Bloodborne Pathogen Exposure Research Articles

A safety information campaign to reduce sharps injuries: Results from the Stop Sticks campaign

Injuries from medical sharps devices and blood-borne pathogen (BBP) exposure are a significant risk to many healthcare workers. Risk awareness communications and sharps safety strategies are key components of BBP exposure prevention efforts. The research reported here includes an evaluation of a large-scale communication intervention aimed at raising awareness among healthcare workers regarding the risks of sharps injuries and BBP exposure, as well as methods of prevention. The Stop Sticks campaign was a multi-media communication intervention targeted at multiple healthcare facilities in Columbia, South Carolina. Following a comprehensive needs assessment in each facility, tailored communications were delivered via several channels. Samples included individual hospital departments, an entire hospital, and a nursing home. Results indicate high levels of knowledge and communication channel recall, minimal attitude and behavior change, and a strong association between sharps-related safety behavior and safety climate. Overall, this research suggests the blitz approach is viable for raising awareness of occupational safety and health issues. Based on these findings, several recommendations are offered for conducting safety campaigns in healthcare facilities.

The Health Care Work Environment and Adverse Health and Safety Consequences for Nurses

Nurses' working conditions are inextricably linked to the quality of care that is provided to patients and patients' safety. These same working conditions are associated with health and safety outcomes for nurses and other health care providers. This chapter describes aspects of the nursing work environment that have been linked to hazards and adverse exposures for nurses, as well as the most common health and safety outcomes of nursing work. We include studies from 2000 to the present by nurse researchers, studies of nurses as subjects, and studies of workers under similar working conditions that could translate to nurses' work environment. We explore a number of work organization factors including shift work and extended work hours, safety climate and culture, teamwork, and communication. We also describe environmental hazards, including chemical hazards (e.g., waste anesthetics, hazardous drugs, cleaning compounds) and airborne and bloodborne pathogen exposure. Nurses' health and safety outcomes include physical (e.g., musculoskeletal disorders, gastrointestinal, slips, trips and falls, physical assault) and psychosocial outcomes (e.g., burnout, work-family conflict). Finally, we present recommendations for future research to further protect nurses and all health care workers from a range of hazardous working conditions.

Population Risk of Syringe Reuse: Estimating the Probability of Transmitting Bloodborne Disease

In 2008, the Medical Officer of Health at Alberta Health Services (Edmonton, Canada) was notified that, in some practice settings, a syringe was used to administer medication through the side port of an intravenous circuit and then the syringe, with residual drug, was used to administer medication to other patients in the same manner. This practice has been implicated in several outbreaks of bloodborne infection in hospital and clinic settings. A risk assessment model was developed to predict the risk of a patient contracting a bloodborne viral infection from the practice. The risk of transmission was defined as the product of 5 factors: (1) the population prevalence of a specific bloodborne pathogen, (2) the probability of finding a viral bloodborne pathogen in an intravenous circuit, (3) the rate of syringe reuse, (4) the probability of causing disease given a bloodborne pathogen exposure, and (5) the susceptibility of the exposed person. The risk was modeled first with consistent use of the proximal port of the intravenous circuit. The risk of transmission of hepatitis B virus was approximately 12-53 transmission events per 1,000,000 exposure events for a range of practice probabilities (ie, frequency of the risk practice) from 20% to 80%, respectively. The risk of transmission of hepatitis C virus was approximately 1.0-4.3 transmission events per 1,000,000 exposure events for the same practice probability range, and the risk of transmission of human immunodeficiency virus was approximately 0.03-0.15 transmission events per 1,000,000 exposure events for the same practice probability range. The use of the distal port was associated with a 10-fold decrease in the risk. Practitioners must practice safe, aseptic injection techniques. The model presented here can be used to estimate the risk of disease transmission in situations where reuse has occurred and can serve as a framework for informing public health action.

Occupational Needlestick Injuries in a US Airport

To characterize needlestick injuries (NSIs) among airport workers, and to suggest preventive strategies. A retrospective chart review (2003-2008) of workers evaluated at a clinic in a large US airport that provides occupational health services. Over a period of 6 years, 14 NSI cases were seen. The majority of injuries occurred while workers cleaned lavatories in the airport or on airplanes. Insulin needles were involved in most cases, and the injuries typically occurred on the hand. No cases of hepatitis B, C, or HIV seroconversion were documented, although follow-up was typically incomplete. The improper disposal of used insulin needles among travelers can result in potential bloodborne pathogen exposure among airport workers. Occupational NSIs have not previously been described among airport workers. A multilevel approach to prevention is recommended.

Increase in Sharps Injuries in Surgical Settings Versus Nonsurgical Settings after Passage of National Needlestick Legislation

The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings. We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members. Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others. Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers.

Guidance for Occupational Health Services in Medical Centers

Guidance for Occupational Health Services in Medical Centers

An experimental method for detecting blood splatter from retractable phlebotomy and intravascular devices

This study was designed to evaluate the safety of retractable intravascular devices in terms of their potential to produce blood splatter. A method for measuring this blood splatter designed by the research team was used to evaluate 3 specific intravascular devices. Scientific filters were positioned around the retraction mechanisms of the devices and weighed with an analytical scale, both before and after activation, in a simulated vein containing mock venous blood. The difference in filter mass was used as the primary unit of analysis to detect blood splatter. In addition, the filters were visually inspected for the presence or absence of blood. A paired t-test revealed significant differences in the prefilter and postfilter groups for 2 of the 3 devices tested (P < .0001). In addition, visible blood was detected on 23% to 40% of the scientific filters for 2 of the devices. Our findings indicate a potential for bloodborne pathogen exposure with the use of intravascular devices with a retractable mechanism. This experiment may serve as a model in the design and implementation of future sharps device evaluation protocols to validate the threat of bloodborne pathogen exposure.

Occupational exposure to blood and body fluids among health care workers in a general hospital, China

To understand current status of occupational exposure to blood and body fluids (BBF), and awareness of knowledge about occupational bloodborne pathogen exposures and universal precaution among hospital-based health care workers (HCWs). A cross-sectional study was conducted during April to May 2004 to study incidence of occupational exposure to BBF among 1,144 hospital-based HCWs. The total incidence and the average number of episodes exposure to BBF was 66.3/100 HCWs per year and 7.5 per person per year in the past year, respectively. The incidence (per 100/HCWs per year) and the average number of episodes (per HCW per year) of percutaneous injury (PCI), mucous-membrane exposure (MME), and exposure to BBF by damaged skin was 50.3 and 1.8; 34.4 and 1.7; and 37.9 and 4.0, respectively. The leading incidence and the average number of episodes of PCI occurred in delivery room (82.6 and 1.8). The highest percentage of PCI's that occurred during the previous 2 weeks occurred during a surgical operation (22.8%). Of all sharp instruments, the suture needle contributed the highest percentage of PCI's (24.7%) among HCWs in the last 2 weeks. Over two-thirds (68.3%) of respondents were immunized with Hepatitis B vaccine; less than one-half (47%) of HCWs wore gloves while doing procedures on patients. The respondents demonstrated a lack of knowledge regarding transmission of bloodborne diseases and universal precautions. Risk for potential exposure to BBF appears high in HCWs, and almost all of episodes are not reported. It is urgent to establish the Guideline for Prevention and Control of Occupational Exposure to Bloodborne Pathogens among HCWs. Am. J. Ind. Med. 52:89-98, 2009. (c) 2008 Wiley-Liss, Inc.

Preventing Hepatitis B Transmission in the Perioperative Environment: Focus on Policies and Procedures

Health care workers can become infected with the hepatitis B virus through direct contact with blood or other potentially infectious materials during the performance of their duties. Vaccination is the best way to prevent transmission of hepatitis B in the perioperative setting. The next best thing is to have rational policies that are followed by all and are based on the Occupational Safety and Health Administration Bloodborne Pathogen Exposure Standard. Other measures can include modifying work practices, reengineering needed sharps, and eliminating unsafe sharps in the health care environment. All levels of staff, including physicians, registered nurses, and surgical technicians, must be involved in the development of the policy, compliance with procedures and policies, and periodic review.

Home health care registered nurses and the risk of percutaneous injuries: A pilot study

Home health care is the fastest-growing sector in the health care industry, expected to grow 66% over the next 10 years. Yet data on occupational health hazards, including the potential risk of exposure to blood and body fluids, associated with the home care setting remain very limited. As part of a larger study of bloodborne pathogen risk in non-hospital-based registered nurses (RNs), data from 72 home health care nurses were separately analyzed to identify risk of blood/body fluid exposure. A 152-item self-administered mailed risk assessment questionnaire was completed by RNs employed in home health care agencies in New York State. Nine (13%) of the home health care nurses experienced 10 needlesticks in the 12-month period before the study. Only 4 of the needlesticks were formally reported to the nurse's employer. The devices most frequently associated with needlesticks were hollow-bore and phlebotomy needles, and included 3 needles with safety features. Exposure was most commonly attributed to patient actions, followed by disposal-related activities. These data suggest that home health care nurses may be at potential occupational risk for bloodborne pathogen exposure. Risk management strategies tailored to the home health care setting may be most effective in reducing this risk.

Sharps Injuries and Bloodborne Pathogen Exposures in Home Health Care

Home health care is one of the fastest growing industries in the United States. Approximately 20,000 provider agencies deliver home health care services to 7.6 million individuals with acute illness, long-term health conditions, permanent disability, or terminal illness. The home health care setting poses many challenges that likely increase the risk of sharps injuries. Home health nurses face unique challenges in preventing and reporting sharps injuries in the home. This article examines the nature of and risk factors for sharps injuries in the home health care setting, the scope of the problem, the legislative and regulatory framework relevant to sharps injuries, and the role of occupational health nurses in promoting a culture of safety to prevent sharps injuries and bloodborne pathogen exposures.

Sharps injuries and bloodborne pathogen exposures in home health care.

Home health care is one of the fastest growing industries in the United States. Approximately 20,000 provider agencies deliver home health care services to 7.6 million individuals with acute illness, long-term health conditions, permanent disability, or terminal illness. The home health care setting poses many challenges that likely increase the risk of sharps injuries. Home health nurses face unique challenges in preventing and reporting sharps injuries in the home. This article examines the nature of and risk factors for sharps injuries in the home health care setting, the scope of the problem, the legislative and regulatory framework relevant to sharps injuries, and the role of occupational health nurses in promoting a culture of safety to prevent sharps injuries and bloodborne pathogen exposures.

Sharps Injuries and Bloodborne Pathogen Exposures in Home Health Care

Sharps Injuries and Bloodborne Pathogen Exposures in Home Health Care

Evaluation of a healthcare safety climate measurement tool

Problem Psychometrically validated measurement tools are needed to evaluate an organization's safety climate. In 2000, Gershon and colleagues published a new healthcare safety climate measurement tool to determine its relationship to safe work behavior (Gershon, R., Karkashian, C., Grosch, J., Murphy, L., Escamilla-Cejudo, A., Flanagan, P., et al. (2000). Hospital safety climate and its relationship with safe work practices and workplace exposure incidents. American Journal of Infection Control, 28, 211–21). The present study evaluated the psychometric properties of the Gershon tool when modified to address respiratory rather than bloodborne pathogen exposures. Method Medical practitioners, nurses, and nurse aides (n = 460) were surveyed using the modified Gershon tool. Data were analyzed by factor analysis and psychometric properties of the tool evaluated. Results Eight safety climate dimensions were extracted from 25 items (Cronbach's alpha range: 0.62 – 0.88). Factor extractions and psychometric properties were reasonably consistent with those of the Gershon tool. Impact on Industry The Gershon safety climate tool appears to have sufficient reliability and validity for use by healthcare decision makers as an indicator of employee perceptions of safety in their institution.

Bloodborne Pathogen Exposure Risk Among Surgeons in Sub-Saharan Africa

To document the frequency and circumstances of bloodborne pathogen exposures among surgeons in sub-Saharan Africa, we surveyed surgeons attending the 2006 Pan-African Association of Surgeons conference. During the previous year, surgeons sustained a mean of 3.1 percutaneous injuries, which were typically caused by suture needles. They sustained a mean of 4.1 exposures to blood and body fluid, predominantly from blood splashes to the eyes. Fewer than half of the respondents reported completion of hepatitis B vaccination, and postexposure prophylaxis for human immunodeficiency virus was widely available. Surgeons reported using hands-free passing and blunt suture needles. Non-fluid-resistant cotton gowns and masks were the barrier garments worn most frequently.

Occupationally acquired infectious diseases among health care workers in Brazil: Use of Internet tools to improve management, prevention, and surveillance

Education is a major component of prevention strategies to reduce the risk of occupational transmission of bloodborne pathogens to health care personnel. This study describes the results of an Internet-based project, "Projeto Riscobiologico.org", for which the main objectives are to disseminate information in the Portuguese language about occupational exposures to bloodborne pathogens through a mailing list and Web site as well as to increase case reports of these events in Brazil. The mailing list expanded quickly with a total of 2078 participants (from 337 different cities and all Brazilian states), and 5613 messages were exchanged over a 5-year period. Mean length of participation was almost 2 years (697 days). Most of the participants (74%) reported that they frequently manage occupational exposures. Nevertheless, results showed an important lack of basic knowledge regarding this issue. In contrast with the high participation in the mailing list, a small number of institutions started to participate in the voluntary surveillance system. The Internet can be used as a tool to increase knowledge and improve practices in the prevention of occupational bloodborne pathogen exposures. In addition, it may represent a unique opportunity to implement a national surveillance system.

Potential work‐related exposures to bloodborne pathogens by industry and occupation in the United States Part II: A telephone interview study

The companion surveillance portion of this study [Chen and Jenkins, 2007] reported the frequency and rate of potential work-related exposures to bloodborne pathogens (BBP) treated in emergency departments (EDs) by industry and occupation, but it lacks details on the circumstances of the exposure and other relevant issues such as BBP safety training, use of personal protective equipment (PPE) or safety needles, or reasons for seeking treatment in a hospital ED. Telephone interviews were conducted with workers who had been treated in EDs for potential work-related exposures to BBP in 2000-2002. Respondents were drawn from the National Electronic Injury Surveillance System. Of the 593 interviews, 382 were from hospitals, 51 were from emergency medical service/firefighting (EMS/FF), 86 were from non-hospital healthcare settings (e.g., nursing homes, doctors' offices, home healthcare providers, etc.), 22 were from law enforcement (including police and correctional facilities), and 52 were from other non-healthcare settings (i.e., schools, hotels, and restaurants). Needlestick/sharps injuries were the primary source of exposure in hospitals and non-hospital healthcare settings. Skin and mucous membrane was the primary route of exposure in EMS/FF. Human bites accounted for a significant portion of the exposures in law enforcement and other non-healthcare settings. In general, workers from non-hospital settings were less likely to use PPE, to have BBP safety training, to be aware of the BBP standards and exposure treatment procedures, and to report or seek treatment for a work-related exposure compared to hospital workers. This study suggests that each industry group has unique needs that should be addressed.

There’s No Place Like Home: A Qualitative Study of the Working Conditions of Home Health Care Providers

Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures. The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts. HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands. The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.

Potential work‐related bloodborne pathogen exposures by industry and occupation in the United States Part I: An emergency department‐based surveillance study

Since the early 1990s, researchers have attempted to assess the magnitude of potential work-related bloodborne pathogen (BBP) exposures in the U.S. The only data-derived estimate of 385,000 needlestick and other sharps injuries per year was reported in 2004. The estimate was derived from a convenience sample and did not include exposures outside of hospitals. This study seeks to understand the magnitude and distribution of the exposures across all industries and occupations. Data were from the 1998 to 2000 National Electronic Injury Surveillance System (NEISS), a stratified probability-based sample of U.S. hospital emergency departments (EDs). NEISS covers all industries and occupations. National estimates of exposures and exposure rates (the number of exposures/1,000 full-time equivalents (FTE)) were computed. An estimated 78,100 potential work-related exposures to BBP were treated in hospital EDs annually in the U.S. While hospitals accounted for 75% of all these exposures, 11 other industries had a substantial number of exposures. While registered nurses accounted for 36% of all exposures, 13 other occupations had a substantial number of exposures. Hospitals had the highest exposure rate of 11.3/1,000 FTE, followed by nursing homes (2.8), and residential care facilities without nursing (1.9). Registered nurses had the highest exposure rate of 15.3/1,000 FTE, followed by clinical laboratory technologists and technicians (13.9), and physicians (7.1). While this study begins to more completely describe the problem of potential BBP exposure in the workplace, it is but a first step in further understanding the complex issues surrounding workplace BBP exposures.

Non-Hospital Based Registered Nurses and the Risk of Bloodborne Pathogen Exposure

The aim of this study was to assess the risk of blood and body fluid exposure among non-hospital based registered nurses (RNs) employed in New York State. The study population was mainly unionized public sector workers, employed in state institutions. A self-administered questionnaire was completed by a random stratified sample of members of the New York State Nurses Association and registered nurse members of the New York State Public Employees Federation. Results were reviewed by participatory action research (PAR) teams to identify opportunities for improvement. Nine percent of respondents reported at least one needlestick injury in the 12-month period prior to the study. The percutaneous injury (PI) rate was 13.8 per 100 person years. Under-reporting was common; 49% of all PIs were never formally reported and 70% never received any post-exposure care. Primary reasons for not reporting included: time constraints, fear, and lack of information on reporting. Significant correlates of needlestick injuries included tenure, patient load, hours worked, lack of compliance with standard precautions, handling needles and other sharps, poor safety climate, and inadequate training and availability of safety devices (p<0.05). PAR teams identified several risk reduction strategies, with an emphasis on safety devices. Non-hospital based RNs are at risk for bloodborne exposure at rates comparable to hospital based RNs; underreporting is an important obstacle to infection prevention, and primary and secondary risk management strategies appeared to be poorly implemented. Intervention research is warranted to evaluate improved risk reduction practices tailored to this population of RNs.