Hollow-bore Needles Research Articles

Effect of Needle Size on Pain Perception in Patients Treated With Botulinum Toxin Type A Injections: A Randomized Clinical Trial.

Transcutaneous injection through smaller hollow-bore needles may decrease patient discomfort, but current evidence is equivocal. To compare injection discomfort in patients treated with botulinum toxin type A with 30- and 32-gauge needles. Split-face, patient- and injector-blinded randomized clinical trial at the dermatology service of an urban university medical center. The 20 participants were women aged 25 to 70 years in good health and with moderate dynamic forehead and glabellar wrinkles. Data were collected from November 20, 2013, through January 16, 2014. Follow-up was complete on January 16, 2014. Data from the per-protocol population were analyzed from July 1 to July 31, 2014. One side of each patient'sforehead received botulinum toxin type A in saline injected with a 32-gauge needle; the other side received the same treatment injected with a 30-gauge needle. In addition, each patient received randomized injections of saline only to both upper inner arms with the same types of needles. Primary outcomes included the patient-reported pain rating on a visual analog scale (VAS) on either side of the face and arms and the proportion of patients whose VAS ratings corresponded with more than moderate (ie, clinically significant) pain. The secondary outcome consisted of patient-reported information about the character of the pain at both sites using the expanded and revised version of the Short-Form McGill Pain Questionnaire. All 20 patients completed the study. Overall, facial and arm injections were nominally but not significantly more painful with 30-gauge needles (mean [SD] VAS ratings for the face, 4.16 [2.55] vs 3.41 [2.31], P = .34; for the arm, 1.66 [2.07] vs 1.21 [1.65], P = .45). For facial injections, the likelihood of clinically significant pain (VAS rating, ≥5.4) was significantly greater with 30-gauge needles, which were associated with such pain in 8 patients (40%) compared with the 32-gauge needles, which were associated with such pain in 3 patients (15%) (odds ratio, 3.80 [95% CI, 1.05-13.78]; P = .04). No difference was found in the character of pain associated with needle bore (P > .05 for all comparisons). For facial injections of neurotoxin in saline, 30-gauge needles were associated with greater incidence of clinically significant pain than 32-gauge needles. For patients prone to experience clinically significant pain with facial injections, use of 32-gauge needles may minimize this discomfort. clinicaltrials.gov Identifier: NCT01981174.

Post-exposure prophylaxis against Ebola virus disease with experimental antiviral agents: a case-series of health-care workers

Although a few international health-care workers who have assisted in the current Ebola outbreak in west Africa have been medically evacuated for treatment of Ebola virus disease, more commonly they were evacuated after potential accidental exposure to Ebola virus. An urgent need exists for a consensus about the risk assessment of Ebola virus transmission after accidental exposure, and to investigate the use of post-exposure prophylaxis (PEP). Experimental vaccines have occasionally been used for Ebola PEP, but newly developed experimental antiviral agents have potential advantages. Here, we describe a new method for risk assessment and management of health-care workers potentially exposed to Ebola virus and report the use of experimental antiviral therapies for Ebola PEP in people. We devised a risk assessment and management algorithm for health-care workers potentially exposed to Ebola virus and applied this to eight consecutive individuals who were medically evacuated to the UK from west Africa between January, and March, 2015. PEP with antiviral agents was given to health-care workers assessed to have had substantial risk exposures to Ebola virus. Participants were followed up for 42 days after potential exposure. Four of eight health-care workers were classified as having had low risk exposures and managed by watchful waiting in the community. None of these health-care workers developed Ebola virus disease. The other four health-care workers had intermediate or maximum risk exposures and were given PEP with antiviral agents. PEP was well tolerated with no serious adverse effects. None of these four health-care workers, including two with maximum risk exposures from penetrating injuries with freshly used hollow-bore needles, developed Ebola virus disease. Standardised risk assessment should be adopted and consensus guidelines developed to systematically study the efficacy and safety of PEP with experimental agents. New experimental antiviral treatments are a viable option for PEP against Ebola. Royal Free London NHS Foundation Trust.

Needle Stick Injuries and their Related Safety Measures among Nurses in a University Hospital, Shiraz, Iran.

BackgroundThis study aimed to determine the prevalence and factors related to needle stick injuries (NSIs) and to assess related safety measures among a sample of Iranian nurses.MethodsIn this cross-sectional study, a random sample of 168 registered active nurses was selected from different wards of one of the hospitals of Shiraz University of Medical Sciences (SUMS). Data were collected by an anonymous questionnaire and a checklist based observational method among the 168 registered active nurses.ResultsThe prevalence of NSIs in the total of work experience and the last year was 76% and 54%, respectively. Hollow-bore needles were the most common devices involved in the injuries (85.5%). The majority of NSIs occurred in the morning shift (57.8%) and the most common activity leading to NSIs was recapping needles (41.4%). The rate of underreporting NSIs was 60.2% and the major reasons for not reporting the NSIs were heavy clinical schedule (46.7%) and perception of low risk of infection (37.7%). A statistically significant relationship was found between the occurrence of NSIs and sex, hours worked/week, and frequency of shifts/month.ConclusionThe study showed a high prevalence of NSIs among nurses. Supportive measures such as improving injection practices, modification of working schedule, planning training programs targeted at using personal protective equipment, and providing an adequate number of safety facilities such as puncture resistant disposal containers and engineered safe devices are essential for the effective prevention of NSI incidents among the studied nurses.

Knowledge, Awareness and Practice Regarding Needle Stick Injuries in Dental Profession in India.

DEAR EDITOR, Needle stick injuries (NSIs) has always been one of the most important risk factor for health care workers (HCWs) for transmission of various infections such as hepatitis B, hepatitis C, and human immunodeficiency virus.[1] Variety of procedures like needle recapping, injuries sustained in the operating room, blood collection or intravenous line administration, suturing, checking blood sugar etc., can lead to accidental NSIs [Table 1].[2,3] Although modern dentistry has been cited as the least hazardous of the all the occupations, risks like NSI still challenge the status of this occupation.[4] Compared with many other health care settings, dental professionals are at higher risk of acquiring infections due to the fact that dentists work in a limited-access and restricted-visibility field and frequently use sharp devices.[5] Table 1 Various determinants of NSIs Every year about 16 billion injections are administered in developing and transitional nations and approximately three million individuals are injured annually due to needle stick and sharp injuries.[6] These types of blood-borne exposures can be career and life-ending. There is gross under reporting of NSI and therefore the incidence of NSI is higher than the current estimates.[7] In developing countries such as Ghana, Indonesia and Uganda, 80–90% of patients who visited a health center received one or more injections per visit.[8] Another study reported a high incidence of needle stick and sharp injuries among HCWs in Jordan.[9] In a country like India, in spite of large number of awareness programs, it is not possible to estimate the annual incidence of NSI in different occupations because of scarcity of data.[1] Very few studies that have been conducted among dental HCWs reporting their knowledge, awareness and practice regarding NSI. Findings of a study conducted on dental students reported that on an average 89.23% of the students had correct knowledge about NSI and 89% of them were aware of taking postexposure prophylaxis (PEP) after an accidental NSI.[10] According to some other study reports, 11% of the students were not aware that the virus could be transmitted through infected needles and found that 44% of the students would destroy the needle using needle destroyer and 15% would destroy in puncture-resistant container with disinfectant.[11] Only 39.8% of the health care students could correctly define sharp instrument injury in some other study reports and 75.4% of the students experienced sharp instrument injuries during the last 1-year and 52.3% of the sharp instrument injuries occurred during administration of local anesthetic injection.[12] Reports of another study revealed that 88% of the dental students were aware of the occupational blood-borne diseases, and 75% of them reported exposures majority of who were postgraduate students.[13] It can be concluded that knowledge, awareness and practices of the dental students in among different studies is adequate though there is considerable variation in practice and management of NSI. Not every NSI can be preventable, but according to research 83% of injuries from hollow-bore needles can be prevented.[14] The present article also concludes that for prevention of NSI, knowledge and awareness amongst dental HCWs should be increased. More studies should be conducted involving dentists and other dental professionals as there is scarcity of literature on knowledge and awareness levels of dentists in India. Various health and safety measures can be adopted to decrease the incidence of NSI. Workers should be properly trained Personal protective equipment and clothing should be provided An effective occupational health and safety program should be established that includes immunization, PEP, medical and dental surveillance.

Knowledge, attitude, and practice of needle stick and sharps injuries among dental professionals of Bangalore, India.

Background:A needle stick injury (NSI) is an accidental skin-penetrating stab wound from a hollow-bore needle containing another person's blood or body fluid. Healthcare workers (HCWs) including dental professionals are at an occupational risk of exposure to blood-borne pathogens following NSIs and sharps injuries (SIs). A thorough understanding of the safe practices while handling needles and sharps is crucial for HCWs to create a risk-free work place environment.Aims and Objectives:To assess the knowledge, attitude, practice, and prevalence of NSIs and SIs among dental professionals in a dental college at Bangalore.Materials and Methods:A cross-sectional survey was conducted in September 2012 using a structured, pretested, guided interview-based questionnaire that was administered to 200 dental professionals in a dental college at Bangalore to assess the knowledge, attitude, practices, and self-report information of NSIs.Results:In the present study, 81.5% of dental professionals were vaccinated against hepatitis B. A total of 27.5% participants had an NSI during the previous 12 months. About 41.80% of NSIs occurred during device recapping. Most common reason for failure to report the incidents of NSIs, as declared by 29.09% of the participants, included the fear of being blamed or getting into trouble for having an NSI.Conclusion:The knowledge of dental professionals on NSIs and their preventive measures are inadequate; however, training on Universal Precaution Guidelines, protocols regarding post-exposure prophylaxis, and safety devices has to be provided to prevent such injuries in future among the dental professionals.

From clinician to suspect case: my experience after a needle stick in an Ebola treatment unit in Sierra Leone.

While providing clinical care in the confirmed ward of the Ebola Treatment Unit (ETU) at the Kenema Government Hospital (KGH) in Kenema, Sierra Leone, I accidentally stuck an 18-gauge hollow-bore needle deep into my left thumb. I could immediately feel some blood oozing under my gloves, and I squeezed the area of penetration to try to promote additional bleeding. I rinsed the outside of my gloves with the only available option—0.5% bleach. In an ETU, one cannot simply remove one's gloves and clean one's hands with soap and water as one would with a needle stick in other clinical environments. After the momentary shock and embarrassment subsided, I notified my clinical partner about what transpired and then called by radio to have an urgent egress from the ETU.

Occupational Injuries Prone to Infectious Risks amongst Healthcare Personnel in Kuwait: A Retrospective Study

Objective: The study aimed at determining the prevalence of incident occupational exposure to blood and other potentially infectious materials (OPIM) among healthcare personnel (HCP) during 2010 and at evaluating the factors associated with these incidents. Subjects and Methods: An epidemiological, retrospective, record-based study was conducted. All self-reported incidents of occupational exposure to blood and OPIM among HCP from all healthcare settings of the Kuwait Ministry of Health during 2010 were included. Results: The total number of the exposed HCP was 249. The prevalence of incident exposure was 0.7% of the HCP at risk. Their mean age was 32.31 ± 6.98 years. The majority were nurses: 166 (66.7%), followed by doctors: 35 (14.1%), technicians: 26 (10.4%) and housekeeping personnel: 22 (8.8%). Needle stick injury was the most common type of exposure, in 189 (75.9%), followed by sharp-object injury, mucous-membrane exposure and contact with nonintact skin. The majority of needle stick exposures, i.e. 177 (93.7%), were caused by hollow-bore needles. Exposure to blood represented 96.8%, mostly during drawing blood and the insertion or removal of needles from patients [88 (35.4%)] and when performing surgical interventions [56 (22.6%)]. Easily preventable exposures such as injuries related to 2-handed recapping of needles [24 (9.6%)] and garbage collection [21 (8.4%)] were reported. Exposures mainly occurred in the inpatient wards [75 (30.1%)] and operating theaters [56 (22.6%)]. Among the exposed HCP, 130 (52.2%) had been fully vaccinated against hepatitis B virus (HBV). Conclusion: Needle stick injuries are the most common exposure among HCP in Kuwait, and nurses are the most frequently involved HCP category. A good proportion of exposures could be easily prevented. HBV vaccination coverage is incomplete.

Universal treatment success among healthcare workers diagnosed with occupationally acquired acute hepatitis C

Healthcare workers (HCWs) are at risk of occupationally acquired hepatitis C. In the UK, 17 HCWs were diagnosed with occupationally acquired acute hepatitis C between 2002 and 2011. All 17 cases involved percutaneous injuries from hollowbore needles, 16 known to be contaminated with blood. Of these 17 HCWs, 15 received antiviral therapy and 14 are known to have achieved viral clearance. Treatment success was irrespective of genotype. The successful treatment of HCWs emphasizes the need for UK guidelines on the management of occupationally acquired acute hepatitis C.

Frequency of use and activation of safety-engineered sharps devices: a sharps container audit in five Australian capital cities

Sharps injuries (SI) among healthcare personnel (HCP) in Australia are of such concern the matter was brought before Parliament in 2013. Many SI from safety-engineered devices (SED) are due to nonactivation. Monitoring of activation is recommended. This paper outlines a sharps container (SC) contents audit conducted in Australian capital cities. Reusable, 22 L SC (Sharpsmart, Daniels Corporation, Melbourne) were randomly selected from random healthcare facilities (HCF) in five cities. Wearing protective apparel, the operator opened and decanted SC and sorted hollow-bore needles (HBN) into: capped v. uncapped non-SED, and activated or non-fully activated SED. Volumes and weights were recorded for inter-study comparisons. WinPepi v2.78 was used to calculate probability (significance set at ≤ 0.05), relative-risk and 95% confidence limits. 1212 L of sharps (167.9 kg) from 102 SC from 27 hospitals were audited. Many devices were bloodcontaminated. Of the 9651 HBN, 30.4% were SED and 19.4% of the SED were not, or partially, activated. Of the 6718 non-SED, 30.6% were capped needles or capped needle-syringes. City averages for capped or naked sharps ranged from 64.2% (Sydney) to 97.8% (Adelaide) while hospital averages ranged from 32.6 to 100%. Overall, 54.2% of devices were discarded ‘sharp’. It is disturbing that 75.5% of hollow-bore needles were capped or naked, indicating a high proportion of Australian HCP are unnecessarily at risk of SI while handling sharps. The high non-use of SED and non-activation of SED needs researching.Widespread SED evaluation and adoption (automatic and semi-automatic SED where feasible), repetitive competency training and safety-ownership are needed. Legislation may be indicated.

Do ward and department managers know their responsibilities in relation to the management of sharps, and is this reflected in the way that they practise sharps management?

Needlestick injuries (NSIs) involving hollowbore needles are the most commonly reported occupational exposure within the healthcare sector in the United Kingdom (HPA, 2012). It is estimated that at least 100,000 NSIs occur each year but due to under-reporting the figure may be much higher (RCN, 2008). Many strategies aimed at preventing NSIs have been implemented in the healthcare environment, including administrative controls, safer work practices and engineering controls, but despite these measures NSIs remain a serious health and safety threat (EU, 2010). New legislation has now been introduced as part of EU Directive 2010/32/EU, which requires UK and all EU member states to bring into force regulations, laws and administrative provisions to further protect healthcare workers from sustaining NSIs (EU Directive, 2010). The aim of this study was to determine the degree of responsibility that NHS ward/department managers felt they have in relation to the prevention and management of NSIs and if this was reflected in the way that they carry out relevant practices in their clinical environment. The study also aimed to identify factors which might impact on the ward/department managers' ability to manage sharps effectively. The study found that although ward/department managers did acknowledge a high degree of responsibility overall for the prevention and management of NSIs, there were some concerns highlighted in relation to certain practices. These included not ensuring that all staff had received up to date training on the safe use and disposal of sharps and not disseminating information on NSI incidences and outcomes to staff in their clinical areas. The findings of this study have the potential to inform and enhance future training and education schedules that relate to NSI prevention and management and to improve the corporate strategic commitment to reducing NSIs across healthcare organisations.

Prevalence of needle stick injuries among dental, nursing and midwifery students in Shiraz, Iran.

Background: The risk of occupational exposure to blood borne pathogens (including hepatitis B, hepatitis C and HIV) via sharp injuries such as needle stick injuries (NSIs) among health care workers, especially dental, nursing and midwifery students is a challenging issue. Inadequate staff, lack of experience, insufficient training, duty overload and fatigue may lead to occupational sharp injuries. The aim of this prospective cross-sectional study was to evaluate the frequency of NSIs in Iranian dental, nursing, and midwifery students and their knowledge, attitude and practices regarding prevention of NSIs.Methods: A questionnaire was provided to 264 dental and 435 nursing and midwifery students during their under graduate clinical training. 52% of dental students and 48% of nursing and midwifery students responded to the questionnaire. The questionnaire was pre-tested for reliability on 9.2% of the 55 sample population and found to have a high (r=0.812) test-retest reliability.Results: 73% of students reported at least one NSI during the past year. Activities most frequently associated with injuries involved use of a hollow-bore needle during venous sampling or IV injection in both groups, followed by wound suturing in nursing and midwifery students and recapping in dental students. NSIs and non-reporting of NSIs were highly prevalent in these participants. The reason for not reporting injuries included not knowing the reporting mechanism or not knowing to whom to report.Conclusion: Education about transmission of blood borne infections, standard precaution and increasing availability of protective strategies must be enforced. Furthermore, an optimization of the management for reporting is warranted.

Occupational Exposure to Sharp Instrument Injuries among Dental, Medical and Nursing Students in Mahatma Gandhi Mission's Campus, Navi Mumbai, India

ABSTRACTBackgroundSharp instrument injuries among health care students significantly increase the risk of transmission of different blood-borne pathogens which can lead to serious consequences including death.ObjectivesThe study was carried out to determine the prevalence and factors associated with sharp instrument injuries among the health care students in the Mahatma Gandhi Mission's Campus, Navi Mumbai and to make recommendations to the institutional authorities about measures to be undertaken to prevent such injuries among the students.Materials and MethodsA cross-sectional questionnaire study was conducted among 700 health care students which included dental, medical and nursing students during their clinical training at Mahatma Gandhi Mission's Campus, Navi Mumbai from May 2012 to July 2012. It was a self-administered questionnaire with a 1-year recall period for sharp instrument injury. The data was analyzed using descriptive statistics and Chi-square test.ResultsThe questionnaire was completed by 627 students of which 76.4% of nursing, 75.4% of dental and 48.7% of the medical students had experienced sharp instrument injuries in the past 1 year with hollow-bore needle being the most common instrument causing such injuries. Overall, 77.4% of the students had not reported the incident of the injury and only 34.4% of the students had taken postexposure prophylaxis.ConclusionEducational interventions with effective training on proper handling and disposal of sharp instruments and postexposure prophylaxis along with the formation of a reporting center are some of the recommendations which can reduce the occupational exposure to sharp instrument injuries among the health care students.How to cite this articleHussain JSA, Ram SM, Galinde J, Jingade RRK. Occupational Exposure to Sharp Instrument Injuries among Dental, Medical and Nursing Students in Mahatma Gandhi Mission's Campus, Navi Mumbai, India. J Contemp Dent 2012;2(2):1-10.

Quantification of HIV-1 viral RNA in the blood in needles used for venous puncture in HIV-infected individuals

Occupational HIV infection among healthcare workers is an important issue in exposures involving blood and body fluids. There are few data in the literature regarding the potential and the duration of infectivity of HIV type 1 (HIV-1) in contaminated material under adverse conditions. We quantified HIV-1 viral RNA in 25×8mm calibre hollow-bore needles, after punctures, in 25 HIV-1-infected patients selected during the sample collection. All of the patients selected were between the ages of 18 and 55. Five samples were collected from 16 patients: one sample for the immediate quantification of HIV-1 RNA in the plasma and blood samples from the interior of 4 needles to be analyzed at 0 h, 6 h, 24 h, and 72 h after collection. In nine patients, another test was carried out in the blood from one additional needle, in which HIV-1 RNA was assessed 168 h after blood collection. The method used to assess HIV-1 RNA was nucleic acid sequence-based amplification. Up to 7 days after collection, HIV-1 RNA was detected in all of the needles. The viral RNA remained stable up to 168 h, and there were no statistically significant differences among the needle samples. Although the infectivity of the viral material in the needles is unknown, the data indicate the need to re-evaluate the practices in cases of occupational accidents in which the source is not identified.

Occupational transmission of hepatitis C in healthcare workers and factors associated with seroconversion: UK surveillance data

The study aims were to describe a case series of occupationally acquired hepatitis C (HCV) infections in UK healthcare workers and examine factors associated with transmission using exposure data reported to the Health Protection Agency between July 1997 and December 2007. Fifteen reported cases of documented HCV seroconversion occurred after percutaneous exposure, the majority from hollow-bore needles used in the source patient's vein or artery and contaminated with blood or blood-stained fluid. The seroconversion rate was 2.2% (14/626). In multivariable analysis of healthcare workers with percutaneous exposure to blood or blood-stained fluid, we demonstrate that blood sampling procedures (odds ratio [OR], 5.75; 95% CI, 1.33-24.91; P = 0.01) and depth of injury (OR for deep vs superficial injury, 21.99; 95% CI, 2.02-239.61; P = 0.02) are independently associated with a greater risk of HCV seroconversion. This is the first UK study of occupationally acquired HCV in healthcare workers. It has reinforced our knowledge of risk factors for HCV transmission. Most of these exposures and transmissions were preventable. Healthcare employers should provide regular education on the risks of occupational exposure and prevention through standard infection control procedures. They should ensure the availability of effective prevention measures and facilitate prompt reporting and adequate follow-up of exposures.

To the point: needlestick injuries, risks, prevention and the law

Healthcare staff are at risk of infections if they are exposed to bloodborne pathogens from needlestick injuries (NSIs). In 2010, the European Union adopted a directive to prevent injuries and infections to healthcare workers from sharp objects, including NSIs. It recommended an integrated approach to preventing these injuries; this includes risk assessment, training and the provision of safety needle devices (SNDs). This directive has to be enshrined in UK legislation by May 2013. NSIs are under reported, but nearly half of nurses may have had such an injury. NSIs occur in many clinical areas, often when nurses are busy or tired, and most are caused by conventional hollow-bore needles. SNDs, if implemented and used correctly, reduce the risk of NSI. This article examines: the legislation; the prevalence of NSI; the risk of infection transmission; devices and procedures associated with NSI; SNDs; and costs of NSIs and SNDs.

Local skin reaction following an accidental injection from a BCG vaccine in a healthcare worker

Exposure to blood-borne pathogens from sharp injuries continue to pose a significant risk to healthcare workers (HCW). The number of sharps injuries sustained by HCW is still unclear, primarily due to under-reporting of events. Healthcare professionals are at risk of sustaining such injuries from hollow-bore needles. Sharps injuries are associated with risk of infection with blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) hepatitis C virus (HCV) and other live organisms. Here we are reporting a case of an adverse reaction in a HCW due to an accidental sharps injury by a needle used to administer the Bacillus Calmittee Gurien (BCG) vaccine.

Needlestick and Sharps Injuries among Theatre Care Professionals

Health care professionals are exposed to blood and other body fluids in the course of their work: (Al-Benna et al 2008). The World Health Organisation (2003) estimates that 9% of the 35 million healthcare professionals worldwide will experience percutaneous exposure to bloodborne pathogens each year (WHO 2003). In the U.K. about 100,000 sharps injuries occur in NHS hospitals each year (Trim & Elliott 2003). This is 17% of all accidents involving NHS staff (NAO 2003). Four percent of NHS staff sustain from 1 to 6.2 sharps injuries each year. These injuries occur mainly in clinical areas such as wards and theatres, but also in non-clinical areas due to accidental handling of inappropriately discarded sharps (Trim & Elliott 2003, Waterson 2004). Percutaneous injuries involving hollowbore needles remain the most commonly reported occupational exposures in the healthcare setting (HPA 2010). Consequently, workers are at risk of infection with bloodborne viruses including human immunodeficiency virus, hepatitis B virus, hepatitis C virus and bacterial infections (Al-Benna et al 2008).

The comparison of the frequency and nature of sharps injuries reported by doctors versus nurses from surgical wards in the context of the prevalence of HBV, HCV and HIV: a cross-sectional sero-survey

ObjectiveTo evaluate the nature and frequency of sharps injuries among doctors and nurses from the same surgical/gynaecological wards and the prevalence of HIV/HBV/HCV infection, an anonymous cross-sectional sero-survey was conducted...

Occupational injury history and universal precautions awareness: a survey in Kabul hospital staff

BackgroundHealth staff in Afghanistan may be at high risk of needle stick injury and occupational infection with blood borne pathogens, but we have not found any published or unpublished data.MethodsOur aim was to measure the percentage of healthcare staff reporting sharps injuries in the preceding 12 months, and to explore what they knew about universal precautions. In five randomly selected government hospitals in Kabul a total of 950 staff participated in the study. Data were analyzed with Epi Info 3.ResultsSeventy three percent of staff (72.6%, 491/676) reported sharps injury in the preceding 12 months, with remarkably similar levels between hospitals and staff cadres in the 676 (71.1%) people responding. Most at risk were gynaecologist/obstetricians (96.1%) followed by surgeons (91.1%), nurses (80.2%), dentists (75.4%), midwives (62.0%), technicians (50.0%), and internist/paediatricians (47.5%). Of the injuries reported, the commonest were from hollow-bore needles (46.3%, n = 361/780), usually during recapping. Almost a quarter (27.9%) of respondents had not been vaccinated against hepatitis B. Basic knowledge about universal precautions were found insufficient across all hospitals and cadres.ConclusionOccupational health policies for universal precautions need to be implemented in Afghani hospitals. Staff vaccination against hepatitis B is recommended.

Percutaneous and Mucocutaneous Exposures in Nursing Students: An Italian Observational Study

To investigate occupational exposures to biological material potentially infected by blood-borne viruses in nursing student population during the course years. An observational retrospective study was designed. Data were collected in May 2007. Two-thousand-two-hundred-fifteen nursing students from the 3 years of degree course were enrolled in the four Italian universities. A structured questionnaire was constructed and was given out unannounced to nursing students in four universities on a randomly chosen day. The likelihood of association between nursing student exposure and certain assumed risk factors was measured. The exposure risk is associated with each study year of nursing students. Specifically, the probability of accidental exposure is reduced significantly with the increase of clinical skills during the training period. The risk for exposure in the 1st year students appears significantly higher than in those of the next years (odds ratio [OR] 1.465; 95% confidence interval [CI] 1.105-1.943). Data highlighted a gradual increase of bio-safety knowledge in nursing students from the 1st to the 3rd years of study. However, a statistically significant association exists only between awareness of a correct use of gloves and exposure risk (OR 0.435; 95%CI 0.227-0.834). Mucocutaneous exposures are more frequent than percutaneous exposures (62.2%), and the hollow-bore needle is the device most often involved. In 42.5% of cases, accidental exposures occurred when nursing students are working alone in a medical ward or surgery area. During their clinical training, nursing students can encounter a real risk for percutaneous and mucocutaneous exposures to blood potentially infected with blood-borne viruses. However, this risk is reduced with an increase in clinical skills. Results show that some new strategies are necessary for exposure risk reduction such as development of simulation laboratories for nursing practice and the adequate presence of tutors in clinical training education.