Percutaneous Injuries Research Articles

Prevention of Needlestick and Sharp Injuries Among Hospitals in Thailand: A National Survey

percutaneous exposure to infected blood. According to the CDC, an estimated 385,000 percutaneous injuries occur in HCW annually. Transmission of hepatitis B (HBV), hepatitis C (HCV), or human immunodeficiency virus (HIV) after mucous membrane or nonintact skin exposure to blood has also been reported. PROJECT: Risk of BBP transmission following occupational exposures depends on the HCW’s immune status, source patient factors, and the type of injury and quantity of blood transferred to the HCW. Prevention of transmission requires prompt reporting, expert postexposure assessment, and rapid dispensing of post-exposure prophylaxis medications (PEP). A body substance exposure (BSE) hotline was implemented by our healthcare organization in 1997, staffed by trained nurse specialists with infectious disease physician oversight and standing HIV PEP orders. The hotline is answered 24-7, and procedures are in place at all entities for source patient lab testing, HIV PEP, and employee testing. RESULTS: Six hotline nurse specialists serve the hotline at least 8 weeks per year, taking call for a week at a time. The hotline services 11 inpatient facilities, 3 long-term care facilities, 3 occupational health clinics, 2 physician medical groups, 1 orthopedic surgery center, 1 behavioral health agency, 1 home care agency, external healthcare agencies, and first responders. A total of 4,682 hotline calls have been managed (Figure 1) from 2000 to 2013, and HCW self-reported BSE are collected in an electronic data repository. The annual increase in the number of calls represents an increase in hotline customers. LESSON LEARNED: The BSE hotline provides a regional service to support exposed employees with after-hours expertise avoiding employee visits to the ER. Standardized training, assessment tools, standing orders, protocols, and expert physician guidance provides consistent exposure management for exposed HCW by nurse specialists. The hotline services over 28,000 employees and calls are responded towithin 10 minutes. Specialists provide HIV PEP within two hours of warranted exposures for BBP exposure prevention.

Healthcare Personnel Post Exposure Management Hotline: Thirteen Years in Review

Transmission of bloodborne pathogens (BBP) from patients to healthcare workers (HCW) is a significant occupational hazard for HCW. The greatest risk of infection transmission is through percutaneous exposure to infected blood. According to the CDC, an estimated 385,000 percutaneous injuries occur in HCW annually. Transmission of hepatitis B (HBV), hepatitis C (HCV), or human immunodeficiency virus (HIV) after mucous membrane or non-intact skin exposure to blood has also been reported.

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The estimated risk of contamination through percutaneous injuries involving HIV-contaminated sharp objects is 0.32%. It is well known that a high viral load is one of the conditions that increase the risk of HIV-1 transmission in occupational accidents. In order to estimate the level of viral load that could be necessary for HIV-1 transmission to health care workers undergoing occupational accidents with contaminated needles, blood-soiled needles were obtained from HIV-positive patients just after drawing blood to determine HIV-1 viral load by NASBA. Detection of HIV-1 genome was performed by reverse-transcription polymerase chain reaction (RT-PCR) after RNA extraction directly wash-outs collected from needles immediately after blood drawing. Samples collected from needles used on 102 HIV-1-positive patients were RT-PCR tested but only 7 were HIV-1-positive. Each patient sample was compared to its respective viral load. All 7 RT-PCR-positive samples were from patients with viral loads higher than 160,000 RNA copies/mm3. Since the needle samples tested here could be considered to be of very high risk of HIV-1 transmission following an occupational accident, RT-PCR detection of HIV-1 genome was only possible in patients with high viral load. These results indicate that, among all risk factors, high HIV-1 viral load probably is the most important risk factor for HIV transmission to health care workers during occupational exposure. Key words: HIV, viral load, polymerase chain reaction (PCR), RNA, occupational accidents.

Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel

Needlestick injuries from devices used for blood collection or for injections expose healthcare workers to the risk of blood borne infections such as hepatitis B and C, and human immunodeficiency virus (HIV). Safety features such as shields or retractable needles can possibly contribute to the prevention of these injuries and it is important to evaluate their effectiveness. To determine the benefits and harms of safety medical devices aiming to prevent percutaneous exposure injuries caused by needles in healthcare personnel versus no intervention or alternative interventions. We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, Nioshtic, CISdoc and PsycINFO (until January 2014) and LILACS (until January 2012). We included randomised controlled trials (RCT), controlled before and after studies (CBA) and interrupted time-series (ITS) designs on the effect of safety engineered medical devices on needlestick injuries in healthcare staff. Two authors independently assessed study eligibility and risk of bias and extracted data. We synthesized study results with a fixed-effect or random-effects model meta-analysis where appropriate. We included four RCTs with 1136 participants, two cluster-RCTs with 795 participants and 73,454 patient days, four CBAs with approximately 22,000 participants and seven ITS with an average of seven data points. These studies evaluated safe modifications of blood collection systems, intravenous (IV) systems, injection systems, multiple devices and sharps containers. The needlestick injury (NSI) rate in the control groups was estimated at about one to five NSIs per 1000 person-years. There was only one study from a low- or middle-income country. The risk of bias was high in most studies.In one ITS study that evaluated safe blood collection systems, NSIs decreased immediately after the introduction (effect size (ES) -6.9, 95% confidence interval (CI) -9.5 to -4.2) and there was no clear evidence of an additional benefit over time (ES -1.2, 95% CI -2.5 to 0.1). Another ITS study used an outdated recapping shield.There was very low quality evidence that NSIs were reduced with the introduction of safe IV devices in two out of four studies but the other two studies showed no clear evidence of a trend towards a reduction. However, there was moderate quality evidence in four other studies that these devices increased the number of blood splashes where the safety system had to be engaged actively (relative risk (RR) 1.6, 95% CI 1.08 to 2.36).There was no clear evidence that the introduction of safe injection devices changed the NSI rate in two studies.The introduction of multiple safety devices showed a decrease in NSI in one study but not in another. The introduction of safety containers showed a decrease in NSI in one study but inconsistent results in two other studies.There was no evidence in the included studies about which type of device was better, for example shielding or retraction of the needle. For safe blood collection systems, we found very low quality evidence in one study that these decrease needlestick injuries (NSIs). For intravenous systems, we found very low quality evidence that they result in a decrease of NSI compared with usual devices but moderate quality evidence that they increase contamination with blood. For other safe injection needles, the introduction of multiple safety devices or the introduction of sharps containers the evidence was inconsistent or there was no clear evidence of a benefit. All studies had a considerable risk of bias and the lack of evidence of a beneficial effect could be due both to confounding and bias. This does not mean that these devices are not effective.Cluster-randomised controlled studies are needed to compare the various types of safety engineered devices for their effectiveness and cost-effectiveness, especially in low- and middle-income countries.

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.

Crimean-Congo Hemorrhagic Fever: A Reemerging Disease

Context: Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral disease which has 30% to 80% mortality rate. In endemic areas, livestock handlers, skin processors, veterinary staff, livestock market employees, farmers, and health care staff are at risk. Diagnosis is made based on clinical manifestations, epidemiologic factors, and laboratory tests. Here, we reviewed the epidemiology, clinical manifestation, diagnosis, treatment, and the prophylaxis of CCHF. Evidence Acquisition: We searched electronic databases (PubMed and Scopus) from January 1980 to May 2014. Key words including CCHF, epidemiology, clinical manifestation, treatment, and prevention routes were searched. Results: CCHF is widely distributed in different countries worldwide and is also endemic in our country, Iran. Treatment is mainly supportive; however, if the patient is suspected to have CCHF, ribavirin therapy is needed immediately. High dose methylprednisolone, interferon, and intraveonus immunoglobulin (IVIG) are other treatment protocols. Postexposure prophylaxis should be considered potentially in people who were exposed to CCHF virus, such as those who have mucous membrane contact or percutaneous injuries in contact with body secretions or blood of infected animal or patients with CCHF. Conclusions: CCHF is a fatal viral disease. Therefore, preexposure and postexposure prophylaxis should be potentially considered to decrease the rate of infection.

Hepatitis-B: an Alarming Infectious Condition- How Aware are We???

<strong>Background & Objectives:</strong>Infections caused by blood-borne pathogens like HCV, HBV or HCV have emerged as a hurricane for health-care workers. Among them, Hepatitis-B is a leading cause of morbidity & mortality all around the world especially placing health workers at higher occupational risks. Also percutaneous injuries in dental clinic are risk factors for transmission of HBV. Hence a bi-directional relationship exists between dentist & patient regarding transmission of HBV. The present study is designed to evaluate degree of awareness & knowledge about HBV & status of vaccination against it, among the dental students & clinicians.<p><strong>Methods:</strong> A cross-sectional study was conducted on 279 dental professionals including 41 clinicians, 45 post-graduate students, 80 interns and 113 B.D.S III & IV Yr students by means of a questionnaire. Data was collected & then analyzed in SPSS version-16.</p><p><strong>Result:</strong> Our results were noteworthy that nearly 89.6% claimed that hepatitis-b is preventable. Positively, 90.71% subjects were vaccinated against HBV & 62.8% showed positive attitude towards HBV+ patients. However, some alarming findings are that 54.64% didn’t know about post-exposure prophylaxis and 79.84% didn’t have any idea about serum HBV DNA viral load considered safe according to CDC.</p><p><strong>Conclusion:</strong> The present study consolidates the urgent need for further spread of knowledge & awareness about Hepatitis-B. We also highlight practice of “Standard Infection Control” measures and strict adherence to tenets of CDC guidelines. Hence the call of the hour is to spread awareness about Hepatitis-B which can turn to be a “mouse or an elephant in dental clinic.”</p>

Needle stick injuries in restorative dentistry: The need for prevention

Risk of exposure to blood‑borne pathogens has always been a problem for healthcare professionals including dental professionals. The emergence of acquired immunodeficiency syndrome (AIDS) in 1981 brought the issue to the forefront of public health policy. Percutaneous injuries, which include needle stick injuries (NSI), expose dental healthcare workers to deadly blood‑borne pathogens such as Hepatitis C virus (HCV), Hepatitis B virus (HBV), and Human Immunodeficiency Virus (HIV). The risk of transmission of HCV, HBV, and HIV from patient to the healthcare personnel is 3%, 30%, and 0.3%, respectively. [1,2] Although the likelihood of being infected by a blood‑borne virus (BBV) may be low after a single exposure, the consequences for the dental professional who becomes infected are potentially serious and include the potential of transmission of blood‑borne pathogens and associated detrimental effects on their personal and professional lives. [3] Needles used for injecting local anesthesia during restorative procedures and the use of sharps during endodontic and prosthodontic procedures pose a high risk of transmission of BBVs. Procedures in restorative dentistry that may make the patient to cause a sudden jerky movement can lead to increase probability of NSI. Thus, education and training regarding the use of universal precautions when handling body fluids should be conducted. New employees should go through the training program stressing the need to report all injuries and the availability of chemoprophylaxis. Improving sharps disposal by introducing improved sharps containers in the dental clinics. Sharps should be disposed immediately. Recapping and re‑sheathing should be discouraged and new arrangements for sharps disposal should be done to avoid overfilling boxes. NSI prevention strategies for dental professionals should be implemented in the dental curriculum and during the pre‑occupational/occupational training programs. Since a relatively high percentage of patients are positive for major blood‑borne infections, the risk of exposure to blood‑borne pathogens for healthcare workers through NSI should not be ignored. Regular health checkups, tests for serum antibodies and antigens of HBV, and appropriate hepatitis B vaccination are mandatory for occupational safety of healthcare workers. Report of NSI cases should be encouraged since it is needed for root cause analysis of the adverse events and future prevention. The report of NSI events is also highly important for the injured parties in view of risk assessment and implementation of appropriate prophylactic measures for blood‑borne infections.

Incidence and frequency of mucocutaneous exposure and percutaneous injuries in Greek nurses: are they protected enough?

Background: Occupational exposure to blood and body fluids by sharps and needlestick injuries is common among healthcare workers, resulting in over 1,000 infections per year. Aim: To estimate the incidence and frequency of occupational exposure among nurses in correlation to their hepatitis B immunization levels. Methods: This is a cross-sectional, questionnaire-based survey, performed between May and September 2008 in 17 Greek public hospitals. Results: Overall, 72% of nurses reported at least one type of exposure (mucocutaneous or percutaneous) within their professional career. Of these, 51% had at least one mucous membrane exposure, whereas 65.2% had sustained at least one needlestick injury, only 19.7% of which had reported it to the Infections Control Department. In total, 63.2% of nurses reported that they were protected through hepatitis B vaccination. Conclusions: The rates of occupational exposure presented in this study are particularly high. Further, a significant percentage of healthcare workers are not protected against hepatitis B infection.

Diagnostic and prognostic value of minor elevated cardiac troponin levels for percutaneous coronary intervention-related myocardial injury: a prospective, single-center and double-blind study

Cardiac troponin-I (cTnI) and -T (cTnT) are sensitive and specific markers of myocardial injury. However, the role of increased cTnI and cTnT in percutaneous coronary intervention (PCI)-related myocardial injury remains controversial. In this prospective, single-center and double-blind study, we aimed to determine the diagnostic and prognostic value of cTnI as well as cTnT (cTns) in PCI-related myocardial injury in a Chinese population. A total of 1,008 patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome were recruited. The levels of cTnI and cTnT were examined before and after PCI. All patients were followed up for 26±9 months to observe the incidence of major adverse cardiac events (MACEs). Our results showed that post-PCI cTnI and/or cTnT levels were increased to more than the 99th percentile upper reference limit (URL) in 133 (13.2%) patients, among which 22 (2.2%) were more than 5 × 99th percentile URL. By univariate analysis, an elevation in cTns after PCI was not an independent predictor of increased MACEs, HR 1.35 (P = 0.33, 95%CI: 0.74–2.46). In conclusion, our data demonstrate that the incidence of PCI-related myocardial injury is not common in a Chinese population and minor elevated cTns levels may not be a sensitive prognostic marker for MACEs.

Implementing AORN Recommended Practices for Sharps Safety

Prevention of percutaneous sharps injuries in perioperative settings remains a challenge. Occupational transmission of bloodborne pathogens, not only from patients to health care providers but also from health care providers to patients, is a significant concern. Legislation and position statements geared toward ensuring the safety of patients and health care workers have not resulted in significantly reduced sharps injuries in perioperative settings. Awareness and understanding of the types of percutaneous injuries that occur in perioperative settings is fundamental to developing an effective sharps injury prevention program. The AORN “Recommended practices for sharps safety” clearly delineates evidence-based recommendations for sharps injury prevention. Perioperative RNs can lead efforts to change practice for the safety of patients and perioperative team members by promoting the elimination of sharps hazards; the use of engineering, work practice, and administrative controls; and the proper use of personal protective equipment, including double gloving.

Impact of a single safety-engineered device on the occurrence of percutaneous injuries in a general hospital in Brazil

Health care workers are exposed to bloodborne pathogens through occupational injuries, and the replacement of sharps by safety-engineered devices has been recommended as a key preventive measure. This recommendation has been difficult to implement in Brazil. We conducted a retrospective study of selected data from a database of blood and body fluid exposures reported from January 2007 through December 2011 in a public general hospital in Rio de Janeiro where, from the end of 2009, a safety lancet for blood glucose testing (BGT) was introduced. A log-binomial model was used to evaluate the effect of the introduction of the safety lancet on the proportion of percutaneous injuries (PIs) during BGT in the nursing staff. Nursing staff had a significant reduction in rate of PIs per 100 full-time equivalents from 2007 to 2011 (P < .001), and medical residents had the highest rate throughout the same period. A reduction of PIs by small-gauge needles was observed since 2009, and injuries during BGT fell abruptly in 2010 and 2011 paralleling the number of purchased safety lancets (P < .001). The adoption of a single safety device, which required no training, significantly reduced PIs among the nursing team.

Percutaneous Injuries and Transmission of HIV Among Cases Referred for Post Exposure Prophylaxis to Razi Hospital in Ahvaz, a City in the Southwest Iran

Background: Health care workers (HCWs) and public in Iran may be at the risk of percutaneous injury (PI) as well as infection with human immunodeficiency virus (HIV). Objectives: The aim of this study was to evaluate the PI and transmission of HIV infection in PI cases referred to an HIV preventive focal point unit. Patients and Methods: In this prospective study, 369 PI cases who had referred to Razi Hospital of Ahvaz, from 1993 to 2008 were studied. PI cases were placed in three groups: occupational (HCWs), accidental (children) and victims of a crime (women). The data including demographic, occupational, PI incidence place, post-exposure prophylaxis (PEP) and follow-up tests for HIV infection were analyzed in SPSS 16 using chi square test. Results: From a total of 369 cases, 273 (74%) were HCWs, among which nurses (70%) were the most involved employees, followed by surgeons (18.3%) and lab workers (8.4%). Fifty five cases (14.9%) were accidental needle stick (NS) and 41 (11.1%) were victims. Among HCWs, 38 (13.8%) were injured by needles soiled with HIV infected bloods. Only 105 (28.4%) needed PEP, among which 92 (87.6%), including 50 surgeons, 21 nurses and 18 lab workers were HCW. The results of HIV tests in all cases were negative. Conclusions: Although nurses are the most involved occupational group in documented NS, surgeons are the most important high risk HCW who need PEP. No case of seroconversion has taken place as a result of PI.This means that the current PEP may have an effective role in HIV prevention.

Use of Double Gloving to Reduce Surgical Personnel’s Risk of Exposure to Bloodborne Pathogens: An Integrative Review

Surgical team members are known to have a higher incidence of percutaneous injuries compared with other health care workers, which increases surgical personnel’s risk both of exposure to bloodborne pathogens and acquiring bloodborne illnesses. The purpose of this integrative review was to determine whether double gloving reduces the surgical team member’s risk of percutaneous injury when compared with single gloving. Factors addressed are double gloving versus single gloving, use of an indicator glove system, optimum levels of protection, and policies and procedures to facilitate compliance with double gloving. Evidence supports the use of double gloving and double gloving with an indicator glove system to decrease the risk of percutaneous injury and therefore is an effective barrier to bloodborne pathogen exposure. Perioperative managers and educators should develop educational methods to support double-gloving compliance; monitor and conduct periodic audits to evaluate compliance; and review and revise quality improvement strategies as necessary to protect surgical employees from percutaneous injuries.

Needlestick fluid transmission through surgical gloves of the same thickness

Using two gloves during surgical procedures is more protective than one in relation to percutaneous needle injuries, but it remains unclear whether the use of two thin-walled gloves is equally as protective as a single thicker-walled glove. To compare the volume of contaminant transmitted from fluid-coated solid cutting suture needles through the same thickness of the same glove material made up of differing numbers of layers during simulated needlestick injuries. A colorimetric enzyme assay was used to determine the volume of fluid transferred through identical glove materials in mechanized simulated needlestick injuries. The needles were mechanically transferred through varying glove layers [zero (control), one and two] where the cumulative thickness of the double layer was equal to the single thicker layer. The force required to puncture the test mater ials was also recorded. In simulated 'needlestick' injury experiments, significantly less fluid was transmitted through the double, thin glove layer compared with the single thick layer (P < 0.05). The double, thin glove layer transmitted 16% of needle fluid compared with 21% for the single thicker glove layer. Significantly more force was required to puncture the double layer compared with the single thicker layer (P < 0.05), but for any individual puncture there was no association between the puncture force and the volume of fluid transmitted. A double layer of glove material was more resistant to puncture and removed more enzyme contaminant from a solid cutting suture needle compared with an equivalent single thick layer of glove material.

Évaluation des pratiques des médecins libéraux sur la gestion des risques professionnels liés à l’exposition aux liquides biologiques

During their practice, liberal physicians might have a risk of viral exposure to biological fluids. That risk is well-known in hospitals. The purpose of this study was to measure those occupational risks into their own private practice. This observational descriptive transversal multicentral, epidemiological study is based on the information collected from 400 physicians (general practitioners, ENT specialists, dermatologists, pediatricians, rheumatologists and gynecologists), working in own private practice in Lorraine. They received by post a confidential survey consisting of multiple-choice and open questions, asking for their activity, their risks of being exposed to biological fluids, their vaccine coverage and their potentially infectious medical waste (PIMW) management. Among 175 physicians who replied to the survey, 153 did invasive procedures and 58 encountered an accidental blood exposure (ABE). The execution of invasive procedures was the main factor in having an ABE (P=0.0023). Around 89.5 % of the complications were due to percutaneous injuries. Still 30.9 % of the physicians always recapped needles and 40 % hadn't a complementary health cover. More than 82 % were up-to-date on mandatory vaccinations (hepatitis B and diphtheria-tetanus-poliomyelitis). In private practice, 97.6 % of physicians sort out blunt objects (prickly or sharp), which is quite satisfactory in comparison with only 60.5 % of them who sort out soft wastes and 44.6 % of blunt objects at patient's home. Even if physician's blunt objects disposal in private practice and their mandatory vaccination are satisfactory, "standard" precautions, safety equipment use and soft wastes disposal can be improved.

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

An estimated 400,000–800,000 sharps-related injuries occur among healthcare workers (HCWs) annually in the United States. The risk of needlestick exposure may be particularly high among emergency medicine (EM) residents, who are learning new procedures in a relatively uncontrolled environment. Despite the potentially serious consequences of percutaneous injuries (PCIs), practitioners in training often down-play the occurrence of PCIs and do not report exposures.Current literature implies that underreporting of needlestick injuries is multifactorial. By not seeking care after needlesticks occur and thereby delaying treatment, residents incur more risk from exposures. We sought to elucidate the underlying issues that might contribute to this lack of reporting needlestick injuries. Using an anonymous survey, we collected information regarding factors that contributed to sustaining a PCI as well as perceived barriers that prevented residents from reporting these exposures. This information is desirable for both residency programs and employee health departments to reduce the occurrence of unreported exposures.The survey contained 19 questions, and all subjects were EM residents from the 8 Accreditation Council for Graduate Medical Education–accredited programs in the state of Illinois during the period January–February 2011. The voluntary survey was distributed via e-mail and through a paper version distributed at a regional EM residency conference.

The use of subcutaneous infusion in medication administration

The subcutaneous administration of medications is an area that receives little attention compared with other types of parenteral therapy. Parenteral administration is used by many thousands of patients who self-administer their medication on a daily basis—for example, those using insulin to manage diabetes, recipients of some types of hormone therapy and so on. It is also an effective route for the continuous administration of medication(s) in individuals who are terminally ill. Patients approaching the end of their life may be unable to tolerate the administration of oral medication to control their symptoms and make them more comfortable. This paper will discuss how subcutaneous infusion can be used to deliver these medications, but at the same time how important the selection of the most appropriate subcutaneous infusion device is to the overall comfort of the patient, and to reduce the potential for sharps-related injuries to healthcare workers. Appropriate device selection, together with its management, is an important contributing factor to patient safety and comfort. It will diminish the potential for premature device loss, which can lead to repeated insertion procedures for the patient, as well as delaying their medication. There is also a resource implication for the NHS, as the replacement of any device involves the use of additional equipment and staff time. Additionally, the use of any infusion device poses a risk to healthcare workers of acquiring a bloodborne infection should they experience a percutaneous injury. Knowledge of what equipment is available will reduce the potential risk to these staff.

Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: What is the evidence?

The occupational hazard associated with percutaneous injury in the operating room (OR) has encouraged harm reduction through behaviour change and the use of safety-engineered surgical sharps. Some Canadian regulatory agencies have mandated the use of "safety scalpels." Our primary objective was to determine whether safety scalpels reduce the risk of percutaneous injury in the OR, while a secondary objective was to evaluate risk reduction associated with other safety practices. We used evidence review methods described by the International Liaison Committee on Resuscitation and conducted a systematic, English-language search of Ovid, MEDLINE and EMBASE using the following search terms: "safety-engineered scalpel," "mistake proofing device," "retractable/removable blade/scalpel," "pass tray," "hands free passing," "neutral zone," "sharpless surgery," "double/cutproof gloving" and "blunt suture needles." Included articles were scored according to level of evidence; quality; and whether they were supportive, opposed or neutral to the study question(s). Of 72 included citations, none was supportive of the use of safety scalpels. There was high-level/quality evidence (Cochrane reviews) in support of risk reduction through double-gloving and use of blunt suture needles, with additional evidence supporting a pass tray/neutral zone for sharps handling (4 of 5 articles supportive) and use of suturing adjuncts (1 article supportive). There is insufficient evidence to support regulated use of safety scalpels. Injury-reduction strategies should emphasize proven methods, including double-gloving, blunt suture needles and use of hands-free sharps transfer.

The serious and ongoing issue of needlestick in Australian healthcare settings

Australian healthcare workers and especially nurses repeatedly have their safety and health jeopardized through occupational exposures to blood and body fluids. Percutaneous or needlestick injuries are especially concerning and consistent. The purpose of this article is to again draw attention to the serious and costly issue of needlestick injuries in Australian healthcare settings. Specifically it considers the context of needlestick injuries and safety engineered devices within Standard 3 of the Australian Commission on Safety and Quality in Health Care's National Standards reform agenda. Given that Standard 3 alone will likely be insufficient to reduce needlestick injuries, this article also discusses improvements and current challenges in international needlestick injury reduction in an attempt to stimulate key opinion leader consideration of Australia adopting similar strategies.