Occupational Exposure to Potentially Infectious Biological Material Among Physicians, Dentists, and Nurses at a University

Objective

The objective of this study was to evaluate the prevalence and incidence of accidents with biological material, the level of knowledge, and compliance to standard precautions (SPs) among dentists, physicians, nurses, and dental and medical students.

Methods

A closed cohort study with a prospective and retrospective component was conducted between August 2014 and September 2015. The participants were contacted in two moments during the follow-up period, during which a structured questionnaire divided into six sections was used; the interviews were conducted during the follow-up period (Month 6) and at the end of the observation period (Month 12).

Results

The global prevalence of accidents in the previous 12 months was 10.2%, with a difference between professionals and students (13.0% vs. 5.1%, respectively; p < 0.003). The incidence rate was 6.49 per 100 person/year, with difference between the groups (6.09 per 100 person/year in professionals and 7.26 per 100 person/year in students), type of specialization (hazard ratio, 3.27), and hours worked per week (hazard ratio, 2.27). The mean of compliance to SP was 31.99 (±3.85) points, with a median of 33 (30, 35) points against the expected 27.75 points. Adherence to SP was associated with the accident report (p < 0.020).

Conclusion

We conclude that the proportion/incidence rate of accidents with biological material was high in relation to that in the literature, being higher in professionals and especially among physicians. The levels of knowledge and adherence to SP were good, with the best found in dentists and dental students.

Catching and Correcting Unreported, Under-Reported Accidents (Near-Misses) among Healthcare Provider in Thailand

OBJECTIVES

Latent errors in an incident reporting system pose threats to accident and near-miss prevention in hospitals. The aims of this study were to gain insight into the incident reporting system by exploring and investigating the refinement of unreported and under-reported (near-miss) patterns and by estimating under-reported annual hospital accidents over three months in one hospital.

METHODS

Sequential mixed-method research was undertaken using both qualitative and quantitative approaches. 120 health care providers were selected from 13 departments of a selected study hospital. Self-reported questionnaires, information from annual reports and focus group interviews among stakeholders were employed. Based on a quantitative mixed-model approach, estimation of lost cases from near-miss incidents was made.

RESULTS

In 2015, 20% of accidents had been reported to the hospital center while under-reported accidents and near-miss incidents by self-report over 3 months equaled 18% and 25.9%, respectively. Recent trends were positive, driven by changing values about incident reporting. However, confusion and fear still remain among practitioners about near-miss reporting due to old beliefs. This study confirms that incident reporting needs improvement so that there is an enhanced organizational culture of safety, raised awareness for individual reporting, and recovery of lost cases using mixed-model estimation of near-misses.

Participatory organizational intervention for improved use of assistive devices for patient transfer: study protocol for a single-blinded cluster randomized controlled trial

Background

Epidemiological studies have shown that patient transfer is a risk factor for back pain, back injuries and long term sickness absence, whereas consistent use of assistive devices during patient transfer seems to be protective. While classical ergonomic interventions based on education and training in lifting and transferring techniques have not proven to be effective in preventing back pain, participatory ergonomics, that is meant to engage and motivate the involved parties while at the same time making the intervention maximally relevant, may represent a better solution. However, these findings are largely based on uncontrolled studies and thus lack to be confirmed by studies with better study designs. In this article, we present the design of a study which aims to evaluate the effect and process of a participatory organizational intervention for improved use of assistive devices.

Methods

The study was performed as a cluster randomized controlled trial. We recruited 27 departments (clusters) from five hospitals in Denmark to participate in the study. Prior to randomization, interviews, observations and questionnaire answers (baseline questionnaire) were collected to gain knowledge of barriers and potential solutions for better use of assistive devices. In April 2016, the 27 departments were randomly allocated using a random numbers table to a participatory intervention (14 clusters, 324 healthcare workers) or a control group (13 clusters, 318 healthcare workers). The participatory intervention will consist of workshops with leaders and selected healthcare workers of each department. Workshop participants will be asked to discuss the identified barriers, develop solutions for increasing the use of assistive devices and implement them in their department. Use of assistive devices (using digital counters -, primary outcome, and accelerometers and questionnaire - secondary outcome), perceived physical exertion during patient transfer, pain intensity in the lower back, occurrence of work-related back injuries during patient transfer, organizational readiness to change, knowledge on how to perform proper patient transfer, social capital and work ability (secondary outcomes) were assessed at baseline and will also be assessed at 1 year follow-up. Process evaluation will be based on qualitative and quantitative data to assess the implementation, the change process, and the impact of context aspects.

Discussion

The study will evaluate the effect and process of a participatory intervention on improving the use of assistive devices for patient transfer among hospital healthcare workers. By using cluster-randomization, as well as process- and effect evaluation based on objective measures we will contribute to the evidence base of a promising intervention approach.

Trial registration

ClinicalTrials.gov (NCT02708550). March, 2016.