Characteristics of needlestick and sharps injuries of the hands in the operating room among orthopedic surgeons in Japan

Among the reports on needlestick and sharps injuries (NSIs), many are orthopedic-related due to the frequent use of sharp devices such as pins and wires. This study aimed to identify high-risk instruments, the most common injury sites for each instrument, and the circumstances of NSIs of the hand during orthopedic surgeries in Japan. Incidents of exposure to blood or bodily fluids among physicians during orthopedic surgeries reported to the Japan-EPINet between 2000 and 2015 were included in this study. The four most common devices were identified and the associations among years of experience, equipment users, and injured sites were analyzed. We identified 666 cases of NSIs affecting orthopedic surgeons in the operating room. The instrument most frequently responsible for NSIs was suture needles, which were involved in 265 cases (39.7%). The second most common instrument was pins/wires, which was involved in 111 cases (16.6%). NSIs of the hands of orthopedic surgeons were frequently caused by suture needles used in all surgeries, but relatively often caused by orthopedic devices. Orthopedic surgeons must be aware that they are at risk of NSIs and must take appropriate measures and always be cautious when performing surgery, regardless of their years of experience.

Evaluation of human error in workers of an Iranian copper mine during the COVID-19 pandemic using the CREAM

BACKGROUND

The outbreak of COVID-19 has adversely affected both global economy and public health around the world. These effects have also been observed in many workplaces, including mines.

OBJECTIVE

This study aimed to examine the human error of copper miners during the pandemic.

METHOD

This descriptive-analytical, cross-sectional study was performed on 192 workers of a copper mine in Iran. For this, occupation tasks were firstly analyzed using the Hierarchical Task Analysis (HTA), and then the human error in different subunits was assessed using the basic Cognitive Reliability and Error Analysis Method (CREAM). The prevalence of COVID-19 among miners was determined by assessing positive PCR test records.

RESULTS

The probability of human error in the operational subunits including mining, crushing, processing, and support subunits was estimated to be 0.0056, 0.056, 0.0315, and 0.0177, respectively. All three operational units were found to be in the scrambling control mode. The support unit was determined to be in the tactical control mode. Approximately 50% of all workers had been infected with COVID-19, with the highest prevalence in support units.

CONCLUSION

The results suggest that during the COVID-19 pandemic, copper miners are at higher risk of human error induced by poor working conditions. Therefore, it is recommended to employ some management strategies such as promotion of safety, health monitoring, and adopting supportive measures to control occupational stresses and therefore the probability of human error in the mine's operational units.

Effects of high ambient temperature on construction workers performance: A longitudinal empirical study

INTRODUCTION

The construction industry is known to be of high-risk when compared to other industries. Ambient temperature can also exacerbate this risk, where hot weather conditions can lead to increased physical and mental fatigue, reduced performance, slower reactions and more human errors. Yet this issue is rarely researched objectively. This paper describes a longitudinal empirical study that aimed to assess how high ambient temperatures affect construction workers performance.

METHOD

A sample of 120 randomly selected workers (age range 22-35 years) from a large construction company in Dubai participated in this study. Since construction workers performance cannot be directly measured due to the nature of work involved, performance of 60 participants was measured on a task battery involving single reaction time and choice reaction time in summer months before starting work and 5.5 h after starting work. Then the same procedure was repeated on 60 workers in winter months. Accident reports for one full year within the same company were also collected and analyzed.

RESULTS

Results show that performance on both tasks before starting work was significantly lower in summer than in winter months possibly due to accumulated fatigue resulting from the high ambient temperature in summer. Results also show that performance on both tasks significantly deteriorated during the first 5.5 h of work to a greater extent in summer months than in winter months. Results also indicate that accidents showed an increasing trend in summer months.

CONCLUSIONS

Accumulated fatigue due to high ambient temperature in Summer is thought to cause this drop in performance and increase in accidents.

PRACTICAL IMPLICATIONS

Based on the findings, recommendations to enhance construction workers performance and reduce accidents are given.

The contribution of human error related to occupational accident among traditional divers

OBJECTIVE

The research aims to identify human error committed by traditional divers while fishing, and to determine the relationship between human error as a cause of occupational accidents at sea.

METHOD

A cross-sectional study with total of 186 traditional divers participated. The data was collected by questionnaires, and analyzing with chi-square test (p-value=0.05).

RESULTS

More than 83% of respondents had experienced occupational accident and behave human error while diving (81%). Type of human error such as rush of work, never attend safety training and does not have diving certificate, dives more than 30min, continues to work even tired, dives more than once a day, and continues to dive despite bad weather. The types of occupational accidents were slips, scratches, shipwrecks, hit by rocks, and suffered open wounds. The statistical test p value=0.000 (<0.05) and OR=44.883.

CONCLUSIONS

There is a relationship between human errors and occupational accident.

Use of eye tracking in analyzing distribution of visual attention among critical care nurses in daily professional life: an observational study

Patient safety is a priority in healthcare, yet it is unclear how sources of errors should best be analyzed. Eye tracking is a tool used to monitor gaze patterns in medicine. The aim of this study was to analyze the distribution of visual attention among critical care nurses performing non-simulated, routine patient care on invasively ventilated patients in an ICU. ICU nurses were tracked bedside in daily practice. Eight specific areas of interest were pre-defined (respirator, drug preparation, medication, patient data management system, patient, monitor, communication and equipment/perfusors). Main independent variable and primary outcome was dwell time, secondary outcomes were hit ratio, revisits, fixation count and average fixation time on areas of interest in a targeted tracking-time of 60 min. 28 ICU nurses were analyzed and the average tracking time was 65.5 min. Dwell time was significantly higher for the respirator (12.7% of total dwell time), patient data management system (23.7% of total dwell time) and patient (33.4% of total dwell time) compared to the other areas of interest. A similar distribution was observed for fixation count (respirator 13.3%, patient data management system 25.8% and patient 31.3%). Average fixation time and revisits of the respirator were markedly elevated. Apart from the respirator, average fixation time was highest for the patient data management system, communication and equipment/perfusors. Eye tracking is helpful to analyze the distribution of visual attention of critical care nurses. It demonstrates that the respirator, the patient data management system and the patient form cornerstones in the treatment of critically ill patients. This offers insights into complex work patterns in critical care and the possibility of improving work flows, avoiding human error and maximizing patient safety.

Designing and evaluating an interprofessional education conference approach to antimicrobial education

BACKGROUND

Arguably, Medical School curricula are deficient in learning opportunities related to the safe and effective use of medicines, in particular antimicrobials. Infection management is complex and multidisciplinary, and learning opportunities should reflect these principles. Aligned to the complexity of the subject matter, simulation and interprofessional based teaching are methods that can foster the collaborative skills required of future healthcare professionals. There have been calls to develop these methods in the teaching of safe prescribing and the management of infections; however, reports of such studies are limited.

METHODS

We developed an interprofessional education (IPE) conference for second year undergraduate medical and pharmacy students based in the North East of England. We considered contact theory in the design of three small group interprofessional workshops, on the broad themes of antimicrobial stewardship, infection management and patient safety. A mixed methods approach assessed students' attitudes towards IPE, barriers and facilitators of learning, and perceived learning gains. Qualitative data from workshop evaluation forms were analysed thematically, while quantitative data were analysed descriptively and differences between medical and pharmacy cohorts analysed using unpaired two-tailed t-tests.

RESULTS

226/352 students returned the workshop evaluation forms (66% of pharmacy students, 62% of medical students). 281/352 students responded to a series of Likert scale questions on the value of interprofessional education (88% of pharmacy students, 70% of medical students). Students reported acquisition of knowledge and skills, including concepts and procedures related to infection management and antimicrobial prescribing, and the development of problem-solving and critical evaluation skills. Students reflected on their attitude towards interprofessional collaboration. They reported a greater understanding of the roles of other healthcare professionals, reflected on the importance of effective communication in ensuring patient safety, and were more confident to work in interprofessional teams after the conference.

CONCLUSIONS

A robust IPE event, theoretically underpinned by contact theory and developed collaboratively, achieved interprofessional learning at scale and helped develop healthcare professionals willing to collaborate across disciplines. The resources, and evaluation insights based on the 3P (presage, process, and product) model of learning and teaching, will be of value to other educators who seek to develop theoretically-sound IPE interventions.

Data Integrity-A Study of Current Regulatory Thinking and Action

In reaction to breaches of data integrity in the pharmaceutical industry, regulatory authorities have introduced inspection approaches or initiatives with the aim of reducing occurrences of data integrity problems. This review article-based on study of 65 cases of regulatory action from 2002 to 2014-provides an overview of current regulatory thinking and action on breaches of data integrity affecting GxP (health-related regulations) processes supporting non-clinical studies, clinical studies, laboratory controls, and production controls. These case studies largely represent position of the U.S. Food and Drug Administration and the regulatory agencies affiliated with the European Medicines Agency. Also discussed is the role of human factors as a potential source of data integrity problems. The article concludes by recommending some remedial controls that could be established to avoid or reduce occurrences of data integrity problems.Lay Abstract: In fulfilling their mission to protect public health, regulatory agencies (e.g., U.S. Food and Drug Administration, European Medicines Agency) must establish confidence that medical products they approve are fit for their intended use. In so doing they rely on scientific and operational data generated during research, development, manufacturing, sales, marketing, distribution, and post-marketing surveillance activities. The level of confidence they build is directly proportional to the scientific validity and integrity of data presented to them by the sponsors of medical products. In this article we present analysis of 65 case studies that document regulatory action taken by various regulatory agencies on breach of data integrity between 2002 and 2014. The ensuing discussion on current trends largely represents position of the U.S. Food and Drug Administration and European Medicines Agency. The article concludes by proposing some remedial controls that could be established by pharmaceutical companies to avoid or reduce occurrences of data integrity problems.

Applications of integrated human error identification techniques on the chemical cylinder change task

This paper outlines the human error identification (HEI) techniques that currently exist to assess latent human errors. Many formal error identification techniques have existed for years, but few have been validated to cover latent human error analysis in different domains. This study considers many possible error modes and influential factors, including external error modes, internal error modes, psychological error mechanisms, and performance shaping factors, and integrates several execution procedures and frameworks of HEI techniques. The case study in this research was the operational process of changing chemical cylinders in a factory. In addition, the integrated HEI method was used to assess the operational processes and the system's reliability. It was concluded that the integrated method is a valuable aid to develop much safer operational processes and can be used to predict human error rates on critical tasks in the plant.

Human factors in anaesthetic crisis

This paper discusses some of the key aspects of human factors in anaesthesia for the improvement of patient safety. Medical errors have emerged as a serious issue in healthcare delivery. There has been new interest in human factors as a means of reducing these errors. Human factors are important contributors to critical incidents and crises in anaesthesia. It has been shown that the prevalence of human factors in anaesthesia can be as high as 83%. Cognitive thinking process and biases involved are important in understanding human factors. Errors of cognition linked with human factors lead to anaesthetic errors and crisis. Multiple errors in the cognitive thinking process, known as “Cognitive dispositions to respond” have been identified leading to errors. These errors classified into latent or active can be easily identified in the clinical vignettes of serious medical errors. Application of the knowledge on human factors and use of cognitive de-biasing strategies can avoid human errors. These strategies could involve use of checklists, strategies to cope with stress and fatigue and the use of standard operating procedures. A safety culture and health care model designed to promote patient safety can compliment this further. Incorporation of these strategies strengthens the defence layers against the “Swiss Cheese” models, which exist in the health care industry.