Percutaneous Injuries Research Articles

Knowledge and practices of health care workers regarding needle - stick injury in a tribal setting of Rajnandgaon, Chhattisgarh, India

Background: Needle Stick Injuries (NSIs) in healthcare settings are a global issue. Percutaneous injuries, caused by needle sticks and other sharps, are a serious concern for all Health Care Workers and pose a significant risk of occupational transmission of blood borne pathogens. The incidence of NSI is considerably higher than current estimates, because of gross under reporting and hence a low injury rate should not be interpreted as a nonexistent problem. The present study was carried out to determine the occurrence of NSI among various categories of HCWs . Methods: The present prospective cross sectional study was carried out at the 400 bedded Government Medical College Hospital, Rajnandgaon, Chhattisgarh, India during period from November 2015 to August 2016. Out of total (180) study participants, 18 were doctors, 142 nurses and 20 lab technicians from different clinical departments/wards of the hospital. Data was collected by using a predesigned pretested questionnaire. The first part of the questionnaire contained information on background characteristics and second part contained the questions regarding knowledge and practices about NSI. Results: Out of 180 HCW, 149 (82.78%) were females and, 31 (17.22%) were males. Majority of the subjects were nurses (78.89%). 92.2% subjects were aware of the Needle Stick Injury (NSI). 85% of the subjects knew that certain diseases can be spread through NSI. Almost all of them were using disposable/auto disabled syringes and needles at the hospital. Re-capping of used needle was practiced by 35.5% subjects. 63.8% subjects gave history of NSI in the last one year. Most chances of getting NSI were found to be while working in the Obstetrics and Gynecology Department (29.4%). 68.9% of the study subjects were immunized completely against Hepatitis B . Conclusions: There was gap between the knowledge and use of preventive measures. There is a need to address this gap by organizing on job training, retraining at regular intervals, workshops for HCWs regarding hazards, preventive measures and post-exposure prophylaxis for NSIs. Preventing NSI should be an essential part of any blood borne pathogen prevention strategy in the work place.

Needle stick injuries and awareness towards post exposure prophylaxis for HIV among private general practitioners of Davangere city

Background: Health care workers are at increased risk of infection with blood borne pathogens. Most exposures among health care workers are caused by percutaneous injuries with sharp objects contaminated with blood or body fluids. HIV post-exposure prophylaxis (PEP) is effective in preventing potential HIV infection following accidental exposure. The objective of the study was to determine the prevalence of needle stick injuries (NSI) and factors affecting NSI among private general practitioners, awareness towards post exposure prophylaxis for HIV among private general practitioners, practice of post exposure prophylaxis for HIV among private general practitioners.Methods:The Cross-sectional, questionnaire-based study was conducted among private general practitioners of Davangere city.Results: The prevalence of needle stick injures (NSI) in the life time of private general practitioners was 92.4%. In our study all participants had heard of HIV post exposure prophylaxis (PEP). Out of 150, 12 (8 %) had accidental exposure and 8 (67%) received HIV-PEP after exposure. Out of 8, 3(38%) completed the full HIV-PEP course.Conclusions:Majority of the respondents had needle stick injuries at least once in their life time. Majority of respondents had NSI while recapping needle. Majority of the participants had good level of awareness on PEP. Despite of good level of awareness they fail to practice HIV PEP.

Expression of neurotrophic factors in injured spinal cord after transplantation of human-umbilical cord blood stem cells in rats.

We induced percutaneous spinal cord injuries (SCI) using a balloon catheter in 45 rats and transplanted human umbilical cord blood derived mesenchymal stem cells (hUCB-MSCs) at the injury site. Locomotor function was significantly improved in hUCB-MSCs transplanted groups. Quantitative ELISA of extract from entire injured spinal cord showed increased expression of brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) and neurotrophin-3 (NT-3). Our results show that treatment of SCI with hUCB-MSCs can improve locomotor functions, and suggest that increased levels of BDNF, NGF and NT-3 in the injured spinal cord were the main therapeutic effect.

An Evaluation of Percutaneous Injuries of Healthcare Personnel: An Eigth-Year Data Analysis

Objective: The sharp object injuries constitute an important problem for the healthcare staff. The aim of this study is to retrospectively evaluate percutaneous injuries in Inonu University, Faculty of Medicine in the last eight years. Materials and Methods: Percutaneous injuries that occurred in our hospital between 2006 and 2013 were evaluated respectively.. Results: 144 percutaneous injuries recorded during the last eight years were included in the study. The rates of exposure were found to be 44% (63) for cleaning personnel, 17% (25) for nurses, 12% (17) for medical students, 12% (17) ancillary staff and caregivers, 6% (9) for apprentice nurses, 5% (7) for technicians, and 4% (6) for doctors. The number of percutaneous injuries were found to be 126 (87%) for needle stick injuries, 11 (8%) for lancet injuries and 7 (5%) for mucosal (eye) contacts. We have observed a significant decrease in the total injuries and injured cleaning personnel, ancillary staff, and nurses (p<0.001). Conclusions: Throughout 8 years, percutaneous injuries were significantly reduced among healthcare staff. We plan to provide continuous education for healthcare personnel and follow up feedback in our hospital. Keywords: Sharp Injurious; Health Worker; Needle Stick Injurious.

Prevalence of percutaneous injuries and associated factors among health care workers in Hawassa referral and adare District hospitals, Hawassa, Ethiopia, January 2014

BackgroundAccidental percutaneous injury and acquiring blood-borne diseases are common problems among health care workers (HCWs). However, little is known about the prevalence and associated factors for needle stick injury among HCWs in Ethiopia.MethodsA cross sectional study was conducted by including 526 HCWs (physicians, nurses, laboratory technicians, midwives and others), working in two public hospitals (Hawassa Referral and Adare District hospitals), from January 1–30, 2014. Binary logistic regression was done to assess the association of selected independent variables with accidental percutaneous injury.ResultsThe prevalence of at least one episode of percutaneous injury was about 46 % of which more than half (28 %) occurred within one year prior to the study period and only 24 % took prophylaxis for human immune deficiency virus (HIV) infection. The adjusted logistic regression analysis revealed that HCWs who recap needles were twice as likely to face a percutaneous injury. Chance of exposure to needle stick or sharp injuries also increased with increase in educational status. Having a previous history of needle stick or sharp injury was found as one of the risk factors for the occurrence of another injury. Nurses and cleaners were also at increased risk for the occurrence of percutaneous injuries.ConclusionNeedle stick and sharp injuries were common among HCWs in the study hospitals, which warrants training on preventive methods.

Occupational exposure to blood borne pathogens among healthcare workers: a cross-sectional study of a registry in Colombia.

BackgroundOccupational exposure to blood borne pathogens caused by percutaneous injuries or mucosal contamination is frequent among Healthcare Workers (HCW).MethodsA cross-sectional analysis of HCW with an occupational exposure to blood reported to professional risk insurance agencies between 2009 and 2014 was performed. Comparisons between groups according to exposure level (mild, moderate, and severe) were evaluated.ResultsTwo thousand, four hundred three reports were classified according exposure as mild 2.7 %, moderate 74.8 %, severe 21.9 %. Factors related: health sciences student with mild exposure events [adjusted odds ratio (AOR) 11.91, 95 % CI 5.13–27.61, p < 0.00001], and physician with moderate exposure events (AOR 1.90, 95 % CI 1.17–3.07, p = 0.009). Factors inversely related: physician with severe exposure events (AOR 0.54, 95 % CI 0.32–0.91, p = 0.02) and health sciences student with moderate exposure events (AOR 0.08, 95 % CI 0.04–0.15, p < 0.00001). It was found an important relationship between severe events with infectious diseases specialist assessment, and follow-up adherence. Additionally, a case of Human Immunodeficiency Virus seroconversion was presented (0.0004 %), no other seroconversions were observed.ConclusionsOccupational exposure events must be managed according to established protocols, but adherence failure was evident with the exception of severe exposure cases. Thus, interventions to enhance occupational safety are required. Occupation must be considered as a risk factor during initial assessment of events.

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.

The status of occupational blood and infectious body fluids exposures in five blood centres in China: a 5-year review.

Little information about the occupational exposures to blood and body fluid (BBF) among blood service workers (BSWs) in blood stations in China is available currently. To assess current status of occupational exposure to BBF and assess the knowledge about occupational blood-borne pathogen exposures and universal precaution among BSWs in blood donations in China. To understand the incidence of occupational exposure in five blood centres in China. A cross-sectional study was conducted from January 2008 to December 2013. There were a total of 99 BBF exposures reported during the study period. The total incidence of BBF exposures was 4.4 per 100 person-years. Higher rates were observed for persons employed less than five years and persons less than 45 years old. Nurses have the highest percentage (49.5%) of BBF exposures. BBF exposures occurred most commonly during the afternoon (62.7%). Percutaneous injuries were the most common BBF exposures. Most incidents occurred during sharps use (73.4%). The major cause of occupational exposure was that there was no continuous training (48.4%) and improper use of equipment (23.2%). Only 56.6% of BBF exposures had appropriate first aid measures. During this research work, one staff member was reported to have seroconverted to syphilis after BBF exposure. To reduce BBF exposures, it is urgent to take several effective actions in China, including improved occupational health systems, adequate education, administrative support, increased use of standard precautions, better safety devices/products and work practices.

Large Percutaneous Tracheostomy-Induced Injury Repair by Thoracoscopic Approach

Large Percutaneous Tracheostomy-Induced Injury Repair by Thoracoscopic Approach

Percutaneous and Mucocutaneous Exposure Among Orthopaedic Surgeons: Immediate Management and Compliance With CDC Protocol.

Orthopaedic surgeons are at a high risk of sustaining a percutaneous or mucocutaneous exposure to blood and body fluids. The Center for Disease Control and Prevention recommends a wash with soap and water and notification of the concerned hospital authorities after any percutaneous/mucocutaneous exposure, but a systematic amenability with these guidelines is not always seen. This cross-sectional study was undertaken to determine current knowledge and practices of orthopaedic surgeons in case of a percutaneous sharp injury exposure, emphasizes the immediate first aid steps taken after an exposure, the degree of reporting, and to explore the reasons for noncompliance. Finally, we sought to create awareness about the prevailing Center for Disease Control and Prevention guidelines after any exposure to blood or body fluids. We conducted a cross-sectional survey using an anonymous prepared questionnaire. The study population included exclusively orthopaedic surgeons, including residents, fellows, and attending physicians at 4 US institutions. The questionnaire was also available online on the OTA Web site as a part of survey monkey. The questionnaire comprised 9 multiple choice questions, and more than 1 response could be given for some questions. The questions addressed previous needle stick/sharp injury exposure, number of times that had happened, whether reported to the hospital administration, reason for nonreporting, and risk perception for transmission of blood-borne pathogens (human immunodeficiency virus, HBsAg, and hepatitis C virus). The questions were also asked based on what should be done in four different clinical settings based on respondents risk perception. Of fifty eight attendings, 7 fellows, 45 residents, and 7 respondents who did not indicate their position participated in the survey for a total of 117 respondents. Out of 99, 24 had sustained it once, 18 twice, 11 three times, and 35 at least 4 times. When questioned about informing the incident to the hospital administration, 38% had always reported the incident, 33% had never reported the incident, and the remaining 29% had not reported it every time. Of note, 87% gave the correct response about the risk of transmission of human immunodeficiency virus after an exposure. On questioning about the risk of hepatitis B transmission, from an HBsAg- and HBeAg-positive source, 13% gave the correct response, whereas from HBsAg-positive and HBeAg-negative source, 30% gave the correct response. Regarding transmission of hepatitis C virus from a positive source, 36% responded correctly. The surgeons seemingly attempted to risk stratify their exposure, and they were more likely to report their exposure in the higher risk scenarios. This study demonstrates that orthopaedic surgeons of all levels of training are at high risk of occupational exposure to blood-borne pathogens. Moreover, despite the level of training, the majority of surgeons do not follow the recommended steps, although we do not know the reasons for such behavior. Also, there is a low awareness of the significant risk of hepatitis transmission among orthopaedic surgeons treating a population with a high prevalence of undiagnosed hepatitis.

Development of an Experimental Animal Model for Lower Back Pain by Percutaneous Injury-Induced Lumbar Facet Joint Osteoarthritis.

We report generation and characterization of pain-related behavior in a minimally invasive facet joint degeneration (FJD) animal model in rats. FJD was produced by a non-open percutaneous puncture-induced injury on the right lumbar FJs at three consecutive levels. Pressure hyperalgesia in the lower back was assessed by measuring the vocalization response to pressure from a force transducer. After hyperalgesia was established, pathological changes in lumbar FJs and alterations of intervertebral foramen size were assessed by histological and imaging analyses. To investigate treatment options for lumber FJ osteoarthritis-induced pain, animals with established hyperalgesia were administered with analgesic drugs, such as morphine, a selective COX-2 inhibitor, a non-steroidal anti-inflammatory drug (NSAID) (ketorolac), or pregabalin. Effects were assessed by behavioral pain responses. One week after percutaneous puncture-induced injury of the lumbar FJs, ipsilateral primary pressure hyperalgesia developed and was maintained for at least 12 weeks without foraminal stenosis. Animals showed decreased spontaneous activity, but no secondary hyperalgesia in the hind paws. Histopathological and microfocus X-ray computed tomography analyses demonstrated that the percutaneous puncture injury resulted in osteoarthritis-like structural changes in the FJs cartilage and subchondral bone. Pressure hyperalgesia was completely reversed by morphine. The administration of celecoxib produced moderate pain reduction with no statistical significance while the administration of ketorolac and pregabalin produced no analgesic effect on FJ osteoarthritis-induced back pain. Our animal model of non-open percutanous puncture-induced injury of the lumbar FJs in rats shows similar characteristics of low back pain produced by human facet arthropathy.

Cochrane Review Brief: Gloves, Extra Gloves or Special Types of Gloves for Preventing Percutaneous Exposure Injuries in Healthcare Personnel

Cochrane Review Brief: Gloves, Extra Gloves or Special Types of Gloves for Preventing Percutaneous Exposure Injuries in Healthcare Personnel

Knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst students in two Chinese dental schools.

To investigate the knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst dental students at two Chinese dental schools, as well as important factors that are associated with their career choice and attitudes towards infected patients. The study was conducted using a student self-administered questionnaire from March to June 2013 at two Chinese dental schools. Chi-square tests and multivariable logistic regression were used to compare the categorical variables and identify the variables related to attitudes. One hundred and seventy-one students answered the questionnaire (response rate 83%). Most participants had incomplete knowledge about occupational exposure and participants' compliance with the infection control programme during routine clinical work was low. Fifty-six participants (34%) experienced at least one occupational exposure, but only one reported the incident. Percutaneous injuries and mucous membrane exposures were the main causes for exposure. Protection of the eyes and post-exposure management were inadequate. According to most participants, they had received insufficient education. Their concerns about the risk of infectious professional exposure would influence their career choice and approach to patients. Only 14% and 26% of the participants were willing to treat human immunodeficiency virus- and hepatitis B virus-infected patients, respectively. More effective education on prevention and management is required for dental students to reduce the harm caused by occupational exposure. It is important to ensure dental students' knowledge and understanding before allowing them to enter clinical training.

Rapid diagnostics for Ebola in emergency settings

Rapid diagnostics for Ebola in emergency settings

Coronary high-intensity plaque on T1-weighted magnetic resonance imaging and its association with myocardial injury after percutaneous coronary intervention.

Non-contrast T1-weighted imaging (T1WI) has emerged as a novel non-invasive imaging for vulnerable coronary plaque showing a high-intensity plaque (HIP). However, the association between HIP and percutaneous coronary intervention (PCI) has not been evaluated. We investigated the association between the presence of HIP and the incidence of myocardial injury after PCI. A total of 77 patients with stable angina were imaged with non-contrast T1WI by using a 1.5 T magnetic resonance system (HIP and non-HIP group, N = 31 and 46 patients, respectively). We defined HIP as a coronary plaque to myocardium signal intensity ratio (PMR) of ≥1.4. High-sensitive cardiac troponin-T (hs-cTnT) was measured at baseline and 24 h after PCI. Percutaneous coronary intervention-related myocardial injury (PMI) was defined as an elevation of hs-cTnT >5× 99th percentile upper reference limit. High-intensity plaque was associated with the characteristics of ultrasound attenuation and positive remodelling on intravascular ultrasound. Although baseline hs-cTnT was similar between the groups, increase in hs-cTnT was significantly greater in the HIP vs. non-HIP group (0.065 [0.023-0.304] vs. 0.017 [0.005-0.026], P < 0.001). Percutaneous coronary intervention-related myocardial injury occurred more frequently in the HIP than non-HIP group (58.1 vs. 10.9%, P < 0.001), and the cut-off value of PMR found to be 1.44 for predicting PMI (sensitivity 78.3% and specificity 81.5%). In multivariate analysis, a PMR of ≥1.4 was a significant predictor of PMI (odds ratio 5.63, 95% confidence interval 1.28-24.7, P = 0.022). High-intensity plaque on non-contrast T1WI was characterized as vulnerable coronary plaque on IVUS and was associated with higher incidence of PMI.

Evaluation of High Risk Blood and Body Fluid Exposures at a Large Urban Teaching Hospital

Evaluation of High Risk Blood and Body Fluid Exposures at a Large Urban Teaching Hospital

Iatrogenic percutaneous vascular injuries: clinical presentation, imaging, and management.

Vascular interventional radiology procedures are relatively safe compared with analogous surgical procedures, with overall major complication rates of less than 1%. However, major vascular injuries resulting from these procedures may lead to significant morbidity and mortality. This review will discuss the etiology, clinical presentation, diagnosis, and management of vascular complications related to percutaneous vascular interventions. Early recognition of these complications and familiarity with treatment options are essential skills for the interventional radiologist.

Percutaneous injuries among healthcare workers at a general hospital

Objectives: Percutaneous injuries (PCIs) remain a common incident among healthcare workers (HCWs) despite the introduction of safety programs. The aim of this study was to assess the PCIs, required precautions, and applications after the injuries among healthcare workers in a small general hospital. Materials and methods: We assessed the occurrence of PCIs at a General Hospital (EGH) from January 2007 to November 2010. During this period, all injury cases among HCWs were reported to the Infection Control Committee (ICC) using percutaneous injury notification form. The injury notification forms were evaluated retrospectively. Results: Totally 275 health personnel were working in our hospital, 36 healthy workers have been exposed to PCIs during this period. The incidence of PCIs was 2,9/10000 in 2007, 3,1/10000 in 2008, 3,8/10000 in 2009 and 3,9/10000 patient-days in 2010. Injured staff were recorded as, 16 nurses (44%), 12 cleaning staffs (34%), and eight (22%) doctors. The device leading to damage was most frequently the needle-channel. Ten sources (27%) were detected positive for hepatitis B virus (HBV), four (11%) for hepatitis C virus (HCV), and two (5%) for Crimean-Congo hemorrhagic fever virus (CCHFV). No case of seroconversion has been recognized for any of the above mentioned infections. Conclusions: Percutaneous injuries remain to occur among HCWs. Since some the sources were infected, the health personnel are endangered for infections due to PCIs. The health personnel should presume that all patients are infected, and thus should work following universal precautions to avoid complications about the PCIs.

Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in French Hospitals, 2003-2012: Results of the French National Network Survey, AES-RAISIN.

To assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities. Retrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008-12). Reported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012. Of the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.

Understanding sharps injuries in home healthcare: The Safe Home Care qualitative methods study to identify pathways for injury prevention.

BackgroundHome healthcare is one of the fastest growing sectors in the United States. Percutaneous injuries from sharp medical devices (sharps) are a source of bloodborne pathogen infections among home healthcare workers and community members. Sharps use and disposal practices in the home are highly variable and there is no comprehensive analysis of the system of sharps procurement, use and disposal in home healthcare. This gap is a barrier to effective public health interventions. The objectives of this study were to i) identify the full range of pathways by which sharps enter and exit the home, stakeholders involved, and barriers for using sharps with injury prevention features; and ii) assess the leverage points for preventive interventions.MethodsThis study employed qualitative research methods to develop two systems maps of the use of sharps and prevention of sharps injuries in home healthcare. Twenty-six in-depth interview sessions were conducted including home healthcare agency clinicians, public health practitioners, sharps device manufacturers, injury prevention advocates, pharmacists and others. Interview transcripts were audio-recorded and analyzed thematically using NVIVO qualitative research analysis software. Analysis of supporting archival material also was conducted. All findings guided development of the two maps.ResultsSharps enter the home via multiple complex pathways involving home healthcare providers and home users. The providers reported using sharps with injury prevention features. However, home users’ sharps seldom had injury prevention features and sharps were commonly re-used for convenience and cost-savings. Improperly discarded sharps present hazards to caregivers, waste handlers, and community members. The most effective intervention potential exists at the beginning of the sharps systems maps where interventions can eliminate or minimize sharps injuries, in particular with needleless treatment methods and sharps with injury prevention features. Manufacturers and insurance providers can improve safety with more affordable and accessible sharps with injury prevention features for home users. Sharps disposal campaigns, free-of-charge disposal containers, and convenient disposal options remain essential.ConclusionsSharps injuries are preventable through public health actions that promote needleless treatment methods, sharps with injury prevention features, and safe disposal practices. Communication about hazards regarding sharps is needed for all home healthcare stakeholders.