Percutaneous Injuries Research Articles

Chinks in the armor: Percutaneous injuries from hollow bore safety-engineered sharps devices

Despite their overwhelming efficacy, safety-engineered sharp devices (SESDs) cause a residual fraction of injuries. Although the fraction of injuries from SESDs is less than that reported for nonsafety devices, it remains a "preventable fraction" and is a sizable target for further advances. A retrospective review of 3,297 percutaneous injuries from hollow bore safety-engineered devices occurring between 2001 and 2009 was conducted examining the Exposure Prevention Information Network (EPINet) needlestick surveillance data. Nurses sustain 64.6% of all SESD injuries. 42.9% Of SESD injuries occur after device use and are likely preventable through consistent and effective use of safety-engineered technology. Excluding injuries that occurred during device use or between procedural steps, 71.8% (n/N = 28/39) of physician injuries, 58.2% (n/N = 645/1,109) of injuries to nurses, and 45.8% (n/N = 88/192) of injuries to phlebotomists occurred when an available SESD was not fully activated. Passive devices that do not require action on the part of the end user to engage a safety feature currently represent a small portion of the SESD market. Wider dissemination of a broader array of passive SESDs coupled with continual education of end users is essential to an effective sharps injury prevention program.

Guidance on Occupational-Related HIV Post-Exposure Prophylaxis (PEP) in the Intensive Care Setting

Healthcare workers are at risk for transmission of HIV via percutaneous injury (most commonly) or mucosal membrane exposure. Post-exposure prophylaxis provides a treatment strategy to prevent transmission of HIV among healthcare workers who have been exposed to a high-risk source. In this article, the likelihood of risk of transmission, issues surrounding testing source patients, and factors to consider when initiating post-exposure prophylaxis following occupational exposure to HIV in an intensive care setting are reviewed.

Advancing infection control in dental care settings: Factors associated with dentists' implementation of guidelines from the Centers for Disease Control and Prevention

The authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings-2003. In 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling. Responding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied. Implementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines.

Percutaneous injuries amongst Greek endodontists: a national questionnaire survey

To investigate amongst Greek endodontists the incidence of percutaneous injuries, the circumstances associated with them, the therapeutic measures taken after the injuries and their compliance with infection control measures. One hundred and forty-seven endodontists met the inclusion criteria and were invited to participate in the survey. Personal and professional data, information on percutaneous injuries in the past 5 years and on infection control practices were gathered through interviews based on a questionnaire. Data were analysed using chi-square test, independent samples t-test, one-way anova and Pearson's correlation coefficient. The level of significance was set at P = 0.05. The response rate was 84%. The injury rate was estimated at 1.35 per endodontist per year. Endodontic files were associated with 37% of the injuries and fingers were injured in 75% of the most recent cases. Medical assistance was sought in 36% of the most recent injuries. Endodontists who always or usually practiced 4-handed endodontics (P = 0.007) as well as those not performing surgical endodontics (P = 0.007) reported significantly fewer injuries. In 91% of the participants, a complete hepatitis B virus vaccination was reported. Gloves, masks, rubber dam isolation and puncture-resistant containers for disposal of sharp instruments were always used by 98%, 94%, 100% and 81% of the respondents, respectively. The injury rate was low. The practice of four-handed endodontics was associated with a reduced number of percutaneous injuries; the performance of surgical endodontics increased their incidence. Greek endodontists showed a high level of compliance with infection control measures.

133 Stick and Tell: A Survey of Emergency Medicine Residents and Needlestick Exposures

Study Objectives: An estimated 400,000 to 800,000 needlestick injuries annually in the US involves health care workers. Although percutaneous injury are a common occurrence in the emergency department (ED), there is a large discrepancy between the number of actual events and the events reported to employee health. Despite the potentially serious consequences of percutaneous injury, practitioners often downplay the occurrence and do not report exposures. This study was conducted in order to investigate needlestick incidence and the resident's attitude associated with reporting injuries.

Incidence of Percutaneous Injuries and Non-Reporting Rates Among First-Aid Responders in Taiwan

We determined the incidence of percutaneous (needlestick and sharps) injuries among emergency medical technicians (EMTs) in one county in Taiwan, compared this with the official reporting rate, and sought reasons for non-reporting. An anonymous questionnaire was distributed to all EMTs in that county, eliciting percutaneous injuries occurrences, reasons why, and reporting data. Data were analyzed by logistic regression. A total of 329 out of 353 EMTs completed the questionnaire, giving a response rate of 93.2%. Thirty-nine EMTs (11.9%) experienced at least one percutaneous injury in the preceding 12 months. Older, less experienced EMTs were at greater risk of percutaneous injuries. None of the EMTs officially reported their percutaneous injuries primarily because they thought reporting was not mandatory and that the reporting process was too complicated. About one in eight EMTs had experienced at least one percutaneous injury in the preceding year. None of these injuries was officially reported to their organization. Ways to make reporting more user friendly are required, along with resources to minimize percutaneous injuries among EMTs in Taiwan.

Chinks in the Armor: Activation Patterns of Hollow-Bore Safety-Engineered Sharp Devices

A retrospective review of secondary injury data was used to evaluate the characteristics of percutaneous injuries from safety-engineered sharp devices. Injury rates and safety device activation rates differed by healthcare provider type. Approximately 22.8%-32% of injuries could have been prevented had an available safety feature been activated after use.

The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre

To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Surgeons and peri-operative nurses risk acquiring blood-borne viral infections during surgical procedures. Appropriate first-aid and prophylactic treatment after an injury can significantly reduce the risk of infection. However, studies indicate that injuries often go unreported. The 'systems approach' to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety. A postal survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals, face-to-face interviews with selected participants and telephone interviews with Infection Control Nurses. The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. Only 54.9% (112/204) reported every injury. Surgeons were poorer at reporting: 70/133 (52.6%) reported all or >50% of their injuries compared with 65/71 nurses (91.5%). Injuries are frequently under-reported, possibly compromising safety in operating theatres. A significant number of inoculation injuries are not reported. Factors influencing under-reporting were identified. This knowledge can assist managers in improving reporting and encouraging a robust safety culture within operating departments.

Impact of infection control educational activities on rates and frequencies of percutaneous injuries (PIs) at a tertiary care hospital in Saudi Arabia

To study the impact of educational activities on the rates and frequencies of percutaneous injuries (PIs) at a tertiary care hospital in Saudi Arabia. PI surveillance is a routine activity in King Abdulaziz Medical City (a 900-bed teaching tertiary health care hospital) in Riyadh using the Exposure Prevention Information Network (EPINet) data collection tool. From 2001 through 2003, educational activities were conducted for health care workers (HCWs) to prevent PIs. The education included lectures on the risk of unsafe practices that may lead to PIs and how to avoid them. Data from before (1997-2000) and after (2004-2008) the intervention were imported from our surveillance system and statistically analyzed. The total overall rate of PIs per 1000 HCWs was significantly lower in the post-intervention period than in the pre-intervention period (14 vs. 32.8/1000 HCWs, respectively). The rates of PIs among nurses and housekeepers showed a significant decrease (15 vs. 37.6/1000 HCWs and 10 vs. 34.5/1000 HCWs, respectively). The frequency of PIs in the emergency department (ED) and intensive care units (ICUs) showed a significant decrease (3.4% for both vs. 12.4% and 13.7%, respectively). PIs associated with devices, such as needles on IV lines, IV catheters, lancets and suture needles, showed a significant decrease. PIs occurring during device disassembly and from inappropriately discarded devices also decreased significantly. The educational program reduced some categories of PIs, including the overall rate, the rate among nurses and housekeepers, the frequency in the ED and ICUs and the frequency among needles on IV lines, IV catheters, lancets and suture needles. Other PI categories did not change significantly.

Sharps injuries and their prevention: what the new European legislation may mean for palliative care services

Approximately 3 million health-care workers throughout the world, and more than 1 million in Europe, experience a percutaneous injury each year as a result of accidents with needles or other sharps. The consequences of this can be devastating, ranging from fear, anxiety, discomfort, and embarrassment to contraction of blood-borne infections. A new European Union Directive on the prevention of sharps injuries that must be implemented by May 2013 aims to ensure that health-care workers throughout Europe have access to safer sharps and needle-free devices. The present paper outlines what the introduction of this directive will mean for health-care services, with particular consideration of palliative and specialist palliative care services.

Dental Students and Bloodborne Pathogens: Occupational Exposures, Knowledge, and Attitudes

Dental professionals may be exposed to bloodborne pathogens in their work, and dental students may be a particularly vulnerable group. Fear of exposure has also been linked to discriminatory practices. A cross-sectional survey of dental students was conducted at one U.S. dental school to assess their knowledge about the transmission of bloodborne pathogens and management of exposures; the frequency of their bloodborne pathogen exposures (BBPEs); and associations among their prior exposure, knowledge, perception of knowledge, and attitudes toward practice. Overall, 220 students (72.1 percent) responded to the survey, and 215 (70.5 percent) answered questions about exposures. The prevalence of BBPE was 19.1 percent and was greater among clinical than preclinical students (p<0.01). Percutaneous injuries occurred in 87.5 percent of those exposed. All students (preclinical and clinical combined) answered more survey questions correctly about transmission of bloodborne pathogens (66.7 percent) than about post-exposure management (25.0 percent). Fewer than half reported adequate knowledge of transmission and management (47.5 percent and 37.3 percent, respectively). In this context, 8.2 percent of the respondents acknowledged an unwillingness to perform procedures on patients with HIV. Since knowledge gaps may lead to failure to report incidents and delays in appropriate exposure management and some negative attitudes towards treating individuals with HIV persist, these findings justify improving BBPE education at U.S. dental schools.

A prospective survey of percutaneous injuries in dental post graduates during periodontal procedures.

Abstract: Occupational exposures to blood borne pathogens can occur as a result of percutaneous injuries during periodontal procedures. Detailed attention to the pattern of injuries could help in developing improved strategies to further minimize their incidence.We surveyed 12 residents enrolled in the MDS course for one year to find out how many percutaneous injuries occurred during periodontal procedures .Survey questionnaire inquired in detail about the circumstances, site and the nature of injury. We also noted the risk status of patient and device which caused the injury.A total of 48 percutaneous injuries (7.84%) were received in 612 periodontal procedures in the 1 year survey. The injury rate was 4/year/resident and individual residents suffered from 2-7 injuries during the study. The difference in number of percutaneous injuries sustained in surgical periodontal procedures (41/265) was highly significant statistically (p<0.0001) when compared to those in non surgical interventions (7/670).Most injuries occurred from suture needle followed by Castroviejo and injection needle. There is a low probability of occupational transmission of blood borne diseases in periodontal procedures. The findings of this study could possibly contribute further in efforts to reduce the incidence of percutaneous injuries during periodontal procedures.

A prospective survey of percutaneous injuries in dental post graduates during periodontal procedures.

A prospective survey of percutaneous injuries in dental post graduates during periodontal procedures.

Abstract No. 321: Don't get poked: simple steps for safe sharps handling in interventional radiology

Interventional radiologists are at risk of percutaneous injuries from sharp instruments. There is an estimated 1% chance of contracting hepatitis C due to occupational exposure following needlestick injuries. The increasing prevalence of blood-borne pathogens including hepatitis B & C, and Human Immunodeficiency Virus (HIV), puts nurses, residents, fellows, and interventional radiologists at risk for occupational exposure.

Occupational health problems of dentists in the United Arab Emirates

The aim of this study was to investigate the prevalence of some occupationally related health problems among dentists in the United Arab Emirates (UAE). A cross-sectional study using the one-stage complex sampling technique to evaluate the results of a self-reporting questionnaire distributed to 844 dentists working in three cities (Abu Dhabi, Dubai and Sharjah) in UAE. Seven hundred and thirty-three (87%) dentists, aged 22-70 years, responded. The most common occupational health problems were musculoskeletal pain [497 (68%)] and percutaneous injury [306 (42%)]. Around one-fifth [135 (18%)] of dentists had a history of contact dermatitis, mostly caused by latex gloves, 53% had eye problems and 5% had hearing problems. As exposure to potential infectious agents is of concern, continuing education in the avoidance of percutaneous injuries would be beneficial. Further studies are needed to identify the causes of musculoskeletal pain and the appropriate interventions to reduce its prevalence; similar measures are required to reduce exposure to agents which may produce contact dermatitis. The awareness of occupational health problems should be highlighted at all clinical and research symposia.

Transmission of hepatitis C virus by occupational percutaneous injuries in South Korea

Korea is an endemic area of hepatitis. Hepatitis C virus (HCV) infections caused by occupational percutaneous injuries are a serious problem for healthcare workers and there has been a gradual increase in the number of HCV infections. We therefore determined the transmission rate of HCV after occupational percutaneous injury. This was a retrospective cohort study reviewing all occupational blood exposure reports made between January 1, 2004, and December 31, 2008, at a university-affiliated acute care hospital. Over the 5-year study period, there were 1,516 accidents of occupational exposure to blood; of these, 327 (21.6%) were to the blood of HCV-infected patients and 3 (0.9%) healthcare workers became infected with HCV (95% CI 0.6-8.8). In Korea, although the bloodborne accidents leading to exposure to HCV occurred frequently (21.6%), the transmission rate was very low (0.92%).

Gender differences in characteristics, occupational exposure, and infection control practices among dental professionals in Edo State, Nigeria

The objective of this study was to assess the gender differences in the characteristics of dental professionals in Edo State, Nigeria, their occupational exposure to percutaneous injuries, and their infection control practices. A cross-sectional survey was conducted among dental professionals working in two tiers of healthcare delivery across Edo State, from December 2008-February 2009. A self-administered questionnaire elicited information on demography, and prevalence of percutaneous injuries and infection control practices, such as hand hygiene, glove use, eye protection, protective clothing, and hepatitis B vaccination. A total of 90 questionnaires were returned, yielding a response rate of 93.8%. There was signifcant gender difference in the age (p-value = 0.008) and profession of the respondents (p-value = 0.001), with more male dental surgeons (65.6%), and more female dental auxiliaries (73.1%). There was a gender difference in percutaneous occupational exposure (p-value = 0.602) and hepatitis B va...

Awareness and Prevalence of Accidental Blood-borne Exposures Among Students of Sri Sai College of Dental Surgery Vikarabad

ABSTRACT Background Studies have demonstrated that dental stu-dents / dentists are among the most vulnerable to blood-borne exposures. Objectives The objective of this study was to assess the awareness and prevalence of accidental blood-borne exposures among undergraduate and postgraduate dental students. Materials and Methods A cross-sectional survey was conducted among 281 students at Sri Sai College of Dental Surgery-Vikarabad, in which a structured pre-tested self-administered questionnaire was given to all clinical dental students and the responses were subjected to statistical analysis. Results The response rate in present study was 87%. The mean age of the subjects was 22.9 years and awareness on blood borne exposures was found to be 88.9%. 76% of the students reported having undergone accidental exposures with 24% of them being Per-cutaneous injuries. In 49% of respondents syringe needle was the most common instrument causing accidental injury. Conclusion Accidental exposures and non-reporting of accidental exposures were prevalent in these students.

Prevalence of percutaneous injuries and associated factors among dental surgeons

PURPOSE: The practice of dentistry usually involves contact with secretions from the oral cavity through percutaneous injuries, which is a risk factor for the transmission of infections, especially hepatitis B, between the professional and patients. This study aimed to assess the prevalence of percutaneous injuries and associated factors among dental surgeons. METHODS: A total of 187 dental surgeons from the city of Pelotas, Brazil, participated in this study. Data concerning the socio-demographic aspects, occurrence of accidents, types of instruments, use of personal protective equipment, immunization coverage related to hepatitis B and tests for serum conversion were collected through self-reported questionnaires. The data underwent descriptive analysis and chi-square testing or Fisher's exact test, with P<0.05. RESULTS: The prevalence of percutaneous injuries was 59.8%, and there was no association with the risk factors evaluated. Of the dentists interviewed, 97.3% had been vaccinated against hepatitis B; however, only 86.2% had received the three recommended doses. The use of probes and handling needles were the most common causes of percutaneous injuries (37.0% and 29.0%, respectively). CONCLUSION: The results showed that the prevalence of percutaneous injuries was high among dental surgeons, and there is a need for emphasis on the prevention of hepatitis B through the administration of the three vaccine doses and the use of personal protective equipment.

Thoracic duct injury due to left subclavicular vein catheterization: A new conservative approach to a chyle fistula using biological glue

INTRODUCTIONA thoracic duct injury complicated with a chylous fistula is a rather rare occurrence associated with left subclavicular catheterization. We present a new method of its conservative management which seems to be the least interventional described so far. It can be used in cases of this iatrogenic injury irrespective of the rate of chyle loss. PRESENTATION OF CASEOur case report involves a 59-year-old patient with a high-output chyle fistula due to left subclavicular vein catheterization, in which biological cyanoacrylic glue was used through percutaneous infusion to the venous angle, where the thoracic duct was leaking. An extensive review of the relevant literature is presented. DISCUSSIONMost of the high-output fistulas require a long time of conservative treatment, which may result in severe complications due to the prolongation of chyle loss. An operation may be needed in selected cases. Our proposed interventional method can be used in cases of percutaneous injury of a chyle duct, with immediate results. CONCLUSIONAn iatrogenic chyle fistula due to left subclavicular catheterization can be obtained with a percutaneous injection of biological glue directly onto the injured vessel.