Trends in bloodborne pathogen exposure and follow-up at an urban teaching hospital: 1987 to 1997

Masking by health care and public safety workers in non-patient care areas to mitigate SARS-CoV-2 infection: A systematic review

Objectives

Wearing a mask is an important method for reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in health care and public safety settings. We assess the evidence regarding masking in the workplace during the initial months of the COVID-19 pandemic (PROSPERO CRD4202432097).

Methods

We performed a systematic review of published literature from 4 databases and evaluated the quality of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. We searched for observational and experimental research involving public safety and health care workers. We included articles evaluating the use of masks, versus no mask, on the outcome of SARS-CoV-2 infection.

Results

Our search yielded 15,013 records, of which 9 studies were included. Most studies (n = 8; 88.9%) involved infections or outbreaks among health care workers. The majority (88.9%) used in-depth interviews of cases and non-cases to obtain self-reported use of masks during periods of exposure. One of 9 studies quantitatively assessed differences in SARS-CoV-2 infection based on use of masks in non-patient care settings. Use of observational study designs, small sample sizes, inadequate control for confounding, and inadequate measurement of exposure and non-exposure periods with infected coworkers contributed to the quality of evidence being judged as very low.

Conclusions

The available evidence from the initial months of the pandemic suggests that the use of masks in congregate, non-patient care settings, such as breakrooms, helps to reduce risk of SARS-CoV-2 virus transmission. However, this evidence is limited and is of very low quality. Prospective studies incorporating active observation measures are warranted.

Occupational exposure to blood and body fluids and associated factors among health care workers at the University of Gondar Hospital, Northwest Ethiopia

Background

Occupational exposure to blood and body fluids (BBFs) is a serious concern for health care workers (HCWs) and presents a major risk factor for transmission of infectious diseases such as hepatitis B virus (HBV), hepatitis C virus, and human immune deficiency virus. The main objective of this study was to assess the magnitudes of occupational exposure of blood and body fluids and associated factors among health workers at the University of Gondar Hospital.

Methods

An institution-based cross-sectional study was conducted from 1 February to 31 May 2017 at the University of Gondar Hospital. A total of 282 health care workers were selected by simple random sampling technique. Descriptive data was presented as absolute number with percentage, and multivariate analysis was used to assess the statistical association between associated factors and occupational exposure to BBFs. A P value of < 0.05 was considered as statistical significant.

Result

A total of 282 HCWs participated with the mean (±SD) age of 30.51 ± 5.86 year. Of the total, 58.5% (165) and 42.2% (119) of the study participants had been exposed to BBFs splash and needlestick injury (NSI) in their lifetime, respectively. However, 39.0% (110) and 20.6% (58) of the HCWs were exposed to splash and NSI in the past 1 year, respectively. Not wearing eye goggle, lack of training on infection prevention, taking of HBV vaccination, and recapping of used needle were risk factors associated with BBFs splash exposure, whereas taking HBV vaccination and recapping of used needle were associated risk factors with NSI exposure.

Conclusion

This study showed a high percentage of occupational exposure to blood and body fluids among health care workers. Not wearing eye goggle, HBV vaccine status, and recapping needles were found to be independent predictors of occupational exposure to BBFs among HCWs. Therefore, relevant stakeholders need to formulate strategies to create a favorable working environment and increase their adherence to universal precautions.

Reducing needlestick injuries through safety-engineered devices: results of a Japanese multi-centre study

BACKGROUND

Quantitative information on the effectiveness of safety-engineered devices (SEDs) is needed to support decisions regarding their implementation.

AIM

To elucidate the effects of SED use in winged steel needles, intravenous (IV) catheter stylets and suture needles on needlestick injury (NSI) incidence rates in Japan.

METHODS

Japan EPINet survey data and device utilization data for conventional devices and SEDs were collected from 26 participating hospitals between 1 April 2009 and 31 March 2014. The NSI incidence rate for every 100,000 devices was calculated according to hospital, year and SED use for winged steel needles, IV catheter stylets and suture needles. Weighted means and 95% confidence intervals (CI) were used to calculate overall NSI incidence rates.

FINDINGS

In total, there were 236 NSIs for winged steel needles, 152 NSIs for IV catheter stylets and 180 NSIs for suture needles. The weighted NSI incidence rates per 100,000 devices for SEDs and non-SEDs were as follows: winged steel needles, 2.10 (95% CI 1.66-2.54) and 14.95 (95% CI 2.46-27.43), respectively; IV catheter stylets, 0.95 (95% CI 0.60-1.29) and 6.39 (95% CI 3.56-9.23), respectively; and suture needles, 1.47 (95% CI -1.14-4.09) and 16.50 (95% CI 4.15-28.86), respectively. All devices showed a significant reduction in the NSI incidence rate with SED use (P < 0.001 for winged steel needles, P = 0.035 for IV catheter stylets and P = 0.044 for suture needles).

CONCLUSION

SED use substantially reduces the incidence of NSIs, and is therefore recommended as a means to prevent occupational infections in healthcare workers and improve healthcare safety.

Healthcare worker adherence to follow-up after occupational exposure to blood and body fluids at a teaching hospital in Brazil

Healthcare workers (HCWs) are at a high risk for exposure to pathogens in the workplace. The objective of this study was to evaluate HCW adherence to follow-up after occupational exposure to blood and body fluids at a tertiary care university hospital in the city of São Paulo, Brazil. Data were collected from 2102 occupational exposures to blood and body fluids reports, obtained from the Infection Control Division of the Universidade Federal de São Paulo/Escola Paulista de Medicina/Hospital São Paulo, in São Paulo, Brazil, occurring between January of 2005 and December of 2011. To evaluate adherence to post-exposure follow-up among the affected HCWs, we took into consideration follow-up visits for serological testing. For HCWs exposed to materials from source patients infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV), as well as from source patients of unknown serological status, follow-up serological testing was scheduled for 3 and 6 months after the accident. For those exposed to materials from source patients co-infected with HIV and HCV, follow-up evaluations were scheduled for 3, 6, and 12 months after the accident. During the study period, there were 2056 accidental exposures for which data regarding the serology of the source patient were available. Follow-up evaluation of the affected HCW was recommended in 612 (29.8%) of those incidents. After the implementation of a post-exposure protocol involving telephone calls and official letters mailed to the affected HCW, adherence to follow-up increased significantly, from 30.5 to 54.0% (P = 0.028). Adherence was correlated positively with being female (P = 0.009), with the source of the exposure being known (P = 0.026), with the source patient being HIV positive (P = 0.029), and with the HCW having no history of such accidents (P = 0.047). Adherence to the recommended serological testing was better at the evaluation scheduled for 3 months after the exposure (the initial evaluation) than at those scheduled for 6 and 12 months after the exposure (P = 0.004). During the study period, there was one confirmed case of HCW seroconversion to HCV positivity. The establishment of a protocol that involves the immediate supervisor of the affected HCWs, in the formal summoning of those HCWs is necessary in order to increase the rate of adherence to post-exposure follow-up.

Occupational exposure of health care personnel to hepatitis B and hepatitis C: prevention and surveillance strategies

Ensuring the safety of personnel working in health care environments can be challenging and requires a multifaceted approach to target reductions in occupational exposures to blood-borne pathogens, such as hepatitis B or hepatitis C. This article reviews the epidemiology of occupational exposures to hepatitis B and hepatitis C in health care personnel in hospital settings. The nature and likelihood of risk to health care personnel are evaluated along with estimates of seroconversion risk. The review focuses on prevention programs and available surveillance programs to aid in monitoring and reducing occupational exposures to blood-borne pathogens.

Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers

OBJECTIVE

To evaluate the effect of introducing an engineered device for preventing injuries from sharp instruments (engineered sharps injury prevention device [ESIPD]) on the percutaneous injury rate in healthcare workers (HCWs).

METHODS

We undertook a controlled, interventional, before-after study during a period of 3 years (from January 1998 through December 2000) at a major medical center. The study population was HCWs with potential exposure to bloodborne pathogens. HCWs who sustain a needlestick injury are required by hospital policy to report the exposure. A confidential log of these injuries is maintained that includes information on the date and time of the incident, the type and brand of sharp device involved, and whether an ESIPD was used.

INTERVENTION

Introduction of an intravenous (IV) catheter stylet with a safety-engineered feature (a retractable protection shield), which was placed in clinics and hospital wards in lieu of other IV catheter devices that did not have safety features. No protective devices were present on suture needles during any of the periods. The incidence of percutaneous needlestick injury by IV catheter and suture needles was evaluated for 18 months before and 18 months after the intervention.

RESULTS

After the intervention, the incidence of percutaneous injuries resulting from IV catheters decreased significantly (P<.01), whereas the incidence of injuries resulting from suture needle injuries increased significantly (P<.008).

CONCLUSION

ESIPDs lead to a reduction in percutaneous injuries in HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens.

Perceived barriers to implementation of a successful sharps safety program

IN RESPONSE TO INCREASING needle sticks and sharps injuries at a large, urban trauma center in the northeastern United States, a nurse educator assembled a focus group of OR staff members to determine what they perceived to be barriers to successful implementation of a sharps safety program. THE FOCUS GROUP IDENTIFIED inadequate communication, powerlessness, resistance to change, intimidation, inconsistencies in practice, negative attitudes, inexperienced staff members, and time constraints as barriers to a successful change implementation. USING THIS INFORMATION, the nurse educator identified strategies to implement a practice change to decrease the rate of needle sticks and sharps injuries.

An Assessment of Universal versus Risk-Based Hepatitis C Virus Testing of Source Patients Postexposure to Blood and Body Fluids Among Healthcare Workers

OBJECTIVE

The objective of this study was to assess the impact of universal versus risk-based hepatitis C (HCV) testing of source patients' (SPs) postexposure to blood and body fluids on the HCV exposure rates among healthcare workers.

METHODS

Exposure and test result information between 1993 and 2004 was abstracted from the Johns Hopkins Bloodborne Pathogen Database. A Poisson regression model estimating HCV infection among underlying SPs based on partial testing was developed and applied.

RESULTS

After adjusting for the effect of partial testing of SPs, the estimated underlying prevalence of HCV-positive SPs increased slightly during the study period, from 11.9% to 15.1%, but the trend was not statistically significant. Yield curve of HCV-positive SPs rose quickly when SPs' testing rates were low but became flat when SPs' testing rates were high.

CONCLUSION

Reliance on HCV risk factors to screen SPs resulted in an underestimation of the prevalence of HCV in SPs before 1997 when the testing rates were between 15.4% and 25.6%. When SPs' testing rates were above 65%, our model predicted no additional yield of HCV-positive SPs.

Epidemiological characteristics of occupational blood exposures of healthcare workers in a university hospital in South Korea for 10 years

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.