Needleless System Research Articles

Needlestick injuries among anesthesia providers from a large US academic center: A 10-year retrospective analysis

Study objectiveAnesthesiologists are at high risk for needlestick injury. Such injuries pose a serious health threat from exposure to bloodborne pathogens. This retrospective analysis aimed to examine needlestick injury rate among anesthesia providers between 2010 and 2020 at the University of California Los Angeles, Department of Anesthesiology and Perioperative Medicine to determine specialty-specific factors associated with these injuries. DesignRetrospective analysis. SettingAcademic Anesthesiology Department. Patients and interventionsNone. MeasurementsAll reported incidents of needlestick injuries to employees are sent to the Injury and Illness Prevention Committee. We included all anesthesia residents, fellows, nurse anesthetists, solo anesthesiologists, and supervising anesthesiologists. Main resultsThe overall rate of reported needlestick injuries was 5.3%. The rates for anesthesia residents were 2.1%, 13.5%, 7.9%, and 6.7% for post graduate year 1–4 (PGY 1–4) residents. The rates were 14.3%, 4.7%, 2.1%, and 6.9% for fellows, nurse anesthetists, supervising anesthesiologists, and solo anesthesiologists, respectively. We found that PGY2 residents had a higher injury rate than PGY1 residents (p-value<0.001). When grouping PGY2, PGY3, and PGY4 residents together, they had a collective rate of 9.4%. Furthermore, residents had a higher needlestick injury rate than supervising anesthesiologists (p-value <0.001). ConclusionsPGY2 residents and fellows had the highest rate of needlestick injury. Our study highlights the trend of increasing sharps injuries after PGY1 while supervising anesthesiologists had the lowest rate. Proposed mechanisms for the increased sharps injuries include residents' transition from medicine-based internship to the operating room environment with increased exposure to potentially injurious equipment, overnight call, and increased work-related and cognitive stress. Improving understanding of institution-specific prevention programs, raising awareness during their initial high-intensity training period with one-to-one supervision when habits are formed, and reducing exposure to sharps using a needleless system are some steps toward reducing the incidence of sharps injuries in a field where the risk remains high.

Occupational Safety for Nurses

Occupational hazards have a deleterious effect on the individuals health and safety as well as organizational effectiveness. The occupational safety issues may broadly be studied under two headings viz. Physical and psychological aspects. Physical aspects of occupational health related to the occupational environment and include injuries, accidents, ergonomic problems, physical hazards, chemical substances, communicable disease and violence in the workplace and Psychological aspect are lack of reward, workload, staffing, role conflict, role ambiguity, meeting emotional needs of the patient, leadership style and professional conflict as the main sources of stress on nurses. To overcome these issues there are few strategies such as The Factories Act,1948, The Employees State Insurance Act, 1948, Role of TNAI and Stress Management Intervention Programmes (SMI) are applied. Except that the nurse administrative has to implement the universal precautions, protective personnel equipment and compulsory HBV vaccination, needleless delivery system and non latex gloves, periodic breaks, safe working environment and safe patient lifting devices etc. Organizations must consider what they can do to eliminate occupational physical problems, workplace stressors. This will necessarily result in improved well-being of the individual as well as increased effectiveness of the organization.

Enhancement of the Mechanical Properties of PAN Nanofiber/Carbon Nanotube Composite Mats Produced via Needleless Electrospinning System

The current research presents the optimization of the parameters involved in the production of polyacrylonitrile (PAN) nanofibers via the needleless electrospinning system. The experiments were designed using the Taguchi method to investigate the morphological, physical, and mechanical properties of the nanofibers. The single-wall carbon nanotubes (CNT) were used in order to improve the mechanical properties of the electrospun nanofibers. The diameter of the PAN nanofibers in the needleless system was less than 300 nm, which was smaller than that in the conventional system. The results showed that the concentration had the greatest impact on the fiber diameter than other parameters in both PAN and PAN/CNT nanofibers. The specific stress of the nanofibers produced by the needleless electrospinning system was lower than that created by the conventional electrospinning system. Addition of The CNT caused to improve the specific stress of the PAN/CNT nanofibers compared with the PAN nanofibers. However, excessive amounts of CNT had a negative effect on the elongation and modulus because of the aggregation of CNT inside the nanofibers. The X-ray diffraction analysis was used to study the crystalline behavior of the PAN nanofibers produced via the needleless electrospinning system. The results showed that the PAN nanofibers had amorphous structure compared with the conventional PAN nanofibers.

Is the anchor matter? A short-term follow-up of the effect of mini-invasive mid urethra sling without anchor for urinary incontinence women

ObjectiveStress urinary incontinence (SUI) is a common disease in aged women, and some of them need surgical correction. Recently, the mid-urethral sling is an accepted surgical approach for SUI. However, complication may occur in this surgery, and some of them are needle-related. Therefore, the needleless system may diminish this-type complication. Materials and methodsWe conducted a retrospective study to evaluate the feasibility of women with SUI undergoing needleless sling surgery in 2017. Assessments were performed by two independent special urogynecologists before, during and post operation periods. We used a category-time-site-pain code following the International Continence Society and International Urogynecological Association (ICS/IUGA) Complication Classification Code (CCC) guidelines. ResultsThirty-eight women were analyzed. The characteristics of the patients were 66.3 ± 12.8 years old (mean ± standard deviation) of age, 2.8 ± 1.2 of parity, and 25.6 ± 4.2 kg/m2 of body mass index. All had history of vaginal delivery for term. The objective cure rate at 2- and 4-week follow-up was 97.4% (n = 37) and 94.7% (n = 36), respectively. The subjective cure rate at 2- and 4-week follow-up was both 89.5% (n = 34). Both objective and subjective cure rates remained constant and similar to the end of 4 weeks. There were 6 patients (15.8%) who had complications according to ICS/IUGA CCC guidelines. ConclusionThis needleless mid-urethral sling procedure seemed to be feasible in the management of women with SUI in this small series and short-term follow-up study, suggesting that a further prospective, randomized, comparative study with other tension-free procedures and mini-sling systems can be conducted.

Evaluation of effective needleless electrospinning parameters controlling polyacrylonitrile nanofibers diameter via modeling artificial neural networks

In this study, we aimed to predict the effects of different needleless electrospinning parameters on the diameter of polyacrylonitrile (PAN) nanofibers via artificial neural network method. The various factors, including polymer solution concentration, applied voltage, and spinneret-to-collector distance, were designed to investigate the diameter of PAN nanofibers produced via needleless electrospinning system. Levenberg–Marquardt, Bayesian regularization, and scaled conjugate gradient back-propagation algorithms were used for the analysis. The results indicated that PAN nanofiber diameters had a direct correlation with the polymer solution concentration and applied voltage and an inverse relation with the nozzle-to-collector distance. The Pearson correlation coefficients were significant at <.01% level for all prediction models. The Bayesian regularization mode I achieved the highest regression value (.9944) for the test data set. The regression value was also calculated and the maximum regression value (.9936) was obtained for the Bayesian regularization model I.

Su1143 EFFICACY, TOLERANCE, AND SAFETY OF HYBRID ARGON PLASMA COAGULATION FOR THE TREATMENT OF BARRETT'S ESOPHAGUS: A SINGLE CENTER PILOT STUDY

A novel technique for Barrett’s esophagus (BE) ablation, termed Hybrid APC, has recently been developed. Prior to APC ablation the mucosa is raised using a submucosal injection that is created using a needle-less system with a high pressure water jet. This has the potential to reduce injury to the underlying submucosa thus possibly decreasing rate of stricture formation. The current literature on this novel method is limited. The aims of this pilot study were to evaluate the efficacy, tolerance and safety of Hybrid-APC for the treatment of Barrett’s esophagus. Patients with biopsy proven BE referred to our tertiary care center for mucosal ablation were eligible for this study. Both treatment-naïve and patients previously treated were included. The procedure was performed by 2 endoscopists using a standardized technique as follows: after APC marking of the Barrett’s segment, submucosal injection of the tissue was performed followed by first pass of APC mucosal ablation. Areas of coagulated tissue were then debrided off using a distal attachment cap. Repeat submucosal injection followed by 2nd pass APC mucosal ablation was then performed at a lower dose. Efficacy of ablation was measured on follow up endoscopy by demonstrating either a reduction of visible BE or biopsies proving complete resolution of intestinal metaplasia (CRIM). To evaluate tolerance and safety, patients were called on post-procedure days 1 and 7. A total of 17 patients with biopsy proven NDBE 58.8%, LGD 17.6%, HGD 23.5% underwent 24 treatments with Hybrid APC. Average age was 69.2 years, Male 83.3%, Prague C ranged 0-6 and Prague M ranged 0-8. 58.8% of patients had undergone prior RFA, 17.6% prior EMR, 11.7% prior cryotherapy and 35.3% were naive. The average procedure time was 20.64 minutes. With regards to efficacy, 8 of 17 had follow up endoscopy and all had endoscopic improvement of BE disease with the average length of BE at initial procedure Prague C 0.44 M 1.88 and at follow-up Prague C 0.13 M 0.4. The reduction in maximal extent of BE was statistically significant (P=0.0157). Four out of 8 patients achieved CRIM. 3 patients reached CRIM after one Hybrid APC treatment. With regards to tolerance, average pain scores (0 to 10 scale) on follow up day 1 was 2.39, and on day 7 was 0.42. With regards to safety, there was one treatment-related stricture which required a single balloon dilation (stricture rate 4.2%). There were no other early or late complications. According to this pilot study, Hybrid APC appears promising in the treatment of Barrett’s Esophagus. Our study demonstrated tolerability and a safety profile similar to radiofrequency ablation. These results warrant further study in a large multicenter trial.

Preparation and Characterization of Polyvinyl Butyral Nanofibers Containing Silver Nanoparticles

Various concentrations of AgNO3 added polymer solutions were electrospun using needleless electrospinning system. Silver nanoparticles were prepared by reducing silver salt using ascorbic acid which is a mild reducing agent. Antibacterial activity of samples tested. Results showed that with the same amount of Silver NPs, higher concentration of PVB polymer solution has better efficiency against to E. coli owing to higher productivity.

Breathable Medicine: Pulmonary Mode of Drug Delivery.

Pharmaceutically active compounds require different modes of drug delivery systems to accomplish therapeutic activity without loss of its activity and lead to exhibit no adverse effects. Originating from ancient days, pulmonary mode of drug delivery is gaining much importance compared to other modes of drug delivery systems with respect to specific diseases. Pulmonary drug delivery is a non-invasive route for local and systemic therapies together with more patient convenience, compliance and is a needleless system. In this review, we addressed the vaccine delivery via non- or minimally invasive routes. Polymeric nanoparticles are preferred for use in the pulmonary delivery devices owing to a prolonged retention in lungs. Small site for absorption, mucociliary clearance, short residence time and low bioavailability are some of the limitations in pulmonary drug delivery have been resolved by generating micro- and nano-sized aerosol particles. We have classified the breathable medicine on the basis of available devices for inhalation and also prominent diseases treated through pulmonary mode of drug delivery. Owing to increasing toxicity of pharmacological drugs, the use of natural medicines has been rapidly gaining importance recently. The review article describes breathability of medicines or the pulmonary mode of drug delivery system and their drug release profile, absorption, distribution and efficacy to cure asthma and diabetes.

English

BACKGROUND: Preoperative anxiety and long-term behavioural problems are inevitable consequences in absence of preoperative sedation in paediatric patients undergoing surgery. An ideal premedicant removes fear and anxiety in tender minds of children and achieves a calm, sedated child for smooth induction of anaesthesia and rapid recovery in postoperative period. Midazolam is the most commonly used premedicant in children as it satisfies most of the criteria of ideal premedicant but its route of administration is a debatable issue in anaesthesia practice. AIMS: This study evaluated the efficacy of atomized intranasal midazolam spray as a painless, user- friendly, needleless system of drug administration for pre-anaesthetic medication in paediatric patients. SETTINGS AND DESIGN: Tertiary hospital, a prospective, randomized, controlled, clinical study. METHODS AND MATERIAL: 60 ASA physical status I children of 2-5 years age group, weighing 10-18 kg scheduled for routine surgeries participated in the study. Children were randomly assigned to Group M: Received intranasal midazolam spray in doses of 0.2 mg/kg and Group N: Received normal saline drops (1-2 drops/nostril). Patients were observed in preoperative room for 20 min. Acceptance of drug, response to drug administration, sedation scale, separation score, acceptance to mask, recovery score and side effects of drug were noted. STATISTICAL ANALYSIS: Student 't' test, standard error of difference between two means and Chi-square test. p value 0.05). 20 min after premedication 76.66% in group M and 10.00% group N, children showed satisfactory sedation (p<0.05). 73.33% in group M while 26.66% in group N, children showed acceptable parental separation and 86.66% in group M while 23.33% group N, children showed satisfactory acceptance to mask (p<0.05). Transient nasal irritation in the form of rubbing of nose, watering, sneezing and lacrimation was observed in 40% children of group M. Intranasal midazolam by atomized spray is safe and effective premedicant in paediatric patients. It produces effective sedation and anxiolysis in children. Transient nasal irritation is an undesirable side effect observed with intranasal route.

Cutaneous Histologic Artifact Associated with the Use of a Needle‐Free Anesthesia Device for Skin Biopsy

A needle-free system that delivers lidocaine to the dermis using pressurized gas is often used as an alternative anesthetic for venipuncture and intravenous catheterization in children. This case report illustrates the potential histologic artifacts that may arise when using a needleless device for a cutaneous punch biopsy. We suggest against using a needleless system for pediatric skin biopsies.

N056 The benefits of introducing a luer needleless system for healthcare staff safety

N056 The benefits of introducing a luer needleless system for healthcare staff safety

Effects of Single Vaginal Incision Technique on Quality of Life in Women with Stress Urinary Incontinence

Study Objective To estimate the short-term effects of a minimally invasive single vaginal incision technique without passing through the abdomen or groin (ContaSure Needleless System) on the quality of life in women with incontinence. Design Prospective cohort study (Canadian Task Force classification II-2). Setting Tertiary referral urogynecology clinic. Patients 50 consecutive patients with urodynamically proved stress urinary incontinence from October 2008 to March 2009. Interventions Preoperative and postoperative scores on the short forms of the IIQ-7 (Incontinence Impact Questionnaire, UDI-6 (Urinary Distress Inventory) PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function), and long form of the P-QOL (Prolapse Quality of Life) were evaluated in 50 patients with urodynamically proved stress urinary incontinence. Scores were compared with postoperative urodynamic findings. Measurements and Main Results Mean (SD) follow-up was 433.5 (44.1) days (95% CI, 420.1–445.1). Patients showed statistically significant improvement insofar as preoperative and postoperative scores on the IIQ-7, P-QOL, and PISQ-12 and the irritative and stress subgroups of UDI-6. Obstructive score of UDI-6 worsened, consistent with the findings of pressure-flow studies. Postoperatively, 40 patients (80%) were urodynamically continent. Eight patients (16%) were still incontinent; however, their quality of life scores (IIQ-7 and UDI-6 stress) improved. Two patients (4%) continued to experience leakage, with equal or worsened quality-of-life scores. Conclusion Early clinical results of the present trial demonstrate that the ContaSure Needleless System seems to be capable of improving significantly all aspects of quality of life in women with incontinence. To improve the willingness for treatment of women with stress incontinence, this minimally invasive technique should be encouraged after confirming its efficacy in larger prospective, randomized, comparative trials.

Evaluation of the immune response induced by intradermal vaccination by using a needle-less system in comparison with the intramuscular route in conventional pigs

The immune response induced by intradermal vaccination using a needle-less device was evaluated in conventional pigs in comparison with the more conventional intramuscular vaccination; to this purpose, vaccination against Aujeszky’s Disease (AD) was used as a model of antiviral immunity. Two groups of pigs ( n = 10 each) were vaccinated 4 weeks apart respectively by the intramuscular (IM group) and intradermal route (ID group; needle-less I.D.A.L.® vaccinator) with an AD modified live virus. Ten pigs injected with the vaccine adjuvant only were kept as sham-vaccinated controls (C group). On blood samples collected at 0, 2, 4, 5, 6 and 7 weeks post-vaccination (PV) ADV-specific virus neutralizing (VN) antibodies, IFN-γ secreting cells (SC), lymphocyte subsets and IFN-γ gene expression in PBMC were evaluated. VN antibodies increased after the 1st vaccination and peaked after the 2nd vaccination in both vaccinated groups. Also IFN-γ SC reached maximum levels in both groups after administration of the booster dose. Pigs in the control group remained negative for both parameters throughout the study. Flow cytometry showed persistently higher levels of CD3−CD8α+ Natural Killer cells in both vaccinated pigs. The ID group showed an earlier and regulated activation characterized by an increase of cytotoxic CD8β+ T lymphocytes and CD25+ cells after the boosting dose. No statistically significant differences between treated and control groups were detected for memory CD4+CD8α+ low T cells. Upregulation of IFN-γ gene expression in PBMC was detected in ID and IM pigs after both vaccine administrations, although at a different extent. Overall, the results showed that the intradermal vaccine delivery by a needle-less device can prime a strong humoral and cellular immune response comparable to that obtained by the intramuscular vaccination.

The usability and acceptability of a needleless connector system

Needleless connectors were introduced into clinical practice to reduce the rate of needlestick injuries to healthcare workers (HCWs). There have, however, been limited reports of user acceptability of these devices. The usability and acceptability of the Clearlink needleless connector (Baxter Healthcare, UK) was therefore completed by HCWs at University Hospital Birmingham NHS Foundation Trust following a 12-month clinical evaluation. Seventy percent (28/40) of HCWs reported that they would prefer to use Clearlink needleless connectors rather than conventional luers caps, 15% (6/40) would use either, and only 15% (6/40) preferred to use luer caps. In total, 85% of HCWs reported that Clearlink was acceptable to use in the clinical situation. The results demonstrate that comprehensive training and technical support both before and after new device implementation were essential to ensure a smooth transition.

Comparison of needle and syringe and a needleless injection system in producing local anaesthesia for intravenous cannulation

Comparison of needle and syringe and a needleless injection system in producing local anaesthesia for intravenous cannulation

Efficacy of Safety-Engineered Device Implementation in the Prevention of Percutaneous Injuries: A Review of Published Studies

Nearly 6 years have passed since the Needlestick Safety and Prevention Act of 2000 was signed into law. We reviewed studies published since 1995 that evaluated the effect of safety-engineered device implementation on rates of percutaneous injury (PI) among health care workers. Criteria for inclusion of studies in the review were as follows: the intervention used to reduce PIs was a needleless system or a device with engineered sharps-injury protection, the outcome measurements included a PI rate, the intervention was evaluated in a defined population with clear comparison groups in clinical settings, and outcomes and denominators used for rate calculations were objectively measured using consistent methodology. All 17 studies reported substantial decreases in device-associated or overall PI rates after device implementation (range of reduction, 22%-100%). The majority of studies (n=12) were uncontrolled before-after trials with limited ability to control for confounding variables. In addition, implementation of safety-engineered devices was often accompanied by other interventions, and direct measurement of outcomes was not performed. Nevertheless, safety-engineered devices are an important component in PI prevention.

Sharps injury recordkeeping activities and safety product use in California health care facilities:: Pilot study results from the sharps injury control program

Background: In 1999, licensed health care facilities in California (N = 2532) were invited to participate in a survey about occupational bloodborne pathogens exposure surveillance activities, recordkeeping methods, and use of safety-enhanced sharps devices. Results: A total of 1274 facilities responded to the survey from January 1999 through August 1999 (response rate = 50%). Sharps-related injuries were recorded for multiple departments on various forms in diverse manners. Only 66% of hospitals, 37% of home health agencies, and 33% of skilled nursing facilities reported sharps injuries on a mandated sharps injury log. More than 70% of facilities stated that they used some type of safety device or needleless system, but this figure varied by type of device and facility type. Eighty-four percent of general acute care hospitals, 28% of home health agencies and skilled nursing facilities each had evaluated at least 1 safety-enhanced device. Almost 90% of all facilities expressed a need for educational materials on topics such as device selection and evaluation. Conclusions: Standardization of surveillance and recordkeeping activities does not exist across facility types. Standards and regulations demand complex recordkeeping activities. Increased funding for distribution of educational materials and on-site training should accompany changes in mandated reporting activities when appropriate. Increased testing and evaluation of devices across facility types are necessary to ensure that safety-enhanced devices are protective of health care workers and patients. (Am J Infect Control 2002;30:269-76.)

Study of a needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes

Study of a needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes

Comparison of the microbial barrier properties of a needleless and a conventional needle-based intravenous access system

Background: Sporadic reports of increased infection rates involving needleless access systems, especially in home-care settings, have raised questions concerning the safety of all needleless systems. Addressing this concern, Baxter Healthcare Corporation and the Centers for Disease Control and Prevention performed parallel laboratory studies comparing the microbial barrier properties of the Interlink (trademark of Baxter Healthcare Corporation, Deerfield, Ill) needleless system with a conventional intravenous access system. Methods: Studies of needleless and conventional systems evaluated fluid path contamination introduced through injection site septa, which were intentionally inoculated with high levels of bacteria and subsequently punctured with and without alcohol swabbing disinfection before access. Results: With disinfection, the combined effects of the disinfection technique and the barrier properties of the septa prevented the transfer of organisms into the fluid path in 94% to 96% of needleless test articles and 96% to 100% of conventional test articles. Without disinfection, the barrier properties of the septa alone prevented the transfer of organisms into the fluid path in 20% to 69% of needleless test articles and 10% to 28% of conventional test articles. Conclusions: The data demonstrate the needleless system performs as well as the conventional intravenous access system with respect to the risk of microbial contamination and reinforce the need for appropriate septum disinfection before accessing either system (AJIC Am J Infect Control 1998;26:437-41).

Percutaneous injury analysis: consistent categorization, effective reduction methods, and future strategies.

To report the results of an 8-year analysis of percutaneous injuries (PI), to describe interventions to decrease these injuries, and to discuss future prevention strategies. Using consistent methods, 881 percutaneous injury reports were reviewed, categorized, and analyzed from 1986 through 1993. A 620-bed acute-care county teaching hospital located in San Jose, California, that is affiliated with Stanford University Medical School, Palo Alto, California. Employees of Santa Clara Valley Medical Center who reported percutaneous injuries from 1986 through 1993. Placement of needle disposal containers in all patient care areas, 1987; education, 1987 to present; communication of percutaneous injury analyses to all departments, 1988 to present; and safety product evaluation and purchases, 1991 to present. The total number of PI decreased by 65% (P = .0007) from 1986 through 1993. Recapping injuries decreased from 1986 through 1993 by 88% (P < .0002); interventions that included convenient placement of needle disposal containers and consistent annual education may have contributed to this decrease. Injuries from manipulating intravenous lines or heparin locks decreased in 1992 (P < .03) after purchase of a needleless system for intravenous lines. Injuries from improper disposal or from abrupt patient movement did not decrease significantly over the 8-year period. This institution has conducted percutaneous injury analysis for 8 years, utilizing consistent reviewers and categorization methods. Successful interventions have reduced recapping injuries, injuries from manipulating intravenous lines/heparin locks, and the overall numbers of PI. The categories of "Improper Disposal" and "Patient Moved Abruptly" present challenges for future reductions, as well as the recently identified problem of staff not using available safety devices or using them improperly.