Preventing percutaneous injuries among dental health care personnel

Behavioural video to navigate predoctoral dental students toward safer practice (revision of EJE-21-4739)

INTRODUCTION

Local anaesthesia is considered essential knowledge within the dental profession as it helps to address pain management. Operator percutaneous needlestick injuries associated with the delivery of dental anaesthesia are common for dental healthcare providers. The study proposes a supplemental technique to reduce self-inducing novice operator needlestick injury to complement existing pedagogies for the preclinical local anaesthesia curriculum. The purpose of the study is to evaluate whether a local anaesthesia behavioural video can navigate students to safer clinical practice. Further, a supplemental technique is proposed in whether assessing instrument retraction technique in clinical patient care leads to decreased self-inducing intraoral needle stick injury for novice predoctoral dental operator.

MATERIALS AND METHODS

Beginning in 2011, predoctoral dental students were asked to view a "what not to do" video within a summative assessment and identify at least five behaviours that were unacceptable errors for delivering local anaesthesia. Operator intraoral needlestick injury was also tracked per the bloodborne exposure reports within predoctoral patient clinics.

RESULTS

Data from the learners' responses identified progression in recognising unacceptable errors from behavioural video. Intraoral needlestick injury, 8 and 9 years prior and after the introduction of video showed significance with a low correlation coefficient.

CONCLUSION

More data need to be gathered and evaluated in other dental school settings to determine whether this supplemental educational video decreases needlestick injury in novice operators. Results suggest this behavioural video may guide novice operators to overall safer clinical practice.

A 19-Year Study of Dental Needlestick and Sharps Injuries in Japan

BACKGROUND

Needlestick and sharps injuries (NSIs) are serious problems for dental health care workers (DHCWs) because they are at risk for occupational blood-borne infections. In this study, risk factors for NSIs in DHCWs at Tohoku University Hospital (TUH) in Japan over 19 years were analysed.

METHODS

NSI data of DHCWs at TUH from April 2002 to March 2020 were collected from the Exposure Prevention Information Network (EPINet) and statistically analysed.

RESULTS

A total of 195 NSIs occurred during the 19-year study period. Approximately 58.5% of NSIs occurred in DHCWs with less than 5 years of experience. Injection needles were the most frequent cause of NSIs (19.0%) followed by suture needles (13.3%) and ultrasonic scaler chips (12.8%). Needle injuries occurred mainly on the left hand, whereas ultrasonic scaler chip and bur injuries occurred on the right hand and other body parts whilst DHCWs were placing the instruments back on the dental unit hanging holder without removing the sharps. NSIs from other instruments primarily occurred on both hands and foot insteps during cleanup. No case of occupational blood-borne infection caused by NSIs was observed during the study period at TUH.

CONCLUSIONS

NSIs occurred in DHCWs with less experience, and there were associations between the instruments, timing of use, and NSI site. EPINet was considered a valuable tool for monitoring NSIs in order to develop future strategies for minimising NSIs.

Occupational percutaneous injuries and exposures in a dental teaching environment: A 10-year report

PURPOSE

Percutaneous injuries (PIs) are woefully underreported and the risk at dental academic institutions is higher due to lack of knowledge and experience of students. The aims of this study are to (1) present data on the prevalence of PIs and exposures over a 10-year period in a dental teaching institution; (2) provide information on areas with increased risk as it relates to personnel and instruments; and (3) improve the awareness of the risk of occupational PIs and exposures in dentistry.

METHODS

Data presented were collected as a part of an infection control program. A description of the incident reporting and collecting methodology is provided. Distribution tables and confidence intervals for injuries by year were calculated. Overall associations were produced using either Fisher's exact or Chi-square test.

RESULTS

Between 2009 and 2019, a total of 342 PIs (338) and mucosal exposures (4) were reported. A significant number of injuries occurred while reaching for an instrument (15.2%), injecting local anesthetic (13.2%), and cleaning an instrument (11.7%). About 31% of the injuries were caused by needlesticks followed by burs (22.8%). There was a statistically significant association between work practice controls and activity type (p < 0.001) and position (p = 0.01). PIs and compliance issues were higher among the third-year dental students.

CONCLUSIONS

There was a declining trend in incidents over the years, which could be attributed to the extra-protective measures that were implemented. Uncovered dental burs and needlesticks continue to be the predominant cause of PIs in academia. We found that collection of data on such occupation-related injuries to be useful in observing any trends and implementation of corrective actions.

Knowledge and awareness regarding occupational needle stick and sharp injuries among dental personnel in Malaysia

BACKGROUND

Accidental occupational injuries increase the risk of communicable diseases like hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among dental personnel. Such occupational injuries affect healthcare quality by enhancing dissatisfaction and lack of motivation to work among dental personnel.

OBJECTIVE

The present study aims to assess knowledge and awareness regarding needle stick and sharp injury among dental personnel and compared the knowledge and awareness level about needle stick injuries between dental professionals and dental supporting staff working at the School of Dental Sciences, Universiti Sains Malaysia.

METHODS

This cross-sectional study was conducted from March 2016 to March 2017. The total sample included 112 registered dental personnel including dental professionals (lecturers, dental officers, and postgraduate students) and dental supportive staff (including staff nurses and dental surgery assistant) who were selected from the School of Dental Sciences, Universiti Sains Malaysia at Kelantan District of Malaysia. Data were collected by a structured questionnaire.

RESULTS

In our study 60.7% respondents answered correctly for all the statements regarding knowledge and 51.8% of the respondents answered correctly for the statements regarding awareness on needle stick and sharp injury. No significant difference of knowledge level has been observed between the dental professionals and dental supportive staff (p < 0.819), whereas the awareness level was significantly different between these two groups (p < 0.016).

CONCLUSIONS

There is a difference regarding awareness level on needle stick and sharp injury between dental professionals and dental supportive staff in our study but no differences were found in knowledge level between two groups.

Self-reported percutaneous injuries of students and interns at the School of Dentistry in Trinidad: A follow up study of an updated sharps protocol

Objective To report the results of a survey of all percutaneous injuries that occurred between 2009 – 2014 among students and interns at the dental school in Trinidad and to evaluate compliance with the protocol for the management of percutaneous injuries. Methods Data was collected via questionnaires administered to 186 clinical students and interns in 2012 and 2014. Data were analysed using SPSS® 17.0 Statistical software. Results A 90% response rate was obtained. Forty-eight persons (29%) reported one or more sharps injuries at the dental school. Of the 76 sharps injuries reported, 55 were percutaneous. Needle sticks and burs accounted for the majority of injuries and mostly occurred while working on patients. There were no significant relationships (p>0.05) between sex nor student year with the occurrence of injuries. 76% of the respondents described their concern for contracting blood borne injuries from sharps injuries as “high.” After injury, 41% of the respondents followed the school’s protocol for sharps injuries. Conclusion The prevalence of percutaneous injuries among students and interns at the UWI dental school in Trinidad is 23% and occur most commonly while working on patients. Compliance with the protocol for percutaneous injuries needs to be improved. The protocol needs to be audited to improve efficiency and reinforced to the students, interns and clinical supervisors during their clinical years.

Knowledge, Attitudes, and Practices on Infection Control Measures in Stomatology Students in Lima, Peru

Introduction

The level of knowledge, attitudes, and practices with respect to infection control measures in undergraduate stomatology students is not well understood; that is why these variables were evaluated in the students of the Universidad Privada San Juan Bautista between September and November of 2017.

Methods

A cross-sectional study was carried out. A total of 347 students from the Ica, Lima Norte, and Chorrillos campuses were evaluated. The sample was calculated using the statistical formula of comparison of means. The questionnaire of the CDC (Center of Contagious Diseases) was used to measure the variables described.

Results

It was observed that 72.05% of the students preferred to use oral rinsing before starting a treatment, 72.62% used the autoclave as the primary equipment to sterilize their instruments in the dental clinic, 95.10% considered that isolation is important in the control of the infection, 46.40% affirmed that tuberculosis is the most infectious disease, and only 26.51% considered it to be hepatitis B. On the other hand, it was found that the scores of knowledge, attitudes, and practices were 2.74 ± 2.16, 3.59 ± 0.88, and 3.59 ± 1.73, respectively.

Conclusions

The level of knowledge was low among the students evaluated; however, as far as the level of practices and attitudes was high, even so, this topic must be reinforced so that stomatology students reflect on the importance of the risks that exist to get infected with any disease inside the dental office, as outside of it.

Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel

BACKGROUND

Percutaneous exposure injuries from devices used for blood collection or for injections expose healthcare workers to the risk of blood borne infections such as hepatitis B and C, and human immunodeficiency virus (HIV). Safety features such as shields or retractable needles can possibly contribute to the prevention of these injuries and it is important to evaluate their effectiveness.

OBJECTIVES

To determine the benefits and harms of safety medical devices aiming to prevent percutaneous exposure injuries caused by needles in healthcare personnel versus no intervention or alternative interventions.

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, Nioshtic, CISdoc and PsycINFO (until 11 November 2016).

SELECTION CRITERIA

We included randomised controlled trials (RCT), controlled before and after studies (CBA) and interrupted time-series (ITS) designs of the effect of safety engineered medical devices on percutaneous exposure injuries in healthcare staff.

DATA COLLECTION AND ANALYSIS

Two of the authors independently assessed study eligibility and risk of bias and extracted data. We synthesized study results with a fixed-effect or random-effects model meta-analysis where appropriate.

MAIN RESULTS

We included six RCTs with 1838 participants, two cluster-RCTs with 795 participants and 73,454 patient days, five CBAs with approximately 22,000 participants and eleven ITS with an average of 13.8 data points. These studies evaluated safe modifications of blood collection systems, intravenous (IV) systems, injection systems, multiple devices, sharps containers and legislation on the implementation of safe devices. We estimated the needlestick injury (NSI) rate in the control groups to be about one to five NSIs per 1000 person-years. There were only two studies from low- or middle-income countries. The risk of bias was high in 20 of 24 studies. Safe blood collection systems:We found one RCT that found a safety engineered blood gas syringe having no considerable effect on NSIs (Relative Risk (RR) 0.2, 95% Confidence Interval (95% CI) 0.01 to 4.14, 550 patients, very low quality evidence). In one ITS study, safe blood collection systems decreased NSIs immediately after the introduction (effect size (ES) -6.9, 95% CI -9.5 to -4.2) but there was no further decrease over time (ES -1.2, 95% CI -2.5 to 0.1, very low quality evidence). Another ITS study evaluated an outdated recapping shield, which we did not consider further. Safe Intravenous systemsThere was very low quality evidence in two ITS studies that NSIs were reduced with the introduction of safe IV devices, whereas one RCT and one CBA study provided very low quality evidence of no effect. However, there was moderate quality evidence produced by four other RCT studies that these devices increased the number of blood splashes when the safety system had to be engaged actively (relative risk (RR) 1.6, 95% CI 1.08 to 2.36). In contrast there was low quality evidence produced by two RCTs of passive systems that showed no effect on blood splashes. Yet another RCT produced low quality evidence that a different safe active IV system also decreased the incidence of blood leakages. Safe injection devicesThere was very low quality evidence provided by one RCT and one CBA study showing that introduction of safe injection devices did not considerably change the NSI rate. One ITS study produced low quality evidence showing that the introduction of safe passive injection systems had no effect on NSI rate when compared to safe active injection systems. Multiple safe devicesThere was very low quality evidence from one CBA study and two ITS studies. According to the CBA study, the introduction of multiple safe devices resulted in a decrease in NSI,whereas the two ITS studies found no change. Safety containersOne CBA study produced very low quality evidence showing that the introduction of safety containers decreased NSI. However, two ITS studies evaluating the same intervention found inconsistent results. LegislationThere was low to moderate quality evidence in two ITS studies that introduction of legislation on the use of safety-engineered devices reduced the rate of NSIs among healthcare workers. There was also low quality evidence which showed a decrease in the trend over time for NSI rates.Twenty out of 24 studies had a high risk of bias and the lack of evidence of a beneficial effect could be due to both confounding and bias. This does not mean that these devices are not effective.

AUTHORS' CONCLUSIONS

For safe blood collection systems, we found very low quality evidence of inconsistent effects on NSIs. For safe passive intravenous systems, we found very low quality evidence of a decrease in NSI and a reduction in the incidence of blood leakage events but moderate quality evidence that active systems may increase exposure to blood. For safe injection needles, the introduction of multiple safety devices or the introduction of sharps containers the evidence was inconsistent or there was no clear evidence of a benefit. There was low to moderate quality evidence that introduction of legislation probably reduces NSI rates.More high-quality cluster-randomised controlled studies that include cost-effectiveness measures are needed, especially in countries where both NSIs and blood-borne infections are highly prevalent.

Application of forensic luminol for blood detection in endodontic files

Abstract Introduction Blood is a biological material with high potential of infectious transmission in dental environments, including herpes simplex, hepatitis and AIDS. Aim To investigate the efficacy of luminol in detecting blood in endodontic files before and after the sterilization process. Material and method Luminol was used to investigate the presence or absence of traces of blood tissue in 50 endodontic files, visible to naked eye or not, after performing endodontic treatment and after the cleaning/sterilization process. The results obtained were tabulated and statistically analyzed by using the Friedman’s test at a significance level of 5% (p<0.05). Result By naked eye, it was found that 31/50 files showed no trace of blood, 8/50 showed a slight presence of blood and 11/50 showed a considerable presence of blood after endodontic treatment. After the use of luminol, however, 16/50 endodontic files showed no trace of blood, 19/50 showed a slight presence of blood and 15/50 showed a considerable presence of blood. After the cleaning and sterilization process, no blood was detected in the files. Conclusion It was concluded that the luminol solution is effective in detecting blood tissue in endodontic files as well as in validating the cleaning/sterilization process.

Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries

A modified retraction technique was introduced into the DDS degree preclinical anesthesia course in 2011 with the goal of reducing needlestick exposure incidents. In numerous studies of dental exposures, injuries from dental anesthetic needles account for the highest proportion of all exposures. The purpose of this study was to assess the preliminary impact of a modified retraction technique on the incidence of blood and body fluids (BBF) exposure incidents associated with needles during injection. Data from evaluations of students from 2014 and 2015 were obtained and tracked to determine whether the modified retraction technique was "excellent," "clinically acceptable," or "clinically unacceptable." Data were collected to determine if the patient perceived the modified retraction technique as "comfortable" or "correctable when addressed" to help improve student technique for future injections. Likewise, data from the blood-borne exposure database where all information related to BBF exposures is recorded were reviewed and the information separated by year and class. This study presents preliminary data only and because of the small sample size does not lend itself to validation by statistical analysis. However, the technique effectively removes the operator's hand from the field during injection, reducing the risk of accidental intraoral needlestick to the nondominant hand of the operator.

Needle-Stick Injuries Among Healthcare Workers in a Teaching Hospital

Background:

Needle-Stick Injuries (NSIs) are among the hazards and problems that can expose health workers to infections.

Objectives:

This study aimed to determine the rate of NSIs in a teaching hospital in Tehran, Iran.

Materials and Methods:

This cross-sectional, analytical and descriptive study was conducted at one of the teaching hospitals in Tehran, Iran, in 2013. The study population was 344 employees in various occupational groups selected via census. Data were collected using a researcher-made questionnaire. The collected data were analyzed using some statistical tests, including independent-samples t-test with SPSS software version 21.0.

Results:

The results showed that only 50.2% of injuries had been reported; 67.8% of all participants (n = 211) had at least one NSI. Most NSIs had been reported in the emergency department (33.5%). Most participants mentioned the injection syringe needles as the main cause of their injuries (71.1% of all NSIs). Among NSIs, those caused by insulin syringe needles (6.2%) were the second cause. In this study, females had NSIs more than males. There was a statistically significant relationship between sex and the rate of NSIs (P < 0.05).

Conclusions:

Considering the high rate of occupational injuries, further preventive measures should be implemented to prevent these injuries from occurring. Providing initial and continuing training for employees is very important. Directing special attention to emergency department employees may be effective in reducing occupational injuries.

Percutaneous self-injury to the femoral region caused by bur breakage during surgical extraction of a patient's impacted third molar

Extraction of an impacted third molar is one of the most frequently performed techniques in oral and maxillofacial surgery. Surgeons can suffer numerous external injuries while extracting a tooth, with percutaneous injuries to the hand being the most commonly reported. In this article, we present a case involving a percutaneous injury of the surgeon's femoral region caused by breakage of the fissure bur connected to the handpiece during extraction of the third molar. We also propose precautions to prevent such injuries and steps to be undertaken when they occur.

Risk of Methicillin-Resistant Staphylococcus aureus Transmission in the Dental Healthcare Setting: A Narrative Review

Objective.

Information on the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection transmission in dental healthcare settings was incomplete only few years ago; therefore, MRSA infection control guidelines were necessarily based on data extrapolated from other fields. Recently, publication of specific studies have made it possible to review such risk.

Methods.

Studies of MRSA infection in dentistry were searched for using EMBASE, MEDLINE, and Google and were allocated into the following sections: (1) direct evidence: documented cases of MRSA transmission in dentistry; (2) indirect evidence: carriage rates among dental healthcare providers (DHCPs) and patients (high carriage rates suggest that transmission is likely); (3) speculative evidence: MRSA occurrence in the dental environment (high environmental contamination probably increases the risk of infection); and (4) speculative evidence: MRSA carriage in human dental plaque and saliva (oral carriers may spread MRSA in the environment during dental therapy, with consequent environmental contamination and probable increased risk of infection).

Results.

Our findings were as follows. First, transmission has been ascertained during surgical interventions, particularly in surgical units and among head and neck cancer patients. Second, carriage rates among DHCPs were lower than those among other healthcare workers. Carriage rates among adult patients were low, whereas among pedodontic and special care patients rates were higher than those in the general population. Third, MRSA has been detected in the environment of emergency and surgical units and in dental hospitals. Some individuals in poor general condition were oral MRSA carriers.

Conclusions.

The occupational risk of MRSA infection among DHCPs is minimal. Among special patients (eg, special care, hospitalized and cancer patients) the risk of infection is high, whereas among the remaining patients undergoing conventional therapy such risk is probably low.

Safety and efficacy of a novel nasal spray for maxillary dental anesthesia

This study examines the efficacy, safety, and tolerability of a nasal spray to induce anesthesia of maxillary teeth. Forty-five healthy adults requiring restoration of one maxillary tooth were randomized in a 1:2 ratio to receive (1) an intra-oral lidocaine-epinephrine injection with buffered saline nasal spray bilaterally, or (2) a tetracaine hydrochloride-oxymetazoline hydrochloride nasal spray bilaterally with sham injection. Primary endpoints were use of rescue anesthesia and patient global pain assessment. Secondary outcomes included vital sign changes, soft-tissue anesthesia, and treatment-emergent adverse events. In intent-to-treat analysis, 25 of 30 patients given nasal spray (83.3%) did not require rescue anesthesia. Proportion of anesthesia successes for nasal spray was significantly different from the hypothesized placebo anesthesia success of 30% (one-sided p value < .0001 by exact binomial test). Mean duration of soft-tissue anesthesia did not differ significantly by treatment for 3 of 4 sites assessed. No serious adverse events or systemic effects were observed. Tetracaine hydrochloride-oxymetazoline nasal spray appears to provide adequate and safe anesthesia for the majority of maxillary dental procedures. Based on the results from this Phase 2 study, pivotal trials are warranted to validate these findings in an expanded patient population.

Occupational exposure to blood and body fluids in a department of oral sciences: results of a thirteen-year surveillance study

Objectives. Aim of this analysis was to identify trends that will aid in the prevention of injury. Methods. Our data were collected from 1999 to 2011 during a surveillance program of occupational exposures to blood or other potentially infectious materials in a Dental School by using a standard coded protocol. Results. 63 exposures were reported. 56/63 (89%) percutaneous and 7/63 (11%) mucosal, involving a splash to the eye of the dental care workers (DCW). 25/63 (40%) involved students, 23/63 (36%) DCW attending masters and doctorate, 13/63 (21%) DCW attending as tutors and 2/63 (3%) staff. 45/63 (71%) and 18/63 (29%) occurred respectively during and after the use of the device; of last ones, 1/18 (0.05%) were related to instrument clean-up and 1/18 (0.05%) to laboratory activity, 12/18 (67%) occurred when a DCW collided with a sharp object during the setting, and 4/18 (22%) during other activities. The instrument and the body part most likely involved were needle and finger respectively. The overall exposure rate was 4.78 per 10,000 patient visits. Conclusions Our results may serve as benchmark that Dental Schools can employ to assess their frequency of injury.

Factors affecting occupational exposure to needlestick and sharps injuries among dentists in Taiwan: a nationwide survey

Background

Although the risks of needlestick and sharps injuries (NSIs) for dentists are well recognized, most papers published only described the frequency of occupational exposure to NSIs. Less has been reported assessing factors contributing to exposure to NSIs. The purpose of this study was to update the epidemiology of NSIs among dentists in Taiwan and identify factors affecting NSIs in order to find preventive strategies.

Methodology/Principal Findings

A nationwide survey was conducted in dentists at 60 hospitals and 340 clinics in Taiwan. The survey included questions about factors supposedly affecting exposure to NSIs, such as dentist and facility characteristics, knowledge and attitudes about infectious diseases, and practices related to infection control. Univariate and multivariate logistic regression analyses were conducted to determine the association between risk factors and exposure to NSIs. In total, 434 (74.8%) of 580 dentists returned the survey questionnaires, and 100 (23.0%) reported that they had experienced more than one NSI per week. Our data showed that the risk of occupational NSIs is similarly heightened by an older age (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.62–6.25), more years in practice (OR, 2.57; 95% CI, 1.41–4.69), working in clinics (OR, 1.73; 95% CI, 1.08–2.77), exhibiting less compliance with infection-control procedures (OR, 1.82; 95% CI, 1.04–3.18), having insufficient knowledge of blood-borne pathogens (OR, 1.67; 95% CI, 1.04–2.67), and being more worried about being infected by blood-borne pathogens (OR, 1.82; 95% CI, 1.05–3.13).

Conclusions/Significance

High rates of NSIs and low compliance with infection-control procedures highly contribute to the chance of acquiring a blood-borne pathogen infection and threaten occupational safety. This study reveals the possible affecting factors and helps in designing prevention strategies for occupational exposure to NSIs.

Advances in local anesthesia in dentistry

Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia.

HIV transmission in the dental setting and the HIV-infected oral health care professional: workshop 1C

This workshop addressed two important issues: first, the global evidence of HIV transmission from health care provider to patient and from patient to health care provider in the general health care environment and the dental practice setting; second, in the era of highly active antiretroviral therapy, whether oral health care professionals living with HIV pose a risk of transmission to their patients and whether standard infection control is adequate to protect both the patient and the oral health care professional in dental practice. The workshop culminated in a general discussion and the formulation of a consensus statement from the participating delegates, representing more than 30 countries, on the criteria under which an HIV-infected oral health care professional might practice dentistry without putting patients at risk. This consensus statement, the Beijing Declaration, was agreed nem con.

A percutaneous injury by a contaminated instrument is a human bite equivalent

BACKGROUND

Percutaneous exposure incidents represent an important occupational health issue.

CASE REPORT

A paediatric dentist was cut by a small round bur in a handpiece. A few hours later the elbow became swollen and painful. Since the bur had been contaminated with saliva and oral flora, the injury was treated as a human bite equivalent. An X-ray revealed the broken piece of the bur in the soft tissue of the dentist's elbow.

CONCLUSION

Care should be taken to prevent and treat injuries by sharp items, during and also following dental treatment.

Occupational exposures to bloodborne viruses among German dental professionals and students in a clinical setting

PURPOSE

Exposures to bloodborne pathogens pose a serious risk to dental healthcare workers (DHCW). Despite improved methods of preventing exposures like needlestick injuries (NSI), occupational exposures still continue to occur. The purpose of this study was to evaluate the incidence of occupational exposures to patient body fluids among German DHCW, to assess the rate of reporting of such incidents, and to evaluate the association of various factors with these exposures.

METHODS

Data was obtained through an anonymous questionnaire.

RESULTS

Our study confirms that occupational skills are an important factor concerning NSI. It turned out that dental students (0.74 NSI p. a.) had nearly twice the number of NSI compared with dentists with more or less than 10 years working experience (0.42, 0.49 NSI p. a., respectively, P < 0.0001). Overall, 54.3% (n = 144/265) of respondents had sustained at least one NSI in their professional life. Only 28.5% of injured dental students and DHCW reported all of their NSI, the main reason (19.1%) for not reporting NSI was little or no perception of risk on behalf of the respondent. One-fourth of respondents were not wearing a mask and 55.6% were not wearing protective goggles during their last occupational exposures.

CONCLUSIONS

Occupational exposure to blood or body fluids is a common problem among DHCW and dental students. Measures must be adopted by official institutions, public health service, occupational health association and universities in order to reverse this situation.

Integration of patient safety technologies into sclerotherapy for varicose veins

The American College of Surgeons, the Joint Commission, the Needlestick Safety and Prevention Act, and the Occupational Safety and Health Administration all direct surgical departments, including vascular surgeons who supply sclerotherapy services, to develop formal mechanisms to improve the safety of the patient and health care worker (HCW), including integration of new safety technologies. The purpose of the present study was to identify and evaluate new safety technologies for outpatient sclerotherapy for chronic venous disease. Using national resources for patient safety and literature review, the following safety technologies were identified: (1) a safety needle to reduce inadvertent needlesticks to workers, and (2) the reciprocating procedure device (RPD) to reduce iatrogenic injuries to patients. Both devices were evaluated in the clinic, and physician responses were determined. Although the safety sheath of the needle was somewhat bulky and could interfere with the ultrasound transducer, sclerotherapy could be performed with it. The RPD safety device required instruction to show how the RPD functioned ("push-push" to aspirate-inject with the RPD rather than the usual "push-pull" with the conventional syringe), but the RPD permitted better needle control and more precise injections. The RPD was well accepted by physicians who found it to be convenient, safer, and less painful. Subsequently, the involved services successfully integrated these safety technologies into their routine clinical practices. As recommended by the Joint Commission, safety technologies can be successfully evaluated and introduced into the clinic to improve patient and HCW safety during physician-performed syringe and needle procedures, including sclerotherapy.

Integration of new safety technologies for needle aspiration of breast cysts

INTRODUCTION

National and international regulatory agencies and professional societies mandate systematic improvements in both the safety of patients and heath care workers (HCW), including the integration of safety technologies into the procedures of obstetrics and gynecology (Ob-Gyn).

MATERIALS AND METHODS

Using national resources for patient safety and literature review, these safety technologies were identified: (1) a safety needle to reduce needle sticks to HCW, and (2) the reciprocating procedure device (RPD) to reduce injuries to patients. These technologies were introduced in a trial fashion into routine breast cyst aspiration, and physician responses were determined.

RESULTS

The safety needle presented a number of difficulties associated with the safety sheath, but could be used efficiently for breast cyst aspiration. The RPD safety device functioned well for breast aspiration procedures and was well accepted by physicians.

CONCLUSIONS

New safety technologies can be successfully evaluated and introduced into the clinic to improve patient and HCW safety during outpatient breast procedures. Since these technologies have been demonstrated to decrease injuries to patients and HCW by 60-70%, serious efforts should be undertaken to systematically integrate safety technologies into the routine practice, including aspiration of breast cysts.