Injuries In Healthcare Workers Research Articles

Textbook of Obstetric Anesthesia

Textbook of Obstetric Anesthesia

Procedure‐Specific Rates for Needlestick Injuries in Health Care Workers

Procedure‐Specific Rates for Needlestick Injuries in Health Care Workers: Lukas Jyuhn‐Hsiarn Lee, et al. Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University—To assess the rates of needlestick injuries (NSIs) from different types of injection procedures in health care workers, we conducted a prospective study in a university hospital in Taiwan. NSIs in the departments of internal medicine and surgery were prospectively monitored during July 1994‐March 1995. All the injured were interviewed to identify their associated procedures. The corresponding numbers of injection procedures were collected during the study period to estimate the denominator of medical procedures. A total of 81 cases of contaminated NSIs were actively collected over a 9‐month period compared with 54 NSIs from a routine self‐reporting system. Procedures involving intravenous catheter stylets had the highest needlestick injury rate, 43.5/100,000, followed by blood transfusion and blood drawing, 17.7 and 13.3/100,000, respectively. These rates may aid priority setting to introduce safer needle devices when resources are limited.

Needle-stick injuries in primary care

Needle-stick injuries in health-care workers are almost completely preventable by improving

保健医療労働者の針刺し外傷の手技別分析

保健医療労働者の針刺し外傷の手技別分析

Manual Handling Injuries in Health Care Workers

Nursing aides are particularly susceptible to manual handling injuries because they have the primary responsibility for heavy lifting. The aim of this study was to determine why a specific group of nursing aides have the highest manual handling injury rate in their hospital. The study investigated the adequacy of the manual handling training program, knowledge of manual handling, mechanical aid availability, and use of mechanical aids. Results indicated that the nursing aides’ manual handling knowledge was adequate but that they rarely used mechanical aids. This lack of use of aids was in part due to an over-reliance on their own strength and abilities. This may have been due to a lack of suitable mechanical aids on the wards or a lack of familiarity with the available aids. This study suggests that neither training alone nor the purchase of equipment alone is likely to resolve manual handling problems.

Needlestick and sharps injuries among health-care workers in Taiwan.

Sharps injuries are a major cause of transmission of hepatitis B and C viruses and human immunodeficiency virus in health-care workers. To determine the yearly incidence and causes of sharps injuries in health-care workers in Taiwan, we conducted a questionnaire survey in a total of 8645 health care workers, including physicians, nurses, laboratory technicians, and cleaners, from teaching hospitals of various sizes. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 per person in the past 12 months, respectively. Of most recent episodes of needlestick/sharps injury, 52.0% were caused by ordinary syringe needles, usually in the patient units. The most frequently reported circumstances of needlestick were recapping of needles, and those of sharps injuries were opening of ampoules/vials. Of needles which stuck the health-care workers, 54.8% had been used in patients, 8.2% of whom were known to have hepatitis B or C, syphilis, or human immunodeficiency virus infection. Sharps injuries in health-care workers in Taiwan occur more frequently than generally thought and risks of contracting blood-borne infectious diseases as a result are very high.

A critical review of the literature on sharps injuries: epidemiology, management of exposures and prevention.

This article reviews the literature related to the epidemiology, prevention and management of sharps injuries in health care workers, particularly nurses, and the subsequent risk of harm. The studies are reviewed chronologically, beginning with the efforts to reduce sharps injuries by changing behaviours, followed by the introduction of barriers to protect the caregiver, and finally, the engineering of safer products. Initial efforts to prevent sharps injuries focused on placing rigid, disposal containers at the site where sharps were used and instructing health care workers to refrain form the practice of recapping. When these interventions were shown to alter the type, but not the overall number, of sharps injuries, alternative measures were sought. This search intensified with the increasing evidence of the small, but measurable, risk of the transmission of human immunodeficiency virus from sharps injuries. The current knowledge of the factors related to sharps injuries has been collected primarily through retrospective surveillance. This surveillance has been conducted primarily in hospital settings and has focused on the type of sharp and the purpose for which it was used rather than prospective research. Research is now needed to elucidate the organizational and behavioural factors leading to sharps injury both within the hospital as well as other health care settings. The implications for nursing practice are discussed.

Health care concerns related to lifting: an inside look at intervention strategies.

As members of injury prevention and injury management teams, physical therapists and occupational therapists have the opportunity to evaluate back stress associated with patient-lifting activities. In this study, three mathematical formulas are presented that can be used to objectively assess health care workers' maximum safe lifting capacity for moving patients. Recommendations to reduce the rate of back injury in health care workers include the use of lifting machines for moving patients, mandatory in-service education on body mechanics, and employee assistance programs that improve job satisfaction and worker morale.

Prevention of back injuries in healthcare workers

A laboratory study was conducted to evaluate five different manual techniques (two-person lifting; rocking and pulling the patient using a gait belt with two persons; walking belt with handles with one and two persons; and a patient handling sling with cutouts with one person) for transferring patients from wheelchair to toilet and toilet to wheelchair. In addition, three different mechanical hoists (H, T and A) were studied for transferring patients from toilet to wheelchair. Six female nursing students with prior patient transfer experience served both as nurses and passive patients. The mean trunk flexion moments, erector spinae muscle forces and compressive forces for the four manual pulling methods ranged from 93 to 133 Nm, 1861 to 2653 N and 1974 to 2745 N, respectively, as compared to about 200 Nm, 4100 N and 4800 N for two-person manual lifting. Manual lifting was perceived to be the most stressful by the nurses and the least comfortable and secure by the patients. Hoist A was perceived to be the least stressful and the most comfortable and secure. Hoists H and T were perceived to be more stressful, less comfortable and less secure than the walking belt. An intervention study was conducted in two units of a nursing home (140 beds and 57 NAs) to determine the effectiveness of ergonomic changes. Nursing assistants (NAs) in the two units of the nursing home were trained in the use of selected devices and shower rooms and toilets were modified. The mean acceptability rates for walking belt and hoist A were 81% and 87%, respectively. The reported incidence and severity rates for back injuries over 13 months decreased from 83 to 43 and from 634 to 0, respectively, after the intervention. Nursing assistants perceived their job as “very light” after the intervention as compared to between “somewhat hard” and “hard” before intervention.

A needleless intravenous system: an effective risk management strategy.

Historically, healthcare workers have not taken accidental needlesticks seriously and often have not even reported them. In the last five years, healthcare workers' awareness that needlesticks are a serious source of workplace exposure to hepatitis B virus (HBV) or the human immunodeficiency virus (HIV) has resulted in far more reported needlestick injuries. The risk of seroconversion following a needlestick with HIV-infected blood is approximately 1 in 300.1 Along with the risks of HIV and HBV numerous other infections can be transmitted by needlesticks. There is also the psychological effect on healthcare workers who may fear the possibility of contracting an infection every day while at work. In October 1989, at Columbia Hospital in Milwaukee, Wisconsin, a 394-bed facility, a needlestick task force was formed to address the number of employee needlestick occurrences reported to the occupational health department Members of the task force included an infectious disease physician and representatives from the infection control department, emergency department, pharmacy, operating room, intensive care unit, occupationalhealth department, laboratory department, housekeeping department, infusion therapy team, and materials distribution department. The goal of the needlestick task force was to reduce the number of blood exposure needlesticks to employees. The first strategy to reduce needlesticks was to re-educate staff to practice safety by avoiding recapping and properly taping all connections with needles on intravenous tubing lines and intravenous piggyback lines. This attempt was unsuccessful. Healthcare workers continued to have needlestick injuries bec us changing their clinical practice was too difficult. Studies have indicated that healthcare workers, in gene al, are not compliant with intravenous needle safety issues such as recapping and p operly taping intravenous lines. In a report on the epidemiology of hospital sharps injuries, Dennis G. Maki, MD, states, As have others, we have come to the conclusion that the greatest impact in reducing sharps injuries in HCW (healthcare workers) might be achieved by innovative technology-based approaches to prevention that implicitly reduce the risk of injury, despite carelessness or apathy on the part of an HCW ...analogous to mandating airbags in cars. Making impervious disposal units conveniently available was a first step. However, we need far more: systems that permit vascular access in drawing blood in which the user is implicitly shielded from contact with the used needle such as 'needleless systems' for administrating parenteral medications.2 Having learned this, the next step for the task force at Columbia Hospital was to investigate new products designed to eliminate needlestick injuries. After many months of testing and evaluating new roducts, a needleless intravenous system was approved. The product consisted of a reflux valve that locks on the end of the angiocatheter and a protector needle that can be used with the reflux valve on a rubber port anywhere on the intravenous line. The plastic reflux valve is accessible only by intravenous tubing or syringes without needles. Once the initial venipuncture is performed, the intravenous tubing system is completely needleless. Intravenous piggyback medications are con-

A Five-Year Study of Needlestick Injuries

Objective:To decrease the numbers of needlesticks among healthcare workers.Design:All reported needlestick injuries at Santa Clara Valley Medical Center, San Jose, California, were reviewed, analyzed, and tabulated by the infection control department yearly from 1986 to 1990.Setting:A 588-bed county teaching hospital in San Jose, California, affiliated with Stanford University.Participants:All employees of Santa Clara Valley Medical Center who reported needlestick injuries on injury report forms.Interventions:From April to December 1987, more needle disposal containers were added to as many patient care areas and as close to the area of use as possible. Results of 1986, 1988, 1989, and 1990 analyses were communicated yearly to all personnel, extensive educational programs were conducted in 1987 and 1988, and educational efforts continued in 1989 and 1990.Results:In 1986, there were 259 needlestick injuries at our institution, 22% (32) from recapping. After needle disposal containers were added to all patient care areas, needlestick injuries for 1988 totalled 143, a 45% decrease in the total needlestick injuries and a 53% decrease in recapping injuries. Communication of results to all areas of the hospital and educational activities were started in 1987 and continued through the next 3 years. In 1989, there were 135 needlestick injuries, a decrease of 6% from 1988; recapping injuries decreased 40% from 1988. In 1990, there were 104 needlestick injuries, a 23% decrease since 1989, and a 33% decrease in recapping injuries. The total number of needlestick injuries from 1986 to 1990 decreased by 60%, and those injuries from recapping decreased by 81% to 89%.Conclusions:We have continued to monitor needlestick injuries, communicate findings to all personnel, and include needlestick prevention in educational programs. We contend that more convenient placement of needle disposal containers, communication of tidings, and education do decrease needlestick injuries in healthcare workers.

Cost - Effectiveness of Prophylactic AZT Following Neediestick Injury in Health Care Workers

In response to health care workers' concerns about contracting infection with the human immunodeficiency virus (HIV) in the workplace, several institutions now offer prophylactic azido-deoxythymidine (AZT) for needlesticks sustained while exposed to HIV-infected patients. The authors designed a model to evaluate the cost-effectiveness of AZT prophylaxis. If AZT were 100% effective, prophylaxis would cost $2,388 per life-year gained and $66,876 per life saved using a societal perspective. For each $100 increase in the cost of AZT, the cost per life-year saved increased $1,190. Reducing the efficacy of AZT to 75, 50, and 25% raised the costs per life-year gained to $3,184, $4,775, and $9,551, respectively. If AZT were given for all needlesticks without regard to the HIV status of the source, the costs of prophylaxis would rise substantially. It is concluded that AZT, if moderately effective, can be cost-effective as a prophylactic agent but only if used in instances where the source is known to have an HIV infection.

A five-year study of needlestick injuries: significant reduction associated with communication, education, and convenient placement of sharps containers.

To decrease the numbers of needlesticks among healthcare workers. All reported needlestick injuries at Santa Clara Valley Medical Center, San Jose, California, were reviewed, analyzed, and tabulated by the infection control department yearly from 1986 to 1990. A 588-bed county teaching hospital in San Jose, California, affiliated with Stanford University. All employees of Santa Clara Valley Medical Center who reported needlestick injuries on injury report forms. From April to December 1987, more needle disposal containers were added to as many patient care areas and as close to the area of use as possible. Results of 1986, 1988, 1989, and 1990 analyses were communicated yearly to all personnel, extensive educational programs were conducted in 1987 and 1988, and educational efforts continued in 1989 and 1990. In 1986, there were 259 needlestick injuries at our institution, 22% (32) from recapping. After needle disposal containers were added to all patient care areas, needlestick injuries for 1988 totalled 143, a 45% decrease in the total needlestick injuries and a 53% decrease in recapping injuries. Communication of results to all areas of the hospital and educational activities were started in 1987 and continued through the next 3 years. In 1989, there were 135 needlestick injuries, a decrease of 6% from 1988; recapping injuries decreased 40% from 1988. In 1990, there were 104 needlestick injuries, a 23% decrease since 1989, and a 33% decrease in recapping injuries. The total number of needlestick injuries from 1986 to 1990 decreased by 60%, and those injuries from recapping decreased by 81% to 89%. We have continued to monitor needlestick injuries, communicate findings to all personnel, and include needlestick prevention in educational programs. We contend that more convenient placement of needle disposal containers, communication of findings, and education do decrease needlestick injuries in healthcare workers.

Epidemiology of hospital sharps injuries: A 14-year prospective study in the pre-AIDS and AIDS eras

The world pandemic of acquired immunodeficiency syndrome (AIDS) has focused enormous attention on the problem of accidental sharps injuries sustained by health care workers (HCWs) and the risk of occupationally acquired infection by human immunodeficiency virus (HIV). At the 1980 Conference, we reported a 4-year epidemiologic study (1975–1979) of sharps injuries in HCWs at our hospital. Using the same reporting system and analyses, we now report the epidemiology of sharps injuries in our center during the current AIDS era (1987–1988) and assess trends over the 14-year period. Despite greatly increased institutional efforts to prevent sharps injuries, the annual incidence has increased more than threefold (60.4 to 187.0 1,000 HCWs), reflecting better reporting and increased exposure. Reported injuries by house officers have increased ninefold. Adjusting for inflation, the direct costs of sharps injuries has increased sevenfold ($5,354 to $37,271/year). Environmental service HCWs (305.8 sharps injuries per 1,000 employees) now have the highest incidence in our center, followed by nursing personnel ( 196.5 1,000 ) and laboratory personnel ( 169.9 1,000 ), but as in 1975–1979, two thirds of all injuries occur in nursing personnel. Although phlebotomy team members have a very low risk per procedure ( 1 26,871 draws), their annual incidence is extraordinarily high, 407.0 1,000 . Injuries continue to occur mainly during disposal of waste, linen, or used procedure trays (19.7% of all injuries), administration of parenteral injections or infusion therapy (15.7%), surgery (16.0%), blood drawing (13.3%), or recapping of used needles (10.1%). Making disposal units available at every bedside has reduced injuries from needle disposal two-fold since 1975–1979. With consistent application of a stringent postexposure protocol, and wide acceptance of the hepatitis B vaccine, we have had no sharps injury-related infections during the past 3 years. These data indicate the increasing risk, complexity and cost of sharps injuries in HCWs and the need for more innovative—ideally, technology-based—approaches to prevention. Certain groups of HCWs are at very high risk. Comprehensive postexposure protocols that are uniformly applied can provide substantial protection to exposed HCWs.

Effect of Educational Programs, Rigid Sharps Containers, and Universal Precautions on Reported Needlestick Injuries in Healthcare Workers

To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital. Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially. A 700-bed general hospital that serves as the main teaching hospital of the University of Cincinnati. All employees of University Hospital who reported to personnel health for management of needlestick injuries. In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice. Surveillance identified 1,602 needlestick injuries (320/year) or 104/1,000/year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers. The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.

Effect of Educational Programs, Rigid Sharps Containers, and Universal Precautions on Reported Needlestick Injuries in Healthcare Workers

AbstractObjective:To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital.Design:Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially.Setting:A 700-bed general hospital that serves as the main teaching hospital of the University of cincinnati.Participants:All employees of University Hospital who reported to personnel health for management of needlestick injuries.Interventions:In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice.Results:Surveillance identified 1,602 needlestick injuries (320/year) or 104/1 ,000/ year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers.Conclusions: The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.

NEEDLESTICK TRANSMISSION OF HTLV-III FROM A PATIENT INFECTED IN AFRICA

This article reports a case of needlestick transmission of human T-lymphotropic virus type III (HTLV-III) infection to a health care worker in the UK from a patient who was presumably infected while in Africa. The patient, a white woman who had lived in central southern Africa, presented at the hospital with general malaise, dry cough, and fever. Lung biopsy revealed Pneumocystis carinii pneumonia infection, and the patient was seropositive for HTLV-III infection with a titer of 260. The patient reported that she had been unwell for 2-3 years. She had none of the accepted risk factors for acquired immunodeficiency syndrome (AIDS), and neither she nor her husband had visited the US, the Caribbean, or Zaire. Serum from the husband was positive for HTLV-III antibodies at a titer of 450. Despite intensive management and treatment with pentamidine, the patient died. During management of this case, a nursing staff member sustained a needlestick injury to the finger while resheathing a hypodermic needle. A small amount of blood was probably injected. 13 days later, the health care worker developed a severe flu-like illness with sore throat, headache, myalgia, and facial neuralgia. A macular rash and generalized lymphadenopathy were also noted. Serum drawn 27 days after the incident was negative for anti-HTLV-III infection, but titers on days 49 and 57 were 12 and 24, respectively. This contrasts with experience in the US, where needlestick injuries in health care workers have not resulted in either disease or transmission. It is assumed that the patient acquired AIDS in Africa, and that the infection was transmitted heterosexually. This case raises the possibility of differences in infectivity and other characteristics between HTLV-III viruses of US and African origin.