJETIVO: identificar os acidentes de trabalho com material biológico ocorridos com os trabalhadores de enfermagem do Hospital Geral de Palmas (HGP) e verificar a ocorrência de subnotificação no Serviço de Segurança do Trabalho (SST) do HGP. MÉTODO: estudo descritivo transversal, com dados coletados por meio de um questionário autoaplicável que foi respondido por 389 profissionais de enfermagem (91% do efetivo) nos meses de agosto e setembro de 2007. RESULTADOS: dentre os profissionais de enfermagem, 178 (45,7%) declararam já ter sofrido acidente com material biológico (55,6% por acidente perfurocortante e 44,4% com fluidos), sendo 106 (59,9%) técnicos de enfermagem, 57 (32%) auxiliares de enfermagem e 15 (8,4%) enfermeiros. Considerando todos os profissionais de enfermagem (n=389), com ou sem antecedente de acidente, os auxiliares constituíram o grupo mais exposto aos riscos de acidentes (54,3%), seguidos pelos técnicos (49,8%) e pelos enfermeiros (21,1%). Dos 178 profissionais que sofreram acidentes, 95 (53,3%) trabalhavam de 1 a 5 anos e 39 (21,9%) há mais de 10 anos. Dentre os 178 profissionais acidentados, apenas 64 registraram o acidente no SST, resultando em 64% de subnotificação. CONCLUSÃO: estes resultados evidenciam a necessidade de reformulação do protocolo de encaminhamento para o atendimento ao acidentado e a participação efetiva dos profissionais de enfermagem nessa reformulação.

HIV-related avoidance and universal precaution in medical settings: opportunities to intervene

OBJECTIVE

To determine the association between adherence to universal precaution (UP) and avoidance attitudes toward patients living with HIV/AIDS (PLH) among service providers.

DATA SOURCES/SETTING

A total of 1,760 health service providers were randomly selected from 40 county hospitals in two provinces of China.

STUDY DESIGN

A self-administered questionnaire was used to collect demographic characteristics, UP knowledge and training, UP adherence, availability of UP supplies at work, and avoidance attitudes toward PLH in a cross-sectional survey.

DATA ANALYSIS

A series of regression models were used to examine associations among the UP-related factors and their relationship to avoidance attitudes toward PLH.

PRINCIPAL FINDINGS

UP training was associated with better knowledge of and adherence to UP and perceived availability of UP supplies in hospitals. UP training, knowledge, and adherence were significantly associated with avoidance attitudes toward PLH in medical practice. Being a nurse was also related to HIV-related avoidance.

CONCLUSION

UP promotion campaigns, including in-service training and reinforcement of UP adherence, could play an important role in the battle against HIV-related avoidance in medical settings. Intervention programs should focus on not only individual providers' attitudes and behaviors but also on structural support for norms shifts in the medical community.

Reducing needle stick injuries in healthcare occupations: an integrative review of the literature

Needlestick injuries frequently occur among healthcare workers, introducing high risk of bloodborne pathogen infection for surgeons, assistants, and nurses. This systematic review aims to explore the impact of both educational training and safeguard interventions to reduce needlestick injuries. Several databases were searched including MEDLINE, PsycINFO, SCOPUS, CINAHL and Sciencedirect. Studies were selected if the intervention contained a study group and a control group and were published between 2000 and 2010. Of the fourteen studies reviewed, nine evaluated a double-gloving method, one evaluated the effectiveness of blunt needle, and one evaluated a bloodborne pathogen educational training program. Ten studies reported an overall reduction in glove perforations for the intervention group. In conclusion, this review suggests that both safeguard interventions and educational training programs are effective in reducing the risk of having needlestick injuries. However, more studies using a combination of both safeguards and educational interventions in surgical and nonsurgical settings are needed.

Knowledge, attitudes, perceived vulnerability of Chinese nurses and their preferences for caring for HIV-positive individuals: a cross-sectional survey

AIMS

The study was to assess HIV/AIDS knowledge, attitudes and perceived vulnerability with potential factors.

BACKGROUND

HIV/AIDS is a public health catastrophe in China. Nurses are expected to care for nurture, comfort and advocate for all patients regardless of their condition. However, in the area of HIV/AIDS, nurses suffer as a result of expectations put on them by their professional roles.

DESIGN

This was a descriptive, cross-sectional design that used a survey approach.

METHOD

Data were collected from Summer 2003-Winter 2004.

RESULTS

Nurses reported significant perceived severity of risk from occupational exposure. Many nurses were frequently exposed to being stuck by needles (86%) and being splashed by body fluids and more than half of them (59.7%) were concerned about contracting HIV/AIDS. Nurses who had experience of finger pricks worried about potentially contacting HIV and being unaware of it (odds ratio= 0.444, p = 0.004). Nurses demonstrated a lack of knowledge and training in infectious diseases which may be a result of the fact that the study location is not considered a 'concentrated area' for infectious disease transmission; therefore, the need for the infectious diseases training has not been considered urgent.

CONCLUSIONS

A well-designed educational programme on occupational hazards and risk behaviour should be implemented to educate nurses in suburban cities and the general public. Hospital administrators should implement on-site continuing education on HIV/AIDS throughout China. Armed with better knowledge of both transmission routes and precautions, nurses can protect themselves while providing care to patients.

RELEVANCE TO CLINICAL PRACTICE

Nurses in China urgently need psychosocial and physical supports from families, friends, communities and their working environments while combating HIV epidemic. With good support system, nurses will better educate patients and their family members on how to prevent transmission not only of HIV/AIDS but of a wide range of other infectious diseases as well.

[Application and evaluation of a web-based education program on blood-borne infection control for nurses]

PURPOSE

To develop a web-based program on blood-borne infection control and to examine the effect of the newly developed program on perceived threat of diseases, knowledge, preventive health behaviors for blood-borne infections, and incidence rates of accidental needle sticks and other sharp object injuries in nurses.

METHODS

The program was developed through the processes of analysis, design, development, implementation, and evaluation. The research design involved a nonequivalent control group for pretest and posttest experiments. The setting was a 745-bed general hospital located in Korea.

RESULTS

The program was designed and developed after consulting previous studies. After development of the program was completed, it was evaluated and revised by a panel of experts. The total score for perceived threat of diseases, knowledge, preventive health behaviors in the experimental group was significantly higher compared to the control group (p<.05). The incidence rates for needle sticks and other sharp object injuries in the experimental group were significantly lower compared to the control group (p<.05).

CONCLUSION

Application of a Web-based, blood-borne infection control program is effective, and can be expanded to other healthcare workers who also have a high risk of blood-borne infections.

Patient Demographics and Learning Needs: Examination of Relationship

Background: Limited research has examined differences in patients’ learning needs in relation to demographic characteristics, such as age, gender, level of education, and culture. Yet such knowledge is essential to develop postoperative educational interventions that are tailored to patients’ needs. Study purpose: The purpose of this study was to examine the relationship between learning needs and the demographic characteristics of patients who have undergone coronary artery bypass graft (CABG) surgery. Method: A descriptive design was used.The sample of convenience included 38 patients who met eligibility criteria. Major results: Statistically significant relationships were found between the patients’ age, gender, and cultural background, and learning needs ( p < .05) and not between the learning needs and level of education. Application: These preliminary highlight the importance of attending to learning needs of patients with different backgrounds in order to improve self-management following CABG surgery.

Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study

Background

Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan.

Methods

At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated; surveillance data from 2002 to 2007 was analyzed and compared with various risk factors.

Results

During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394; 28.5%) followed by registered nurses (n = 283; 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002–04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including; hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and patients visits in clinics (p = 0.01).

Conclusion

We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project.

Universal precautions in the era of HIV/AIDS: perception of health service providers in Yunnan, China

With a rising HIV/AIDS epidemic, it has become especially important for health service providers in China to understand and correctly adhere to universal precautions. Using qualitative interview data, perspectives from both health administrators and service providers working at all levels of China's health care system were examined. Service providers admitted selective adherence and non-adherence to universal precautions in their daily medical practice, and gave their explanations for such behaviors. Lack of time to put on protective gear, gear's interference with medical procedures, lack of administrative support, heavy workload in hospitals, inaccurate risk assessment, and beliefs that compliance with universal precautions is unnecessary, time consuming and costly were mentioned as reasons behind noncompliance. Effective universal precaution interventions need to target both administrators and providers, and address both structural barriers and individual attitudinal and behavioral factors.

Review of personal protection equipment used in practice

Standard precautions offer a consistent approach to infection control that does not rely on knowledge or suspicion of infection, and contributes to staff and patient safety by reducing the risk of exposure to potentially infectious material. One of the cornerstones of standard precautions is the appropriate use of personal protective equipment (PPE) whenever contact with blood or body fluids is anticipated. However, evidence suggests that compliance with standard precautions including correct use of PPE is inadequate. Demographic and epidemiological changes in the U.K., and the drive to provide more complex patient care outside acute hospitals may lead to increased infection risks for both patients and community healthcare workers. This review examines the importance and use of PPE by community nurses and discusses the implications for practice of poor compliance with standard precautions. Recommendations for practice will be made aimed at improving compliance with this important element of standard precautions.

The effectiveness of a training program on reducing needlestick injuries/sharp object injuries among soon graduate vocational nursing school students in southern Taiwan

Needlestick/sharp injuries (NSIs/SIs) are a serious threat to medical/nursing students in hospital internships. Education for preventing NSIs/SIs is important for healthcare workers but is rarely conducted and evaluated among vocational school nursing students. We conducted an educational intervention for such students after their internship rotations before graduation. This program consisted of a lecture to the students after the internship training and a self-study brochure for them to study before their graduation. This study used the pre-test questionnaires completed by all students and the post-test questionnaires completed by 107 graduates after work experience as licensed nurses to assess the effectiveness of the intervention. After educational intervention, the incidence of NSIs/SIs decreased significantly from 50.5% pre-test to 25.2% post-test, and the report rate increased from 37.0% to 55.6%, respectively. In conclusion, this intervention significantly reduced the incidence of NSIs/SIs and increased the report rate of such events.

Chinese health care providers’ attitudes about HIV: a review

China has one of the fastest growing HIV epidemics in the world with an increase in reported cases of about 30% yearly (UNAIDS, 2004). As the epidemic has grown, there have been several studies of health care provider attitudes towards HIV in China over the last 15 years. While attitudes have evolved, misconceptions about transmission of HIV, low levels of support for people living with HIV/AIDS and stigmatized groups, and a poor understanding of the importance of condoms in HIV prevention, remain. The studies are limited by a weakness of survey instruments and an absence of focus on the gendered nature of the HIV epidemic. Recommendations for future research in this area include development of a theoretical base, consideration of gender and stigma, and incorporation of these issues into the survey instruments.

A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions

AIMS

The review examines from international research: the extent to which practitioners comply with infection control precautions; the pertinent issues that are considered influential in compliance; what strategies have been evaluated to instigate positive behaviour changes amongst practitioners and the effect of these interventions.

BACKGROUND

Internationally, standard/universal precautions (UP) are regarded as fundamental in the prevention and control of infection, and effective in protecting practitioners and patients. However, adherence has been problematic and the practice of standard/UPs is globally suboptimal.

DESIGN AND METHODS

Literature review where relevant evidence was identified using several electronic databases, from 1994 to 2006, with number of key terms utilized. Data were extracted by using key headings, which facilitated analysis.

RESULTS

Thirty-seven studies were appraised. Twenty-four related to measuring practitioner compliance and 13 studies that evaluated the effect of a research intervention on compliance. In addition, other studies were included which examined the specific reasons for suboptimal compliance, or discussed infection control precautions generally.

CONCLUSIONS

Compliance to infection control precautions is internationally suboptimal. The evidence confirms that compliance to specific aspects of standard/UPs varies, and practitioners are selective in their application of recommended practice. Compliance does improve following a structured intervention; however, research fails to indicate for how long the intervention affects practitioner compliance, or whether compliance after a period of time returns to the norm. Several reasons for non-compliance are discussed, and recommendations for future research are suggested. Relevance to clinical practice. Suboptimal compliance has significant implications for staff safety, patient protection and the care environment. Infection control teams and researchers need to consider the reasons for non-compliance and provide a supportive environment that is conducive to the routine, long-term application of standard precautions.

Review of standard precautions and sharps management in the community

Standard precautions are imperative for staff and patient safety and provide a basis for sound infection control practice in all health-care settings. One key element of these precautions relates to the safe handling and management of sharps to prevent occupational acquisition of blood-borne viral infection. Many inoculation injuries could be avoided by following standard precautions whenever contact with blood or body fluids is anticipated. However, evidence suggests that compliance with standard precautions is inadequate. With the modernization of the health service in the UK, community health care is becoming more complex, potentially increasing the risk of inoculation injury to community nurses. Although compliance with standard precautions in hospitals is well documented, there is limited research specific to community nurses. This review examines compliance with standard precautions by community nurses and discusses some strategies aimed at improving compliance with one of the key elements of standard precautions, i.e. sharps management.

Relative effectiveness of worker safety and health training methods

OBJECTIVES

We sought to determine the relative effectiveness of different methods of worker safety and health training aimed at improving safety knowledge and performance and reducing negative outcomes (accidents, illnesses, and injuries).

METHODS

Ninety-five quasi-experimental studies (n=20991) were included in the analysis. Three types of intervention methods were distinguished on the basis of learners' participation in the training process: least engaging (lecture, pamphlets, videos), moderately engaging (programmed instruction, feedback interventions), and most engaging (training in behavioral modeling, hands-on training).

RESULTS

As training methods became more engaging (i.e., requiring trainees' active participation), workers demonstrated greater knowledge acquisition, and reductions were seen in accidents, illnesses, and injuries. All methods of training produced meaningful behavioral performance improvements.

CONCLUSIONS

Training involving behavioral modeling, a substantial amount of practice, and dialogue is generally more effective than other methods of safety and health training. The present findings challenge the current emphasis on more passive computer-based and distance training methods within the public health workforce.

Needlestick and sharps injuries among nursing students

AIMS

This paper reports the first investigation of the prevalence and nature of needlestick injuries among Australian nursing students.

BACKGROUND

Needlestick and sharps injuries are the most efficient method of transmitting blood-borne pathogens between patients and healthcare staff. Although nurses are known to be a high-risk subgroup for these events, nursing students may be at even greater risk due to their limited clinical experience. Despite this fact, the epidemiology of needlestick and sharps injuries among nursing students has not been clearly elucidated in Australia.

METHODS

A questionnaire-based methodology adapted from other international investigations was conducted among nursing students. We recruited a complete cross-section of students from a large university nursing school in North Queensland, Australia, in March 2004, and analysed needlestick and sharps events as a percentage of all students and also as a proportion of all cases. Risk factors were evaluated using logistic regression.

RESULTS

From a group of 319 students, 274 successfully completed questionnaires were obtained (overall response rate 85.9%). A total of 38 students (13.9%) reported a needlestick or sharps injury during the previous 12 months. By causative item, 6.2% of students had been injured by a normal hollow-bore syringe needle, 3.6% by a glass item and 3.3% by an insulin syringe needle. Regarding prior usage, 81.6% of all injuring items were unused, 15.8% had been used on a patient and the status of 2.6% was unknown. Most needlestick injuries occurred either in the nursing laboratory (45%) or the teaching hospital (37%). Opening the needle cap was the most common causative event (28% of all cases). A total of 39.5% of needlestick injuries were not reported. The main reason for non-reporting was that the item was unused (42%). Logistic regression analysis revealed that students in the third year were 14.8 times more likely to have experienced a needlestick injury than their counterparts in other years (odds ratio 14.8, 95% confidence interval 5.2-50.3, P < 0.01). These injury rates were higher among Australian nursing students than in other international studies.

CONCLUSIONS

Although hepatitis B vaccination coverage among the students was excellent, it is important that the principles of infection-control training and reporting of all needlestick and sharps continue to be emphasized throughout undergraduate nursing education.