Percutaneous Injuries Research Articles

Seroconversion rate among health care workers exposed to HIV-contaminated body fluids: The University of Pittsburgh 13-year experience

The studies enumerating the risk of HIV transmission to health care workers (HCWs) as 0.3% after percutaneous exposure to HIV-positive blood, and 0.09% after a mucous membrane exposure, are weakened by dated literature. Our study aims to demonstrate the seroconversion rate after exposure to HIV-contaminated body fluids in a major academic center in the United States. A prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at an academic medical center was analyzed. Data collected included the type of injury, injured body part, type of fluid, contamination of sharps, involvement of resident physicians, use of postexposure prophylaxis, and patients' HIV, hepatitis B virus, and hepatitis C virus status. A total of 266 cases were included in the study. Most exposures were caused by percutaneous injuries (52.6%), followed by 43.2% mucocutaneous injuries. Of the injuries, 52.6% were to the hand and 33.5% to the face and neck. Blood exposure accounted for 64.3% of all cases. Of the patients, 21.1% received postexposure prophylaxis. None of the HCWs exposed to HIV-contaminated body fluids seroconverted (seroconversion rate, 0%). HIV does not seem to be as easily transmitted by needlestick, laceration, or splash injuries as previously surmised. Further large-scale and multicenter studies are needed for a more accurate estimation of the risk of transmission of HIV in U.S. health care workers.

Seroconversion rates among health care workers exposed to hepatitis C virus–contaminated body fluids: The University of Pittsburgh 13-year experience

Hepatitis C virus (HCV) transmission to health care personnel (HCP) after exposure to a HCV-positive source has been reported to occur at an average rate of 1.8% (range, 0%-10%). We aimed to determine the seroconversion rate after exposure to HCV-contaminated body fluid in a major U.S. academic medical center. A longitudinal analysis of a prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at the University of Pittsburgh Medical Center was performed. Data collected include type of injury and fluid, injured body part, contamination of sharps, resident physicians' involvement, and patients' hepatitis B virus (HBV), HCV, and HIV status. A total of 1,361 cases were included in the study. Most exposures were caused by percutaneous injuries (65.0%), followed by mucocutaneous injuries (33.7%). Most (63.3%) were injuries to the hand, followed by the face and neck (27.6%). Blood exposure accounted for 72.7%, and blood-containing saliva accounted for 3.4%. A total of 6.9% and 3.7% of source patients were coinfected with HIV and HBV, respectively. The HCV seroconversion rate was 0.1% (n = 2) because of blood exposure secondary to percutaneous injuries. This study provides the largest and most recent cohort from a major U.S. academic medical center. The seroconversion rates among HCP exposed to HCV-contaminated body fluids was found to be lower than most of the data found in the literature.

Prevalence of Percutaneous Injuries among Dentists in Palestine: A Cross Sectional Study

Dentistry is a profession which commonly deals with contact of secretions from the oral cavity. Percutaneous injuries can further accentuate the dentist’s risk for diseases such Hepatitis B and HIV. Hence we conducted a study which aimed to assess the prevalence of percutaneous injuries and the associated factors among dentists. A total of 300 dentists from Palestine were requested for an online survey regarding percutaneous injuries, among which 201 dentists responded. Demographic data, Hepatitis B vaccination status, use of personal protective barriers and incidences of percutaneous injuries from dental instruments were assessed. The prevalence of percutaneous injuries was 90% among the dentists. 97.5% of the dentists were vaccinated against Hepatitis B. However, only 87% had received all the three recommended doses. Percutaneous injury was more common with probes/ explorers, endodontic files and needles in the decreasing order, accounting to 31.3%, 31% and 26.6% respectively. Hence the study showed that the prevalence of percutaneous injuries was high among dentists and it is necessary to emphasize the importance of personal protective barriers and vaccination against Hepatitis B.

Bloodborne pathogen exposures: Difference in reporting rates and individual predictors among health care personnel.

Employees in health care settings are at varying risk for bloodborne pathogen (BBP) exposures. We compared differences in reporting rates of BBP exposures among health care personnel during 2 different time periods, assessing job category, years of experience, and sex as potential predictors for exposure. A retrospective review of the employee health department BBP database at 2 time periods (September 1, 2012-April 30, 2013, and September 1, 2013-April 30, 2014) in which 2 different reporting protocols (call center vs pager) was used. A survey was administered to assess reported and unreported exposures within a 12-month period. BBP exposures were highest among residents and lowest among students. Physicians' reporting rate doubled when the call center was no longer used (relative risk, 2.40; 95% confidence interval [CI], 1.04-5.52). Percutaneous injuries were the most common (78.3%), and most occurred in the operating room or postanesthesia unit (30.8%) and patient rooms (28.9%). Of 1,105 survey respondents, 103 (9.3%) recalled some type of exposure, but only 80 (77.7%) reported these exposures. When accounting for years of experience and sex, job category was significantly associated with injury or exposure within the previous 12 months (P < .001). Risk of exposure among residents was 3 times higher (odds ratio, 3.10; 95 CI, 1.60-6.00) than nurses. Risk and reporting behaviors of BBP exposures vary widely across different providers. Training and education to prevent BBP exposures may need to be tailored toward different provider types.

Reported incidences and factors associated with percutaneous injuries and splash exposures among healthcare workers in Kahama District, Tanzania

Background: Percutaneous injuries and mucocutaneous blood and other body fluids exposure are among the common hospital hazards affecting health care workers (HCWs) worldwide. These exposures pose risks of contracting infections such as Hepatitis B and C and Human Immunodeficiency viruses. This study aimed to determine the incidence and human factors associated with percutaneous injuries and splash exposures among healthcare workers in Kahama District, Tanzania. Methods : This descriptive cross sectional study was conducted in Kahama District of north-western Tanzania and involved randomly selected healthcare workers. Structured self-administered questionnaire was used to collect data between July and October 2015. Results: A total of 277 HCWs participated in the study. Among them 146 (53%) were nurses, 138 (14%) auxiliary staff 36 (13%), 32 (12%) laboratory personnel and 25 (9%) were doctors. The mean age was 37.4 years. Seventy-one percent of the participants had more than 10 years’ of working experience. About 59% of participants reported incidences of percutaneous injuries and mucocutaneous blood and other fluids exposures. About 90% of participants agreed to experience the incidences several times. While 60% disagreed with availability of personal protective gears, non-reporting of the cases was noted by 26% of participants. Majority (81%) disagreed with existence of infection prevention and control (IPC) guidelines and protocols. The main human factors associated with the percutaneous injuries and splash exposures included HCWs experience at work (71%), long working hours (29%), type of workplace (48%) and inadequate use of IPC guidelines and protocols (48%). Conclusion: More than half of participants reported incidents of percutaneous injuries and mucocutaneous blood and other body fluids in Kahama District of Tanzania. Adherence to universal precautions, training and reduction of long working hours are necessary in order to reduce infections from percutaneous injuries and exposures.

The seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in patients undergoing septoplasty

IntroductionWorldwide, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus are major health problems. Healthcare workers are at risk of transmitting blood–borne viruses, and surgeons have a higher risk of exposure to blood and higher rates of percutaneous injury than other healthcare workers. Septoplasty is among the 3 most commonly performed otolaryngological surgeries worldwide. ObjectiveTo determine the seroprevalence of Hepatitis B surface antigen, Hepatitis C virus antibody, and Human Immunodeficiency Virus antibody in patients undergoing septoplasty with and without turbinate surgery under general anesthesia, and to determine if preoperative testing should be performed in such patients. MethodsThis retrospective cross-sectional study included 3731 patients that underwent septoplasty with and without turbinate surgery between January 2005 and July 2015. HBsAg, anti-HCV, and anti-HIV seropositivity in the patients was evaluated retrospectively. ResultsMean age of the patients was 36 years (range: 11–81 years). In all, 117 (3.6%) patients were positive for HBsAg, 12 (0.3%) were positive for anti-HCV, and 7 (0.2%) were positive for anti-HIV. ConclusionsEducation of healthcare workers combined with routine preoperative serological testing in patients undergoing septoplasty under general and local anesthesia are needed to increase awareness of hepatitis B and C, and HIV infection among healthcare workers and patients in order to decrease the transmission rate.

Abstract: Seroconversion Rates Among Healthcare Workers Exposed to Human Immunodeficiency Virus and Hepatitis C-Contaminated Body Fluids: The University of Pittsburgh Experience

BACKGROUND: Human Immunodeficiency Virus (HIV) and hepatitis C virus (HCV) transmission to healthcare personnel (HCP) following percutaneous exposure to the blood of a source patient, has been reported to occur at an average rate of 0.3% (0.2–0.5%) 1 and 1.8% (range 0–10%),1,2 respectively. Most of this data is either outdated or was from predominantly non-US centers. We aimed to determine the seroconversion rate after exposure to HIV or HCV-contaminated body fluid at a major academic medical center in the US. METHODS: A longitudinal analysis of a prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at the University of Pittsburgh Medical Center was performed. Inclusion criteria included HCP who sustained needlestick, laceration, or splash injuries from known HIV or HCV-positive patients. Exclusion criteria included missing data (on the type of injury and fluids), and a positive HIV or HCV status of the HCP. Data collected included the type of injury, injured body part, type of fluid, contamination of sharps, and patients’ HIV and HCV status. Univariate and bivariate statistical analyses were performed using SPSS statistical software (version 19.0; SPSS Inc., Chicago, IL, USA). RESULTS: 1,627 cases (HIV=266, HCV=1,361) were included in the study. The majority of the cases were due to percutaneous injuries (HIV=52.6%, HCV=65.0%) as opposed to mucocutaneous injuries (HIV=43.2%, HCV=33.7%), and the majority of injuries occurred in the hand (HIV=52.6%, HCV=63.3%). Blood exposure accounted for 64.3% (HIV) and 72.7% (HCV) of cases, saliva for 5.6% (HIV) and 3.4% (HCV), and other fluids for 13.6% (HIV) and 11% (HCV). The seroconversion rate was calculated at 0% after a mucocutaneous exposure to either HIV- or HCV-contaminated body fluid, but was 0% (n=0) for HIV and 0.2% (n=2) for HCV, after a percutaneous exposure. The two seroconverted cases were secondary to blood exposure via percutaneous injuries. CONCLUSION: This study provides the most recent data from a major US academic medical center. The seroconversion rates among HCP exposed to HIV and HCV-contaminated body fluids (0% and 0.2% respectively), were found to be lower than most of the data found in the literature. HIV and HCV do not seem to be easily transmitted by needlestick, laceration, or splash injuries. However, further large-scale studies are needed for a more accurate estimation of the risk of transmission. DISCLOSURE:The authors have no financial interest to declare in relation to the content of this article. REFERENCES: 1. CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR 2001;50 (No. RR-11):1–52. 2. Mitsui T, Iwano K, Masuko K, Yamazaki C, Okamoto H, Tsuda F, Tanaka T, et al. Hepatitis C virus infection in medical personnel after needlestick accident. HEPATOLOGY 1992;16:1109–1114.

Management of health care workers following occupational exposure to hepatitis B, hepatitis C, and human immunodeficiency virus.

Needlestick injury or mucosal contact with blood or body fluids is well recognised in the health care setting. This study aimed to describe the post-exposure management and outcome in health care workers following exposure to hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) during needlestick injury or mucosal contact. This case series study was conducted in a public clinic in Hong Kong. All health care workers with a needlestick injury or mucosal contact with blood or body fluids who were referred to the Therapeutic Prevention Clinic of Department of Health from 1999 to 2013 were included. A total of 1525 health care workers were referred to the Therapeutic Prevention Clinic following occupational exposure. Most sustained a percutaneous injury (89%), in particular during post-procedure cleaning or tidying up. Gloves were worn in 62.7% of instances. The source patient could be identified in 83.7% of cases, but the infection status was usually unknown, with baseline positivity rates of hepatitis B, hepatitis C, and HIV of all identified sources, as reported by the injured, being 7.4%, 1.6%, and 3.3%, respectively. Post-exposure prophylaxis of HIV was prescribed to 48 health care workers, of whom 14 (38.9%) had been exposed to known HIV-infected blood or body fluids. The majority (89.6%) received HIV post-exposure prophylaxis within 24 hours of exposure. Drug-related adverse events were encountered by 88.6%. The completion rate of post-exposure prophylaxis was 73.1%. After a follow-up period of 6 months (or 1 year for those who had taken HIV post-exposure prophylaxis), no hepatitis B, hepatitis C, or HIV seroconversions were detected. Percutaneous injury in the health care setting is not uncommon but post-exposure prophylaxis of HIV is infrequently indicated. There was no hepatitis B, hepatitis C, and HIV transmission via sharps or mucosal injury in this cohort of health care workers.

Occupational Exposure to Positive Blood and Body Fluids among Health Care Workers in a Chinese University Hospital: A Three Years Retrospective Study

&lt;p&gt;Health care workers (HCWs) are exposed to blood and body fluids (BBF) due to occupational accidents. However, few studies have investigated the prevalence of occupational exposure in Chinese HCWs thus far. There is a clearly a critical need to characterize its epidemiology more fully in China so that effective prevention programs can be implemented. We conducted a retrospective study at a university hospital in China, giving an epidemiological analysis on these exposed HCWs whose pathogens of BBF from patients were positive [human immunodeficiency virus (HIV) / hepatitis B (HBV) / hepatitis C (HCV)]. From July 1st 2011 to June 30th 2014, a total of 155 occupational exposures to positive BBF were reported, with an incidence of 16.64 (/1000 person-years). Percutaneous injuries were the most common type of exposure episodes (89.03%). The most common type of exposed blood-borne pathogens was HBV (83.87%), and the majority of the respondents were nursing students, with an incidence of 34.22 (/1000 person-years). More effective preventive strategies on HCWs’ BBF occupational exposure should be implemented in China, especially for nursing students.&lt;/p&gt;

Knowledge, attitude and behaviour regarding hepatitis C virus infection amongst Brazilian dental students

Dental health professionals, including dental students, are at high risk of exposure to infection with the hepatitis C virus (HCV) through occupational percutaneous injuries and eye exposure. Further, fear of HCV infection is associated with discriminatory attitudes. The current study aimed to evaluate the knowledge about HCV infection amongst dental students and their attitudes towards patients infected with HCV. A cross-sectional survey was conducted amongst 340 Brazilian dental students from two public universities using an instrument containing information regarding demographic characteristics, knowledge of HCV and attitudes towards patients with HCV infection. Descriptive statistics, Fisher's exact test, Student's t-tests, Mann-Whitney U-test and multiple logistic regression (MLR) were carried out (P < 0.05 was considered significant). Response rate was 90% (n = 306), and more than half (54%, n = 165) of participants had high knowledge level (above the mean); 97.7% (n = 299) demonstrated positive attitudes. MLR showed that high knowledge of dental students regarding HCV was substantially influenced by advancement in year of study (last year; P < 0.001) and type of university (federal; P = 0.049). Positive attitude towards HCV-infected patients was mainly influenced by age (P = 0.004) and male gender (P = 0.022). These results demonstrated a satisfactory knowledge about HCV infection amongst dental students, but some gaps were observed, suggesting the importance of continuous education about HCV in this population to prevent HCV infection as well as discrimination and prejudice towards patients with hepatitis C.

Epidemiology and clinical consequences of occupational exposure to blood and other body fluids in a university hospital in Saudi Arabia.

Objectives:To describe the epidemiological characteristics, clinical impact, and adequacy of post-exposure management of occupational exposure to blood and body fluids (BBFs).Methods:Retrospective chart review of individuals reporting exposure to BBFs from 2007 to 2013 at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia.Results:The total number of exposures reported was 326 exposures, of which 302 (92.6%) exposures were percutaneous, 21 (6.5%), mucocutaneous, and 3 (0.9%), bites. Nursing staff/students had the highest rate of exposure (149, or 45.6%), followed by physicians (57, or 17.5%). Surgeons were found to have a significantly higher risk for sharp injuries compared with other physicians (26.3%, or 15 exposures, p<0.005). Most (216, or 72.5%) percutaneous injuries were caused by hollow-bore needles. Majority of exposures (124, or 42.6%) occurred after using the needle/sharp item and before disposal. Two-thirds (219, or 67%) of exposed individuals were immune to hepatitis B at the time of exposure. With appropriate post-exposure management, none of exposed individuals seroconverted to HIV, hepatitis B or C virus infections.Conclusion:Occupational exposure to BBFs remains a concern among healthcare workers. Educational programs targeting high-risk groups entailing reinforcement of prevention and adherence to post-exposure management guidelines are needed.

Post exposure prophylaxis against human immunodeficiency virus: Awareness knowledge and practice among Nigerian Paediatricians

Objective : To determine the level of awareness, knowledge and practice of human immunodeficiency virus post exposure prophylaxis (HIV PEP) among paediatricians in Nigeria. Methodology : The study was a cross sectional questionnairebased survey conducted among paediatrcians that attended the Paediatric association of Nigeria annual scientific conference in 2015. Results : Most of the respondents (96%) were aware of the concept HIV PEP. The scores on knowledge of PEP for all the respondents ranged from 18% to 91 % with a mean score of 46.5 ± 14.1%. There was no significant difference between the performance of those who had received training on HIV PEP (48.0 ± 13.2%) and those who had not (45.1 ± 14.8%), p = 0.21, t =1.26. Ninety one (60.7%) of the respondents had been exposed to percutaneous injury during work. Thirty (33%) of the exposed paediatricians did not know the patient’s HIV status and only 10 (11%) received PEP, with only 7 (7.7%) of them completing the PEP for 4 weeks Conclusion : Despite the high level of HIV PEP awareness, there was an unacceptable high rate of occupational exposures and poor knowledge of HIV PEP among Paediatricians. Additionally, there was a low uptake of HIV PEP services amongst exposed Paediatricians in Nigeria. There is need for urgent action to curb this trend. Key Words : HIV PEP, Paediatrician, Nigeria

Occupational Exposure to Blood and Other Body Fluids Among Healthcare Workers in Three Teaching Hospitals, Southeast Iran

Background: Healthcare workers (HCWs) regularly face the risk of exposure to sharp injuries and splashes as an occupational haz- ard, which presents a major risk for acquiring blood-borne infectious agents. Objectives: This study aimed to determine the occurrence of needlestick injuries (NSIs) and other high-risk occupational exposures to blood and body fluids (BBFs) among HCWs in three teaching hospitals aliated with the Zahedan University of Medical Sciences. Patients and Methods: A cross-sectional study was carried out from March 2013 to December 2014. Information on self-reported incidents, circumstances surrounding occupational exposure, and post-exposure management were collected from an ongoing surveillance system. Descriptive statistics and chi square tests were used for data analysis. Results: A total of 236 incidents of occupational exposure were registered during the study period. Nurses (82, 34.7%) were most fre- quently exposed to BBFs, followed by physicians (57, 24.2%). Two hundred and nineteen (92.8%) of the personnel sustained NSIs, and 17 (7.2%) had splashes to mucus membranes. The incidents were most frequently reported from the internal medicine ward (19.1%) followed by the operating theater (17.1%). Subjects with splashes to mucus membranes were more likely to postpone seeking medi- cal advice following exposure, as compared with needlestick cases (23.5% versus 5%, P < 0.016). A significantly greater proportion of pediatric and emergency department sta were found to delay post-exposure measures (P < 0.040). Conclusions: The relatively high prevalence of percutaneous injuries and splashes in this study emphasized the importance of im- proved prevention strategies, better hospital surveillance for occupational exposure, and enhanced training of healthcare workers.

Fluoroscopically Guided C2 Percutaneous Vertebroplasty: A Surgical Technique Note on an Anterior Ascending Approach

Background: C2 vertebroplasty is more challenging than transpedicular percutaneous vertebroplasty in the thoracic and lumbar spine. Objective: We report an anterior ascending approach for C2 percutaneous vertebroplasty to avoid potential injury to vital structures surrounding the C2 vertebra. Study Design: A technique note with 5 consecutive cases. Setting: Neurosurgery department of a university hospital. Methods: Fluoroscopically guided manual compression was applied using 3 fingers at the C5 level between the muscle and trachea. The larynx and trachea were displaced medially and the carotid artery laterally. The anterior cervical spine was palpated, and a 15-gauge 4-inch bone marrow biopsy needle was introduced through an anterior ascending approach. When the tip touched the intervertebral disc between C2 and C3, the needle was pushed through the disc until it penetrated into the C2 vertebral body. After confirming adequate needle insertion, vertebroplasty was performed. Results: Pain relief was achieved in 4/5 (80%) patients. One patient possibly did not benefit from percutaneous vertebroplasty, and asymptomatic cement extravasation was detected in 2 patients. Limitations: Sample size; impossibility of placebo control. Conclusion: An anterior ascending approach for C2 percutaneous vertebroplasty is a valuable alternative for relieving pain caused by metastatic spinal tumors. This approach is familiar to surgeons performing anterior cervical discectomies, percutaneous nucleoplasty, or odontoid screw placement surgeries. Key words: Vertebroplasty, pain, axis, cement leak, metastases, palliative medicine, spine, fracture

The Effects of the 80-hour Workweek on Occupational Hazards

Background The most recent work-hour restrictions were implemented in July 2011 for training physicians. The impact of these regulations on workplace injuries is not yet fully understood. Our goal is to determine the effect of the work-hour limitation on the rates of needlestick and eyesplash injuries.Methods Approximately 1200 neurosurgery residents and fellows in the United States were emailed a survey, several times, Sept 2013–February 2014. There were 212 responses across postgraduate years 1–7 and fellowship regarding the rate of needlestick and eyesplash injuries experienced or witnessed before and after July 2011.Results Regarding witnessing a needlestick/eyesplash accident: 89.33% of respondents claimed witnessing an injury. Specifically regarding percutaneous injuries (PCIs): before July 2011, 21.77% claimed never witnessing; after July 2011, only 8.9% indicated never witnessing. Specifically regarding eyesplash injuries: comparing the injuries (40.94%) before July 2011 to those (51.94%) after July 2011, the survey indicated an increase in eyesplash injuries.Conclusion The results of this survey document that neurosurgery residents/fellows observed (or personally sustained) an increased number of needlestick and eyesplash injuries after implementation of the July 2011 work-hour limitations. Although the last set of reduced-hour regulations have been in place for more than three years, there does not therefore seem to be a safety advantage associated with them regarding a reduction in PCI or eyesplash accidents. This may be due to other confounding factors, not yet affirmatively identified, which warrant additional investigation and identification, directed at preventing future injuries.

An Analysis of Student Percutaneous Injuries at Dalhousie Dental School

The objective of the study was to determine circumstances under which student clinician injuries occur at the Dalhousie University Dental Clinic. Necessary policies and procedures may then be recommended and implemented to decrease the frequency of such occurrences.

Impact of Safety-Engineered Devices on the Incidence of Occupational Blood and Body Fluid Exposures Among Healthcare Personnel in an Academic Facility, 2000-2014.

Legislative actions and advanced technologies, particularly dissemination of safety-engineered devices, have aided in protecting healthcare personnel from occupational blood and body fluid exposures (BBFE). To investigate the trends in BBFE among healthcare personnel over 15 years and the impact of safety-engineered devices on the incidence of percutaneous injuries as well as features of injuries associated with these devices. Retrospective cohort study at University of North Carolina Hospitals, a tertiary care academic facility. Data on BBFE in healthcare personnel were extracted from Occupational Health Service records (2000-2014). Exposures associated with safety-engineered and conventional devices were compared. Generalized linear models were applied to measure the annual incidence rate difference by exposure type over time. A total of 4,300 BBFE, including 3,318 percutaneous injuries (77%), were reported. The incidence rate for overall BBFE was significantly reduced during 2000-2014 (incidence rate difference, 1.72; P=.0003). The incidence rate for percutaneous injuries was also dramatically reduced during 2001-2006 (incidence rate difference, 1.37; P=.0079) but was less changed during 2006-2014. Percutaneous injuries associated with safety-engineered devices accounted for 27% of all BBFE. BBFE was most commonly due to injecting through skin, placing intravenous catheters, and blood drawing. Our study revealed significant overall reduction in BBFE and percutaneous injuries likely due in part to the impact of safety-engineered devices but also identified that a considerable proportion of percutaneous injuries is now associated with these devices. Additional prevention strategies are needed to further reduce percutaneous injuries and improve design of safety-engineered devices.

Sharps injuries among emergency department nurses in one tertiary care hospital in Ghana

Exposure to bloodborne pathogens is the most serious occupational health risk encountered within the healthcare profession worldwide. The World Health Organization estimates that 3 million healthcare workers experience percutaneous injuries each year. The objectives of this study were to: (1) examine the frequency of sharps injuries, and (2) assess the adequacy, understanding, and use of post-exposure protocols within a sample of the nursing staff at a busy tertiary care emergency department in the Ashanti Region of Ghana. A mixed-methods descriptive study design was used including key informant interviews to develop the survey, a structured survey of emergency department nursing staff, and document review. Overall, the emergency department staff was well informed regarding the risks of sharps injury and the immediate steps to take in the event of a sharps injury. However, few staff could list essential post-exposure follow-up steps. Over one-quarter (28.9%) of emergency nurses reported a sharps injury during a one-year period according to hospital records. The high incidence of sharps injuries indicates an urgent and pressing need for policy and educational interventions to address the infectious disease risk to this group of emergency department staff.

Potential threat of meningitis from ampoule impurities: Prevention is always better than cure!

Sir, Spinal anaesthesia mandates adherence to strict asepsis to prevent potentially dreaded complications such as meningitis. Ampoule impurities can be a potential cause of breach in asepsis. Here, we report an incidence of macroscopic ampoule impurity while loading the local anaesthetic for subarachnoid block. Local anaesthetics used for spinal anaesthesia are usually available in a single use glass ampoule. Few properties that are responsible for its wide use are excellent chemical resistance, impermeability and ability to tolerate sterilisation process. Problems encountered due to the use of glass ampoules are micro particles contamination and occupational risk due to percutaneous injuries while trying to break open the ampoule. To prevent percutaneous injury, mechanisms such as one point cut (OPC) and ‘rupture disk’ have been developed. In the OPC system, a small incision is made in the neck or strangulation point of the ampoule, between the head of the ampoule and the body. A small dot placed a few millimetres above the incision indicates the correct orientation for snapping the ampoule open.[1] In the ‘rupture disk’ system, an area of fragility is caused at the strangulation point using a temper process that partially penetrates the glass causing an area of fragility or weak point. A band is then painted at the strangulation point, indicating its point of weakness[1] [Figure 1a].Figure 1: (a) ‘Rupture disk’ system and one point cut system. (b) Impurity detected in the local anaesthetic solutionIn our case, a fragment of paint from the band accidentally fell into the local anaesthetic solution, while trying to break open the ampoule [Figure 1b]. As the impurity was detected before loading the local anaesthetic solution, the ampoule was discarded and a fresh ampoule was used. Contamination of ampoule with micro particles has been a constant concern among the healthcare providers and has been reported for a long time.[2] In the incident that we report, a visible particle of paint has contaminated the local anaesthetic solution. This not only exposes the patient to the risk of infection and meningitis, but also to a risk of organic reaction due to the injected particle. Meningitis following subarachnoid block has been reported before.[34] Meningitis can occur either due to a breach in asepsis during the procedure or due to the presence of pre-existing bacteraemia in the patient at the time when spinal is performed.[5] Though aseptic causes are more likely, the occurrence of septic meningitis is not uncommon. Strong adherence to asepsis can prevent purely iatrogenic complications such as meningitis from developing. It is preferable to use OPC system as an aid to snap open the ampoule in drugs intended for spinal and epidural use. Even if drugs are loaded from ampoules that have ‘rupture disk’ system, we strongly recommend careful inspection of the drug solution before loading the drug. Pre-sterilising the package and providing sterile ampoules have also been recommended to prevent infection. In addition, prudent measures should be taken to make spinal and epidural drugs available in shatterproof and easily snappable ampoules. The manufacturers should also ensure that the paint used in ‘rupture disk’ ampoule does not get fragmented while snapping open the ampoule. Use of filters in needles and use of smaller gauge needles have also been advocated as measures to reduce loading of glass micro particles in syringes.[1] Use of pre-filled syringes can be the way forward to prevent contamination of drug as well as occupational hazards. To conclude, careful inspection for visible ampoule impurities and ensuring strict asepsis can prevent iatrogenic complications during spinal anaesthesia. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A cross sectional study to evaluate needle stick injuries among health care workers in Malabar medical college, Calicut, Kerala, India

Background: Percutaneous injuries caused by needle sticks pose a significant risk of blood borne pathogens among health care workers. Many factors are involved in transmission of infections like HIV, Hepatitis B and Hepatitis C such as overuse of injections, lack of disposable syringes, safer needle devices, sharps disposal containers, passing instruments from hand to hand, lack of awareness and adequate training. Needle stick injuries (NSI) are under reported, this study helps to know the causes and other factors related to NSI for effective prevention. Methods: Cross-sectional study was conducted among all health care workers who consented to participated in the study in July 1st to July 31st 2016. 514 health workers were interviewed and given a pre-detested, semi-structured questionnaire was given to elicit information regarding the factors for causation ofNSI and its effective prevention. Results: 21.1% (108) of the health care workers had NSI. 45.4% were interns, followed by nursing staff (26.8%). 55.5% (60) had history of NSI while performing any surgeries or assisting procedures. Majority of them knew about the transmission of HIV (100%), Hepatitis B (99.1%) and Hepatitis C (81.4%) and Malaria (20.3). NSI reporting was observed at 46.2%. 88.2% (90) of them had completed their 3 dose schedule of hepatitis B vaccine, 48% (52) had received training on universal precautions. Conclusions: NSI was seen more among interns and nursing staff. They had good knowledge regarding the diseases transmission due to NSI and Vaccination. Effective periodic training on universal precautions can prevent NSI.