Clinical Health Care Workers Research Articles

Conducting Human Biology Research Using Invasive Clinical Samples: Methods, Strengths, and Limitations.

Invasive biological samples collected during clinical care represent a valuable yet underutilized source of information about human biology. However, the challenges of working with clinical personnel and the invasive nature of sample collection in biomedical studies can hinder the acquisition of sufficiently large sample sizes for robust statistical analyses. In addition, the incorporation of demographic data from participants is crucial for ensuring the inclusiveness of representative populations, identifying at-risk groups, and addressing healthcare disparities. Drawing on both research experiences and the existing literature, this article provides recommendations for researchers aiming to undertake efficient and impactful projects involving invasive human samples. The suggested strategies include: (1) establishing productive collaborations with clinicians; (2) optimizing sample quality through meticulous collection and handling procedures; and (3) strategically implementing a retrospective model to capitalize on existing invasive sample repositories. When established, cooperative work between clinical health care workers and biological anthropologists can yield insights into human biology that have the potential to improve human health and wellbeing.

Preparedness of primary health care facilities on implementation of essential non-communicable disease interventions in Osun State South-West Nigeria: a rural–urban comparative study

BackgroundGlobal response to the growing burden of non-communicable diseases (NCDs) in developing countries includes the development of WHO Package of Essential Non-communicable Disease Interventions (WHO PEN) for Primary Health Care (PHC). The study assessed the level of preparedness of PHC facilities on implementation of essential NCD interventions in rural and urban Local Government Areas (LGAs) of Osun State, Nigeria.MethodsThe study was a comparative cross-sectional survey. Information was collected from heads of 33 rural and 33 urban PHC facilities and through direct observation on the domains of staff training, basic equipment, diagnostics and essential medicines for cardiovascular diseases, diabetes and chronic respiratory diseases (CRDs) using a semi-structured interviewer administered questionnaire.ResultsManual sphygmomanometer was found in similar proportions (84.8%) of PHC facilities in rural and urban LGAs. Glucometer was available in 45.5% of the PHC facilities in urban and 33.3% of the PHC facilities in the rural LGAs, the difference was not statistically significant (χ2 = 1.015; p = 0.314). Basic equipment for CRDs were not available in majority of PHC facilities in both locations. Moduretic tablets were the most reported essential NCD medicines, available in 15% of PHC facilities in rural LGAs and none in urban LGAs. The anti-diabetic medicines were not available in any of the PHC facilities in both locations. More than 90% (≥ 30) of the PHC facilities in both locations were not prepared to implement essential interventions for each NCD across domains of staff training and essential medicines. Overall, 97.0% of the PHC facilities in the rural LGAs and all the PHC facilities in urban LGAs were not prepared on implementation of essential interventions for the three NCDs.ConclusionThe level of preparedness of the PHC facilities on implementation of essential NCD interventions in the rural and urban LGAs of Osun State is very low. Government needs to strengthen the PHC system by providing needed essential medicines, basic diagnostics, equipment, and training of clinical health care workers for implementation of essential NCD interventions in the state.

Mental Health of Healthcare Workers during COVID-19 Pandemic in Taiwan: The First Wave Outbreak Occurred 1 Year Later Than in Other Countries.

We probed the psychological influence exerted on traumatic stress endured by healthcare workers (HCWs) and the coping behaviors adopted during the first wave of COVID-19 in Taiwan, which occurred one year later than in other countries. Clinical HCWs from two branches of a hospital network in Taichung, Taiwan, were recruited for this cross-sectional study. The participants were administered a questionnaire on sociodemographic and work-related characteristics, perceived influence exerted by COVID-19, coping behaviors in relation to COVID-19, and Impact of Event Scale-Revised scores. We obtained 769 valid questionnaires. A chi-square test, generalized linear modeling, and multivariate stepwise regression analyses were performed. Although the first wave of COVID-19 occurred one year later in Taiwan than in other countries, the traumatic stress experienced by Taiwanese HCWs was noted to be comparable to that of those in other countries. Factors for increased traumatic stress included caring for more patients with COVID-19, fair or poor self-rated mental health, higher perceived influence of COVID-19, vulnerable household income, and more negative coping behaviors. Positive coping behaviors such as exposure reduction and protection measures decreased traumatic stress. Accordingly, managers should strengthen protective measures, enhance COVID-19-related training, and provide psychological support and counseling for high-risk employees.

Knowledge, Attitude, And Practice Regarding Use of Face Mask Among Health Care Workers as a Measure of Covid-19 Infection Prevention in Federal Medical Centre, Asaba, Delta State Nigeria

Introduction: Effective use of Face mask is very important to protect healthcare workers (HCWs) against respiratory hazards including COVID-19.Several countries are presently using face masks in their infection control plans, besides, incorrect use and disposal may actually increase the rate of transmission. The purpose of this study was to investigate the knowledge, attitude, and practices of healthcare workers (HCWs) regarding the use of face mask as a measure to COVID-19 infection prevention. Materials and Methods: This survey was conducted by interviewing 345 HCWs using a questionnaire consisting of the demographic characteristics, questions regarding the knowledge, attitude, and practices of use of face mask. Each correct answer was scored 1 and each incorrect answer scored 0. The total number of questions were 25; 10 for Knowledge, 8 for Practice and 7 for Attitude of heath care workers on the use of face mask. The final aggregate score was calculated and then labeled according to the percentage of correct responses as good >50% and poor < 50% for Knowledge, Practice and Attitude of health care workers on use of face mask. Data were gathered, analyzed using SPSS software version 25. Results: A total of 345 participants with a mean age of 36.0 years (108 males and 237 females) were included in the study. The Health care workers were good in Knowledge 324 (93.9%), attitude 250 (72.5%), and practice 282(81.7%) regarding use of face mask. However clinical HCW had good knowledge(X2 = 13.84, P value = 0.001, 95% CI= 0.08-0.51) and attitude(X2= 13.80, p value = 0.0001, 95% CI=0.21-0.6) of use of face mask than Non Clinical HCW when compared with their practice(X2=1.10, p value = 0.30, 95 % CI=0.40-1.35) Conclusions: Knowledge, attitude of HCWs regarding the use of face masks were found to be adequate. but moderate-to-poor level of practice regarding the use of face mask. HCWs and general public to create awareness regarding the proper use of face mask by utilizing all social media. Provision of user friendly mask by government to the hospitals and at affordable rate to the public in order to improve their level of practice in wearing the masks.

AWARENESS AND KNOWLEDGE ABOUT DENTAL BIOMEDICAL WASTE MANAGEMENT AMONG HEALTH CARE WORKERS OF GUJARAT, INDIA

Objective: The aim of this study was to assess the knowledge, attitudes, and practices related to medical waste management (MWM) among healthcare workers in clinics. Methods: The introduced study was an enlightening cross-sectional study. A self-directed poll was intended to record age, sex, kind of training, long stretches of training, extra preparation, information and practices on risky dental waste and information, and practice of security measures against cross-disease. The review populace included dental specialists and other medical services laborers of our emergency clinic. No data were accessible about the information on dental specialists with respect to the board of dangerous waste. From each state on India, Health-care laborers were chosen haphazardly from the rundown. A self-controlled poll was asked to the 200 medical care laborers. Overall response rate was 63% (n=200). Identity of the respondents was kept confidential. Results: A total of 200 questionnaires were distributed. Returns were 150 questionnaires with 55% males and 45% females. Only 42% of respondents were aware of the existence of guidelines of waste management. From this study, it was found that majority of study populations were not aware about the management of biomedical waste. Conclusion: Our study showed that although the attitude toward biomedical waste management was highly positive among students and they understood the importance of managing hazardous waste, the knowledge and practice still have scope for improvement. Regular monitoring and training are required at all levels for the management of hazardous dental wastes. Waste management program should be a part of academic curriculum and continuing dental education.

Clinical evaluation of an electronic hand hygiene monitoring system

BackgroundWe aimed to test the accuracy of an electronic hand hygiene monitoring system (EHHMS) during daily clinical activities in different wards and with varying health care professions. MethodsThe accuracy of an EHHMS (Sani Nudge) was assessed during real clinical conditions by comparing events registered by two observers in parallel with events registered by the EHHMS. The events were categorized as true-positive, false-positive, and false-negative registrations. Sensitivity and positive predictive value (PPV) were calculated. ResultsA total of 103 events performed by 25 health care workers (9 doctors, 11 nurses, and 5 cleaning assistants) were included in the analyses. The EHHMS had a sensitivity of 100% and a PPV of 100% when measuring alcohol-based hand rub. When looking at the hand hygiene opportunities of all health care workers combined taking place in the patient rooms and working rooms, the sensitivity was 75% and the PPV 95%. For doctors’ and nurses’ taking care of patients in their beds the EHHMS had a sensitivity of 100% and a PPV of 94%. ConclusionsThe objective accuracy measures demonstrate that this EHHMS can capture hand hygiene behavior under clinical conditions in different settings with clinical health care workers but show less accuracy with cleaning assistants.

Knowledge, Attitudes, and Practices Regarding COVID-19 among Healthcare Workers in Uganda: A Cross-Sectional Survey.

Healthcare workers (HCWs) are at high risk of COVID-19. However, data on HCWs’ knowledge, attitudes, and practices (KAP) toward COVID-19 are limited. Between September and November 2020, we conducted a questionnaire-based COVID-19 KAP survey among HCWs at three hospitals in Uganda. We used Bloom’s cut-off of ≥80% to determine sufficient knowledge, good attitude, and good practice, and multivariate Poisson regression with robust variance for statistical analysis. Of 717 HCWs invited to participate, 657 (91.6%) agreed and were enrolled. The mean age (standard deviation) of enrollees was 33.2 (10.2) years; most were clinical HCWs (64.7%) and had advanced secondary school/other higher-level education (57.8%). Overall, 83.9% had sufficient knowledge, 78.4% had a positive attitude, and 37.0% had good practices toward COVID-19. Factors associated with KAP were: Knowledge: being a clinical HCW (aRR: 1.12; 95% CI: 1.02–1.23) and previous participation in health research (aRR: 1.10; 95% CI: 1.04–1.17); Attitude: age > 35 years (aRR: 0.88; 95% CI: 0.79–0.98); Practice: being a clinical HCW (aRR: 1.91; 95% CI: 1.41–2.59). HCWs in Uganda have good knowledge and positive attitude but poor practices towards COVID-19. Differences in COVID-19 KAP between clinical and non-clinical HCWs could affect uptake of COVID-19 interventions including vaccination.

Psychological impact of the second wave of the COVID-19 pandemic on non-frontline healthcare workers: results of a cross-sectional study in a tertiary care hospital in India

Background: The first wave of the COVID-19 pandemic affected millions of people physically and many more psychologically. Health care workers (HCWs) are amongst those bearing the brunt of the pandemic-induced psychological trauma. This study was one of the first to analyze the psychological effects of the second pandemic wave in India on non-frontline HCWs, a group that has not received much consideration so far.Methods: A cross-sectional survey-based study was performed on a COHORT of 139 HCWs involved in non-covid services during the early phase of the second pandemic wave. In addition to information on demographics and other baseline characteristics, the survey included questions from the depression, anxiety, and stress scale-21 items (DASS-21).Results: The prevalence rates of depression, anxiety and stress in the COHORT were 14.33%, 15.82% and 12.23% respectively. Clinical HCWs had higher mean anxiety scores than the non-clinical group (p=0.01), while the depression and stress scores were similar across all groups (p=0.23 and 0.21, respectively). Multivariate analysis demonstrated correlation of multiple factors with the DASS-21 scores, of which covid positivity and a longer time spent on covid-related information correlated well with all the DASS-21 scale scores (p<0.05).Conclusions: This study demonstrates reasonable prevalence rates of depression, stress and anxiety amongst non-frontline HCWs in the setting of the second covid wave in India. Clinical HCWs seem to be more prone to pandemic-induced anxiety during this wave. There is an urgent need for promoting psychological coping strategies amongst all classes of HCWs.

Job type, neighborhood prevalence, and risk of coronavirus disease 2019 (COVID-19) among healthcare workers in New York City.

In this study, we compared the risk of coronavirus disease 2019 (COVID-19) between clinical and nonclinical healthcare workers (HCWs) while adjusting for home ZIP codes. Clinical HCWs did not have a higher risk of COVID-19, but living in higher-risk ZIP codes was associated with increased infection rates. However, environmental services workers showed increased risk of COVID-19.

The Level of Expression of Anxiety and Depression in Clinical Health Care Workers during the COVID-19 Outbreak in 2 Hospitals in Hanoi, Vietnam.

The disease caused by the SARS-Cov 2 virus has spread to most areas of the world with high rates of infection and deaths. Facing the complicated developments of the epidemic, clinical medical staff (CMS) are at risk of suffering psychological pressure. This study aimed to investigate the situation of anxiety, depression, and related factors affecting CMS during the COVID-19 pandemic at Dong Da General Hospital and Dong Anh General Hospital in Hanoi. A cross-sectional study was conducted from April to July 2020 using self—administered questionnaires amongst 341 CMS. The participants’ anxiety levels were assessed using the standardized General Anxiety Disorder-7 (GAD-7) toolkit and levels of depression expression were assessed based on the standardized Patient Health Questionnaire-9 (PHQ-9) toolkit. Of the CMS who completed the questionnaire, 33.1% had an anxiety disorder and 23.2% exhibited mild to very severe depression. The factors associated with anxiety and depression were department of work, shortage of human resources, and discrimination from the community that directly affects the family of the CMS. The study results highlight the need for a training session to equip CMS with the skills required to cope with psychological stress in all circumstances in general and during the pandemic in particular. This training is especially important for those working in at-risk departments which are susceptible to infection.

A 5-Year Review of Invasive Fungal Infection at an Academic Medical Center.

Background: Invasive fungal infection (IFI) is one of the most common nosocomial infections. However, data on the epidemiology of IFI and susceptibility to antifungal agents in China are quite limited, and in particular, no current data exist on the microbiological, and clinical characteristics of IFI patients in Northeast China.Objectives: The purpose of this study was to provide a retrospective review of the clinical characteristics, laboratory test results, and risk factor predictions of inpatients diagnosed with IFI. Multivariate regression analysis was used to assess prognostic factors associated with the mortality of these patients.Methods: We retrospectively analyzed the results from 509 patients with IFI extracted from the First Hospital of China Medical University from January 2013 to January 2018.Results: Neutrophil numbers, total bilirubin, length of stay in the ICU, renal failure, use of immunosuppressants within the past 30 days, stomach tube placement and septic shock were risk factors for death from IFI. Recent surgery (within 2 weeks) and drainage tube placement did not increase mortality in these IFI patients. Increased serum levels of PCT (AUC 0.601, 95% CI 0.536–0.665, P = 0.003) and CRP (AUC 0.578, 95% CI 0.512–0.644, P = 0.020) provided effective predictors of 30-day mortality rates.Conclusions: We report for the first time epidemiological data on invasive fungal infections in Northeast China over the past 5 years. Despite the limited available clinical data, these findings will greatly aid clinical health care workers with regard to the identification, prevention, and treatment of IFI in hospitalized patients.

Assessment of Knowledge, Attitude, and Practice in respect of Medical Waste Management among Healthcare Workers in Clinics.

Medical waste represents a significant health risk and an environmental pollution concern due to its hazardous characteristics. The knowledge and practice of healthcare personnel in respect of the disposal of medical waste is essential to perform effective medical waste management. Therefore, the aim of this study was to assess the knowledge, attitudes, and practices related to medical waste management among healthcare workers in clinics (medical and dental clinics, specialized medical, laboratory clinics, polyclinics, and midwifery clinics) in Phuket, Thailand. A cross-sectional study was designed with stratified-random sampling used to select the sample of 344 respondents from 172 clinics of which data were collected using face-to-face interviews. The results showed that the majority of respondents (87.2%) were female of whom 36.9% were aged (20–29), 52.0% had more than 5 years working experience, and 51.2% had participated in at least one training course regarding medical waste management. The overall scores for knowledge, attitude, and practice were at a high level (89.5%, 91.9%, and 92.2%, respectively). Significant and positive correlations were found between knowledge and attitude (r = 0.464), knowledge and practice (r = 0.396), and practice and attitude (r = 0.519). Statistical analysis using t tests and one-way analysis of variance showed that working experience and its duration were significant factors influencing good medical waste management practice. However, local authorities should implement a well-planned collection and transfer process for medical waste in order to reduce the risk of environmental pollution and the risk of infection or injury to healthcare workers and the general public.

Health system capacity in Sydney, Australia in the event of a biological attack with smallpox.

Planning for a re-emergent epidemic of smallpox requires surge capacity of space, resources and personnel within health systems. There are many uncertainties in such a scenario, including likelihood and size of an attack, speed of response and health system capacity. We used a model for smallpox transmission to determine requirements for hospital beds, contact tracing and health workers (HCWs) in Sydney, Australia, during a modelled epidemic of smallpox. Sensitivity analysis was done on attack size, speed of response and proportion of case isolation and contact tracing. We estimated 100638 clinical HCWs and 14595 public hospital beds in Sydney. Rapid response, case isolation and contact tracing are influential on epidemic size, with case isolation more influential than contact tracing. With 95% of cases isolated, outbreak control can be achieved within 100 days even with only 50% of contacts traced. However, if case isolation and contact tracing both fall to 50%, epidemic control is lost. With a smaller initial attack and a response commencing 20 days after the attack, health system impacts are modest. The requirement for hospital beds will vary from up to 4% to 100% of all available beds in best and worst case scenarios. If the response is delayed, or if the attack infects 10000 people, all available beds will be exceeded within 40 days, with corresponding surge requirements for clinical health care workers (HCWs). We estimated there are 330 public health workers in Sydney with up to 940,350 contacts to be traced. At least 3 million respirators will be needed for the first 100 days. To ensure adequate health system capacity, rapid response, high rates of case isolation, excellent contact tracing and vaccination, and protection of HCWs should be a priority. Surge capacity must be planned. Failures in any of these could cause health system failure, with inadequate beds, quarantine spaces, personnel, PPE and inability to manage other acute health conditions.

Building Health System Capacity Through Implementation Research: Experience of INSPIRE-A Multi-country PMTCT Implementation Research Project.

Background:The INSPIRE—Integrating and Scaling Up PMTCT through Implementation REsearch—initiative was established as a model partnership of national prevention of mother-to-child transmission of HIV (PMTCT) implementation research in 3 high HIV burden countries—Malawi, Nigeria, and Zimbabwe. INSPIRE aimed to link local research groups with Ministries of Health (MOH), build local research capacity, and demonstrate that implementation research may contribute to improving health care delivery and respond to program challenges.Methodology:We used a mixed methods approach to review capacity building activities, as experienced by health care workers, researchers, and trainers conducted in the 6 INSPIRE projects before and during study implementation.Results:Between 2011 and 2016, over 3400 health care workers, research team members, and community members participated in INSPIRE activities. This included research prioritization exercises, proposal development, good clinical practice and research ethics training, data management and analysis workshops, and manuscript development. Health care workers in clinics and district health offices acknowledged the value of hosting implementation research projects and how the quality of services improved. Research teams acknowledged the opportunities that projects provided for personal development and the value of participating in a multicountry research network.Discussion:INSPIRE provided an opportunity for African-led research in which researchers worked closely with national MOH to identify priority research questions and implement studies. Close partnerships between research teams and local implementers facilitated project responsiveness to local program issues. Consequently, processes and training needed for study implementation also improved local program management and service delivery. Additional benefits included improved data management, publications, and career development.

The current situation and influencing factors of self efficacy in patients with differentiated thyroid cancer treated with radioactive iodine

Objective:To evaluate the level of self management efficacy of differentiated thyroid cancer patients with RAI, and to analyze the influencing factors.Method:The Chinese version of SUPHH questionnaire, medical coping questionnaire, hospital anxiety and depression scale and patients general condition questionnaire were used to investigate 363 patients.Result:The self-management efficacy score of the patients is 89.71±19.45. The results of multiple linear regression showed that the depression, face, avoidance, yield, character, pathological stage and the knowledge were the main influencing factors of self management efficacy.Conclusion:The sense of self management efficacy of differentiated thyroid cancer patients with the RAI treatment is in the middle level, and needs to be improved. Clinical health care workers can refer to the factors and help patients to develop disease self-management programs and finally to improve the quality of patients life.

Common occupational health hazards amongst Health care workers in a Tertiary Health Institution in Bida, North-central Nigeria

Background: Health care workers are continually exposed to occupational health hazards. The study aimed to assess the prevalence of some occupational health hazards and their reporting behavior . Methods: A hospital based cross-sectional study was conducted in August 2014 among health care workers in Bida, Northcentral Nigeria. A total of 200 health care workers from all the departments were included using the multi-staged random sampling technique. Relevant quantitative and qualitative data were collected using semi-structured self-administered questionnaire. The participants were divided into clinical health care workers and non-clinical health care workers. The frequency distribution of the variables were calculated and presented in the form of frequency tables and figures. Results : The overall prevalence of occupational health hazard was 56.8% (n = 108). The most common occupational health hazard among clinical health care workers were needle stick injury (40.7%) and infections with hepatitis B and C viruses (13.9%) and among the non-clinical health care workers were stress (32.8%) and back pain (10.3%). Majority of the health care workers who had occupational health hazards reported appropriately to the committee concerned. Conclusions: Occupational health hazards are common among hospital health care workers and were adequately reported. Training of the health workers on measures to mitigate these hazards may also enhance the reporting behavior and its management when it occurs.

Est-il utile pour les soignants de tester systématiquement VIH, HCV, et HBV avant une chirurgie programmée ?

IntroductionOccupational infection of clinical health care workers with blood-borne viruses (BBVs), like human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) is a current and often emotionally discussed issue. HCV and especially HIV are still stigmatized. The consequence is a broad and maybe irrational fear of professional health care workers being infected occupationally. Therefore, we assessed preoperative screening to: (1) answer whether this can detect not previously diagnosed blood-borne virus infections to a great extent; (2) calculate a cost/benefit ratio to find out, if the screening's potential ability to prevent occupational transmission of BBVs to health care workers faces unjustifiable high costs. HypothesisPreoperative routine screening is limited suitable for enhancement of detecting fomites compared to interview the patient. Materials and methodsRetrospective cohort study of preoperative screening for HIV, HBV and HCV (HBsAg, anti-HCV and HIV-Ab/Ag-combination) for every patient who was admitted to the traumatologic department for elective arthroplasty between 01/01/1997 and 31/12/2008. ResultsA total of 1534 patients underwent elective prosthetic surgery [total hip (879) and knee arthroplasty (508), followed by shoulder, elbow and upper ankle joint]. Six hundred and ninety-three (45.2%) patients were male, 841 (54.8) female. Mean age was 64.2±13.8years. Screening tests were available for 1373 patients (89.5%). Among all screened patients, we found 21 HCV, 10 HBV and 1 HIV infections. Five HBV (0.5%) and 7 HCV infections (0.7%) were unknown before. Every newly detected infectious patient occasions screening costs about 7250€. Considering this data, the risk of HCV transmission from an index patient with unknown status of infectiousness to health care worker after percutaneous contact to blood is 0.08‰ and of HIV transmission is 0.00054‰ in our study population. DiscussionRoutine preoperative screening for BBVs of patients undergoing elective arthroplasty, who were asked for HBV, HCV and HIV, should be reconsidered and is in times of sparse funds overpriced. Level of evidenceIV.

Study of TCM clinical records based on LSA and LDA SHTDT model.

Description of syndromes and symptoms in traditional Chinese medicine are extremely complicated. The method utilized to diagnose a patient's syndrome more efficiently is the primary aim of clinical health care workers. In the present study, two models were presented concerning this issue. The first is the latent semantic analysis (LSA)-based semantic classification model, which is employed when the classification and words used to depict these classfications have been confirmed. The second is the symptom-herb-therapies-diagnosis topic (SHTDT), which is employed when the classification has not been confirmed or described. The experimental results showed that this method was successful, and symptoms can be diagnosed to a certain extent. The experimental results indicated that the topic feature reflected patient characteristics and the topic structure was obtained, which was clinically significant. The experimental results showed that when provided with a patient's symptoms, the model can be used to predict the theme and diagnose the disease, and administer appropriate drugs and treatments. Additionally, the SHTDT model prediction results did not yield completely accurate results because this prediction is equivalent to multi-label prediction, whereby the drugs, treatment and diagnosis are considered as labels. In conclusion, diagnosis, and the drug and treatment administered are based on human factors.

Is there a benefit for health care workers in testing HIV, HCV and HBV in routine before elective arthroplasty?

IntroductionOccupational infection of clinical health care workers with blood-borne viruses (BBVs) like human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) is a current and often emotionally discussed issue. HCV and especially HIV are still stigmatized. The consequence is a broad and maybe irrational fear of professional health care workers being infected occupationally. Therefore, we assessed preoperative screening to: (1) answer whether this can detect not previously diagnosed blood-borne virus infections to a great extent, (2) calculate a cost-benefit ratio to find out, if the screening's potential ability to prevent occupational transmission of BBVs to health care workers faces unjustifiable high costs. HypothesisPreoperative routine screening is limited suitable for enhancement of detecting fomites compared to interview the patient. Materials and methodsRetrospective cohort study of preoperative screening for HIV, HBV and HCV (HBsAg, anti-HCV and HIV-Ab/Ag-Combination) for every patient who was admitted to the traumatologic department for elective arthroplasty between 01/01/1997 and 31/12/2008. ResultsAmong the 1534 patients who underwent elective prosthetic surgery [total hip (879) and knee arthroplasty (508), followed by shoulder, elbow and upper ankle joint], 693 (45.2%) patients were male and 841 (54.8) female. Mean age was 64.2±13.8 years. Screening tests were available for 1373 patients (89.5%). Among all screened patients, we found 21 HCV, 10 HBV and 1 HIV infections. 5 HBV (0.5%) and 7 HCV infections (0.7%) were unknown before. Every newly detected infectious patient occasions screening costs about 7250€. Considering this data, the risk of HCV transmission from an index patient with unknown status of infectiousness to health care worker after percutaneous contact to blood is 0.08 ‰ and of HIV transmission is 0.00054 ‰ in our study population. DiscussionRoutine preoperative screening for BBVs of patients undergoing elective arthroplasty, who were asked for HBV, HCV and HIV, should be reconsidered and is, in times of sparse funds, overpriced. Level of evidenceIV.

Injection safety knowledge and practices among clinical health care workers in Garissa provincial general hospital

Background : The World Health Organization estimates that approximately 16 billion injections are administered in developing countries annually. Injection safety is therefore critical in preventing occupational exposure and infection from blood borne pathogens, hence prevention is a vital part of any comprehensive plan for protecting health workers, patients and maintaining a safe environment. Objective : To determine the knowledge and practice of injection safety among clinical healthcare workers at the Garissa Provincial General Hospital. Design : A cross-sectional descriptive study. Setting : The Garissa provincial General Hospital from September 2011 to July 2012. Results : Injection safety knowledge was high with a score of 12.65 (SD ± 2.3) out of the total of 16 items. Appropriate injection safety practices were reported by most of the respondents. The level of knowledge was not significantly associated with respondents’ demographic characteristics(p>0.05), but was significantly associated with hand washing practice(p<0.05).Inferences were made on an appropriate injection safety practices like non-recapping of needles, hand washing and proper waste management. Drug administration practice varied in the different departments (p=0.043) and recapping of needles was significantly associated with training (p=0.047), designation (p=0.02) and area of deployment (p=0.017). Conclusion : Knowledge on injection safety was high but reported and observed practices were below the set standard. Risky practices such as recapping used syringes, re-use of disposable syringes and overfilling of sharp boxes were observed. There was insufficient provision of injection safety equipment, Poor waste handling and inadequate personal protective gear. Over prescription of unnecessary injections was widespread.