Needle stick injuries in a tertiary eye-care hospital: Incidence, management, outcomes, and recommendations

Bloodborne viral infections: Seroprevalence and relevance of preoperative screening in Indian eye care system - A retrospective study

PURPOSE

To report the seroprevalence of bloodborne viral infection (BBVI) in patients undergoing ophthalmic surgeries and assess the utility and feasibility of preoperative screening for BBVI in India's current eye care system.

METHODS

This retrospective, hospital-based, descriptive study included data from patients undergoing preoperative screening for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and human immunodeficiency virus (HIV) at a tertiary eye care institute from 2018 to 2022. Rapid diagnostic tests (RDTs) were performed on the blood samples after obtaining informed consent from the patients. Seroreactive patients underwent surgery with additional safety precautions. The demographic data and surgical details of these patients were collected and analyzed. ANOVA was used to carry out statistical analysis between groups. During the study period, the number of healthcare workers (HCWs) sustaining needle stick injury (NSI) and accidental sharp injury (ASI) in the operating theater (OT) and details of these injuries were recorded.

RESULTS

Samples from 28,563 patients were included. The seroprevalence of BBVI was 1.87% (536/28563). Hepatitis B virus (322, 60.1%) was the most commonly detected infection, and HIV (59, 11%) was the least detected infection. The mean age of the seroreactive patients was 60.3 ± 30.8 years. The incidence of NSI was 0.49/1000 surgeries. Nurses (11) and technicians (4) in the OT sustained maximum NSI. None of the HCWs had seroconversion after NSI.

CONCLUSION

The overall seroprevalence of BBVI in the current study is lower than that reported in previously published studies from eye care organizations. Currently, mandatory preoperative screening for BBVI to prevent transmission of these infections to HCWs working in the eye care sector in India appears to be less cost-effective.

Needle-Stick Injuries in Ophthalmic Practice

Purpose

Needle-stick injuries (NSI) are a prominent route by which blood-borne infections are transmitted. The unique microsurgical nature of ophthalmic practice constitutes an additional risk to sustain injury. This study aimed to identify the epidemiological profile of needle-stick injuries in a tertiary eye center and to evaluate the implemented safety policy in preventing sharp injuries.

Methods

This was a retrospective cross-sectional study of all sharp injuries that occurred at King Khalid Eye Specialist Hospital (KKESH). Data on all reported sharp injury incidents from 2013 to 2021 were collected. The mechanisms of injury, context, location, and type of prick were collected and analyzed. Also, this study involved an institution-based survey for all ophthalmic staff.

Results

Two hundred and one sharp injury incidents were reported over 9 years. Physicians sustained 46.8% (n=94) of injuries, followed by nurses and ophthalmic technicians, 40.8% (n=82) and 7% (14); respectively. Operating and treatment rooms were the locations of 60.7% of incidents, whereas outpatient clinics and emergency rooms accounted for 19.4% and 13.4% of injuries, respectively.

Conclusion

The current findings add to the growing body of literature on the importance of NSI prevention and reporting strategies. In the present study, sharp injuries were most commonly encountered by ophthalmic staff in the operating rooms. Continuous staff education on handling sharp instruments, encouraging anonymous reporting, and up-to-date revisions of guidelines and policies are of paramount importance to lessen the burden of sharp injuries.

Sharps and needlestick injuries within the operating room: Risk prone procedures and prevalence meta-analysis

BACKGROUND

Sharps and needlestick injuries pose a serious risk to operating theatre personnel with considerable morbidity, mortality and healthcare implications. The cost of prophylaxis and post-exposure treatment is a significant institutional economic burden.

AIM

The aim of the review was to identify the prevalence of sharps and needlestick injury within the operating theatre and to establish the most common critical steps.

METHOD

A systematic literature search was conducted. Abstracts of all studies published in English from 2015 onwards exploring sharps and needlestick injury within the operating theatre were reviewed. Primary outcome measure was sharps and needlestick injury prevalence. Secondary outcome measures included operational steps resulting in sharps and needlestick injury and costs of sharps and needlestick injury management.

RESULTS

Sixteen studies were identified and included in analysis. Cross-sectional studies reported a pooled prevalence of 41.5% (n = 537; 95% confidence interval = 15.961 to 70.220). Retrospective data analysis reported an annualised prevalence of 5.027% (95% confidence interval = 0.676 to 13.073) on a total pooled sample population of 12,929. Further analysis of operational steps identified a 22% prevalence (n= 3460; 95% confidence interval = 14.2 to 31.3) of sharps and needlestick injury occurring during a procedure involving handing or receiving an instrument.

CONCLUSION

Sharps and needlestick injuries are a significant but preventable risk in the operating theatre. Further research into the development of safety devices to reduce injury during instrument transfer is paramount.

Needlestick and sharps' injury in healthcare students: Prevalence, knowledge, attitude and practice

Purpose

Needlestick and sharps injury is an occupational hazard, and it presents with a constant risk of exposure to blood-borne pathogens. Students are particularly at risk due to a lack of experience and handling skills. The present study was designed to assess the prevalence of needle stick injury and evaluate the knowledge, attitude, and practice regarding its prevention and management among students of a medical campus.

Methods

A cross-sectional, questionnaire-based study was conducted among healthcare students of the medical campus in Sangli, Maharashtra. Overall, the study included 942 participants belonging to medical, dental, and nursing faculties.

Results

Overall, the prevalence rate of needlestick and sharps injury was found to be 25.2%. The prevalence was highest amongst nursing students. The students had adequate knowledge about blood-borne virus (BBV) transmission and prevention of needlestick injury. However, there was a substantial shortfall in post-exposure prophylaxis knowledge amongst the students. A deficit in translation between knowledge to practice was noted, particularly in the case of needlestick injury prevention and management.

Conclusion

The present study found that one in four students experience needlestick injury; overall knowledge regarding prevention and management of needlestick injury was lesser than desired, and gaps in knowledge and practice were identified in the present study. This can be rectified by curricular reforms, periodic educational programs and stern reinforcement of guidelines. Instilling reporting centers and devising a standing operating procedure in the event of needlestick injury are the needs of the hour.

Assessment of Hepatitis B, Hepatitis C and Human Immunodeficiency Virus Screening Results Performed Before Elective Eye Surgery

Objective: Although preoperative screening for Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections in patients is a controversial issue in terms of cost-effectiveness and patient privacy, this practice is commonly carried on by surgical branches. The goals of this study were to evaluate the prevalence of preoperative HBV surface antigen (HBsAg), anti-HCV and anti-HIV antibodies, as well as whether seropositive patients were referred to the infectious diseases outpatient clinic. Methods: In this study, blood samples from 884 patients who underwent elective eye surgery at Tokat Gaziosmanpasa University Medical Faculty Hospital between August 2019 and April 2021 were researched for HBsAg, anti-HCV and anti-HIV positivity and seroprevalences were determined. It was also determined whether patients with seropositivity from the hospital automation system had previously been diagnosed and if newly diagnosed patients applied to the infectious diseases outpatient clinic in the subsequent period. Results: The study comprised a total of 884 patients. Males comprised 457 (51.7%) of all patients, with a mean age of 63.21± 16.05. In 29/839 (3.3%) of the patients, HBsAg was positive. Anti-HCV positivity was found in 21/872 (2.4%) people. Anti-HIV positivity was not detected in any of the patients. Conclusion: It would be a more accurate and effective approach to increase compliance with standard hygiene and protection measures rather than requesting routine pre-operative testing for HBV, HCV and HIV. If these tests reveal seropositivity, the patient should be informed of the disease and referred to an infectious disease specialist.

Needlestick injuries among healthcare personnel in Qatar: A retrospective study

Background: A needlestick injury (NSI) is a serious occupational hazard among healthcare personnel (HCP), as it can cause transmission of blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). This study aimed to determine the frequency and distribution of reported NSIs, associated factors, use of post-exposure prophylaxis (PEP), and percentage of seroconversion among HCP in a major tertiary care hospital in Qatar.

Methods: This retrospective study analyzed NSIs among HCP reported in Hamad Medical Corporation facilities in Doha between May 01, 2017, and May 01, 2018. A surveillance follow-up period of 6 months commenced after the 1-year study period.

Results: A total of 130 NSIs were reported during the study period, with an overall incidence of eight injuries per 1000 HCP. The mean age was 34.6 ± 7.9 years. Among the reported cases, the proportion of female HCP (n = 72, 55.4%) was greater than that of male HCP (n = 58, 44.6%). Of 130 NSIs, 79 (60.8%) occurred in nurses, followed by 35 (26.9%) cases in doctors and 16 (12.3%) in other HCP. The total healthcare population comprised 49.6% of nurses and 18% of doctors. NSIs occurred in 10.1 per 1000 nurses and in 12.4 per 1000 doctors. Exposures mainly occurred in the operating theater, 35 (31.5%); inpatient wards, 24 (21.6%); and emergency department, 20 (18%). Common modes of injury were after use or before disposal of the device in 44 (44.4%) cases and during surgical interventions in 35 (35.4%) cases. Hollow-bore needles (64/98, 65.3%) were the most common devices involved. Source serology was documented in 71 (54.6%) cases of which 52 (73.2%) were normal, 9 (12.7%) were abnormal, and 10 (14.1%) were incomplete. Among the exposed HCP, 124 (95.4%) had adequate immunity to HBV. PEP for HBV was indicated in 6 (4.6%) and received by 4 (3.1%) HCP. NSI cases were followed up for 6 months post-exposure, and during this surveillance period, no seroconversion to HBV, HCV, or HIV was detected.

Conclusion: NSIs are common among HCP. In this study, most of the exposed HCP had adequate immunity to HBV. There was no hepatitis B, hepatitis C, or HIV transmission among the study cohort. Adherence to proper needle/sharps disposal techniques and safe practices during procedures will help prevent NSIs.

Practice pattern of cataract surgeons when operating on seropositive patients

Purpose

The aim of this study is to know practice pattern of cataract surgeons when operating on patients, positive for blood-borne viral infections (BBVIs), namely, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. We also studied their awareness, knowledge, and attitude toward universal precautions and guidelines.

Methods

The telephonic survey enrolled practicing cataract surgeons, who were interviewed to record responses pertaining to their practice using an open-ended questionnaire. We studied statistical significance of difference of frequency of prick injuries in topical versus peribulbar anesthesia, and phacoemulsification versus manual small incision cataract surgery by employing Chi-square test. Significance of proportion was calculated using z-test. For all statistical calculations, significance level was set at 0.05%.

Results

Of 623 ophthalmologists contacted, responses of 479 (79%) ophthalmologists were analyzed. Maximum participants were in private practice (48%). During whole practicing carrier, 313 (65%; 95% confidence interval [CI]: 61-70) participants admitted having suffered injury with needle or sharp instruments; of these, 204 (65%; 95% CI: 60-70) participants did not report their injury. Wearing "double gloves" during cataract surgery was the most common barrier adopted by participants.

Conclusion

We found high prevalence of occupational-related sharp injuries among ophthalmologists in this survey. Majority of them were aware of universal precautions, but adherence to postexposure prophylaxis was lacking.

Seroprevalence, risk associations, and cost analysis of screening for viral infections among patients of cataract surgery

Purpose

The purpose of this study was to estimate the prevalence of blood-borne viral infections (triple H: HBV-hepatitis B virus, HCV-hepatitis C virus, and HIV-human immunodeficiency virus) among cataract patients, sought possible risk associations and discuss feasibility of universal preoperative screening.

Methods

This prospective, cross-sectional study enrolled consecutive patients of senile cataract. They were screened by immunoassay-based rapid diagnostic card tests for blood-borne viral infections. Positive cases were confirmed with confirmatory ELISA tests. Seropositive patients were enquired about the exposure to possible risk associations for acquiring these infections. Cost of card test per patient was calculated.

Results

The prevalence of seropositivity for triple H viral infections (HBV, HCV, and HIV) among patients of senile cataract was 5.9% (95% confidence interval [CI]: 5.3-6.6), and HCV was most common viral infection. The dental extraction was most common (54%; 95% CI:48-60) possible risk association. The total cost of primary screening per patient for triple H infections(HBV, HCV, and HIV) was $0.93.

Conclusion

The prevalence of blood-borne viral infection among cataract patients is high in this area. Awareness of the prevalence of blood-borne viral infections in service area, along with knowledge of rate of accidental exposure and risk of transmission would help to understand cost-effectiveness of universal preoperative screening before cataract surgery.