Complying with the Occupational Safety and Health Administration's Bloodborne Pathogens Standard: implementing needleless systems and intravenous safety devices

Occupational infection and needle stick injury among clinical laboratory workers in Al-Madinah city, Saudi Arabia

Background

Clinical laboratory workers face biohazard such as needlestick injury and occupational infection on a daily basis. In this study, we examined self-reported frequency of occupational infection and needlestick injury among the clinical laboratory workers in Al- Madinah, Saudi Arabia.

Methods

A total of 234 clinical laboratory workers were recruited from private and government health sectors to answer a self-administered questionnaire that was prepared to achieve the aims of the study.

Results

The results showed that approximately 33% of the sample had an experienced occupational infection while 24% had experienced a needlestick injury. Approximately, 49% reported that they always recap needle after use, whereas 15% reported doing that most of the times. Occupational infection, needlestick injury and recapping needles after use were associated with lack of training on biosafety (P < 0.05).

Conclusion

The frequency of occupational infection and needlestick injury among clinical laboratory workers in Al-Madinah is high. Interventions related to biosafety and infection control and the use of needlestick prevention devices might be useful in lowering such frequency.

Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis

BACKGROUND

The acquisition of needle-stick injuries (NSI) in a healthcare setting poses an occupational hazard of transmitting blood-borne pathogens from patients to healthcare workers (HCWs). The objective of this study was to systematically review the evidence about the efficacy and safety of using safety-engineered intravenous devices and safety-engineered phlebotomy devices by HCWs.

METHODS

We included randomized and non-randomized studies comparing safety-engineered devices to conventional/standard devices that lack safety features for delivering intravenous injections and/or for blood-withdrawal procedures (phlebotomy). The outcomes of interest included NSI rates, and blood-borne infections rates among HCWs and patients. We conducted an extensive literature search strategy using the OVID interface in October 2013. We followed the standard methods for study selection and data abstraction. When possible, we conducted meta-analyses using a random-effects model. We used the GRADE methodology to assess the quality of evidence by outcome.

RESULTS

We identified twenty-two eligible studies: Twelve assessed safety-engineered devices for intravenous procedures, five for phlebotomy procedures, and five for both. Twenty-one of those studies were observational while one was a randomized trial. All studies assessed the reduction in NSIs among HCWs. For safety-engineered intravenous devices, the pooled relative risk for NSI per HCW was 0.28 [0.13, 0.59] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.34 [0.08,1.49] (low quality evidence). For safety-engineered phlebotomy devices, the pooled relative risk for NSI per HCW was 0.57 [0.38, 0.84] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.53 [0.43,0.65] (moderate quality evidence). We identified no studies assessing the outcome of blood-borne infections among healthcare workers or patients.

CONCLUSION

There is moderate-quality evidence that the use of safety-engineered devices in intravenous injections and infusions, and phlebotomy (blood-drawing) procedures reduces NSI rates of HCWs.

Clinical acceptability and ease of use of a safety IV catheter system

OBJECTIVE

Occupational risk of transmission of bloodborne pathogens represents a major challenge in prevention. Even though preventive recommendations to avoid needlestick injuries among healthcare workers include the use of needle protective devices, its use in developing countries is not a standard practice. This study aimed to measure, on experienced nurses, perception of performance characteristics and activation of the safety feature of a safety closed IV catheter system (BD Pegasus*), called catheter P, versus a non-safety device (BD Intima II † ) called catheter I in healthy volunteers.

METHOD

Fifty-two nurses and 205 healthy volunteers participated in a prospective, randomized, controlled study in a simulated setting. Each nurse performed two insertions of each catheter (one in each forearm) in four study volunteers; the order of insertions was randomly assigned. Statistical analyses were performed to compare the performance of the two catheters regarding Overall Perception of Clinical Acceptability and Ease of Use.

RESULTS

Overall acceptance of the device performance characteristics was 90% or more. In all cases, catheter P performed at least as well as catheter I. There were no differences in the insertion success rate between the two devices (93.7% vs. 96.2%). Activation of the safety feature of catheter P occurred 99.4%. Subjects' perception of pain was similar for both devices. Overall perception of clinical acceptability and ease of use were judged better for catheter P than for catheter I (p = 0.006, and p < 0.001 respectively). All clinicians strongly agreed that catheter P would protect them from needle stick injuries.

CONCLUSIONS

Despite the study limitations, mainly its artificial setting and its inability to blind, the results indicate that the Safety Closed IV Catheter System with its safety feature represents a good alternative for IV catheter insertions that can help reduce the incidence of stick injuries in health care workers.

Transrenal DNA testing: progress and perspectives

Transrenal DNA (Tr-DNA) is a recently discovered class of extracellular urinary DNA that originates from cells dying throughout the body. Postapoptotic DNA is known to appear in the circulating plasma, but it is now recognized that a portion of these fragments cross the kidney barrier and appear in urine in the form of 150-200-bp fragments. Tr-DNA containing fetal sequences has been isolated from the urine of pregnant women, tumor-specific mutations have been detected in Tr-DNA from patients with colon and pancreatic tumors, and donor DNA has been found in Tr-DNA isolated from recipient urine. Furthermore, proviral HIV DNA, bacterial and parasite DNA sequences have been detected in Tr-DNA from infected patients. Potential applications of Tr-DNA-based tests cover a very broad area of molecular diagnostics and genetic testing, including prenatal detection of inherited diseases, tumor diagnostics and therapeutic monitoring and detection of infectious agents. The Tr-DNA test is expected to have utility in treatment monitoring, transplantation monitoring, drug development and broad public health screening, where a noninvasive, common-platform diagnostic technology has particular value. This review describes some of the highlights of Tr-DNA technology applications, advantages over existing technologies and potential problems anticipated in test development.