Body Fluid Exposure Research Articles

Increased Incidence of Blood and Body Fluid Exposure and Lack of Transmission Evidence During COVID-19 Pandemic

Background: Coronavirus disease 2019 (COVID-19) pandemic has been associated with various risks, including the exposure of infectious agents. Objectives: The study aims at describing the incidence of blood and body fluid (BBF) exposure in a COVID-19 facility so as viral transmission potential through blood. Methods: A descriptive study of BBF exposure notified was carried out in a community hospital in Qatar. Results: In 2020, 29 needlesticks injuries were reported, which is a significant increase compared to the year 2019 (6 incidents) and 2018 (5 incidents). No evidence of SARS-CoV-2 transmission was shown concerning the injury using symptoms monitoring and lab test. Conclusion: The increased risk of BBF exposure during the pandemic provides insight into the need to review the prevention practices of occupational exposure during pandemics. Additional studies are required to define the risk of COVID-19 related to occupational exposure to BBF.

Occupational blood exposure beyond needle stick injuries: hospital-based cross-sectional study among healthcare workers in governmental hospitals of Northern Ethiopia

BackgroundOccupational blood exposure is one of the major public health problems that healthcare workers (HCWs) are encountering. Most previous occupational blood exposure studies are delimited to needle stick injury, which could underestimate the real level of blood exposure. On the other hand, others deal with crude blood and body-fluids exposure, which possibly overestimate the magnitude of blood exposure. Therefore, this study aimed at determining the prevalence of occupational blood exposure and identifying associated factors among HCWs in the Southern Tigrai zone governmental hospitals of Northern Ethiopia considering all the potential means of blood exposure (needle stick injury, sharp medical equipment injury, and blood splash) while excluding blood-free body-fluids.MethodsA hospital based cross-sectional study design was employed to gather data from randomly selected HCWs in three governmental hospitals from February to March, 2020. A multivariable logistic regression model was used to identify the independent factors associated with the outcome variable.ResultsFrom the total of 318 HCWs, 148 (46.5 %) were exposed to blood at least once in their lifetime. Working for more than 40 h per week (AOR= 9.4; 95 % CI: 7.61, 11.41), lack of adequate personal protective equipment (PPE) (AOR=3.88; 95 % CI: 1.64, 5.42), Hepatitis B virus vaccination (AOR=0.54; 95 % CI: 0.12,0.78), recapping used needle sticks (AOR=3.18; 95 % CI: 1.28, 8.83), and lack of infection prevention and patient safety (IPPS) training (AOR=13.5; 95 % CI: 8.12,19.11) were detected to significantly increase the likelihood of occupational blood exposure.ConclusionsAs nearly half of the HCWs were exposed to blood, reducing work load below 40 h per week by employing additional staff members, supplying adequate PPE, avoiding recapping of used needle sticks, and providing IPPS training for the HCWs should be practiced.

Hospital hand hygiene monitoring: internal audits and the role of public health residents

Abstract Background Healthcare workers (HCW) adherence to hand hygiene (HH) is the most effective infection prevention and control (IPC) measure to fight healthcare-associated infections (HAI) and is a crucial component for standard precautions, especially in a pandemic context. As suggested by the WHO and Joint Commission Network Project, evaluating adherence to HH is essential to identify deficiencies and promote improvement interventions. Methods San Raffaele Hospital in Milan, Italy, adopted internal audits to measure HCWs' adherence to HH according to WHO Guidelines. Public health (PH) residents were enrolled as auditors. They were trained with WHO technical manual for observers and handovers among residents. WHO observation form was used for collection. Process index was HH adherence, stratified by profession, unit, opportunity and indication. Results 8 PH medical residents carried out observations from January 2018 to December 2019. 434 HCWs were observed in 26 hospital units (191 nurses, 148 physicians, 83 healthcare assistants and 11 other professionals). Global adherence was 53%, calculated on 1,969 opportunities, and 2,221 indications observed, followed by 932 hands rubbing and 110 handwashing. Most observations involved nurses (adherence of 53%) and physicians (54%). Global adherence was generally higher in medicine, specialist surgery and intensive-care units while lower in general surgery and rehabilitation units. Indications with the highest adherence were “after body fluid exposure risk” (69%) and “after touching a patient” (64%). The lowest adherence (44%) was observed for “before clean/aseptic procedure” indication. The belief that gloves use may replace HH might partially explain the data. Conclusions Global HH adherence was in line with significant published data and was far better than 2016 data but slightly lower than observations in 2018 when the program started. We believe 2020 HH compliance could have changed due to HCW involvement in IPC against COVID-19. Key messages Hand hygiene (HH) audits represent a crucial tool of clinical governance and risk management: auditors’ training, monthly and annual reports, and feedbacks allowed to structure a virtuous process. If HH audits aim to improve practice we should understand when HH is most beneficial, assessing quality, improving performances through achievable targets using reproducible methods and technologies.

Addressing Underreporting of Blood and Other Body Fluid Exposures Among Perioperative Personnel.

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Insight into the knowledge, attitude and practices of hand hygiene with alcohol based hand rubs in a public sector tertiary care hospital of a developing country

Background: Health care worker’s hands are mostly responsible for transmission of healthcare associated infections (HCAI). In such instances, alcohol based hand rubs have been endorsed by WHO as the gold standard for hand hygiene for visibly clean hands; whereas, for visibly dirty hands soap and water is recommended. In developing countries (like Pakistan), affected people frequently exceed 25%. However, limited infrastructure in these countries hinders the performance of hand hygiene, but the use of alcohol-based hand rubs in such adverse situations is a practical solution to these constraints.Methods: In January 2021, we initiated a 12 week cross-sectional study in a public sector tertiary care hospital of Karachi, Pakistan. All participants were given a self-designed questionnaire with a consent form thereby giving us permission to use the data. Data was analyzed using statistical package for the social sciences (SPSS version 23).Results: 84.3% of the participants had received prior instructions on hand hygiene; however 71.7% respondents did not have access to alcohol based hand rubs. When questioned if they followed WHO’s five moments of hand hygiene, only 50.5% use alcohol based hand rubs before patient contact; 88.6% used it after patient contact; 83.2% after body fluid exposure risk; 77% before an aseptic task and 78.6% after contact with patient’s surroundings.Conclusions: There is a dire need for concerned authorities to enforce proper hand hygiene in public hospitals of developing countries in order to curb health care associated infections and prolonged hospital stays.

Incidence of Sharps injuries and Body fluid exposures from a tertiary care hospital

Incidence of Sharps injuries and Body fluid exposures from a tertiary care hospital

Hepatitis C virus infection and anaesthesia practice: A narrative review.

This paper reviews the natural and treated history of hepatitis C virus infection, the interactions between current therapies and anaesthesia medications, and the implications of occupational exposure and infection to anaesthetists in light of significant changes in treatment. In the past decade, the introduction of new direct acting antiviral medications has seen high cure rates with a sustained viral response across all virus genotypes. These medications are well tolerated with minimal side-effects. Should a patient on these medications require anaesthesia, there are few clinically significant interactions with commonly used anaesthesia medications, and minimal perioperative investigations are required, although delaying elective surgery until after the completion of treatment regimens should be considered to maximise treatment success. As anaesthetists may practise exposure-prone procedures, regular screening for hepatitis C virus infection remains recommended to enable both patient protection and treatment of the anaesthetist prior to the development of any long-term complications of hepatitis C virus infection. Similarly, early diagnosis and treatment of occupationally acquired hepatitis C virus infection after body fluid exposure is associated with high cure rates with minimal risk of long-term liver damage. Although hepatitis C virus infection remains a significant public health issue in Australia and New Zealand, improvements in outcomes as a result of new treatment regimens have allowed the World Health Organization to target the elimination of hepatitis C virus infection as a public health threat by 2030, and public health strategies are being implemented to achieve this goal.

English

BACKGROUND Health care workers are more prone to occupational hazards, like needlestick injuries, blood, and body fluid exposures. Needlestick injuries (NSI) are responsible for the transmission of serious infections like HIV, HBV and HCV. The occurrence of needlestick injuries is highest among the nurses. The objective of the study was to assess the knowledge, attitude and practice regarding needlestick injuries among nursing faculty in Justice K. S. Hegde Charitable Hospital, Mangalore. METHODS A cross-sectional survey was conducted among the nursing faculty working in a tertiary care hospital based on a structured questionnaire, and the obtained data were further analysed statistically. RESULTS The percentage of needle stick injury was 13.3 % among 75 nursing faculty. 94.7 % of the nurses were aware of the universal precaution guidelines and 84 % knew about post-exposure prophylaxis (PEP). 36 % of nurses knew the preventive guidelines' full details, but 50.7 % of the nurses were unaware of it. Many participants were aware that NSI transmits HIV (92 %) and Hepatitis B (68 %). The leading cause of NSI might be heavy work (54.7 %) followed by hurried procedures (41.3 %). 29.3 % of the nurses were still inclined to recapping the needle after use. 68 % of the nurses were mindful of washing hands with only water post exposure. 28 % were not willing to report a NSI. 80 % of nurses were fully immunised against Hepatitis B. CONCLUSIONS The best way to reduce NSI is to impart knowledge and awareness to the faculty. Our study showed that the knowledge, attitude, and practice among the nursing faculty were promising but requires to be further strengthened. KEY WORDS Needlestick Injury, Nursing Staff, Knowledge, Attitude, Practice

Designing and Implementing National Program of Health Electronic Surveillance Network (HESN); Infection Control Module in Saudi Arabia

Surveillance of health care associated infections is the keystone of Infection Prevention and Control program in any health care setting. Without a reliable surveillance system, it is difficult to monitor the health care associated infections (device associated as well as non-device associated infections). The Infection Control Practitioners (ICPs) in the Kingdom of Saudi Arabia used to collect the Surveillance data manually almost more than a decade back, and then shifted to an electronic Surveillance System few years back, International Nosocomial Infection Control Consortium (INICC). As conventional manual surveillance requires resources and standardization of definitions. Finally, a national, web based, semi-automated system of Health Electronic Surveillance Network (HESN) was developed in the year 2012, but the Surveillance module of Health care associated infections was started in late 2016. Pilot study was done initially for the period of few months in five MOH Hospitals and later 96 MOH Hospitals were added gradually by the end of year 2019. The system is first of its kind as it covers certain public health modules including surveillance, infectious diseases, immunizations of newborns, needle stick injuries, blood and body fluid exposures and dialysis events surveillance. The data is entered by the Infection control department in HESN, followed by Regional Coordinators and supervised by the office of General Directorate of Infection Prevention and Control. Data validation is done by the internal and external validation teams and surprise audit visits to the hospitals. In addition to advantages of being quick, safe and online data management, there are certain limitations as the system is new for most of the ICPs. Therefore, with the passage of time, almost all the Infection control practitioners will adopt it well.

Further Analysis of Attitude of Last Year Nursing Students in Nam Dinh University of Nursing for Blood and Body Fluids Prevention

This study conducted at Nam Dinh University of Nursing based on concept that Positive attitude towards occupational exposure can help nursing students self-correct their behavior in the prevention of blood and body fluid exposure. This paper aims to describe final-year nursing students’ attitude of Nam Dinh University of Nursing towards preventing exposures to blood and body fluids. Related to research methods, Final year full-time nursing students were randomly selected to answer questionnaires. Research results show The mean score of the attitude towards the prevention of exposure to blood and body fluids was 3.69 ± 0.22 points. In which, mean scores of students’ attitude towards severity; the importance of preventive measures; the role of solving, reporting, treating and monitoring post-exposure; self confidence; barriers to the practice of preventive measures are in turn 4,00 ± 0,41 points; 4,23 ± 0,43 points; 3,84 ± 0,48 points;2,8 ± 0,47 points; 3,61 ± 0,43 points. Authors conclude that attitude of final-year nursing students of Nam Dinh University of Nursing towards preventing exposures to blood and body fluids is moderate with mean score is 3,69 ± 0,22 points/5 points. Final-year nursing students have positive attitude towards severity and the importance of preventive measures but have negative attitude towards self confidence to do prevention measures to blood and body fluid exposures.

Further Analysis of Attitude of Last Year Nursing Students in Nam Dinh University of Nursing for Blood and Body Fluids Prevention

This study conducted at Nam Dinh University of Nursing based on concept that Positive attitude towards occupational exposure can help nursing students self-correct their behavior in the prevention of blood and body fluid exposure. This paper aims to describe final-year nursing students’ attitude of Nam Dinh University of Nursing towards preventing exposures to blood and body fluids. Related to research methods, Final year full-time nursing students were randomly selected to answer questionnaires. Research results show The mean score of the attitude towards the prevention of exposure to blood and body fluids was 3.69 ± 0.22 points. In which, mean scores of students’ attitude towards severity; the importance of preventive measures; the role of solving, reporting, treating and monitoring post-exposure; self confidence; barriers to the practice of preventive measures are in turn 4,00 ± 0,41 points; 4,23 ± 0,43 points; 3,84 ± 0,48 points;2,8 ± 0,47 points; 3,61 ± 0,43 points. Authors conclude that attitude of final-year nursing students of Nam Dinh University of Nursing towards preventing exposures to blood and body fluids is moderate with mean score is 3,69 ± 0,22 points/5 points. Final-year nursing students have positive attitude towards severity and the importance of preventive measures but have negative attitude towards self confidence to do prevention measures to blood and body fluid exposures.

Final-year nursing students' attitude of Nam Dinh University of Nursing towards preventing exposure to blood and body fluids

Positive attitude towards occupational exposure can help nursing students self-correct their behavior in the prevention of blood and body fluid exposure. Objective: Describe final-year nursing students’ attitude of Nam Dinh University of Nursing towards preventing exposures to blood and body fluids. Subject and method: Final year full-time nursing students were randomly selected to answer questionnaires. Results: The mean score of the attitude towards the prevention of exposure to blood and body fluids was 3.69 ± 0.22 points. In which, mean scores of students’ attitude towards severity; the importance of preventive measures; the role of solving, reporting, treating and monitoring post-exposure; self-confidence; barriers to the practice of preventive measures are in turn 4,00 ± 0,41 points; 4,23 ± 0,43 points; 3,84 ± 0,48 points;2,8 ± 0,47 points; 3,61 ± 0,43 points. Conclusion: attitude of final-year nursing students of Nam Dinh University of Nursing towards preventing exposures to blood and body fluids is moderate with mean score is 3,69 ± 0,22 points/5 points. Final-year nursing students have positive attitude towards severity and the importance of preventive measures but have negative attitude towards self-confidence to do prevention measures to blood and body fluid exposures.

Aerosol management in dentistry: An update for safe COVID-19 clinical practice

Bioaerosols and splatters generated by air syringes, ultrasonic scalers and high-speed turbine handpieces during dental treatment pose a potential hazard of infection not only to the patients but, to the dentists, dental hygienists, dental assistants as well as other healthcare workers. Severe infectious diseases such as Severe Acute Respiratory Syndrome (SARS), influenza, measles, tuberculosis, hepatitis, HIV AIDS can be transmitted through aerosols. With the emergence of β-coronavirus (COVID-19), questions concerning the protection from such viral transmission in the dental hospital setting have arisen due to close contact and its transmission through the exposure of saliva, blood and other body fluids. A systematic electronic search with relevant key terms viz. Aerosol Management, Dental Aerosols, Dentistry and COVID-19, Dental Unit Waterlines, Preprocedural Mouth rinsing, High Volume Suction Evacuators (HVE) and CDC Guidelines was executed in PubMed and Medline databases for literature extraction and data has been interpreted by including articles based on predefined inclusion criteria.In this review article, we address the importance of understanding and implementation dental safety by following various systems for the management of dental aerosols

Aerosol Management in Dentistry: An Update for Safe Covid-19 Clinical Practice

Patient safety and health worker safety from infectious diseases as well as occupational hazards is of utmost importance in every field of medicine. Bioaerosols and splatters generated by air syringes, ultrasonic scalers and high-speed turbine handpieces during dental treatment pose a potential hazard of infection not only to the patients but, to the dentists, dental hygienists, dental assistants as well as other healthcare workers. Severe infectious diseases such as Severe Acute Respiratory Syndrome (SARS), influenza, measles, tuberculosis, hepatitis, HIV AIDS can be transmitted through aerosols. With the emergence of β-coronavirus (COVID-19), questions concerning the protection from such viral transmission in dental hospital setting have arisen due to close contact and its transmission through the exposure of saliva, blood and other body fluids. Guidelines from regulatory organizations such as CDC regarding infection control in healthcare settings and infection prevention practices should be strictly followed.A systematic electronic search with relevant key terms viz. Aerosol Management, Dental Aerosols, Dentistry and COVID-19, Dental Unit Waterlines, Preprocedural Mouth rinsing, High Volume Suction Evacuators (HVE) and CDC Guidelines was executed in PubMed and Medline databases for literature extraction and data has been interpreted by including articles based on predefined inclusion criteria .In this review article, we address the importance of understanding and implementation of dental safety by following various systems for management of dental aerosols

Reducing Employee Injury Rates with a Hospital-wide Employee Safety Program.

Despite the well-known dangers of working in the healthcare industry, healthcare organizations have historically accepted workplace injuries as business as usual. In 2017, Children's National Hospital began our Employee and Staff Safety program to drive down the employee injury rate and address this disturbing industry trend. With guidance and support from executive leadership, we created an Employee and Staff Safety program that aligned employee safety work with existing patient safety and quality improvement efforts. Team leads collected and analyzed baseline employee injury data and identified areas of highest injuries. Dedicated subcommittees focused on five specific areas: slips, trips, and falls; sharps injuries; blood and body fluid exposures; verbal and physical violence; and overexertion injuries. Subcommittees established aims, identified key drivers, and brainstormed interventions for tests of change. Because the inception of the Employee and Staff Safety program, Children's National has seen significant reductions in our Days Away Restricted or Transfer (DART) rate. The DART rate shows a sustained 37% reduction since the baseline period of FY16-FY17 (1.48 injuries/200,000 h worked to 0.93 injuries/200,000 h worked). The regression trend shows a significant decrease (38.3%) in DART injuries, from 1.544 to 0.952 over 56 months; P = 0.016. Active leadership support and analyzing data on specific employee harm areas coupled with targeted interventions, helped improve Children's National's DART rate. The Employee and Staff Safety program's success in utilizing patient safety and quality improvement tools creates a generalizable framework for other hospitals to advance their high-reliability journey.

A Cross-Sectional Survey on Occupational Blood and Body Fluid Exposure Risk in a Tertiary Hospital in East Malaysia.

Background and AimHealthcare workers (HCWs) routinely experience occupational blood and body fluid exposure (OBBE), including percutaneous injury and splash exposure to non-intact skin. The objective of this study was to determine the prevalence of OBBE and identify associated risk factors.MethodsA cross-sectional study was performed on 334 HCWs at 9 workstations. Data were collected with a self-administered questionnaire that consisted of four parts: sociodemographic variables, work-related information, knowledge about needle stick and sharps injury and splash exposure, and information regarding previous OBBE incidents. The data were analyzed by SPSS version 22.0 software.FindingsThe prevalence of OBBE was 25.1% (95% confidence interval: 20.6–30.2), mostly due to percutaneous injuries, which were not reported to authorities. The highest proportions were among nurses and those working in the medical ward. Needle recapping practices were associated with almost a four-times higher risk of OBBE compared to no-recapping practices. HCWs who did not have any infection prevention training had a three-times higher risk of OBBE.ConclusionFactors associated with OBBE are unsafe work practices, inadequate infection prevention training, and lack of knowledge regarding blood-borne infection. There is a need for more training and increased awareness about the risks of OBBE to reduce unsafe practices.

Prevalence and associated factors of sharps injuries and other blood/body fluid exposures among healthcare workers: A multicenter study.

A multicenter study of sharps injuries (SIs) and other blood or body fluid (OBBF) exposures was conducted among 33,156 healthcare workers (HCWs) from 175 hospitals in Anhui, China. In total, 12,178 HCWs (36.7%) had experienced at least 1 SI in the previous 12 months and 8,116 HCWs (24.5%) had experienced at least 1 OBBF exposure during the previous 12 months.

Mobile application-assisted observation of hand hygiene practices among nurses in a tertiary care center: A cross-sectional study

BACKGROUND: Improper hand hygiene (HH) practices are responsible for nearly 40% of health care-associated infections (HCAIs). Good HH measures are the most cost-effective means of reducing its incidence. Health-care workers (HCWs) play an important role in reducing HCAI by adhering to HH and intensive care unit protocols. OBJECTIVES: The objectives of the study are to assess the knowledge regarding HH among nurses using a questionnaire and to assess compliance to the WHO's “My five moments of hand hygiene” among nurses using a mobile application (App). MATERIALS AND METHODS: This was an observational cross-sectional study in a tertiary care center conducted among 100 nurses willing to participate. Their knowledge on hand hygiene was assessed using the WHO questionnaire, and compliance to the WHO's “My five moments of hand hygiene” was assessed by direct observation and documentation using a mobile App (Speedy Audit™, freely downloadable, developed by Handy Metrics Corporation). The data on compliance were entered into the mobile App which saves it as a MS Excel sheet. The knowledge and compliance rate were then calculated using proportions. RESULTS: Of 100 nurses who participated in the study, 72% had good knowledge about HH practices. Overall compliance to “My five moments of hand hygiene” was 73.6%, with 100% compliance for “after body fluid exposure” and “after touching a patient” and 50% for “after contact with patient surroundings.” CONCLUSIONS: Our study has shown that nurses not only have good knowledge about HH practices but have also implemented it. Periodic awareness programs on HH and the provision of adequate hand washing facilities can facilitate better practices.

Safety culture implications on safe work practices and work place exposure incidents in Operation Theater.

Background & Objectives:The study was undertaken to estimate the prevalence of body and blood fluid exposure incidents such as needle stick injuries, direct contact, splashes, and cuts among health care personnel (HCP) in operation theaters (OTs). The study objective was to investigate perception of safety culture and potential challenges faced by HCP in Pakistani context.Methods:An analytical cross-sectional survey was conducted in four tertiary care hospitals of Rawalpindi and Islamabad that were Akbar Niazi Teaching Hospital (ANTH), Fauji Foundation Hospital (FFH), Benazir Bhutto Hospital (BBH) and Holy Family Hospital (HFH) during March, 2019 to June, 2019. The data of the current study was collected from surgical staff in OTs at four tertiary care teaching hospitals including nurses, house officers, post graduate trainees, registrars, consultants, and technicians in the twin cities i.e., Rawalpindi and Islamabad.Results:In our findings (N=367) there was a high prevalence of exposure incidents in past six months, 45% had had got a needle injury, 36% have got a splash, 28.8% had direct contact and 35.6% had a cut once respectively in past six months, the occurrence of exposure incidents twice, thrice and more is also enormous.Conclusion:The study reflected a dire need of trainings at hospitals so that very strategically the importance of safety being a priority and value of HCP is inculcated on daily basis.

Knowledge and practice of hand hygiene among the doctors of Patan Hospital, Nepal

Introduction: Hand hygiene is the most effective infection prevention measure. This research aims to find out the knowledge and practice of hand hygiene among the doctors of major departments of Patan Hospital.
 Method: A cross-sectional study was conducted among doctors of selected departments of Patan Hospital, Lalitpur, Nepal. The knowledge of hand hygiene was assessed using a WHO knowledge questionnaire. The practice was assessed using a WHO observation checklist. The data was recorded in Epi-info and the analysis was done for knowledge score and compliance with practice using SPSS v15. A p-value of <0.05 was considered statistically significant.
 Result: A total of 104 (98%) of the participants completed each part (knowledge and practice) of the study. The overall mean score (± SD) was 64% ± 8 on knowledge questions about hand hygiene. Knowledge of hand hygiene was not significantly different among departments (p=0.351) and gender (p=0.994). Out of 1022 opportunities, the compliance of hand hygiene among the doctors was 532(52%). The highest compliance for hand hygiene was after exposure to body fluids 93%. The mean time taken for hand rub was 8 seconds and the mean steps performed were 4 out of 8. Compliance with hand hygiene was statistically significant among departments (p= 0.001). However, it was not statistically significant among gender(p=0.198).
 Conclusion: Participants performed relatively well with a moderate score (64%) on knowledge questions but it was not reflected in practice (overall compliance 52%). The majority performed hand hygiene after body fluid exposure (93%) and after touching patients (64%).