Body Fluid Exposure Research Articles

UNIVERSAL PRECAUTIONS: Knowledge, compliance and perceived barriers among dental practitioners of public and private dental institutes in Karachi

Objective: To assess the knowledge and use of universal precautions for blood-borne pathogens and to assess the perceived barriers of adherence to universal precautions at workplace among dentists at public and private dental hospitals in Karachi. In addition, the frequency of exposure to blood-borne pathogens and needle stick injuries among dentists in the last six months. Methodology: A cross-sectional analytical study was conducted in the dental institutes of Karachi. The study tool was a self-administered healthcare professional questionnaire inquiring about respondent characteristics, knowledge level, universal precautions practices, compliance with UP, and body fluid exposure. Of the 500, 370 questionnaires were completed and included in the study. Results: Dentists at both public and private institutes showed the highest percentages (>90%) for statements about HIV/Hepatitis B and C and the route of transmission of these pathogens. Of the 12 up practices, dentists at both institutes showed higher compliance values (>80%) for 5 statements. Overall compliance (at least 60% responses were always in category) was 48% in public practitioners and 13.5% in private institutes. The perceived barriers in UP practices were identified as: unavailability of policies posted in department (pub: 30%, pvt: 82.3%), tough job duties (pub: 50%, pvt: 37.2). Altogether, 309 exposure incidents were reported by dentists in the public sector and 235 in the private sector for the last 6 months before the study. Conclusion: It was concluded that dentists at both institutes have adequate knowledge of blood borne pathogens and adhere to most of universal precautions practices. In the public sector, dentists have a comparatively lower number of factors that interfere with universal precautions than private institutes. Dental institutes should be vigilant about UP adherence among dentists working in OPDs.

Impact of Direct Observation on Hand Hygiene Compliance in a Dental University Hospital: A Retrospective Cohort Study.

Introduction Hand hygiene is crucial for preventing healthcare-associated infections in dental settings. Despite its importance, the hand hygiene compliance rates remain unclear, particularly in dental university hospitals where teaching, research, and clinical practice intersect. This study aimed to establish a baseline of hand hygiene compliance rates in a dental university hospital, evaluate the effectiveness of direct observation in improving compliance, and compare practices among different categories of healthcare workers. Materials and methods This retrospective cohort study was conducted at Kanagawa Dental University Hospital from April 2022 to March 2023. The design included four blinded direct observations to establish baseline compliance rates, followed by educational training and four unannounced explicit observations. Compliance was assessed based on the World Health Organization's "Your 5 Moments for Hand Hygiene: Dental Care," adapted for dental outpatient services. The study focused on hand hygiene using alcohol-based hand sanitizers, and compliance rates were calculated for dentists, dental hygienists, dental assistants, and trainee dentists. Monthly consumption of hand sanitizer per patient was tracked from January 2019 as a secondary measure. Statistical analysis included Fisher's exact test, unpaired t-tests, and analysis of variance (ANOVA). Results The baseline hand hygiene compliance rate was low at 15.6%, with the highest compliance (25.0%) for "After touching patient surroundings." Post-intervention, the overall compliance rate increased significantly to 36.0% (p < 0.001). Significant improvements were observed in moments "After body fluid exposure risk" (11.1% to 31.3%, p = 0.004), "After touching a patient" (12.0% to 52.9%, p = 0.006), and "After touching patient surroundings" (25.0% to 73.3%, p = 0.001). Dental hygienists, assistants, and trainee dentists showed significant increases in hand hygiene compliance, while dentists did not. Hand sanitizer consumption increased significantly from 2019 (2.38 ± 0.29 mL per patient) to 2020 (3.47 ± 0.49 mL, p < 0.001) and remained elevated through 2023. Conclusions This study revealed low baseline hand hygiene compliance in a dental university hospital setting. While direct observation and education led to significant short-term improvements, especially among allied health professionals, the disconnect between observed compliance rates and hand sanitizer consumption suggests these changes may not represent sustainable behavioral shifts. The varying improvement rates among different healthcare workers and the challenges in maintaining long-term adherence highlight the need for tailored, continuous interventions in dental education and practice settings to enhance hand hygiene compliance.

Physicochemical Stability of Doravirine (Pifeltro®): Characterization of Main Degradation Products and Assessment of Stability of Tablets Repackaged in Single-Dose Unit Containers.

Doravarine (DOR) is an antiviral drug with a marketed authorization for the management of occupational blood and body fluid exposure. The currently existing packaging, consisting of multiple unit bottles comprising 30 tablets, is not fully appropriate for daily nominative dispensing at the hospital. This study aims at assessing the impact of the change in packaging on the key attributes of the drug: assay, impurity profile, and dissolution. As the first step, which is not fully depicted in the literature, the main potential impurities that could appear during storage (i.e., degradation products (DPs) of DOR) were characterized using a forced degradation protocol followed by an LC-MS/MS analysis. These results paved the way for in silico toxicological assessment and targeted degradation product profiling. Based on this study, the assessment of the implication of repackaging on the formation of DOR's degradation products should be a primary focus.

Compliance with the five moments for hand hygiene of healthcare workers in a pediatric hospital. A prospective observational study

Introduction: Healthcare-associated infections (HAIs), also known as nosocomial infections or hospital-acquired infections, begin within 48 hours of hospitalization, within 30 days after hospital discharge, or 90 days after undergoing surgical procedures. Objective: The study aimed to describe the compliance with the five moments for hand hygiene (HH) of the healthcare workers (HCWs) in a hospital. Methods: A prospective observational study was conducted from June 1 to 30,2020 in a pediatric hospital. HCWs compliance with the five moments of HH was registered by direct observation blindly to the participants, using the fact sheet for HH of the WHO. In the rows, the five moments of contact with the patients were recorded: before touching a patient, before clean aseptic procedure, after body fluid exposure risk, after touching a patient and after touching patient surroundings. The actions performed, also was registered: hand washing, alcohol hand friction, omission, or use of gloves. Data were analyzed in SPSS V 21. The protocol was approved by the institutional review board. Results: During the study period, 2.595 observations to 104 HCWs were made. They were pediatric residents 38.5 %, nurses 32.7 % and pediatricians 28.8 %. A global compliance with the five moments of HH of the participants were 64.5% (1673/2595). Before touching a patient, the adherence was 86,9%. The nurses adhered in 69%, pediatrician in 68.6 % and the pediatric residents in 57.2%. Discussion: The global percentage of compliance with the five moments of HH of the medical and nursing staff of the pediatric hospital was 64.5%. Nurses had the highest percentage of adherence. Handwashing compliance was higher before contact with the patients.

Blood and body fluids exposure (BBFE): knowledge, attitudes, and practices of healthcare workers involved in plastic and reconstructive surgery in Togo

Introduction: Infectious risk among healthcare workers (HCW) is a major public health issue, especially in developing countries. This study aimed to assess the awareness and frequency of blood and body fluids exposure (BBFE) among HCW involved in plastic surgery care activities at the Sylvanus Olympio Teaching Hospital (SOTH). Methods: A cross-sectional study was conducted among HCW involved in plastic and reconstructive activity in the SOTH from July 1st to September 30th, 2021. The study assessed knowledge, attitude, and practices of HCW in face of BBFE using an anonymous selfadministered questionnaire. Results: A total of 101 participants were included (participation rate 91.8%). There was a male predominance; Male/Female ratio was 3.04. The mean age was 35.5 ± 9.4 years [18-65 years]. More than half of the responders (68.32%) had less than 5 years’ professional experience. Nearly half (48.5%) of the participants already had at least one BBFE. Sting (84.2%), blood splashes (61.4%), or skin cuts (54.5%) were the main mechanisms of occurrence. HIV was the most known hazard mentioned by 99/101 (98%) of the participants followed by hepatitis B (91/101, 90%), hepatitis C (71/101, 70%). No participant mentioned the risk of syphilis, Human Papilloma Virus (HPV), or COVID-19 infection. The approach towards the relative measures to be taken including accident declaration were unsatisfactory. Conclusion: The results of this study highlighted the seriousness of BBFE among HCW involved in plastic and reconstructive activities in the SOTH. There is a need for training and information to increase the awareness and knowledge among this specific staff and by extension among all the technical staff in the SOTH. Introduction : Les risques d’infection chez les professionnels de santé constituent un problème de santé publique particulièrement dans les pays en voie de développement. Cette étude a eu pour but d’évaluer les connaissances, attitudes et pratiques par rapport aux accidents avec exposition au sang ou aux produits sanguins (AES) du personnel impliqué dans les activités de chirurgie plastique et reconstructive au Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO). Méthode : Une étude transversale a été menée auprès du personnel impliqué dans les activités de chirurgie plastique et reconstructrice du CHU SO dans la période du 1er Juillet au 30 septembre 2021. Les connaissances, attitudes, et pratiques du personnel face aux AES a été évaluées par un questionnaire rempli de façon anonyme. Résultats : Un nombre de 101/110 participants (91,8%) ont répondu au questionnaire et ont été inclus dans l’étude. Il y avait une prédominance masculine avec une sex-ration de 3/1. L’âge moyen des participants était de 35,5 ± 9,4 ans avec des extrêmes de 18 et 65 ans. Plus de la moitié des participants (68,32%) avait une expérience professionnelle de moins de 5 ans. Presque la moitié des participants (48,5%) ont déjà été victime au moins une fois d’accident avec exposition au sang ou aux liquides biologiques. Les piqûres (84,2%), les éclaboussements de sang (61,4%), les lacérations cutanées (54,5%) étaient les mécanismes les plus fréquents. L’infection à HIV était le risque le plus connu mentionné par 99/101 (98%) des participants suivis de l’infection à hépatite B (91/101, 90%), et hépatite C (71/101, 70%). Aucun des participants n’a mentionné le risque de contamination par la syphilis, le Human Papilloma Virus (HPV), ou la COVID-19. Les connaissances des premières mesures à prendre ainsi que la déclaration de l’accident étaient insuffisantes chez la majorité des participants. Conclusion : Les résultats de cette étude montrent un déficit de connaissance d’attitudes et de pratiques du personnel impliqué dans les activités de chirurgie plastique et reconstructrice au CHU SO. Il en sort la nécessité de former ce personnel et par extension tout le personnel du CHU SO sur les AES.

Analysis of characteristic and postexposure practices of occupational blood and body fluid exposures among health care workers in Chinese tertiary hospitals: a retrospective ten-year study

BackgroundOccupational blood and body fluid exposure (OBEs) is a highly concerning global health problem in health facilities. Improper or inadequate post-exposure practices increase the risk of infection with bloodborne pathogens. Understanding risk factors for OBEs and evaluating the post-exposure practices will contribute to healthcare workers’ (HCWs) well-being.MethodsThis study retrospectively synthesized and reviewed the 10-year data (from 2010 to 2020) on OBEs in a tertiary teaching hospital.ResultsA total of 519 HCWs have reported OBEs, increasing yearly from 2010 to 2020. Of these, most were nurses (247 [47.2%]), female (390 [75.1%]), at 23–27 years old (207 [39.9%]). The hepatitis B was the primary bloodborne pathogen exposed to HCWs, with 285 (54.9%) cases, internal medicine was the main exposure site (161 [31.0%]), and sharp injury was the main exposure route (439 [84.6%]). Data analysis shows that there are significant differences between exposure route, exposed pathogens, and exposure site among the different occupational categories (X2 = 14.5, 43.7, 94.3, all P < 0.001). 3.3% of HCWs did not take any post-exposure practices. For percutaneous exposure, 4.7% did not rinse the wound, 3.3% did not squeeze out the wound, and 2.3% did not disinfect the wound. In the case of mucosal exposure, 90.4% clean the exposure area immediately.ConclusionsThe data from the past decade underscores the seriousness of current situation of OBEs in Chinese tertiary hospital, particularly among young HCWs, and with hepatitis B as the predominant blood-borne pathogen. This study also identifies HCWs may take incorrect post-exposure practices. It’s crucial in the future to discuss the effectiveness of main groups targeted for focused specialty-specific guidance for the prevention of such accidents, meanwhile, to include blood-borne disease immunity testing in mandatory health check-ups. Additionally, focus on optimizing post-exposure practices, offering significant steps toward prevention of such incidents and reducing infection risks should also be considered in future studies.

Implementation of a hotline (“S-T-I-C-K”) to expedite management of occupational bloodborne pathogen exposures at an academic medical center: A Process Improvement Initiative

Previously, blood and body fluid exposures were managed by a visit to the University Employee Health Clinic during normal business hours and the Emergency Department after hours. We implemented the "S-T-I-C-K" program where health care personnel were evaluated immediately after exposure by a nurse-driven 24/7 hotline. Increasing accessibility to care and a simplified process for exposure management led to a significant decrease in Emergency Department utilization and time between the exposure and receipt of post-exposure prophylaxis.

Blood and body fluids exposure, post-exposure prophylaxis, and HIV self-testing among healthcare workers in northern Nigeria

Introduction In high-HIV burden settings, such as Nigeria, HIV self-testing and post-exposure prophylaxis (PEP) are often recommended, but not widely practiced. This study aims to identify the predictors of PEP utilization and preferences for HIV self-testing among healthcare workers in Nigeria. Methods A total of 403 healthcare workers from a tertiary hospital in Nigeria completed questionnaires. Adjusted odds ratios were derived from logistic regression models. Results Among the respondents, 141 (35.0%) reported experiencing at least one workplace exposure incident, with 72 (51.1%) of them receiving PEP. The majority of healthcare workers (n = 354, 87.8%) expressed a preference for HIV self-testing over traditional HIV testing and counseling. The occurrence of exposure incidents was predicted by the respondent’s sex (adjusted odds ratio [aOR] = 1.25; 95% confidence interval [CI]: 1.15-3.08, female vs. male), age (aOR = 0. 16; 95% CI: 0.03-0.92, >40 vs. <30 years), profession (aOR = 1.88; 95% CI: 1.18-4.66, nurse/midwife vs. physician), work unit (aOR = 0.06; 95% CI: 0.02-0.23, obstetrics/gynecology vs. surgery), and previous HIV testing and counseling (aOR = 0.01; 95% Cl: 0.004-0.03, no vs. yes). Respondent’s profession, work unit, and previous HIV testing and counseling independently predicted a preference for HIV self-testing. Conclusion Further exploration of the feasibility of implementing HIV self-testing as an alternative to traditional HIV testing and counseling for workplace exposures is warranted.

Development of virtual reality educational clips for improving hand hygiene compliance among healthcare providers: a pilot study

The usefulness of virtual reality (VR) technology for healthcare practitioners has been increasingly investigated, but that of infection prevention and control (IPC) training is yet to be well described in the literature. We developed patient-view VR clips to promote hand hygiene compliance in healthcare settings and conducted a pilot study to evaluate their effectiveness and safety in hospitals. In December 2022, we held a hands-on IPC workshop at Marugame Medical Center (Kagawa, Japan). We recruited 20 nurses and five nursing aids for the VR experience using a fully immersive 360-degree head-mounted display. Participants were evaluated using a self-administered questionnaire and a short nursing care scenario based on the direct observation method. All the participants answered that the VR experience was helpful for increasing awareness of the 5 Moments for Hand Hygiene. However, 37.5% and 4.2% reported little or heavy VR sickness, respectively. Hand hygiene compliance among nurses was considerably high, at 95.0% for "Before touching a patient," 95.0% for "Before clean/aseptic procedure," 85.0% for "After body fluid exposure risk," 92.5% for "After touching a patient," and 95.0% for "After touching patients’ surroundings." The results of this pilot study suggest the educational utility of VR clips. Future collaboration between IPC practitioners and digital technology experts is required to develop better educational devices and content.

Compliance with standard precautions, sharp injuries, and blood and body fluid exposure among healthcare workers

Background &amp; Aim: Healthcare workers are exposed to certain infectious diseases through needlestick injuries and exposure to blood and other bodily fluids. This study aimed to determine the prevalence of needlestick injuries and blood and other body fluids exposure among healthcare workers at Namazi Hospital in Shiraz, Iran.&#x0D; Methods &amp; Materials: This cross-sectional study was conducted on 656 Healthcare workers, including students and staff in medical, nursing, laboratory, service, and operating room groups, at the Namazi Hospital, in 2019. A questionnaire with four parts, including demographics, questions about using sharps containers, needle recapping, masks, and glasses, and the experience of sharps injuries or blood and body fluid exposure and reporting them, was distributed using the quota sampling method. To analyze the results, the T‑test and Chi-square test were performed.&#x0D; Results: Nearly 75.2% of the participants always used sharps containers, and 21.7% never recapped syringes. Sharps injuries and blood and body fluid exposure occurred in 40.7% and 39.8% of the participants. Occupation (P&lt;0.001), being a student (P: 0.048), and age (P: 0.008) were associated with sharp injuries. Occupation (P: 0.001), gender (P: 0.016), and age (P&lt;0.001) differed in exposed and no exposed participants to blood and body fluids. The prevalence of reporting exposure was not significantly different between men and women, occupation groups, students and staff, and different ages (P&gt; 0.05).&#x0D; Conclusion: Hospital managers should provide effective educational interventions to protect against occupational hazard exposures. Also, they should provide protective equipment for Healthcare workers.

Investigation of the selection and use of "other" personal protective equipment to prevent mucous membrane exposure in nurses: A cross-sectional study.

Selection and use of personal protective equipment (PPE) to prevent non-percutaneous body fluid exposure (NP BFE) is determined by a clinical assessment of risk. The aim of this study was to explore the selection and use of PPE, particularly masks and eye protection to prevent NP BFE, by nurses. This quantitative single-site two-phased study was guided by the Health Belief Model (HBM). Phase 1 was a retrospective electronic database audit of body fluid exposure surveillance data. Phase 2 included a cross-sectional survey. The highest incidence of reported NP BFE to non-intact skin and mucous membranes during the study period were identified in the emergency department (ED) at 51.3% (20/39), intensive care unit (ICU) at 30.8% (12/39), operating theatre (OT) with 12.9% (5/39), and inpatient renal ward with 5.1% (2/39). Reported PPE use during NP BFE was: 0% face shields or masks, 10% gown/apron, and 15% goggles. Survey results related to Prevention of mucocutaneous exposures were similar across all high-risk units, though ED nurses reported poorer compliance with the use of PPE to prevent exposure. Risk assessment for prevention of NP BFE was reported, yet there was a lack of compliance. The ICU results indicated a positive safety culture in contrast to the ED. The findings are consistent with research identifying inadequate prevention of NP BFE, although nurses are aware of the importance of risk assessment. The HBM has the potential to increase understanding of the differences in nurses' perceptions of risk in safety culture.

Lassa Fever Infection among Healthcare Workers during the 2018 Outbreak in Nigeria

Introduction: Healthcare workers (HCWs) are potentially exposed to infection during viral hemorrhagic fever outbreaks. In the wake of 2018, Nigeria experienced an unprecedented surge in cases of Lassa fever (LF), which affected HCWs. To guide infection prevention and control (IPC) strategies in similar settings, we characterize HCWs' infection and describe the gaps in IPC standards and practices during the outbreak. Methods: Data was collected using a structured questionnaire, interview, and review of case notes of 21 HCW with laboratory-confirmed Lassa fever who were treated at the Irrua Specialist Teaching Hospital (ISTH) Irrua and the Alex-Ekwemen Federal Teaching Hospital, Abakaliki (AEFETHA), between 1st January and 27th May 2018. Information collected was the patients' socio-demographic characteristics, date of potential exposure and onset of illness, nature, and type of exposure, clinical features, outcome, use of personal protective equipment (PPE), and personnel IPC training and were analyzed using descriptive statistics with Microsoft Excel. Results: The study included 21 HCWs, and 12 (57.14%) were doctors. The case fatality rate was 23%. Nearly two-thirds (62%) of the HCWs could describe a likely procedure leading to their exposure and infection. Among 13 HCWs, 85% had multiple blood and body fluids exposure, while 15% had needle stick injury or scalpel cut. About one-fifth of the participants had received some IPC training. Conclusion: Limited IPC adherence and inappropriate risk assessment were identified as factors leading to Lassa fever exposure and infection among HCWs. There is an urgent need to provide IPC training for all HCWs and to ensure an adequate supply of IPC materials to all healthcare facilities as part of emergency preparedness, especially in LF endemic areas.

Estimation of the Prevalence of Occupational Exposure to Biological Fluids among Anesthesiologists: A Survey Study.

Percutaneous injuries caused by sharps and exposure to biological fluids are a serious concern for anesthesiologists and pose a significant risk of transmission of blood-borne pathogens. The aim of this study was to estimate the prevalence of exposure to biological fluids among anesthesiologists. A questionnaire designed initially was validated after it was sent to 10 anesthesiologists with more than 5 years' experience. The validated questionnaire was then administered using Google Forms and the link was circulated electronically (e-mail, WhatsApp, and Telegram). This self-administered questionnaire was completed by 100 anesthesiologists. The various types and methods of body fluid years of exposure were also identified. The prevalence of occupational exposure to body fluids was 100%. Exposure to either blood or cerebrospinal fluids by sharps was seen in 82%. Majority of the pricks were encountered during recapping of used needles followed by pricks during intravenous cannulation. Body fluid exposure onto the bare skin most frequently encountered was blood, mostly obtained during intravenous cannulation. There were 8% patients who had exposure to human immunodeficiency virus (HIV) and hepatitis B or C patients for which they had taken postexposure prophylaxis. Prevalence of exposure to biological fluids among anesthesiologists is alarmingly high. This poses a high risk for transmission of diseases. The use of protective gears and changing our casual attitude can prevent majority of the exposures. The practice of recapping of used needles should be stopped.

Blood and Body Fluid Exposure Among Healthcare Workers and Personal Protective Equipment Usage in the United States.

The International Safety Center disseminates the Exposure Prevention Information Network (EPINet) surveillance system to standardize a system for healthcare facilities to track mucocutaneous blood and body fluid exposures. Occupational exposure incidents to blood and body fluids were recorded within the participant health systems and hospitals (N = 41), using the EPINet Blood and Body Fluid Exposure Report Form. Forms include detailed questions about the circumstances surrounding the exposure, including the type of exposure, body part(s) involved, and if the employee reporting the incident was wearing personal protective equipment (PPE). There were statistically significant differences between participants who wore PPE at time of exposure versus those who did not. Differences were noted by job category (χ2 =32.91, p-value = <.001); where the exposure occurred (χ2 = 32.31, p-value = <.001); what the exposure was a result of (χ2 = 50.19, p-value = <.001); and day versus night shift (χ2 = 11.47, p-value = .001). The study found that occupational exposure to blood and body fluids in 2021 remain high risk given the frequency with which they happen, the exposure site (face) and lack of PPE use. The pandemic seemed to matter little in changing frequencies despite high awareness and growing PPE availability and supply. The findings provide robust information about how exposures occur, why they remain high risk, and how important it is to improve reporting and surveillance to prevent occupational exposures and disease in healthcare in future.

Effectiveness of a Case-based Educational Intervention Focusing on Blood and Body Fluid Exposure Prevention among Nursing Students

Objective: There is a relative lack of research regarding case-based educational interventions to improve blood and body fluid exposure prevention practice among nursing students. Hence, this study aimed to investigate the effect of case-based educational intervention on knowledge, attitudes, and behaviors regarding blood and body fluid exposure prevention among nursing students, at some universities in Vietnam. Material and Methods: This study employed a randomized control trial design. Simple random sampling was used to recruit the target population, to obtain 87 nursing students. Students’ knowledge, attitude and self-reported behavior scale on exposure prevention were used to collect data at three time-points. The 4-week case-based educational intervention was provided to the intervention group (42 students); whereas, the control group received only regular training. Results: The findings revealed that there were significant, positive differences in students’ knowledge, and attitude toward blood and body fluid exposure prevention in the intervention groups than in the control group after receiving the intervention, which remained over time. Conclusion: Higher educational institutions should provide case-based educational intervention to nursing students, so as to enhance their blood and body fluid exposure prevention practices.

Occupational exposure to HIV and utilization of post-exposure prophylaxis among healthcare workers at St. Peter’s specialized hospital in Addis Ababa, Ethiopia

Healthcare workers are susceptible to blood borne pathogens, such as human immunodeficiency virus (HIV). Occupational exposure to HIV infection among healthcare workers is becoming a global public health concern. However, there is limited evidence about occupational exposure of healthcare workers to HIV and utilization of post-exposure prophylaxis in Addis Ababa, Ethiopia. Accordingly, this study was conducted to assess the prevalence of occupational exposure to HIV and utilization of post exposure prophylaxis among healthcare workers at St. Peter’s specialized hospital, Addis Ababa, Ethiopia. A health facility-based cross-sectional study was conducted among 308 randomly selected healthcare workers in April 2022. Structured and pretested self-administered questioner was used to collect data. Occupational exposure to HIV was taken as any percutaneous injury or blood or other body fluids exposure while administering medications, specimen collection, and other procedures with HIV confirmed patients. Multivariable binary logistic regression analysis was used to identify factors associated with occupational exposure to HIV and utilization of post-exposure prophylaxis. Statistically significant association was declared on the basis of adjusted odds ratio with 95% confidence interval and p-value less than 0.05. The study found that 42.3% (95% CI 36.6, 47.9%) of the healthcare workers had occupational exposure to HIV during their career time, out of whom 16.1% (95% CI 11.9, 20.3%) used post-exposure prophylaxis. Healthcare workers with lower-level education such as diploma (AOR: 0.41, 95% CI 0.17, 0.96) and BSc (AOR: 0.51, 95% CI 0.26, 0.92), and healthcare workers who received infection prevention training (AOR: 0.55, 95% CI 0.33, 0.90) had less risk of exposure to HIV. On the other hand, nurses (AOR: 1.98, 95% CI 1.07, 3.67), midwifes (AOR: 3.79, 95% CI 1.21, 11.9), and physicians (AOR: 2.11, 95% CI 1.05, 4.22) had high risk of exposure to HIV compared with other professionals. Moreover, healthcare workers with BSc degree compared with healthcare workers with masters degree (AOR: 3.69, 95% CI 1.08, 12.6), healthcare workers with long service year (AOR: 3.75, 95% CI 1.64, 8.57), and healthcare workers who are working in facilities where prophylaxis is available (AOR: 3.41, 95% CI 1.47, 7.91) had higher odds to utilize post-exposure prophylaxis. Significant proportion of healthcare workers included in the current study had occupational exposure to HIV and very few of them used post-exposure prophylaxis. Healthcare workers need to use appropriate personal protective equipment, safely manage contaminated equipment, and safely administered medications and collect specimen to protect themselves from exposure to HIV. Moreover, use of post-exposure prophylaxis should be promoted when exposure exists.

PD30-10 TRAINEE SAFETY DURING ENDOUROLOGY PROCEDURES: RESULTS OF A NATIONAL SURVEY OF RESIDENTS AND FELLOWS

You have accessJournal of UrologyCME1 Apr 2023PD30-10 TRAINEE SAFETY DURING ENDOUROLOGY PROCEDURES: RESULTS OF A NATIONAL SURVEY OF RESIDENTS AND FELLOWS Kavita Gupta, Kevin Labagnara, Dima Raskolnikov, Michelle Semins, and Alexander Small Kavita GuptaKavita Gupta More articles by this author , Kevin LabagnaraKevin Labagnara More articles by this author , Dima RaskolnikovDima Raskolnikov More articles by this author , Michelle SeminsMichelle Semins More articles by this author , and Alexander SmallAlexander Small More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003316.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urology trainees are at risk from numerous occupational hazards during endourology procedures including radiation, lasers, urine and blood pathogens, chemicals, and uncomfortable postures. With early awareness and education, personal danger can be reduced. We aimed to characterize and evaluate resident and fellow preparedness and safety for these occupational hazards. METHODS: Urology residents and fellows were surveyed through an online form distributed to residency program directors and endourology fellowship directors in the United States. Data were obtained on radiation/laser safety, protective equipment, ergonomics and personal injuries/exposures. Descriptive statistics were performed. RESULTS: 68 trainees responded including 52 residents (77%) and 16 fellows (24%). Respondents were 69% male, and all AUA sections participated (NY 38%, North Central 18%, Mid Atlantic 12%, Western 10% and other 22%). Respondents performed a median 5 (IQR 4-10) endourology procedures per week. Regarding radiation safety, 65% received formal education (via online module 49%, lecture 32% and/or printed material 7%) and 35% received informal or no training. Nearly all use lead aprons (91% communal and/or 16% personal) and thyroid shields (81% communal and/or 24% personal), but only 50% use dosimeters and 16% use lead glasses. 69% have been accidentally exposed to radiation, as frequently as daily 3%, weekly 4% or monthly 15%. 3 trainees reported medical conditions potentially related to radiation including cataracts, thyroid cancer and infertility. Body fluid exposures were reported by 38% of trainees (23% eye splash and 6% sharp stick) with a median 5 (IQR 3-10) exposures. 10% have taken prophylaxis for blood borne pathogens. Finally, 47% reported no ergonomic safety education. 87% suffered acute or chronic pain related to static posturing during endourology procedures, including neck pain 49%, back pain 49%, hand/wrist pain 40%, and shoulder pain 38%. 4 respondents have sought medical attention for these pains. CONCLUSIONS: Trainee safety practices for endourology procedures are highly variable. Many lack formal education about radiation and ergonomic practices, and an alarming number have suffered exposures, medical conditions related to radiation, and acute and chronic pains from static posturing. There is a need to ensure trainees are learning methods to keep them healthy and safe during their career. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e834 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kavita Gupta More articles by this author Kevin Labagnara More articles by this author Dima Raskolnikov More articles by this author Michelle Semins More articles by this author Alexander Small More articles by this author Expand All Advertisement PDF downloadLoading ...

GloveCare: a pilot study in preparation for a cluster crossover randomized controlled trial of non-sterile glove-based care in preventing late-onset infection in the NICU

BackgroundLate-onset infections (LOI) are a major cause of morbidity and mortality among patients in the neonatal intensive care unit (NICU). Gloving after hand hygiene may be a pragmatic approach to prevent infections that arise when healthcare workers’ hands transmit pathogens to neonates.ObjectiveTo determine the feasibility of conducting a multicenter, open-labeled randomized controlled trial (RCT) to determine whether a protocol that requires healthcare workers (HCWs) in a level 3 NICU to wear non-sterile gloves plus hand hygiene reduces the occurrence of a late-onset infection, compared to hand hygiene alone.MethodsIn this single-center pilot study, we recruited neonates admitted to the McMaster Children’s Hospital NICU from June 2017 to May 2018. The NICU was randomized to begin with the standard (control) arm for 6 months (June 2017 to Dec 2017), followed by the gloving (GloveCare) arm for 6 months (Jan 2018 to July 2018), with a 2-week washout period in-between to educate healthcare workers about gloving. We measured numerous feasibility outcomes including enrollment, event rate, and compliance with hand hygiene (Moment 1: before patient contact, Moment 2: before clean procedure, Moment 3: after body fluid contact, Moment 4: after patient contact) and gloving compliance.ResultsWe enrolled 750 neonates (390 Standard care, 360 GloveCare) and achieved 100% enrollment. We found higher hand hygiene compliance during the standard care arm compared to the GloveCare for all four moments of hand hygiene (Moment 1: 87% vs 79%, OR=1.86 (1.34, 2.59); Moment 2: OR=1.73 (1.00, 3.01); Moment 3: OR=1.11 (0.62, 1.98); Moment 4: OR=1.65 (1.27, 2.14)). We developed and validated a method to calculate glove compliance, which ranged from 48 to 85%, and was highest for moment 3 (doffing after a procedure or body fluid exposure risk). No adverse events were documented for patients or staff.DiscussionReduction in hand hygiene compliance in the GloveCare arm presents a pragmatic challenge in ascertaining the effectiveness of gloving to prevent LOI. Most LOIs were non-sterile-site infections, which is considered a less patient-important or clinically relevant outcome compared to sterile-site LOI. Ensuring efficient collection and validation of hand hygiene and gloving data is imperative.ConclusionThe pilot study demonstrated the feasibility of this intervention though modifications to improve hand hygiene compliance during GloveCare will be important prior to a multicenter cluster RCT to assess the efficacy of non-sterile glove-based care in preventing LOI in the NICU.Trial registrationClinicaltrials.gov, NCT03078335

ASSESSING KNOWLEDGE, ATTITUDES, AND PRACTICES OF HEALTHCARE PROFESSIONALS REGARDING HOSPITAL ACQUIRED INFECTION IN TERTIARY CARE TEACHING HOSPITAL AT EASTERN NEPAL: CROSS-SECTIONAL STUDY

Hospital-acquired infections (HAIs) are a common problem and represent significant challenges to the effective delivery of healthcare services faced by hospitals in all countries around the world. Healthcare workers (HCWs) are an important part of the healthcare team that plays a unique role in the control of HAIs. Compliance on the part of healthcare workers (HCWs) with standard precautions has been recognized as being an efficient means to prevent and control HAIs. Objective: The present study was conducted with objective of understanding the level of Knowledge, attitude and practice (KAP) regarding Hospital-acquired infections (HAIs) among health care workers in the Eastern region of Nepal. Method:This descriptive cross-sectional study was conducted among healthcare workers posted in different wards of hospitals of BPKIHS. A self administered questionnaire containing different set of questions regarding knowledge, attitude and practice on HAI were used for data collection. Simple random sampling method was employed. Statistical package for social sciences (SPSS) was used to analyze the data and presented in frequency tables and graph. Results: Regarding knowledge of the participants: Among the total participants in the study, 97% of the participants had good knowledge regarding Hospital acquired infections (HAIs) but only 72% of the participants had received formal training regarding hand hygiene. 97 % participants agreed on the fact that hand hygiene act should be performed before and after direct patient contact. Highest proportions of the participants (97%) were aware of the fact that washing hands with antiseptic decreases the risk of transmission of hospital acquired pathogens. Large proportion of the respondents ( 95%) were aware of the fact that Gloves should be worn if blood or body fluid exposure is anticipated and still considered that gloves provided complete protection against acquiring/ transmitting infections. Hand hygiene (89%) and Personal protective equipment 68%) were common preventive measures of transmission of hospital acquired infection. The common sources of acquiring infections was uniform (59%) whereas commonly hospital acquired infection (HAIs) were reproductive tract infection (86%) and gastro -intestinal tract (GIT) infection (76%) and most susceptible group to hospital acquired infections (HAIs) were OT assistants (74%), Lab technicians(69%) etc. Regarding attitude of the participants, 91% of the participants felt that they would be less likely to transmit infection to the patient if they performed hand-hygiene. Regarding various hindrances in adoption of hand hygiene, few of the respondents (48%) identified that hand hygiene agents were not readily available in our current settings. 31% of the health care workers reported that they often forgot to perform hand hygiene.42% of health care workers found that Gloves are always available when they wanted. 25% of health workers believed that there was very low risk of acquiring infections from my patients.79 % participants thought that all patients are potentially contagious while 88% transmission of hospital acquired infections occurred through unsterilized use of needles and sharp objects. Regarding practice of the participants , majority of respondents (more than 90%) performed hand hygiene before patient contact, after patient contact and caring for wound.95% of the participants practiced hand hygiene after removal of gloves. Majority of the participants (97%) washed their hands after handling every patient. 74% participants practiced of using reusable instruments while 86% respondents practiced of using pre-sterilized instruments. 82 % of the participants exposed to patients blood. Conclusion: All health workers had good knowledge regarding Hospital-acquired infections (HAIs) that was reflected in their attitude and practice on hand hygiene for the prevention of HAIs. However there is the need of regular training and performance feedback regarding hand hygiene and the hospital environment should be hand-hygiene friendly with easily accessible to sinks and other facilities. Improving sustainable supplies like personal protective equipment, water supply and hand washing facilities at patient care site is vital to reduce nosocomial infection. Therefore health workers should strictly follow hospital acquired infection prevention guidelines to reduce infections.

Contact Tracing of Healthcare Workers Exposed to COVID-19 Infection in a Tertiary-Care Hospital: Containing the Contagion.

Healthcare workers (HCWs) are at higher risk of getting infected with COVID-19 infection due to their close proximity to COVID-19-positive patients. We studied the risk stratification and positivity rate in HCWs at risk of getting COVID-19 infection as well as the possible factors responsible for their being at risk of COVID-19 infection during the study period. This prospective study was conducted after approval by the institutional ethics committee. The data regarding demographic variables, risk stratification, COVID-19 (reverse-transcription polymerase chain reaction) report, and possible sources of exposure for HCWs were recorded in a proforma by personal/telephonic interviews as well as from hospital records from March 2020 to June 2021. The data generated were entered into Microsoft Excel® software and analyzed using percentages, proportions, and Chi-square tests for qualitative variables. COVID-19 infection's positivity rate was 19.5% among high-risk and 0.6% among low-risk HCW contacts. HCWs working in non-COVID-19 areas (67.9%) were more at risk than those working in COVID-19 areas (32.1%). In contrast, the COVID-19 positivity rate was significantly higher among high-risk contact HCWs from COVID-19 areas (34.2%) than in non-COVID-19 areas (12.6%). The maximum COVID-19 positivity rate was seen in high-risk contacts with body fluid exposure (21%), performing aerosol-generating procedures (20%), and close exposure in operation theaters (18%). Risk stratification is an important tool to contain infection among HCWs who had unprotected close contact with a COVID-19-positive case. With appropriate contact tracing, we were able to avoid over- and under-quarantine, save many man-hours as well as contain the spread of infection. HCWs should not only wear appropriate personal protective equipment (PPE) during work hours but should also practice mask-wearing and social distancing while they are in the community.