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Battail T, Fort E, Denis MA, Fassier JB, Bonneterre V, Dutheil F, Fontana L, Paul A, Botokeky E, Massardier-Pilonchéry A. Underreporting of occupational blood and body fluid exposure in French university hospitals in 2017. Work 2022; 73:1393-1403. [DOI: 10.3233/wor-210007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Occupational blood and body fluid exposures (OBBFEs) are one of the biological risks run by health professionals, especially in hospitals. OBJECTIVE: The objectives of this study were to assess the occurrence and reporting of occupational blood and body fluid exposures (OBBFEs) in university hospital medical staff and to investigate factors associated to declared OBBFE and factors associated to reported OBBFE. METHODS: A self-administered questionnaire has been e-mailed to all junior and senior medical staff in four university hospital centers in one administrative region of France in 2017. RESULTS: 292 of the 1,228 respondents declared at least one OBBFE. More than two-thirds (70.2%) were under-reporters and more than half (53.8%) non-reporters. Younger subjects, surgical specialties and other associated work accidents were risk factors for OBBFE. Considering the reporting procedure too complex was a risk factor for underreporting. CONCLUSIONS: Underreporting by hospital medical staff was a persistent phenomenon, with a high rate. The OBBFE reporting procedure needs rethinking.
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Affiliation(s)
- Thibault Battail
- Faculty of Health Charles Mérieux Lyon Sud, University of Lyon, Claude Bernard Lyon 1 University, Oullins, France
| | - Emmanuel Fort
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
| | - Marie-Agnès Denis
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Jean-Baptiste Fassier
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Vincent Bonneterre
- “Environment and Health Prediction in Populations” Team, University of Grenoble, Grenoble Alpes University, TIMC-IMAG, UMR, La Tronche, France
- Department of Preventive and Occupational Medicine, University Hospital of Grenoble Alpes (CHU), Grenoble, France
| | - Frédéric Dutheil
- “Physiological and Psychosocial Stress” Team, University of Clermont-Ferrand, Clermont Auvergne University, LAPSCO, UMR, Clermont-Ferrand, France
- Occupational Diseases Center, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | - Luc Fontana
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, Université Jean Monnet, UMRESTTE, UMR T, St Etienne, France
- Department of Preventive and Occupational Medicine, University Hospital of St Etienne (CHU), St Etienne, France
| | - Adèle Paul
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Elsa Botokeky
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Amélie Massardier-Pilonchéry
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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De Carli G, Agresta A, Lecce MG, Marchegiano P, Micheloni G, Sossai D, Campo G, Tomao P, Vonesch N, Leone S, Puro V. Prevention from Sharp Injuries in the Hospital Sector: An Italian National Observatory on the Implementation of the Council Directive 2010/32/EU before and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11144. [PMID: 36078860 PMCID: PMC9518081 DOI: 10.3390/ijerph191711144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
Sharp injuries, determining the risk of bloodborne infections and psychological distress in healthcare workers, may be prevented by a set of strategies, legally enforced in Europe through the Directive 2010/32/EU. To assess its level of implementation in Italy, a national survey was conducted in 2017 and again in 2021, evaluating the progress and possible drawbacks of the COVID-19 pandemic. Altogether, 285 safety managers and 330 nurses from a representative sample of 97 and 117 public hospitals were interviewed using a standardized questionnaire. Knowledge of the Directive requirements decreased significantly, with <60% of participants answering correctly in 2021, and nurses' attendance in specific courses dropped to 25% in 2021 compared to 54% in 2017. Over 75% of hospitals introduced multiple safety-engineered devices (SED), though total replacement occurred in <50% of cases; routine SED availability increased for blood collection (89%) and venous access devices (83%). Incorrect behaviors in handling sharps decreased significantly over time. Nurses' HBV vaccination coverage was high (89% in both surveys); in the last year, 97% were vaccinated against COVID, and 47% against influenza. Average annual injuries per hospital did not increase significantly (32 in 2021 vs. 26 in 2017). In 2017, nurses' perceived safety barriers were working in emergency situations (49%) and lack of resources (40%); in 2021, understaffing (73%), physical fatigue (62%), and handling difficulties while wearing full protective equipment (59%). Safety measures were implemented in Italian hospitals, and although the average injuries per hospital did not show a decrease, these measures could have helped protect healthcare workers during the pandemic, mitigating its potential impact on the increase in situations at risk of injury.
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Affiliation(s)
- Gabriella De Carli
- UOC Infezioni Emergenti e Riemergenti e CRAIDS, Dipartimento di Epidemiologia, Ricerca Preclinica e Diagnostica Avanzata, INMI L. Spallanzani-IRCCS, 00149 Rome, Italy
| | - Alessandro Agresta
- UOC Infezioni Emergenti e Riemergenti e CRAIDS, Dipartimento di Epidemiologia, Ricerca Preclinica e Diagnostica Avanzata, INMI L. Spallanzani-IRCCS, 00149 Rome, Italy
| | - Maria Giuseppina Lecce
- Ufficio IV—Direzione Generale della Prevenzione del Ministero della Salute, 00144 Rome, Italy
| | - Patrizia Marchegiano
- SC Servizio Prevenzione e Protezione Aziendale, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Gianpaolo Micheloni
- Servizio Medicina del Lavoro, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Dimitri Sossai
- U.O. Servizio Prevenzione e Protezione, Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Giuseppe Campo
- INAIL—Sezione Sistemi di Sorveglianza e Gestione Integrata del Rischio, Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro ed Ambientale, 00144 Rome, Italy
| | - Paola Tomao
- INAIL—Laboratorio Rischio Agenti Biologici, Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro ed Ambientale, 00078 Monte Porzio Catone, Italy
| | - Nicoletta Vonesch
- INAIL—Laboratorio Rischio Agenti Biologici, Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro ed Ambientale, 00078 Monte Porzio Catone, Italy
| | - Sara Leone
- UOC Epidemiologia Clinica, Dipartimento di Epidemiologia, Ricerca Preclinica e Diagnostica Avanzata, INMI L. Spallanzani-IRCCS, 00149 Rome, Italy
| | - Vincenzo Puro
- UOC Infezioni Emergenti e Riemergenti e CRAIDS, Dipartimento di Epidemiologia, Ricerca Preclinica e Diagnostica Avanzata, INMI L. Spallanzani-IRCCS, 00149 Rome, Italy
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Erturk Sengel B, Tukenmez Tigen E, Bilgin H, Dogru A, Korten V. Occupation-Related Injuries Among Healthcare Workers: Incidence, Risk Groups, and the Effect of Training. Cureus 2021; 13:e14318. [PMID: 33968528 PMCID: PMC8101271 DOI: 10.7759/cureus.14318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and objective Occupation-related injuries (ORIs) are undesirable and harmful situations among healthcare workers (HCWs) and may have serious consequences. In this study, we aimed to identify and analyze ORI incidences, risk groups, and the outcomes of a training program to prevent them. Materials and methods Between January 2011 and December 2019, HCWs who applied for infection prevention and control (IPC) due to ORIs (percutaneous needlestick and sharp-object injury or contact with blood or body fluids) were included in the study. Their characteristic features, vaccine histories, injury types, viral serologies, and administered prophylaxis were recorded. After 2014, a periodic ORI training program was started. We used joinpoint regression analysis to compare the ORI incidences before and after the education program. Results During the nine-year study period, 965 ORIs were registered. The mean age of HCWs was 39.3 ± 8.4 years, and 67.9% of them were female. The total injury incidence for all professions was 34.1 (95% CI: 33.1-37.5) per 1,000 HCWs. The injury incidences were significantly higher in nurses compared to other HCWs (p<0.01). Most of the injuries occurred in the ward setting (37%). HCWs were injured most commonly while administering treatment (36.7%). The trend analysis for the incidence of injuries showed no significant change throughout the study period. The trend in personal protective equipment (PPE) use showed a significant increase (annual percentage change: 1.7, p<0.01). Conclusions The major finding of this study with respect to its implication on the healthcare system is that nurses are an important risk group for ORIs. Although the ORI incidence did not change during the study period, a significantly increased use of appropriate PPE following a systematic training program implementation was observed.
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Affiliation(s)
- Buket Erturk Sengel
- Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, TUR
| | - Elif Tukenmez Tigen
- Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, TUR
| | - Huseyin Bilgin
- Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, TUR
| | - Arzu Dogru
- Infectious Diseases and Clinical Microbiology, Tuzla Training Hospital, Istanbul, TUR
| | - Volkan Korten
- Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, TUR
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Franchi M, Garzon S, Laganà AS, Baggio S, Cromi A, Ghezzi F, Scambia G, Raffaelli R. Needlestick injuries among obstetrics and gynecology trainees: A survey study. Eur J Obstet Gynecol Reprod Biol 2021; 259:67-74. [PMID: 33601315 DOI: 10.1016/j.ejogrb.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess characteristics, incidence, risk factors, and reporting rate of needlestick injuries (NSIs) among Obstetrics and Gynecology trainees. STUDY DESIGN We performed a nationwide cross-sectional survey study. The 40-items survey Obstetrics Needlestick Injury Questionnaire (ONSI-Q) was used to investigate the prevalence of NSIs, participant attitudes, associated factors, and the NSI reporting rate among trainees in Obstetrics and Gynecology. The target responders were all trainees of Obstetrics and Gynecology training programs in Italy. The trainees were invited between September 2018 and December 2018 via a web-based platform. RESULTS Among 1049 trainees, 1041 (99.2%) completed the survey. Out of 1041 trainees, 639 (61.4%) had at least one NSI, and 90.9% (581/639) experienced at least one during obstetric surgery. The number of NSIs increased with the year of training, with 2.48 NSIs per trainee in the fifth year. 90.6% (579/639) reported details about the most recent NSI, which was during obstetric surgery in 95.3% (552/579) of cases. 57.1% (315/552) experienced the most recent NSI during cesarean section, which was mainly inflicted by someone else (72.4%; 228/315). 42.9% (237/552) of NSIs were during perineal suture, and 84% (199/237) of them were self-inflicted. 77.9% (417/535) of trainees did not report the NSI. Associated factors were non-high-risk patients, self-inflicted NSI, and the first NSI. CONCLUSIONS NSIs are frequent among Obstetrics and Gynecology trainees but not reported, and obstetric surgery is the primary source. These data support the European efforts to improve working practices' safety. The education about protective strategies and reporting should be a priority.
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Affiliation(s)
- Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Silvia Baggio
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
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Tshering K, Wangchuk K, Letho Z. Assessment of knowledge, attitude and practice of post exposure prophylaxis for HIV among nurses at Jigme Dorji Wanghuck National Referral Hospital, Bhutan. PLoS One 2020; 15:e0238069. [PMID: 32857804 PMCID: PMC7454947 DOI: 10.1371/journal.pone.0238069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022] Open
Abstract
Nurses are managing huge number of patients infected with human immunodeficiency virus (HIV), which made them highly vulnerable to HIV infection through occupational exposure such as needle stick injuries and splashing of blood/bodily fluids on mucosal surface. This made the practice of post exposure prophylaxis (PEP) for HIV crucial among nurses. Therefore, our study aimed to assess knowledge, attitude and practice of PEP for HIV among nurses in Bhutan. A cross-sectional study was conducted among 221 registered nurses working at Jigme Dorji Wangchuck National Referral Hospital, Bhutan between April and June 2017. A structured self-administered questionnaire was used to collect data and analysed using SPSS version 21. Majority (80.1%) of our participants had poor knowledge regarding PEP for HIV. Although half (51.1%) of our participants had heard about PEP, only 3 (1.4%) attended a formal training on PEP for HIV. However, a significant proportion of nurses (92.3%) had positive attitude towards PEP for HIV. Out of 221 respondents, 95(43%) had been exposed to needle stick injuries and splashing of blood/bodily fluids while managing patients. Despite significant number of exposures, only 2 (2.1%) of them took PEP and completed 28 days of prophylaxis. Lack of protective barriers at work place (56.8%) and poor knowledge on personal protective equipment (14.7%) were major perceived causes of exposure among study participants. No PEP service (30.2%) and lack of support to report incidents (22.6%) were two major reasons leading to failure of PEP practice among exposed individuals. Despite positive attitude exhibited by majority of our respondents, the level of knowledge and practice of PEP for HIV among nurses was very low. Therefore, a formal training on PEP and 24 hours accessible PEP service with proper guidelines are recommended to improve the overall knowledge and practice of PEP against HIV among nurses.
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Affiliation(s)
- Kezang Tshering
- Department of Pharmacy, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- * E-mail:
| | - Kinzang Wangchuk
- Department of Community Health, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Zimba Letho
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Auta A, Adewuyi EO, Tor-Anyiin A, Edor JP, Kureh GT, Khanal V, Oga E, Adeloye D. Global prevalence of percutaneous injuries among healthcare workers: a systematic review and meta-analysis. Int J Epidemiol 2018; 47:1972-1980. [DOI: 10.1093/ije/dyy208] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Emmanuel O Adewuyi
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Amom Tor-Anyiin
- Royal Alexandra Hospital Pharmacy, Alberta Health Services, Edmonton, AB, Canada
| | - Joseph P Edor
- Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Gbednet T Kureh
- Department of Pharmacology, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Vishnu Khanal
- Nepal Development Society, Bharatpur, Chitwan, Nepal
| | - Enoche Oga
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Davies Adeloye
- Centre for Global Health Research and the World Health Organization Collaborating Centre for Population Health Research and Training, Usher Institute, University of Edinburgh, Edinburgh, UK
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Jahic R, Piljic D, Porobic-Jahic H, Custović A, Petrovic J, Piljic D. Epidemiological Characteristics of the Accidental Exposures to Blood-Borne Pathogens Among Workers in the Hospital. Med Arch 2018; 72:187-191. [PMID: 30061764 PMCID: PMC6021162 DOI: 10.5455/medarh.2018.72.187-191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/15/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The main route of acquiring infectious blood and body fluids in hospital conditions is accidental exposure to stinging incidents. AIM The aim of this study was to determine the epidemiological characteristics of accidental exposures to blood-borne pathogens among different professional groups of health care workers (HCWs). MATERIALS AND METHODS A cross-sectional study was conducted using the "Questionnaire on the HCWs exposure to blood and blood transmitted infections" at the University Clinical Centre Tuzla, Bosnia and Herzegovina, from the 1st of March to the 31st of December 2014. Study sample consisted of 1031 participants (65% of total employees) stratified into three occupational groups: doctors, nurses and support staff. RESULTS AND DISCUSSION Exposure incident was recorded in 1231 participants (54.8%) at least once in the last 12 months. An average number of exposure incidents per HCWs in total years of service was 7.07± 8.041. Out of total sample, 70% reported at least one type of exposure incident. Nurses had a higher frequency of multiple contacts compared to doctors and support staff (χ2=37.73; df=4; p<0.001). The frequency of reported incidents among nurses at the surgical departments was almost two times higher (1.7). 75.5% (778/1031) of the participants, reported not having been exposed to these incident. Doctors were significantly less likely to report exposure incidents than nurses and support staff. There were significant differences in reporting rate (χ2=32,66; df=4; p<0.001). CONCLUSION HCWs in hospitals have a high prevalence of occupational exposure to blood-borne infections. Seventy percent of the HCWs is periodically or constantly exposed to or contact related to blood. Nurses are most frequently exposed occupational group among HCWs, while the lowest reporting rate on an exposure incident is among doctors.
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Affiliation(s)
- Rahima Jahic
- Clinic for Infectious diseases, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Dilista Piljic
- Clinic for Infectious diseases, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Humera Porobic-Jahic
- Clinic for Infectious diseases, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Amer Custović
- Department for Hygienic-epidemiological surveillance, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Jasminka Petrovic
- Clinic for Infectious diseases, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Dragan Piljic
- Clinic for Cardiovascular surgery, University Clinical Center Tuzla, Bosnia and Herzegovina
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Chauvin A, Hutin A, Leredu T, Plaisance P, Pateron D, Yordanov Y. Accidental blood exposures among emergency medicine residents and young physicians in France: a national survey. Intern Emerg Med 2017; 12:221-227. [PMID: 27179649 DOI: 10.1007/s11739-016-1458-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
The aim of the present study was to investigate the epidemiological characteristics of blood or fluid exposure (BFE) and occupational infection risk among emergency medicine (EM) residents and young physicians (<35 years old) in France. We led a cross-sectional, anonymous, online survey. 1779 participants were contacted with a response rate of 36 % (n = 633). Among the respondents, 459 (72 %) reported at least one BFE. Among participants with at least one BFE, 35 % (n = 163) never reported the exposure to the relevant medical authorities or support. Among participants who reported exposure, 63 % (n = 232) did it immediately. Among participants who never or not systematically reported their BFE, most of them (62 %, n = 181/289) did not do so because the procedure was too long, and 28 % (n = 82/289) estimated the risk as low even if only one-third (n = 166/458) checked their HIV status even though the BFE was at a transmission risk. Circumstances in which the participants had the most BFE were: suturing 57 % (n = 262/457) and when making precipitated gestures 24 % (n = 111/457). The latest exposures were caused by a solid needle in 42 % (n = 191/455) or hollow-bore needle in 27 % (n = 123/455). Post-exposure reporting rates were low. Reporting procedure itself and self-management were the main reasons for BFE underreporting. Simplifying procedures might increase BFE reporting, and allow appropriate post-exposure counseling and/or prophylaxis.
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Affiliation(s)
- Anthony Chauvin
- Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Faculté de Médecine, Université Diderot, Paris, France.
- AJMU, Association des Jeunes Médecins Urgentistes, Paris, France.
- Hospital Lariboisière, Service d'Accueil des Urgences, 2, rue Ambroise Pare, 75010, Paris, France.
| | - Alice Hutin
- AJMU, Association des Jeunes Médecins Urgentistes, Paris, France
- Emergency Département, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Descartes, Paris, France
| | - Thomas Leredu
- AJMU, Association des Jeunes Médecins Urgentistes, Paris, France
- Emergency Département, Hôpital Mignot, Versailles, France
| | - Patrick Plaisance
- Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Diderot, Paris, France
| | - Dominique Pateron
- Emergency Département, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Pierre et Marie Curie, Paris, France
| | - Youri Yordanov
- Emergency Département, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Pierre et Marie Curie, Paris, France
- AJMU, Association des Jeunes Médecins Urgentistes, Paris, France
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Mannocci A, De Carli G, Di Bari V, Saulle R, Unim B, Nicolotti N, Carbonari L, Puro V, La Torre G. How Much do Needlestick Injuries Cost? A Systematic Review of the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel. Infect Control Hosp Epidemiol 2016; 37:635-46. [PMID: 27022671 PMCID: PMC4890345 DOI: 10.1017/ice.2016.48] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/10/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To provide an overview of the economic aspects of needlestick and sharps injury (NSI) management among healthcare personnel (HCP) within a Health Technology Assessment project to evaluate the impact of safety-engineered devices on health care METHODS A systematic review of economic analyses related to NSIs was performed in accordance with the PRISMA statement and by searching PubMed and Scopus databases (January 1997-February 2015). Mean costs were stratified by study approach (modeling or data driven) and type of cost (direct or indirect). Costs were evaluated using the CDC operative definition and converted to 2015 International US dollars (Int$). RESULTS A total of 14 studies were retrieved: 8 data-driven studies and 6 modeling studies. Among them, 11 studies provided direct and indirect costs and 3 studies provided only direct costs. The median of the means for aggregate (direct + indirect) costs was Int$747 (range, Int$199-Int$1,691). The medians of the means for disaggregated costs were Int$425 (range, Int$48-Int$1,516) for direct costs (9 studies) and Int$322 (range, Int$152-Int$413) for indirect costs (6 studies). When compared with data-driven studies, modeling studies had higher disaggregated and aggregated costs, but data-driven studies showed greater variability. Indirect costs were consistent between studies, mostly referring to lost productivity, while direct costs varied widely within and between studies according to source infectivity, HCP susceptibility, and post-exposure diagnostic and prophylactic protocols. Costs of treating infections were not included, and intangible costs could equal those associated with NSI medical evaluations. CONCLUSIONS NSIs generate significant direct, indirect, potential, and intangible costs, possibly increasing over time. Economic efforts directed at preventing occupational exposures and infections, including provision of safety-engineered devices, may be offset by the savings from a lower incidence of NSIs. Infect Control Hosp Epidemiol 2016;37:635-646.
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Affiliation(s)
- Alice Mannocci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Gabriella De Carli
- Department of Epidemiology, Pre-Clinical Research and Advanced Diagnostics, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Virginia Di Bari
- Department of Epidemiology, Pre-Clinical Research and Advanced Diagnostics, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Rosella Saulle
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Nicola Nicolotti
- Department of Epidemiology, Pre-Clinical Research and Advanced Diagnostics, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Lorenzo Carbonari
- Department of Economics and Finance & CEIS, University of Rome “Tor Vergata”Italy
| | - Vincenzo Puro
- Department of Epidemiology, Pre-Clinical Research and Advanced Diagnostics, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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Surgical Team Stability and Risk of Sharps-Related Blood and Body Fluid Exposures During Surgical Procedures. Infect Control Hosp Epidemiol 2016; 37:512-8. [DOI: 10.1017/ice.2016.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVETo explore whether surgical teams with greater stability among their members (ie, members have worked together more in the past) experience lower rates of sharps-related percutaneous blood and body fluid exposures (BBFE) during surgical procedures.DESIGNA 10-year retrospective cohort study.SETTINGA single large academic teaching hospital.PARTICIPANTSSurgical teams participating in surgical procedures (n=333,073) performed during 2001–2010 and 2,113 reported percutaneous BBFE were analyzed.METHODSA social network measure (referred to as the team stability index) was used to quantify the extent to which surgical team members worked together in the previous 6 months. Poisson regression was used to examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and accounting for procedure duration. Separate regression models were generated for percutaneous BBFE involving suture needles and those involving other surgical devices.RESULTSThe team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93 [95% CI, 0.88–0.97]). However, the association was stronger for percutaneous BBFE involving devices other than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85–0.99]) than for exposures involving suture needles (0.96 [0.88–1.04]).CONCLUSIONSGreater team stability may reduce the risk of percutaneous BBFE during surgical procedures, particularly for exposures involving devices other than suture needles. Additional research should be conducted on the basis of primary data gathered specifically to measure qualities of relationships among surgical team personnel.Infect Control Hosp Epidemiol 2016;37:512–518
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Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure. Infect Control Hosp Epidemiol 2015; 37:80-7. [PMID: 26434696 DOI: 10.1017/ice.2015.233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms. DESIGN A 10-year retrospective cohort design. SETTING A single large academic teaching hospital. PARTICIPANTS All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF exposures were analyzed. METHODS Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors. RESULTS The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results showed associations were generally stronger for suture needle-related exposures. CONCLUSIONS Results largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types. Infect. Control Hosp. Epidemiol. 2015;37(1):80-87.
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Myers DJ, Epling C, Dement J, Hunt D. Risk of Sharp Device–Related Blood and Body Fluid Exposure in Operating Rooms. Infect Control Hosp Epidemiol 2015; 29:1139-48. [DOI: 10.1086/592091] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.The risk of percutaneous blood and body fluid (BBF) exposures in operating rooms was analyzed with regard to various properties of surgical procedures.Design.Retrospective cohort study.Setting.A single university hospital.Methods.All surgical procedures performed during the period 2001–2002 (n = 60,583) were included in the analysis. Administrative data were linked to allow examination of 389 BBF exposures. Stratified exposure rates were calculated; Poisson regression was used to analyze risk factors. Risk of percutaneous BBF exposure was examined separately for events involving suture needles and events involving other device types.Results.Operating room personnel reported 6.4 BBF exposures per 1,000 surgical procedures (2.6 exposures per 1,000 surgical hours). Exposure rates increased with an increase in estimated blood loss (17.5 exposures per 1,000 procedures with 501–1,000 cc blood loss and 22.5 exposures per 1,000 procedures with >1,000 cc blood loss), increased number of personnel ever working in the surgical field (20.5 exposures per 1,000 procedures with 15 or more personnel ever in the field), and increased surgical procedure duration (13.7 exposures per 1,000 procedures that lasted 4–6 hours, 24.0 exposures per 1,000 procedures that lasted 6 hours or more). Associations were generally stronger for suture needle–related exposures.Conclusions.Our results support the need for prevention programs that are targeted to mitigate the risks for BBF exposure posed by high blood loss during surgery (eg, use of blunt suture needles and a neutral zone for passing surgical equipment) and prolonged duration of surgery (eg, double gloving to defend against the risk of glove perforation associated with long surgery). Further investigation is needed to understand the risks posed by lengthy surgical procedures.
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Munier A, Marzouk D, Abravanel F, El-Daly M, Taylor S, Mamdouh R, Eldin WS, El-Arab HE, Sos DG, Momen M, Okasha O, Le Fouler L, El-Hosini M, Izopet J, Rafik M, Albert M, Abdel-Hamid M, Mohamed MK, Delarocque-Astagneau E, Fontanet A. Frequent transient hepatitis C viremia without seroconversion among healthcare workers in Cairo, Egypt. PLoS One 2013; 8:e57835. [PMID: 23469082 PMCID: PMC3585182 DOI: 10.1371/journal.pone.0057835] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/26/2013] [Indexed: 02/06/2023] Open
Abstract
Backgrounds With 10% of the general population aged 15–59 years chronically infected with hepatitis C virus (HCV), Egypt is the country with the highest HCV prevalence worldwide. Healthcare workers (HCWs) are therefore at particularly high risk of HCV infection. Our aim was to study HCV infection risk after occupational blood exposure among HCWs in Cairo. Methodology/Principal Findings The study was conducted in 2008–2010 at Ain Shams University Hospital, Cairo. HCWs reporting an occupational blood exposure at screening, having neither anti-HCV antibodies (anti-HCV) nor HCV RNA, and exposed to a HCV RNA positive patient, were enrolled in a 6-month prospective cohort with follow-up visits at weeks 2, 4, 8, 12 and 24. During follow-up, anti-HCV, HCV RNA and ALT were tested. Among 597 HCWs who reported a blood exposure, anti-HCV prevalence at screening was 7.2%, not different from that of the general population of Cairo after age-standardization (11.6% and 10.4% respectively, p = 0.62). The proportion of HCV viremia among index patients was 37%. Of 73 HCWs exposed to HCV RNA from index patients, nine (12.3%; 95%CI, 5.8–22.1%) presented transient viremia, the majority of which occurred within the first two weeks after exposure. None of the workers presented seroconversion or elevation of ALT. Conclusions/Significance HCWs of a general University hospital in Cairo were exposed to a highly viremic patient population. They experienced frequent occupational blood exposures, particularly in early stages of training. These exposures resulted in transient viremic episodes without established infection. These findings call for further investigation of potential immune protection against HCV persistence in this high risk group.
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Affiliation(s)
- Aline Munier
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.
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Seroprevalence of hepatitis C virus infection among surgical nurses, their patients and blood donation candidates in Poland. J Hosp Infect 2012; 82:266-70. [PMID: 23110996 DOI: 10.1016/j.jhin.2012.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/28/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the prevalence of anti-hepatitis C virus (HCV) in surgical nurses and midwives, to compare the rate with other female groups (their patients from the same hospitals and blood donation candidates) in a cross-sectional serosurvey, and to evaluate the alleged risk factors for acquiring an occupational infection. METHODS Between February 2008 and June 2009, participants from 16 hospitals selected at random in West Pomerania, Poland completed a written questionnaire detailing potential risk factors for HCV infection. Serum samples were assayed for anti-HCV using third-generation testing methods. RESULTS Of 414 staff members, six were found to be anti-HCV positive [1.4%, 95% confidence interval (CI) 0.7-3.1%]. The seropositive status of staff was discovered during this one-off screening. A logistic regression model indicated that for anti-HCV seropositivity, only the length of employment was associated with increased odds of being infected [odds ratio (OR) 2.8; P < 0.006]. The prevalence of anti-HCV was 1.1% (12/1118, 95% CI 0.6-1.9%) in 1118 female patients, and 0% (0/801, 95% CI 0-1.1%) in 801 female blood donation candidates. A significant staff/patient difference in anti-HCV prevalence was observed among those aged >50 years (6.9% vs 1.0%; P < 0.007). For this age group, being a nurse was associated with higher odds (OR 8.8; P < 0.005) of being infected with HCV. CONCLUSIONS Comparison of HCV prevalence rates pointed to a decreasing trend in the order: surgical nurses/midwives, patients and blood donation candidates; this may indicate occupational risk. The greatest risk factor for contracting HCV infection was length of employment, suggesting a possible effect of accumulated exposure to contaminated blood and other body fluids. There is a need for better recognition of HCV infection as a consequence of prolonged blood exposure among surgical and gynaecological staff.
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Needlestick Injuries, Short Peripheral Catheters, and Health Care Worker Risks. JOURNAL OF INFUSION NURSING 2012; 35:164-78. [DOI: 10.1097/nan.0b013e31824d276d] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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16
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Kuroyanagi N, Nagao T, Sakuma H, Miyachi H, Ochiai S, Kimura Y, Fukano H, Shimozato K. Risk of surgical glove perforation in oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2012; 41:1014-9. [PMID: 22446068 DOI: 10.1016/j.ijom.2012.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 12/21/2011] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
Abstract
Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects.
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Affiliation(s)
- N Kuroyanagi
- Department of Maxillofacial Surgery, Aichi-Gakuin University School of Dentistry, Aichi, Japan
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Ganczak M, Ostrowski M, Szych Z, Korzeń M. A complete HBV vaccination coverage among Polish surgical nurses in the light of anti-HBc prevalence: A cross-sectional sero-prevalence study. Vaccine 2010; 28:3972-6. [DOI: 10.1016/j.vaccine.2010.03.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/18/2010] [Accepted: 03/20/2010] [Indexed: 11/28/2022]
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Smith DR, Muto T, Sairenchi T, Ishikawa Y, Sayama S, Yoshida A, Townley-Jones M. Hospital safety climate, psychosocial risk factors and needlestick injuries in Japan. INDUSTRIAL HEALTH 2010; 48:85-95. [PMID: 20160412 DOI: 10.2486/indhealth.48.85] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
To investigate the interactions between safety climate, psychosocial issues and Needlestick and Sharps Injuries (NSI), a cross-sectional study was undertaken among nurses at a university teaching hospital in Japan (89% response rate). NSI were correlated with various aspects of hospital safety climate including supporting one another at work, the protection of staff against blood-borne diseases being a high management priority, managers doing their part to protect staff from blood-borne disease, having unsafe work practices corrected by supervisors, having the opportunity to use safety equipment to protect against blood-borne disease exposures, having an uncluttered work area, and having minimal conflict within their department. In conclusion, this study has demonstrated the importance of hospital safety climate in Japanese health care practice, particularly its relationship with NSI. Although the provision of safer devices remains critical in preventing injuries, ensuring a positive safety climate will also be essential in meeting these important challenges for nurses' occupational health.
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Affiliation(s)
- Derek R Smith
- WorkCover New South Wales Research Centre of Excellence, School of Health Sciences, Faculty of Health, University of Newcastle, Ourimbah 2258, Australia.
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Khan AM, Rahman AKSM, Pietroni M, Salam MA. Experience of needle-stick injury among healthcare providers at an urban diarrhoeal-disease hospital in Bangladesh. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2009; 103:365-8. [DOI: 10.1179/136485909x435076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Zhang M, Wang H, Miao J, Du X, Li T, Wu Z. Occupational exposure to blood and body fluids among health care workers in a general hospital, China. Am J Ind Med 2009; 52:89-98. [PMID: 19016263 DOI: 10.1002/ajim.20645] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To understand current status of occupational exposure to blood and body fluids (BBF), and awareness of knowledge about occupational bloodborne pathogen exposures and universal precaution among hospital-based health care workers (HCWs). METHODS A cross-sectional study was conducted during April to May 2004 to study incidence of occupational exposure to BBF among 1,144 hospital-based HCWs. RESULTS The total incidence and the average number of episodes exposure to BBF was 66.3/100 HCWs per year and 7.5 per person per year in the past year, respectively. The incidence (per 100/HCWs per year) and the average number of episodes (per HCW per year) of percutaneous injury (PCI), mucous-membrane exposure (MME), and exposure to BBF by damaged skin was 50.3 and 1.8; 34.4 and 1.7; and 37.9 and 4.0, respectively. The leading incidence and the average number of episodes of PCI occurred in delivery room (82.6 and 1.8). The highest percentage of PCI's that occurred during the previous 2 weeks occurred during a surgical operation (22.8%). Of all sharp instruments, the suture needle contributed the highest percentage of PCI's (24.7%) among HCWs in the last 2 weeks. Over two-thirds (68.3%) of respondents were immunized with Hepatitis B vaccine; less than one-half (47%) of HCWs wore gloves while doing procedures on patients. The respondents demonstrated a lack of knowledge regarding transmission of bloodborne diseases and universal precautions. CONCLUSIONS Risk for potential exposure to BBF appears high in HCWs, and almost all of episodes are not reported. It is urgent to establish the Guideline for Prevention and Control of Occupational Exposure to Bloodborne Pathogens among HCWs. Am. J. Ind. Med. 52:89-98, 2009. (c) 2008 Wiley-Liss, Inc.
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Affiliation(s)
- Min Zhang
- National Institute for Occupational Health and Poison Control, China CDC, Beijing, China
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Campins M, Torres M, Varela P, López Clemente V, Gascó A, de la Prada M, Espuga M, Tapias G, Peña P, Hermosilla E, Otero S, Bastida T, Sanz P, María Bayas J, Serra C. Accidentes biológicos percutáneos en el personal sanitario: análisis de factores de riesgo no prevenibles mediante precauciones estándares. Med Clin (Barc) 2009; 132:251-8. [DOI: 10.1016/j.medcli.2008.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 06/27/2008] [Indexed: 10/20/2022]
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Singru SA, Banerjee A. Occupational exposure to blood and body fluids among health care workers in a teaching hospital in mumbai, India. Indian J Community Med 2008; 33:26-30. [PMID: 19966992 PMCID: PMC2782223 DOI: 10.4103/0970-0218.39239] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 12/01/2007] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Exposure to blood and body fluids is one of the hidden hazards faced by health care workers (HCWs). The objective of the present study was to estimate the incidence of such exposure in a teaching hospital. MATERIALS AND METHODS A cross-sectional study among a random sample of residents, interns, nurses and technicians (n = 830) was carried out in a teaching hospital to estimate the incidence of exposure to blood and body fluids in the preceding 12-month period. Self-reported occurrence and the circumstances of the same were recorded by face-to-face interviews using a semi-structured questionnaire. RESULTS The response rate to the study was 89.76%. Occupational exposure to blood and body fluids in the preceding 12 months was reported by 32.75% of the respondents. The self-reported incidence was the highest among the nurses. Needle-stick injury was the most common mode of such exposures (92.21% of total exposures). Index finger and thumb were the commonest sites of exposure. Only 50% of the affected individuals reported the occurrence to concerned hospital authorities. Less than a quarter of the exposed persons underwent post-exposure prophylaxis (PEP) against HIV, although the same was indicated in about 50% of the affected HCWs based on the HIV status of the source patient. CONCLUSIONS Occupational exposure to blood and body fluids was a common occurrence in the study sample. There was gross under-reporting of such incidents leading to a lack of proper PEP against HIV in 50% of those in whom the same appeared to be indicated.
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Affiliation(s)
- Samir A Singru
- Department of Community Medicine, Dr. D.Y. Patil Medical College, Pune - 411 018, Maharashtra, India
| | - Amitav Banerjee
- Department of Community Medicine, Dr. D.Y. Patil Medical College, Pune - 411 018, Maharashtra, India
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Konte V, Nikolopoulos G, Raftopoulos V, Pylli M, Tsiara C, Makri E, Paraskeva D. Surveillance of HIV exposure and postexposure prophylaxis among health care workers in Greece. Public Health Nurs 2007; 24:337-42. [PMID: 17553023 DOI: 10.1111/j.1525-1446.2007.00642.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Many developed countries have implemented surveillance systems for monitoring occupational exposure to HIV. The aim of the present study was to analyze surveillance data on HIV postexposure prophylaxis (PEP) for health care workers (HCWs) in Greece. DESIGN All data reported to the Hellenic Centre for Disease Control and Prevention between January 1996 and June 2005 were analyzed. SAMPLE AND MEASUREMENT: 188 reported occupational exposures to HIV were analyzed, retrospectively. RESULTS Most exposures were in the physicians (37.8%), followed by the nursing personnel (18.6%). Nearly 38% of the HCWs were males and the predominant type of biological material involved in the exposure was blood (74.5%). Two drugs were used for PEP in 23.4% of the HCWs, and 3 drugs in 66.5% of the reported cases. CONCLUSIONS Greek guidelines provide guidance for treating HCWs after occupational exposure to HIV. In our study, antiretroviral treatment, a three-drug regimen in the majority of the cases, was prescribed after evaluation of specially appointed physicians. The surveillance system of occupational exposure to HIV in HCWs should be further developed and enhanced in order to monitor and evaluate the risk factors surrounding the incidents.
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Affiliation(s)
- Vasileia Konte
- HIV Office, Hellenic Centre for Diseases Control and Prevention, Athens, Greece
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Abstract
Although needlestick and sharps injuries (NSI) are known to affect professional nurses at high rates, most studies depend on officially reported data and few have been undertaken in Korea. Thus, we surveyed a large cross-section of nurses from a hospital in Gangneung (response rate, 97.9%). Four hundred thirty-two incidents of NSI were reported by 263 nurses (79.7%) in the previous 12-month period (average, 1.31 events/nurse/year). Syringe needles were the most common devices, affecting 67.3% and comprising 52% of all NSI events. Sixty percent of all NSI events involved contaminated devices. Opening an ampoule or vial was the most common cause (affecting 35.2% of all nurses and accounting for 15.9% of all NSI events). Logistic regression indicated that nurses working in "other" departments were 5.4 times more likely to suffer any NSI (odds ratio [OR] = 5.4; 95% confidence interval [95% CI] = 2.0-15.2; P < .05) and 4.7 times more likely to incur a syringe-needle injury than nurses in intensive care units or inpatient departments (OR = 4.7; 95% CI = 2.0-11.6; P < .05). Younger-than-average nurses (< 27 years) were 4.5 times more likely to suffer NSI (OR = 4.5; 95% CI = 1.7-12.6; P < .05) and 3.1 times more likely to incur a syringe-needle injury (OR = 3.1; 95% CI = 1.4-7.0; P < .05). Working mixed shifts also increased the risk of any NSI (OR = 4.0; 95% CI = 1.7-10.4; P < .05) or syringe-needle NSI (OR = 4.4; 95% CI = 2.0-10.1; P < .05). Overall, our study suggests that NSI are common among Korean hospital nurses and represent a significant occupational burden for this large Asian demographic. Intervention and preventive strategies to help reduce their NSI exposures are urgently required in this country.
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Falagas ME, Karydis I, Kostogiannou I. Percutaneous exposure incidents of the health care personnel in a newly founded tertiary hospital: a prospective study. PLoS One 2007; 2:e194. [PMID: 17332844 PMCID: PMC1805815 DOI: 10.1371/journal.pone.0000194] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 01/17/2007] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Percutaneous exposure incidents (PEIs) and blood splashes on the skin of health care workers are a major concern, since they expose susceptible employees to the risk of infectious diseases. We undertook this study in order to estimate the overall incidence of such injuries in a newly founded tertiary hospital, and to evaluate possible changes in their incidence over time. METHODOLOGY/PRINCIPAL FINDINGS We prospectively studied the PEIs and blood splashes on the skin of employees in a newly founded (October 2000) tertiary hospital in Athens, Greece, while a vaccination program against hepatitis B virus, as well as educational activities for avoidance of injuries, were taking place. The study period ranged from October 1, 2002 to February 28, 2005. Serologic studies for hepatitis B (HBV) and C virus (HCV) as well as human immunodeficiency virus (HIV) were performed in all injured employees and the source patients, when known. High-titer immunoglobulin (250 IU anti-HBs intramuscularly) and HBV vaccination were given to non-vaccinated or previously vaccinated but serologically non-responders after exposure. Statistical analysis of the data was performed using Mc Nemar's and Fisher's tests. 60 needlestick, 11 sharp injuries, and two splashes leading to exposure of the skin or mucosa to blood were reported during the study period in 71 nurses and two members of the cleaning staff. The overall incidence (percutaneous injuries and splashes) per 100 full-time employment-years (100 FTEYs) for high-risk personnel (nursing, medical, and cleaning staff) was 3.48, whereas the incidence of percutaneous injuries (needlestick and sharp injuries) alone per 100 FTEYs was 3.38. A higher incidence of injuries was noted during the first than in the second half of the study period (4.67 versus 2.29 per 100 FTEYs, p = 0.005). No source patient was found positive for HCV or HIV. The use of high-titer immunoglobulin after adjustment for the incidence of injuries was higher in the first than in the second half of the study period, although the difference was not statistically significant [9/49 (18.37%) vs 1/24 (4.17%), p = 0.15]. CONCLUSIONS/SIGNIFICANCE Our data show that nurses are the healthcare worker group that reports most of PEIs. Doctors did not report such injuries during the study period in our setting. However, the possibility of even relatively frequent PEIs in doctors cannot be excluded. This is due to underreporting of such events that has been previously described for physicians and surgeons. A decrease of the incidence of PEIs occurred during the operation of this newly founded hospital.
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MESH Headings
- Accidents, Occupational/prevention & control
- Accidents, Occupational/statistics & numerical data
- Blood
- Blood-Borne Pathogens
- Female
- Greece
- HIV Infections/epidemiology
- HIV Infections/prevention & control
- HIV Infections/transmission
- Hazardous Substances
- Hepatitis B/epidemiology
- Hepatitis B/prevention & control
- Hepatitis B/transmission
- Hepatitis B Vaccines
- Hepatitis C/epidemiology
- Hepatitis C/prevention & control
- Hepatitis C/transmission
- Hospitals, Special/organization & administration
- Hospitals, Special/statistics & numerical data
- Housekeeping, Hospital
- Humans
- Immunization, Passive
- Incidence
- Infectious Disease Transmission, Patient-to-Professional/prevention & control
- Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data
- Male
- Needlestick Injuries/epidemiology
- Needlestick Injuries/prevention & control
- Needlestick Injuries/therapy
- Nursing Staff, Hospital
- Occupational Exposure/prevention & control
- Personnel, Hospital
- Prospective Studies
- Risk Management
- Safety Management
- Vaccination
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Pan A, Signorini L, Magri S, De Carli G. Scalp needlestick injury during fine-needle aspiration cytologic evaluation without needle manipulation: William tell in the laboratory, not quite. Infect Control Hosp Epidemiol 2006; 27:996. [PMID: 16941335 DOI: 10.1086/507292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Smith DR, Mihashi M, Adachi Y, Nakashima Y, Ishitake T. Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital. J Hosp Infect 2006; 64:44-9. [PMID: 16835002 DOI: 10.1016/j.jhin.2006.03.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 03/29/2006] [Indexed: 11/25/2022]
Abstract
The epidemiology of needlestick and sharps injuries (NSIs) was investigated among a complete cross-section of 1,162 nurses from a large hospital in southern Japan (response rate 74.0%). Forty-six percent had experienced an NSI in the previous year. Most were caused by ampoules or vials, which injured 32.3% of all nurses and accounted for 42.9% of all NSI events. Twenty-two percent of all NSIs involved a device that had been used on a patient prior to the NSI (contaminated device), while the usage status of a further 2.8% of devices was unknown. Logistic regression indicated that nurses younger than 25 years of age were 2.18 times more likely to have sustained a single NSI in the past 12 months [odds ratio (OR) 2.18, 95% confidence intervals (CI) 1.15-4.17] and 2.39 times more likely to have sustained multiple NSIs (OR 2.39, 95% CI 1.08-5.34). Working mixed shifts (rotating day and night, as opposed to day shifts alone) was associated with a 1.67-fold increased risk of sustaining any NSI (OR 1.67, 95% CI 1.01-2.85) and a 2.72 times greater risk of sustaining an NSI from a contaminated device (OR 2.72, 95% CI 1.71-4.44). Nurses who reported significant fatigue after work were 1.87 times more likely to sustain multiple NSIs (OR 1.87, 95% CI 1.13-3.13) and 1.94 times more likely not to report their NSIs (OR 1.94, 95% CI 1.03-3.71). Perceived high mental pressure was associated with a 1.75-fold increased risk of sustaining an NSI from a contaminated device (OR 1.75, 95% CI 1.07-2.88). Nurses who reported suboptimal staffing levels in their wards were 2.21 times more likely not to report any NSIs they sustained in the previous year (OR 2.21, 95% CI 1.06-4.89). Overall, this study suggests that NSIs represent a complex and multi-faceted problem for Japanese nurses. Intervention strategies should consider the emerging complicity of psychosocial factors on NSI among hospital staff in Japan, as elsewhere.
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Affiliation(s)
- D R Smith
- Department of Hazard Assessment, National Institute of Industrial Health, Kawasaki, Japan.
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Balsamo AC, Felli VEA. Estudo sobre os acidentes de trabalho com exposição aos líquidos corporais humanos em trabalhadores da saúde de um hospital universitário. Rev Lat Am Enfermagem 2006; 14:346-53. [PMID: 16926990 DOI: 10.1590/s0104-11692006000300007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 03/06/2006] [Indexed: 11/22/2022] Open
Abstract
Este estudo descritivo exploratório, de abordagem quantitativa, teve como objetivos caracterizar os trabalhadores do Hospital Universitário da Universidade de São Paulo que sofreram acidente de trabalho com exposição aos líquidos corporais humanos, e avaliar o protocolo de atendimento aos acidentados. A população consistiu de 48 trabalhadores que sofreram acidente, no período de julho de 2000 a junho de 2001. Para a coleta dos dados, foi elaborado um formulário e realizada entrevista. Os resultados mostraram que os trabalhadores do Departamento de Enfermagem foram os que apresentaram maior risco desses acidentes e 87,50% ocorreram com os materiais perfurocortantes. Quanto à situação/atividade, relacionada ao acidente, os trabalhadores informaram que 25% foram devido ao "ato inadequado durante a realização do procedimento" 19,64% dos trabalhadores referiram que o acidente simplesmente "aconteceu" e 29,17% responderam que não tinham sugestões. Este estudo forneceu ferramentas importantes para a revisão e elaboração de estratégias de prevenção dos acidentes com exposição aos líquidos corporais humanos.
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Smith DR, Smyth W, Leggat PA, Wang RS. Needlestick and sharps injuries among nurses in a tropical Australian hospital. Int J Nurs Pract 2006; 12:71-7. [PMID: 16529593 DOI: 10.1111/j.1440-172x.2006.00553.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although needlestick and sharps injuries (NSI) represent a major hazard in nursing practice, most studies rely on officially reported data and none have yet been undertaken in tropical environments. Therefore, we conducted a cross-sectional NSI survey targeting all nurses within a tropical Australian hospital, regardless of whether they had experienced an NSI or not. Our overall response rate was 76.7%. A total of 39 nurses reported 43 NSI events in the previous 12 months. The most common causative device was a normal syringe needle, followed by insulin syringe needles, i.v. needles or kits and blood collection needles. Half of the nurses' NSI events occurred beside the patient's bed: drawing up medication was the most common reason. Nurses working in the maternity/neonatal wards were only 0.3 times as likely to have experienced an NSI as their counterparts in the medical or surgical wards. Overall, our study has shown that NSI events represent an important workplace issue for tropical Australian nurses. Their actual rate might also be higher than official reports suggest.
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Affiliation(s)
- Derek R Smith
- Department of Hazard Assessment, National Institute of Industrial Health, Kawasaki, Japan.
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Smith DR, Wei N, Zhang YJ, Wang RS. Needlestick and sharps injuries among a cross-section of physicians in Mainland China. Am J Ind Med 2006; 49:169-74. [PMID: 16421917 DOI: 10.1002/ajim.20261] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although needlestick and sharps injuries (NSI) represent a significant occupational hazard for physicians worldwide, their epidemiology has not been previously examined in Mainland China. This study describes the prevalence, distribution, and risk factors for NSI among a cross-section of Chinese physicians. METHODS Data was obtained by an anonymous, self-reporting survey administered to all 361 physicians at a university teaching hospital, during 2004. RESULTS Seventy-nine percent of the physicians responded. Among them, 64% had experienced an NSI in the previous 12 months, 50.3% of which involved contaminated devices. By device, 22.8% were caused by hollow-bore syringe needles, 19.1% by suture needles, and 12.1% by scalpel blades. Surgical procedures accounted for 27.9% of all injuries. Only 15.3% of physicians had officially reported their NSI to management, of which 10% went unreported because the individual felt they were not unlucky enough to get a disease. A statistically significant correlation was demonstrated between NSI and working in the intensive care unit (adjusted odds ratio: 5.3, 95% CI: 1.7-23.4). CONCLUSIONS Although this study suggests that NSI are an important workplace hazard for Chinese physicians, future measures should consider the unique cultural beliefs of Chinese people and its effect on preventive behaviors. The concept of "luck," and its relationship with NSI reporting in particular, may also need to be addressed.
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Affiliation(s)
- Derek R Smith
- Department of Hazard Assessment, National Institute of Industrial Health, 6-21-1 Nagao, Tama-Ku, Kawasaki 215-8585, Japan
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Prüss-Ustün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med 2005; 48:482-90. [PMID: 16299710 DOI: 10.1002/ajim.20230] [Citation(s) in RCA: 383] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The global burden of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infection due to percutaneous injuries among health care workers (HCWs) is estimated. METHODS The incidence of infections attributable to percutaneous injuries in 14 geographical regions on the basis of the probability of injury, the prevalence of infection, the susceptibility of the worker, and the percutaneous transmission potential are modeled. The model also provides the attributable fractions of infection in HCWs. RESULTS Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIV infections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries. The fraction of infections with HCV, HBV, and HIV in HCWs attributable to occupational exposure to percutaneous injuries fraction reaches 39%, 37%, and 4.4% respectively. CONCLUSIONS Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs). These infections are highly preventable and should be eliminated.
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Affiliation(s)
- Annette Prüss-Ustün
- Protection of the Human Environment, World Health Organization, Geneva, Switzerland.
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Oh HS, Yi SE, Choe KW. Epidemiological characteristics of occupational blood exposures of healthcare workers in a university hospital in South Korea for 10 years. J Hosp Infect 2005; 60:269-75. [PMID: 15949619 DOI: 10.1016/j.jhin.2004.11.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 11/29/2004] [Indexed: 11/22/2022]
Abstract
This study investigated the epidemiological characteristics of occupational blood exposures (OBEs) of healthcare workers (HCWs) in South Korea, and examined trends of OBEs after implementing blood exposure prevention (BEP) programmes. The study was conducted between 1 January 1992 and 31 December 2001 at a university-affiliated acute care hospital in Seoul. The BEP programmes comprised in-service education, hepatitis B virus (HBV) vaccination, and postexposure evaluation and prophylaxis. From 959 reported cases of OBEs, the crude incidence density (ID) was 2.62 cases per 100 person-years. The major risk groups for OBEs were physicians (ID 4.34) and new employees. The major type of OBE was from sharps injuries, including needlesticks (94.0%). OBE cases occurred more frequently during the spring (36.4%). The frequency of the serological tests of anti-hepatitis B surface antigen of HCWs changed significantly each year (P<0.05). The major serological risk for source patients was HBV (52.1%), but the risks for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) increased significantly each year (P<0.05). There were no seroconversion cases following OBEs among the tested HCWs. In summary, we established the epidemiological characteristics of OBEs in a South Korean university hospital, and reduced the risk of OBEs of major risk groups by BEP programmes. We also found an increase in the risk of HCV and HIV during the study period, suggesting that OBEs could be a serious threat to HCWs.
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Affiliation(s)
- H S Oh
- Infection Control Service, Seoul National University Hospital, 28 Yongondong Chongnogu, Seoul 110-744, South Korea.
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Abstract
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.
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Affiliation(s)
- Derek R Smith
- Department of Hazard Assessment, National Institute of Industrial Health, Kawasaki, Japan.
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Diaz LF, Savage GM, Eggerth LL. Alternatives for the treatment and disposal of healthcare wastes in developing countries. WASTE MANAGEMENT (NEW YORK, N.Y.) 2005; 25:626-37. [PMID: 15993347 DOI: 10.1016/j.wasman.2005.01.005] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Revised: 01/11/2005] [Accepted: 01/11/2005] [Indexed: 05/03/2023]
Abstract
Waste production in healthcare facilities in developing countries has brought about a variety of concerns due to the use of inappropriate methods of managing the wastes. Inappropriate treatment and final disposal of the wastes can lead to adverse impacts to public health, to occupational health and safety, and to the environment. Unfortunately, most economically developing countries suffer a variety of constraints to adequately managing these wastes. Generally in developing countries, few individuals in the staff of the healthcare facility are familiar with the procedures required for a proper waste management program. Furthermore, the management of wastes usually is delegated to poorly educated laborers who perform most activities without proper guidance and insufficient protection. This paper presents some of the most common treatment and disposal methods utilized in the management of infectious healthcare wastes in developing countries. The methods discussed include: autoclave; microwave; chemical disinfection; combustion (low-, medium-, and high-technology); and disposal on the ground (dump site, controlled landfill, pits, and sanitary landfill). Each alternative for treatment and disposal is explained, including a description of the types of wastes that can and cannot be treated. Background information on the technologies also is included in order to provide information to those who may not be familiar with the details of each alternative. In addition, a brief presentation of some of the emissions from each of the treatment and disposal alternatives is presented.
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Affiliation(s)
- L F Diaz
- CalRecovery Inc., 2454 Stanwell Drive, Concord, CA 94520, USA.
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Trapé-Cardoso M, Schenck P. Reducing percutaneous injuries at an academic health center: a 5-year review. Am J Infect Control 2004; 32:301-5. [PMID: 15292897 DOI: 10.1016/j.ajic.2003.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The University of Connecticut Health Center Employee Health Service collected and used National Surveillance System for Hospital Health Care Workers (NaSH) data to (1) improve surveillance of health care worker blood and body fluid exposures (BBFEs) and (2) target specific interventions for higher-risk groups (nursing staff, medical and dental students, and residents). METHODS All 870 BBFE incidents were abstracted from the NaSH database from the 1997 through 2002 academic years. Incidence rates per 100 full-time-equivalent workers were determined for each targeted occupation group with 95% confidence intervals. RESULTS The number of percutaneous injuries declined among medical/dental students and nursing staff, and to a lesser degree for residents. The incidence rates decreased from 7.9% in 2000 to 2001 to 2.6% in 2001 to 2002 for students and from 9.2% in 1997 to 1998 to 2.7% in 2001 to 2002 for nursing staff. CONCLUSIONS Data from a surveillance database provided guidance for administrative, educational, and engineering control interventions. Active surveillance and periodic review of interventions are important aspects to reduce BBFEs in targeted high-risk occupational groups, especially when the workforce has a high turnover, as is typical in academic health centers.
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Affiliation(s)
- Marcia Trapé-Cardoso
- Division of Occupational and Environmental Medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, USA
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Fereres Castiel J, Mato Chaín G. [Management of the occupational risk of exposure to biological material. From knowledge to action]. Med Clin (Barc) 2004; 122:782-3. [PMID: 15207107 DOI: 10.1016/s0025-7753(04)74384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jesús Hernández Navarrete M, Campins Martí M, Vanessa Martínez Sánchez E, Ramos Pérez F, García de Codes Ilario A, Luis Arribas Llorente J. Exposición ocupacional a sangre y material biológico en personal sanitario. Proyecto EPINETAC 1996-2000. Med Clin (Barc) 2004. [DOI: 10.1016/s0025-7753(04)74151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tarantola A, Golliot F, Astagneau P, Fleury L, Brücker G, Bouvet E. Occupational blood and body fluids exposures in health care workers. Am J Infect Control 2003; 31:357-63. [PMID: 14608303 DOI: 10.1016/s0196-6553(03)00040-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The risk of accidental blood and body fluid (BBF) exposure is a daily concern for health care workers throughout the world, and various strategies have been introduced during the past decade to help reduce that risk. To assess the impact of multifocal reduction strategies introduced in hospitals affiliated with the Northern France network, we recently examined data from 4 years of BBF-exposure reports filed by network employees. A total of 7,649 BBF exposures were reported by health care workers to occupational medicine departments in 61 hospitals. Nurses and nursing students accounted for 4,587 (60%) of exposures, followed by nurses' aides and clinicians. Most (77.6%) of the reports were related to needlestick injury (NSI). In addition, we examined BBF exposure trends over time by analyzing data from 18 hospitals (29.5%) with data available for the time period of 1995 to 1998. These were assessed in nurses, who have the highest and most consistent reporting rate. We noted that the BBF-exposure incidence rate for all BBF exposures in nurses decreased from 10.8 to 7.7 per 100 nurses per year between 1995 and 1998 (P <.001), whereas the NSI rate decreased 8.9 per 100 nurses per year in 1995 to 6.3 in 1998 (P <.001). The percentage of NSIs that resulted from noncompliance with universal precautions also decreased significantly (P =.04). Widespread improvements in procedures and engineering controls were implemented in the Northern France network before and during the study period. Significant reductions were observed in reports of BBF exposures and NSIs, particularly in nurses. These findings are similar to those in other countries and reflect the overall improvement in the management of occupational risk of BBF in health care workers.
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Affiliation(s)
- Amaud Tarantola
- CCLIN Paris-Nord, Institut Biomédical des Cordeliers, 15-21 rue de l'Ecole de Médecine, 75006 Paris, France
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Stein AD, Makarawo TP, Ahmad MFR. A survey of doctors' and nurses' knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals. J Hosp Infect 2003; 54:68-73. [PMID: 12767850 DOI: 10.1016/s0195-6701(03)00074-4] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study investigated knowledge about infection control amongst doctors and nurses through a cross-sectional survey conducted between March and May 2001 in three Birmingham, UK teaching hospitals. Seventy-five doctors and 143 nurses, representing 7% and 4%, respectively, of potential respondents, participated in the study measuring knowledge of, attitudes towards, and compliance with universal precautions. Overall knowledge of risks of blood-borne virus (BBV) transmission from an infected patient after needlestick injury was low [44.0% for hepatitis B virus (HBV), 38.1% for hepatitis C virus (HCV), 54.6% for human immunodeficiency virus (HIV)]. There were significant differences between doctors and nurses concerning the estimations of HBV (e-antigen +) (P=0.006) and HIV (P<0.001) transmission risks. Eighty-six percent of nurses stated that they treat each patient as if they are carrying a BBV compared with 41% of doctors. Doctors and nurses differed significantly in their attitudes about and reported compliance with washing hands before and after patient contact and with wearing gloves when taking blood (P<0.001 for all). Doctors consistently de-emphasized the importance of, and reported poor compliance with, these procedures. Doctors were also more likely to state that they re-sheath used needles manually than were nurses (P<0.001). Thirty-seven percent of respondents reported that they had suffered a needlestick injury with a used needle, with doctors more likely to be injured than nurses (P=0.005). Twenty-eight percent of these doctors and 2% of the nurses did not report their needlestick injuries (P=0.004). Education, monitoring, improved availability of resources, and disciplinary measures for poor compliance are necessary to improve infection control in hospitals, especially amongst doctors.
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Affiliation(s)
- A D Stein
- School of Medicine, The University of Birmingham, Birmingham, UK.
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Abstract
BACKGROUND Working in the health care and research sectors has been linked to various hazards. METHODS Studies published in the peer-reviewed literature that are pertinent to the exposures or diseases relevant to these fields were reviewed. RESULTS The most important exposures include infectious agents, formaldehyde, anesthetic agents, antineoplastic drugs, and ethylene oxide. The best-documented evidence is that of infectious risk primarily among clinical personnel. Monitoring studies of persons occupationally exposed to anesthetics clearly demonstrate behavioral effects, possible risk of reproductive problems, as well as cytogenetic effects of unknown significance. The latter two impairments are also observed among those exposed to antineoplastic drugs and ethylene oxide. Exposure to formaldehyde appears to be associated with nasopharyngeal tumors. Whereas increased risk of cancer of certain sites, particularly the brain and lymphohematopoietic system, is found among research and health care personnel, no specific exposure has been linked to these neoplasms. CONCLUSIONS Although some results are inconsistent, continued environmental and biological monitoring will allow better assessment of exposures and of implemented protection measures.
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Affiliation(s)
- Daniela Vecchio
- Department of Environmental Epidemiology, PRALV, National Cancer Research Institute, Genova, Italy.
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Wang H, Fennie K, He G, Burgess J, Williams AB. 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. J Adv Nurs 2003; 41:187-94. [PMID: 12519278 DOI: 10.1046/j.1365-2648.2003.02519.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the human immunodeficiency virus (HIV) epidemic in China is expanding rapidly, the principles of universal precautions (UP) are not widely disseminated in Chinese hospitals. Lack of training about occupational prevention of bloodborne pathogens (BBP) may place student nurses at risk when they are in clinical practice. AIM To examine the impact of structured training on prevention of occupational exposure to BBP on knowledge, behaviour, and incidence of medical sharp injuries among student nurses in Changsha, China. METHODS A quasi-experimental study evaluated changes in knowledge, self-reported UP behaviours, observed adherence to UP, and needle stick/sharp injuries during a 4-month follow-up period. The study population consisted of 106 student nurses in two classes. One class served as the experimental group, while the other served as a control group. Students in the experimental group participated in a structured training intervention consisting of lectures and demonstrations. RESULTS At 4 months, the group that received the BBP training scored significantly higher than the standard education group on both knowledge (P < 0.001) and behaviour (P = 0.002). Although students in the experimental group were not observed to practise UP significantly more frequently than those in the control group, they were less likely to experience needle stick/sharp injuries (OR = 0.29; 95% CI 0.11, 0.74; P = 0.004). CONCLUSION Structured training in prevention of occupational exposure to BBP improved knowledge and behaviour and reduced the number of needle stick/sharp injuries among Chinese student nurses, compared with students who did not receive the training. Training in the techniques of UP could play a role in reducing the risk for occupational exposure to BBP among Chinese future nurses. In view of the accelerating HIV epidemic, implementation and evaluation of such training programmes are urgently needed.
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Affiliation(s)
- Honghong Wang
- Nursing School, Xiang Ya School of Medicine, Central South University, Changsha, Hunan, China
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Jagger JC. Are Australia's healthcare workers stuck with inadequate needle protection? The most direct way to reduce percutaneous injuries is to make devices safer. Med J Aust 2002; 177:405-6. [PMID: 12381245 DOI: 10.5694/j.1326-5377.2002.tb04876.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2002] [Accepted: 09/02/2002] [Indexed: 11/17/2022]
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