Percutaneous Exposure Incidents Research Articles

Percutaneous Exposure Incidents in U.S. Obstetrics and Gynecology Residents [12A

INTRODUCTION: To examine the self-reported incidence of percutaneous exposure incidents (PEIs) as well as injury reporting trends among U.S. Obstetrics and Gynecology residents. METHODS: IRB approval was obtained. This voluntary survey was distributed to all ACGME-accredited OB/GYN residency program leadership with instructions to forward to all residents in their programs. The online survey was IRB approved and open for responses from May-June 2019. Descriptive statistics were gathered, and variables were evaluated for significance by chi-square analysis. RESULTS: Among the 441 residents who responded, 355 (81%) reported ever experiencing a PEI. Sharps injuries were sustained by 321 (73%), and mucous membrane exposures (MMEs) were sustained by 255 (58%). By the final year of training, 96% of residents experienced at least one sharps injury, and 71% reported at least one MME. Most residents (258, 72%) did not reported an injury in the past. The most common reasons for not reporting included that the patient was perceived to be at low risk for infection (32%), the process was too cumbersome (24%), or the resident was too busy (12%). CONCLUSION: OBGYN residents experience a high rate of PEIs but infrequently report these injuries. Efforts to prevent PEIs are of utmost importance. Increased reporting of these injuries is needed to optimize post-exposure prophylaxis administration.

Percutaneous exposure incidents: a review of practice and awareness of current protocols at a Dental Faculty

AbstractBackgroundResearch has shown that dental care providers (DCPs) and students are among the most vulnerable to accidental exposure to blood‐borne pathogens (BBPs). An exposure to BBPs can have detrimental effects on a DCP's professional and personal life.ObjectivesThe aim of this study to study the prevalence and risk factors of sharps and needlestick injuries (NSIs) sustained by the staff and undergraduate dental students at the Faculty of Dentistry, University of Otago.MethodA cross‐sectional survey among students (fourth & fifth year dental students, postgraduate students), staff (academic/clinical) and dental assistants was performed using a self‐administered questionnaire to collect information pertaining to needlestick and sharps injuries during February 2012–November 2013. Data were tabulated in MS Excel® and analysed using SPSS statistical software®.ResultsOf the 350 questionnaires distributed, 234 participants completed the questionnaire. Seventy participants (29.9%) reported percutaneous injury. Most exposures occurred among undergraduate dental students (70%), followed by postgraduate students, academic staff (18.6%) and dental assistants (11.4%). Prevalence of under‐reporting was noted around 32.8%. Needlestick was the most frequent (34.8%) while injury from surgical bur and scaler tips were reported at 25 (28.1%) and 19 (21.3%) respectively. Only three participants (4.28%) took the post‐exposure prophylaxis after an incident.ConclusionPercutaneous exposure incidents continue to occur in healthcare settings in spite of emphasis on improved work practices and use of safety devices. Improvements are required in the use of safe‐practice and in developing a culture of more comprehensive reporting and adopting post‐exposure prophylaxis when required. Students new to the clinical environment need structured training and education before starting their clinical work to minimise accidental needlestick and sharps injuries.

Reducing the underreporting of percutaneous exposure incidents: A single-center experience

Although risk reduction strategies have been implemented throughout the world, underreporting of percutaneous exposure incidents (PEIs) is common among exposed health care workers. The aim of this study was to determine the incidence rate of reported PEIs before and after implementation of an intensified reporting management policy. The introduction of an intensified reporting system led to significantly increased reporting after a PEI has occurred. However, continuous education needs to be provided to improve awareness.

Knowledge, awareness and compliance among dental professionals regarding percutaneous exposure incidents as occupational hazard

AbstractPercutaneous injuries constitute one of the most common occupational health hazards in healthcare profession. Dental professionals are at more risk of acquiring these injuries due to their limited and restricted working area in mouth. This was a cross-sectional study done among dental professionals in Mangalore, Dakshina Kannada, Karnataka state India to access Knowledge awareness and compliance among dental professionals regarding percutaneous exposure incidents. This study concludes that Dental professionals are at a high risk of occupational disease due to accidental exposure to infected blood and body fluids. for which appropriate measures not taken after one such exposure There is a need of clearing the present misconceptions through educational training programs early in the study period and providing facilities for reporting, documenting, supportive and proper guidelines regarding percutaneous injuries in work place for healthy community.

Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel.

Healthcare workers are at risk of acquiring viral diseases such as hepatitis B, hepatitis C and HIV through exposure to contaminated blood and body fluids at work. Most often infection occurs when a healthcare worker inadvertently punctures the skin of their hand with a sharp implement that has been used in the treatment of an infected patient, thus bringing the patient's blood into contact with their own. Such occurrences are commonly known as percutaneous exposure incidents. To determine the benefits and harms of extra gloves for preventing percutaneous exposure incidents among healthcare workers versus no intervention or alternative interventions. We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, NIOSHTIC, CISDOC, PsycINFO and LILACS until 26 June 2013. Randomised controlled trials (RCTs) with healthcare workers as the majority of participants, extra gloves or special types of gloves as the intervention, and exposure to blood or bodily fluids as the outcome. Two authors independently assessed study eligibility and risk of bias, and extracted data. We performed meta-analyses for seven different comparisons. We found 34 RCTs that included 6890 person-operations as participating units and reported on 46 intervention-control group comparisons. We grouped interventions as follows: increased layers of standard gloves, gloves manufactured with special protective materials or thicker gloves, and gloves with puncture indicator systems. Indicator gloves show a coloured spot when they are perforated. Participants were surgeons in all studies and they used at least one pair of standard gloves as the control intervention. Twenty-seven studies also included other surgical staff (e.g. nurses). All but one study used perforations in gloves as an indication of exposure. The median control group rate was 18.5 perforations per 100 person-operations. Seven studies reported blood stains on the skin and two studies reported self reported needlestick injuries. Six studies reported dexterity as visual analogue scale scores for the comparison double versus single gloves, 13 studies reported outer glove perforations. We judged the included studies to have a moderate to high risk of bias.We found moderate-quality evidence that double gloves compared to single gloves reduce the risk of glove perforation (rate ratio (RR) 0.29, 95% confidence interval (CI) 0.23 to 0.37) and the risk of blood stains on the skin (RR 0.35, 95% CI 0.17 to 0.70). Two studies with a high risk of bias also reported the effect of double compared to single gloves on needlestick injuries (RR 0.58, 95% CI 0.21 to 1.62).We found low-quality evidence in one small study that the use of three gloves compared to two gloves reduces the risk of perforation further (RR 0.03, 95% CI 0.00 to 0.52). There was similar low-quality evidence that the use of one fabric glove over one normal glove reduces perforations compared to two normal gloves (RR 0.24, 95% CI 0.06 to 0.93). There was moderate-quality evidence that this effect was similar for the use of one special material glove between two normal material gloves. Thicker gloves did not perform better than thinner gloves.There was moderate to low-quality evidence in two studies that an indicator system does not reduce the total number of perforations during an operation even though it reduces the number of perforations per glove used.There was moderate-quality evidence that double gloves have a similar number of outer glove perforations as single gloves, indicating that there is no loss of dexterity with double gloves (RR 1.10, 95% CI 0.93 to 1.31). There is moderate-quality evidence that double gloving compared to single gloving during surgery reduces perforations and blood stains on the skin, indicating a decrease in percutaneous exposure incidents. There is low-quality evidence that triple gloving and the use of special gloves can further reduce the risk of glove perforations compared to double gloving with normal material gloves. The preventive effect of double gloves on percutaneous exposure incidents in surgery does not need further research. Further studies are needed to evaluate the effectiveness and cost-effectiveness of special material gloves and triple gloves, and of gloves in other occupational groups.

Epidemiology and risk factors of needle stick injuries

Epidemiology and risk factors of needle stick injuries

Occupational Hazards in Modern Dentistry

ABSTRACTDentists, as well as other dental personnel are constantly exposed to a number of specific occupational hazards. These cause the appearance of various ailments, specific to the profession, which develop and intensify with years. Despite numerous technical advances in recent years, many occupational health problems still persist in modern dentistry. These include percutaneous exposure incidents (PEI), exposure to infectious diseases, radiation, dental materials, musculoskeletal disorders (MSD), dermatitis, respiratory disorders, eye injuries and psychological problems. PEI remains a particular concern, as there is an almost constant risk of exposure to serious infectious agents. Aside from biological hazards, dentists continue to suffer a high prevalence of MSD, especially of the back, neck and shoulders. Awareness regarding these occupational hazards and implementation of preventive strategies can provide a safe working environment for all the dental personnel. There is also a need for continuing dental education programs in dentistry so that dentists can update themselves with the latest and newer techniques and materials.How to cite this articleMohammed NS, Shaik MA. Occupational Hazards in Modern Dentistry. Int J Experiment Dent Sci 2013;2(1):33-40.

Occupational hazards to dental staff

Dental professionals are predisposed to a number of occupational hazards. These include exposure to infections (including Human Immunodeficiency Virus and viral hepatitis); percutaneous exposure incidents, dental materials, radiation, and noise; musculoskeletal disorders; psychological problems and dermatitis; respiratory disorders; and eye insults. Percutaneous exposure incidents remain a main concern, as exposure to serious infectious agents is a virtual risk. Minimizing percutaneous exposure incidents and their consequences should continue to be considered, including sound infection control practices, continuing education, and hepatitis B vaccination. Basically, for any infection control strategies, dentists should be aware of individual protective measures and appropriate sterilization or other high-level disinfection utilities. Strained posture at work disturbs the musculoskeletal alignment and leads to stooped spine. The stooped posture also involved certain groups of muscles and joints. This may lead to diseases of the musculoskeletal system. Continuous educating and appropriate intervention studies are needed to reduce the complication of these hazards. So, it is important for dentists to remain constantly up-to-date about measures on how to deal with newer strategies and dental materials, and implicates the need for special medical care for this professional group.

Occupational Health Hazards in Current Dental Profession- A Review

Dentists, as well as other dental personnel are constantly exposed to a number of specific occupational hazards. These cause the appearance of various ailments, specific to the profession, which develop and intensify with years. In many cases they result in diseases and disease complexes, some of which are regarded as occupational illnesses. Relying on relevant literature, the present paper discusses occupational hazards like stressful situations, latex hypersensitivity, al- lergic reactions due to various dental materials, exposure to radiation (ionizing and non-ionizing), percutaneous exposure incidents (PEI), hazard due to nitrous oxide gas, as well as factors leading to the musculoskeletal system diseases and dis- eases of the peripheral nervous system. Awareness regarding these occupational hazards and implementation of preven- tive strategies can provide a safe working environment for all the dental personnel. There is also a need for continuing dental education programs in dentistry so that dentists can update themselves with the latest and newer techniques and materials.

Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff.

Surgeons and their assistants are especially at risk of exposure to blood due to glove perforations and needle stick injuries during operations. The use of blunt needles can reduce this risk because they don't penetrate skin easily but still perform sufficiently in other tissues. To determine the effectiveness of blunt needles compared to sharp needles for preventing percutaneous exposure incidents among surgical staff. We searched MEDLINE and EMBASE (until May 2011), CENTRAL, NHSEED, Science Citation Index Expanded, CINAHL, Nioshtic, CISdoc, PsycINFO, and LILACS (until September 2010). Randomised controlled trials (RCTs) of blunt versus sharp suture needles for preventing needle stick injuries among surgical staff measured as glove perforations or self-reported needle stick injuries. Two authors independently assessed study eligibility and risk of bias in trials and extracted data. We synthesized study results with a fixed-effect model meta-analysis. We located 10 RCTs involving 2961 participating surgeons performing an operation in which the use of blunt needles was compared to the use of sharp needles. Four studies focused on abdominal closure, two on caesarean section, two on vaginal repair and two on hip replacement. On average, a surgeon that used sharp needles sustained one glove perforation in three operations. The use of blunt needles reduced the risk of glove perforations with a relative risk (RR) of 0.46 (95% confidence interval (CI) 0.38 to 0.54) compared to sharp needles. The use of blunt needles will thus prevent one glove perforation in every six operations.In four studies, the use of blunt needles reduced the number of self-reported needle stick injuries with a RR of 0.31 (95% CI 0.14 to 0.68). Because the force needed for the blunt needles is higher, their use was rated as more difficult but still acceptable in five out of six studies.The quality of the evidence was rated as high. There is high quality evidence that the use of blunt needles appreciably reduces the risk of exposure to blood and bodily fluids for surgeons and their assistants over a range of operations. It is unlikely that future research will change this conclusion.

A percutaneous injury by a contaminated instrument is a human bite equivalent

Percutaneous exposure incidents represent an important occupational health issue. A paediatric dentist was cut by a small round bur in a handpiece. A few hours later the elbow became swollen and painful. Since the bur had been contaminated with saliva and oral flora, the injury was treated as a human bite equivalent. An X-ray revealed the broken piece of the bur in the soft tissue of the dentist's elbow. Care should be taken to prevent and treat injuries by sharp items, during and also following dental treatment.

Percutaneous Exposure Incidents Among Vietnamese Hospital Personnel and the Impact of a Prevention Program

The establishment of a reporting system and management of percutaneous occupational exposures management in a Vietnamese tertiary hospital has been achieved in encouraging the healthcare personnel (HP) to report their occupational exposures and practicing safety practice. Despite the increasing number of HIV positive patients being admitted to the hospital, the comprehensive occupational exposure prevention program, involving supplying sufficient protective barrier equipment and needle disposal units and continuing educational programs for all hospital staff on the use of these equipment has been successful in preventing HIV occupational exposures. Dedicating resources to occupational exposure prevention and HP safety should be a priority for clinical care and treatment programs in Vietnam.

Percutaneous Exposure Incidents Among Vietnamese Hospital Personnel and the Impact of a Prevention Program

Percutaneous Exposure Incidents Among Vietnamese Hospital Personnel and the Impact of a Prevention Program

Percutaneous exposure incidents of the health care personnel in a newly founded tertiary hospital: a prospective study.

BackgroundPercutaneous exposure incidents (PEIs) and blood splashes on the skin of health care workers are a major concern, since they expose susceptible employees to the risk of infectious diseases. We undertook this study in order to estimate the overall incidence of such injuries in a newly founded tertiary hospital, and to evaluate possible changes in their incidence over time.Methodology/Principal FindingsWe prospectively studied the PEIs and blood splashes on the skin of employees in a newly founded (October 2000) tertiary hospital in Athens, Greece, while a vaccination program against hepatitis B virus, as well as educational activities for avoidance of injuries, were taking place. The study period ranged from October 1, 2002 to February 28, 2005. Serologic studies for hepatitis B (HBV) and C virus (HCV) as well as human immunodeficiency virus (HIV) were performed in all injured employees and the source patients, when known. High-titer immunoglobulin (250 IU anti-HBs intramuscularly) and HBV vaccination were given to non-vaccinated or previously vaccinated but serologically non-responders after exposure. Statistical analysis of the data was performed using Mc Nemar's and Fisher's tests. 60 needlestick, 11 sharp injuries, and two splashes leading to exposure of the skin or mucosa to blood were reported during the study period in 71 nurses and two members of the cleaning staff. The overall incidence (percutaneous injuries and splashes) per 100 full-time employment-years (100 FTEYs) for high-risk personnel (nursing, medical, and cleaning staff) was 3.48, whereas the incidence of percutaneous injuries (needlestick and sharp injuries) alone per 100 FTEYs was 3.38. A higher incidence of injuries was noted during the first than in the second half of the study period (4.67 versus 2.29 per 100 FTEYs, p = 0.005). No source patient was found positive for HCV or HIV. The use of high-titer immunoglobulin after adjustment for the incidence of injuries was higher in the first than in the second half of the study period, although the difference was not statistically significant [9/49 (18.37%) vs 1/24 (4.17%), p = 0.15].Conclusions/SignificanceOur data show that nurses are the healthcare worker group that reports most of PEIs. Doctors did not report such injuries during the study period in our setting. However, the possibility of even relatively frequent PEIs in doctors cannot be excluded. This is due to underreporting of such events that has been previously described for physicians and surgeons. A decrease of the incidence of PEIs occurred during the operation of this newly founded hospital.

Occupational Health Problems in Modern Dentistry: A Review

Despite numerous technical advances in recent years, many occupational health problems still persist in modern dentistry. These include percutaneous exposure incidents (PEI); exposure to infectious diseases (including bioaerosols), radiation, dental materials, and noise; musculoskeletal disorders; dermatitis and respiratory disorders; eye injuries; and psychological problems. PEI remain a particular concern, as there is an almost constant risk of exposure to serious infectious agents. Strategies to minimise PEI and their consequences should continue to be employed, including sound infection control practices, continuing education and hepatitis B immunisation. As part of any infection control protocols, dentists should continue to utilise personal protective measures and appropriate sterilisation or other high-level disinfection techniques. Aside from biological hazards, dentists continue to suffer a high prevalence of musculoskeletal disorders (MSD), especially of the back, neck and shoulders. To fully understand the nature of these problems, further studies are needed to identify causative factors and other correlates of MSD. Continuing education and investigation of appropriate interventions to help reduce the prevalence of MSD and contact dermatitis are also needed. For these reasons, it is therefore important that dentists remain constantly informed regarding up-to-date measures on how to deal with newer technologies and dental materials.

Prevalence of percutaneous exposure incidents amongst dentists in Queensland

Percutaneous exposure incidents (PEI) represent an important occupational health issue in dentistry, and one that can incur severe consequences from blood-borne infections. Given the importance of this topic, we considered it necessary to investigate the distribution and cause of PEI among Queensland dentists. In 2004, a self-reporting questionnaire was mailed to a random sample of 400 dentists on the register of the Queensland Branch of the Australian Dental Association. A total of 285 questionnaires (73.1 per cent) were completed and returned. Of the respondents, 73.3 per cent were male and 26.7 per cent female, with a mean age of 45.2 years (SD = 11.9 years). Most were general dentists (89.1 per cent) with the remainder being specialists (10.9 per cent). More than three-quarters (78.5 per cent) reported damaging their gloves at least once during a clinical procedure in the previous 12-month period. Roughly one-quarter (27.7 per cent) had experienced at least one 'sharps' or needlestick injury in the previous 12 months, 16.1 per cent of which involved a contaminated instrument that had been previously used on a patient. The most common devices to cause 'sharps' injury in the previous 12 months were needles (14.4 per cent) and burs (10.2 per cent). Although PEI clearly remains a major occupational health problem for Queensland dentists, the prevalence of needlestick injuries appears to be lower than other studies from developed countries. The identification of needlestick injuries as a common cause of PEI again stresses the importance of preventive strategies with respect to potential blood-borne infections. Further research is now needed to more carefully identify effective measures for reducing PEI among dental personnel.

Percutaneous Exposure Incidents Among Australian Hospital Staff

We investigated all reported percutaneous exposure incidents (PEI) among staff from a large Australian hospital in the 3-year period, 2001-2003. There were a total of 373 PEI, of which 38.9% were needlestick injuries, 32.7% were cutaneous exposures and 28.4% sharps-related injuries. Nurses were the most commonly affected staff members, accounting for 63.5% of the total, followed by doctors (18.8%) and other staff ( 17.7%). Needlestick injuries were responsible for the majority of nurses’ PEI (44.7%). Sharps injuries constituted the major category for doctors (44.3%). Most needlestick injuries (67.6%) were caused by hollow-bore needles, while the majority of cutaneous exposures involved blood or serum (55.8%). Most sharps injures were caused by unknown devices (35.9%) or suture needles (34.9%). Overall, our investigation suggests that PEI is a considerable burden for health care workers in Australia. Further research is now required to determine the relationships, if any, between workers who suffer PEI and those who do not.

Preventing nursing student exposure incidents: the role of personal protective equipment and safety engineered devices.

This descriptive study used a self-selected sample of 580 newly licensed Virginia registered nurses to examine risk factors for percutaneous (needlestick) and mucocutaneous (splash) exposure incidents to blood or body fluids that occurred while they were nursing students. Fifty-one exposure incidents were reported by 42 respondents (7% of total). Twenty of 31 percutaneous exposure incidents were potentially preventable through the use of safety-engineered devices. Similarly, 4 of 10 mucocutaneous incidents occurring during routine procedures were potentially preventable through the use of personal protective equipment. Limited use of safety-engineered devices and personal protective equipment in the occurrence of nursing student exposure incidents suggests that active steps by schools of nursing to ensure student access to and use of personal protective equipment and safety-engineered devices may minimize exposure incident risk for students.