History of injury in a developing country: a scoping review of injury literature in Lebanon

BACKGROUND

Lebanon, an Eastern Mediterranean country, suffers a large burden of injury as a consequence of conflict and war, political instability, and the lack of policies and safety regulations. This article aims to systematically map and comprehensively describe the injury research literature in Lebanon and, to identify gaps for future research.

METHODS

MEDLINE, Embase, Eric and SafetyLit, and the grey literature, including conference proceedings, theses and dissertations, government and media reports, were searched without any date or language limits. Data were extracted from 467 documents using REDCap.

RESULTS

War-related injuries were the most prevalent type of injury in Lebanon, followed by homicide and other forms of violence. While existing literature targeted vulnerable and at-risk populations, the vast majority focused solely on reporting the prevalence of injuries and associated risk factors. There are considerable gaps in the literature dealing with the integration of preventive programs and interventions across all populations.

CONCLUSIONS

Lebanon, historically and currently, experiences a high number of injuries from many different external causes. To date, efforts have focused on reporting the prevalence of injuries and making recommendations, rather than implementing and evaluating interventions and programs to inform policies. Future injury related work should prioritize interventions and prevention programs.

Occupational Exposure to Blood-Borne Pathogens among Healthcare Workers in a Tertiary Care Center in Lebanon

OBJECTIVES

Despite numerous initiatives, occupational exposure to blood-borne pathogens (BBP) caused by percutaneous injuries or mucosal contamination remain common among healthcare workers (HCWs). These exposures were decreasing at the American University of Beirut Medical Center (AUBMC) in the previous decades. Recently, the medical center activity has been increasing with higher number of interventions performed and shorter hospital stay. Our aim was to determine the trend of incidents resulting from BBP exposures at AUBMC from 2014 till 2018 and identify whether the increase in hospital activity affected the rate of these exposures. We also aimed to assess the risk factors associated with needle stick injuries (NSIs).

METHODS

A retrospective observational descriptive study of all exposures to BBPs among HCWs reported to the Environmental Health, Safety, and Risk Management department at the AUBMC between 2014 and 2018 was performed.

RESULTS

There were 967 exposures reported among which 84% were due to needlesticks. Residents (40%), followed by nurses (30%), and then by attending physicians (16%) were the top three most exposed occupational groups. Half of the participants injured themselves using either a syringe or a suture needle; and mostly during or after use. Occupation and incident location were associated with NSIs. The mean BBP exposure incidence rate was 5.4 per 100 full-time employees, 65.6 per 100 bed-years, and 0.48 admission-years. The BBP exposure rate per 100 occupied beds per year decreased between 2014 and 2017 then increased in 2018 (P < 0.001). The number of BBP exposures showed a strong, though non-significant negative correlation with the average length of hospital stay (Spearman correlation coefficient = -0.9, P = 0.083).

CONCLUSIONS

BBP exposure remains a serious occupational hazard. Our study shows that the BBP exposure rate per 100 occupied beds per year started decreasing during the study period before increasing again in 2018. Only the nursing department showed a consistent decrease of exposures. The occupation and incident location were found to be risk factors associated with NSIs. In addition to providing education and training, additional steps such as providing safety equipment and future interventions directed towards adjusting to higher workload should be all considered.

Compliance with standard precautions among baccalaureate nursing students in a Saudi university: A self-report study

Meticulous observance of standard infection control precautions by health care providers is strongly recommended for every patient encounter. Assessment of nursing students' compliance should be carried out regularly in order to ensure adherence to protocols. Thus, this study was conducted to assess self-reported compliance with standard precautions among baccalaureates in nursing students in a Saudi university. A convenience sample of 236 nursing students was surveyed in this cross-sectional, self-reported study, using the Compliance with Standard Precaution Scale Arabic version (CSPS-A). Independent t-test and one-way analyses of variance (ANOVA) were performed to examine the differences on compliance. A multiple regression analysis was performed to identify the factors affecting compliance. The overall compliance rate was 61.0%. The students reported highest compliance in disposing used sharp instruments and other sharp objects into sharps-only boxes, while the lowest compliance rate in using water only for hand washing. Significant differences in compliance were observed when respondents were grouped according to their demographic characteristics. Cultivating a supportive culture of adherence to infection control precautions among nursing students is of paramount importance. The clinical environment should be supportive of a culture where strict compliance with the control and prevention of infection is of prime importance.

Knowledge and practices of healthcare workers in relation to bloodborne pathogens in a tertiary care hospital, Western Saudi Arabia

To assess knowledge and practices of healthcare workers (HCWs) in relation to bloodborne pathogens in a tertiary care hospital, western Saudi Arabia. Self-administered questionnaire was distributed assessing demographic characteristics, knowledge and practices of physicians, nurses and technicians on risks of exposure and prophylaxis against human immunodeficiency virus, hepatitis B virus and hepatitis C virus infections. A total of 466 participants (151; 32.4 % physicians and 315; 67.6 % nurses/technicians) completed the questionnaire. Almost two thirds of the physicians (60.9 %) and half of the nurses/technicians (47.6 %) had history of exposure to risks of bloodborne infection. Although both physicians and nurses/technicians showed acceptable level of knowledge about risks of bloodborne infections, modest proportion knew the correct actions including reporting following exposure. Behavioral-based in-service training interventions and strict policy should be implemented to promote compliance of HCWs to the protective measures against hazards of bloodborne infection.

Biological risk among hospital housekeepers

Although not directly responsible for patient care, hospital housekeepers are still susceptible to accidents with biological material. The objectives of this study were to establish profile and frequency of accidents among hospital housekeepers, describe behaviors pre- and postaccident, and risk factors. This was a cross-sectional study with hospital housekeepers in Goiania, Brazil. Data were obtained from interviews and vaccination records. The observations were as follows: (1) participating workers: 94.3%; (2) incomplete hepatitis B vaccination: 1 in 3; and (3) accident rate: 26.5%, mostly percutaneous with hypodermic needles, and involved blood from an unknown source; roughly half occurred during waste management. Upon review, length of service less than 5 years, completed hepatitis B vaccination, and had been tested for anti-HBs (hepatitis B surface antigen) influenced frequency of accidents. These findings suggest that improper disposal of waste appears to enhance the risk to hospital housekeepers. All hospital workers should receive continued training with regard to waste management.

A Survey of Occupational Exposure to Blood and Body Fluids in Physiotherapists in Western Australia

The aim of this pilot project was to investigate the occurrence of occupational exposure to blood and body fluids in registered physiotherapists in Western Australia. Surveys were sent to physiotherapists with questions regarding personal background, exposure characteristics, and contributing factors included. Descriptive statistical methods were used to identify the area of practice posing the highest risk of exposure to physiotherapists. The authors found that 56.1% of surveyed physiotherapists recorded one or more exposures within the past 5 years. Work in hospitals was found to carry the highest rate of exposure for the physiotherapy profession. Other areas of practice, including community work, private practice, nursing homes/hostels, and work at sporting events carry comparable but lower risks of exposure. In private practice, 50% of exposures were associated with acupuncture. In nursing homes, 60% of exposures were brought on by exposure to contaminated materials, whereas in the community setting most exposures (64%) were attributed to unpredictable/uncontrollable situations. At sporting events, 90% of all exposures were associated with already existing sources of blood and body fluids (wounds). Within the hospital setting, the 3 dominant immediate causes reported were unpredictable situations (33.3%), existing sources (28.4%), and procedural causes (22.2%). The use of personal protective equipment for prevention of exposure is investigated and discussed. Data collected for this survey were not enough to draw conclusive assumptions regarding hazard management. A repeat of this study on a larger scale may provide physiotherapists with the tools and knowledge to minimize the likelihood of exposure and harm arising from exposure.