Proportion Of Healthcare Workers Research Articles

Étude de la prévalence de l’infection tuberculeuse chez le personnel soignant du service des urgences du centre hospitalier de Meaux par dosage de l’interféron gamma

Objective To determine the prevalence of the latent tuberculosis infection (LTBI) among health care workers (HCW) of the emergency ward of Meaux hospital, by comparing it with two witnesses units: the orthopaedic surgery ward (referral service to low risk) and the respiratory ward (referral service to high risk). Methods From July to December 2008, on a voluntary basis, anonymised blood samples of any HCW of the three departments were carried out by the occupational health service. Determination of interferon gamma was released by the test “QuantiFERON-TB Gold” (QFT). Results Of the 137 eligible subject sampled, 16 had a positive QFT test: nine in the emergency ward, six in the respiratory ward and one in the orthopaedic surgery ward. The proportion of HCW with a positive QFT test was not significantly different between the three wards. Discussion This study shows that HCWs of the emergency ward of the Meaux hospital are not working in a department where the risk of LTBI is high. Conclusion Our study shows that, in a territory of health where the incidence of the tuberculosis disease is superior to the national average, the emergency department of Meaux hospital does not belong to an area at high risk of LTBI. It underlines the interest of QFT test for the screening of LTBI among vaccinated persons.

Healthcare Worker Knowledge and Attitudes Regarding Influenza Immunization and Childhood Vaccination

We surveyed healthcare workers (HCWs) about influenza vaccination and routine childhood vaccinations. We found that most HCWs' children received vaccinations, despite concerns regarding safety and efficacy. HCWs who received influenza vaccine were more likely to immunize their children against influenza, although a substantial proportion of HCWs' children did not receive influenza vaccination.

Assessing screening practices among health care workers at a tertiary-care hospital in Sao Paulo, Brazil

OBJECTIVETo ascertain the extent to which screening procedures (with and without evidence of effectiveness) are practiced among health care workers at a tertiary-care hospital in Sao Paulo, Brazil.METHODSFrom February 2001 to September 2003, a cross-sectional study involving physicians, nurses and nursing assistants (aged 40 to 69 years) was carried out at a tertiary-care hospital in the city of Sao Paulo, Brazil. Subjects were interviewed using a questionnaire that addresses 17 procedures with grades of recommendation of A, B, C, D or E, in accordance with the 1996 United States Preventive Services Task Force guidelines for routine screening.RESULTSOf the 333 health care workers included, 228 (68.5%) were female. The mean age was 48.8 (SD 6.6 years). Most subjects had undergone screening for hypertension (blood pressure measurement) and lipid abnormalities (cholesterol testing). Screening for breast and cervical cancer was common among females. Resting electrocardiography, serum glucose testing, urine tests, chest X-rays and serum prostate-specific antigen testing were also quite common. However, only 6 (1.8%) of the subjects had undergone screening for colorectal cancer (fecal occult blood test or sigmoidoscopy).CONCLUSIONSA sizeable proportion of health care workers underwent screening procedures that are not recommended or for which there was insufficient evidence of a benefit. Conversely, certain recommended procedures were performed on a small proportion of such workers. These results indicate that the Brazilian National Ministry of Health must develop nationwide evidence-based screening recommendations and disseminate such recommendations among health care professionals in Brazil.

Referrals for positive tuberculin tests in new health care workers and students: a retrospective cohort study

BackgroundDocumentation of test results for latent tuberculosis (TB) infection is important for health care workers and students before they begin work. A negative result provides a baseline for comparison with future tests. A positive result affords a potential opportunity for treatment of latent infection when appropriate. We sought to evaluate the yield of the referral process for positive baseline tuberculin tests, among persons beginning health care work or studies.MethodsRetrospective cohort study. We reviewed the charts of all new health care students and workers referred to the Montreal Chest Institute in 2006 for positive baseline tuberculin skin tests (≥10 mm). Health care workers and students evaluated for reasons other than positive baseline test results were excluded.Results630 health care students and workers were evaluated. 546 (87%) were foreign-born, and 443 (70%) reported previous Bacille Calmette-Guérin (BCG) vaccination. 420 (67%) were discharged after their first evaluation without further treatment. 210 (33%) were recommended treatment for latent TB infection, of whom 165 (79%) began it; of these, 115 (70%) completed adequate treatment with isoniazid or rifampin. Treatment discontinuation or interruption occurred in a third of treated subjects, and most often reflected loss to follow-up, or abdominal discomfort. No worker or student had active TB.ConclusionsOnly a small proportion of health care workers and students with positive baseline tuberculin tests were eligible for, and completed treatment for latent TB infection. We discuss recommendations for improving the referral process, so as to better target workers and students who require specialist evaluation and treatment for latent TB infection. Treatment adherence also needs improvement.

Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India

The risk of acquiring hepatitis B virus (HBV) infection through exposure to blood or its products is highest amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. India is second to China in the numbers of people with chronic HBV. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs in India. A total of 2162 HCWs were screened for the presence of serological markers of HBV and hepatitis C virus (HCV). Occult HBV infection was tested by detection of HBV-DNA for surface and core regions by nested polymerase chain reaction in HBsAg-negative and IgG anti-hepatitis core antigen-positive subjects. Only 1198 (55.4%) of the 2162 HCWs screened had been vaccinated; and 964 (44.6%) were not vaccination-status conscious; of these HCWs, 600 (27.7%) had never been vaccinated and 364 (16.4%) were unaware of their vaccination status. Protective (> 10 IU/mL) anti-hepatitis B surface (anti-HBs) antigen titers were seen in only 61.7%. The anti-HBs titers were found to be lower with the passage of time; the median anti-HBs titers in subjects who were vaccinated > 10 years ago were significantly lower than those who had been vaccinated < 5 years ago (P < 0.001). One percent of HCWs were HBsAg-positive, and 24.7% of 700 HCWs screened had past exposure (IgG-anti-HBc-positive). Occult HBV was detected in 5% of 120 positive subjects with past exposure; all had anti-HBs titers > 10 IU/mL. Even today, 28% HCWs in India are unvaccinated and 17% are unaware of their vaccination status. This data suggests that use of hepatitis B immune globulin be mandatory in needle-pricked HCWs in India, and that implementation of awareness strategies is urgent. Since the anti-HBs titers decline in a fair proportion, there is justification for giving a booster dose of vaccine 10 years after primary vaccination to HCWs in India.

Bacterial contamination of health care workers' white coats

Patient-to-patient transmission of nosocomial pathogens has been linked to transient colonization of health care workers, and studies have suggested that contamination of health care workers' clothing, including white coats, may be a vector for this transmission. We performed a cross-sectional study involving attendees of medical and surgical grand rounds at a large teaching hospital to investigate the prevalence of contamination of white coats with important nosocomial pathogens, such as methicillin-sensitive Stapylococcus aureus, methicillin-resistant S aureus (MRSA), and vancomycin-resistant enterococci (VRE). Each participant completed a brief survey and cultured his or her white coat using a moistened culture swab on lapels, pockets, and cuffs. Among the 149 grand rounds attendees' white coats, 34 (23%) were contaminated with S aureus, of which 6 (18%) were MRSA. None of the coats was contaminated with VRE. S aureus contamination was more prevalent in residents, those working in inpatient settings, and those who saw an inpatient that day. This study suggests that a large proportion of health care workers' white coats may be contaminated with S aureus, including MRSA. White coats may be an important vector for patient-to-patient transmission of S aureus.

Perfil epidemiológico dos casos notificados de tuberculose entre os profissionais de saúde no Hospital Universitário em Vitória (ES) Brasil

To describe the epidemiological profile of tuberculosis cases reported among health care workers in the Tuberculosis Control Program of the Cassiano Antonio of Moraes University Hospital in Vitoria, Brazil. A retrospective descriptive study of secondary data was conducted between 2002 and 2006. Twenty-five cases of health care workers with tuberculosis were reported: 8 in nursing technicians (32%); 4 in doctors (16%); 3 in nurses (12%); 2 in radiology technicians (8%) and 8 in professionals from other categories (32%). Of those 25 health care workers, 14 (56%) were male and 11 (44%) were female. The incidence of the disease was highest among those from 35 to 39 years of age. The predominant clinical presentation was extrapulmonary (12 cases, 48%), followed by pulmonary (11 cases, 44%) and a combination of the two (2 cases, 8%). Regarding comorbidities, AIDS, alcoholism and smoking, respectively, were present in 33.3% of the study population. Outcomes were as follows: 22 cases of cure (88%); 2 transfers (8%); and 1 death (4%). The proportion of health care workers diagnosed with tuberculosis in the period studied was 2.53%. The results show the need for heath care workers who work in the tuberculosis control program to fill out the field "professional occupation" on the tuberculosis case registry database reporting forms. In addition, this situation draws attention to the need to implement an occupational tuberculosis control program.

Comparação da eficácia da lavagem das mãos versus fricção alcoólica em protocolos atuais e os hábitos de consumo entre os profissionais de saúde

A higiene das mãos é um exercício primário para reduzir a transmissão por contato de agentes infecciosos. Nós avaliamos a eficácia dos utensílios usualmente utilizados pelos profissionais de saúde para a higiene das mãos. Um total de quarenta profissionais de saúde (HCWs) e de trabalhadores da administração de um hospital de ensino lavavam as mãos com água e sabão, utilizando procedimentos- padrões, mas utilizavam o álcool em gel, com e sem protocolos padronizados. Um número total de unidades formadoras de colônia nas mãos foram de 3,52 e 4,48 para os HCWs e o pessoal da administração, respectivamente (p &lt; 0,05). A média de redução do número de organismos antes e depois de quaisquer procedimentos sempre mostrou diferenças estatisticamente significativas tanto para os procedimentos padronizados quanto para os não-padronizados, e todos eles demonstraram resultados semelhantes quando comparados uns aos outros, com apenas duas exceções. Não houve nenhuma diferença na proporção de Staphylococcus aureus e bactérias Gram-negativas entre os HCWs e o pessoal da administração quando colhido o material das mãos de ambos os grupos. Este estudo demonstrou que o uso regular de álcool em gel é tão bom como lavar as mãos com água e sabão, o que poderá aumentar o hábito da higiene das mãos, especialmente em situações em que existe uma falta de pias ou quando os HCWs estiverem sobrecarregados.

Prevalence of HIV infection and median CD4 counts among health care workers in South Africa.

To determine the prevalence of HIV infection and the extent of disease progression based on CD4 count in a public health system workforce in southern Africa. Cross-sectional voluntary, anonymous, unlinked survey including an oral fluid or blood sample and a brief demographic questionnaire. Two public hospitals in Gauteng, South Africa. All 2 032 professional and support staff employed by the two hospitals. HIV prevalence and CD4 cell count distribution. Overall prevalence of HIV was 11.5%. By occupation, prevalence was highest among student nurses (13.8%) and nurses (13.7%). The highest prevalence by age was in the 25 - 34-year group (15.9%). Nineteen per cent of HIV-positive participants who provided blood samples had CD4 counts less than or equal to 200 cells/ microl 28% had counts 201 - 350 cells/ microl, 18% had counts 351 - 500 cells/ microl, and 35% had counts above 500 cells/ microl. One out of 7 nurses and nursing students in this public sector workforce was HIV-positive. A high proportion of health care workers had CD4 counts below 350 cells/ microl, and many were already eligible for antiretroviral therapy under South African treatment guidelines. Given the short supply of nurses in South Africa, knowledge of prevalence in this workforce and provision of effective AIDS treatment are crucial for meeting future staffing needs.

Measles, rubella, mumps, and varicella seroprevalence among health care workers in Turkey: Is prevaccination screening cost-effective?

To investigate the immune status of health care workers (HCWs) against measles, rubella, mumps, and varicella zoster (MMRV) in Turkey and to define an appropriate vaccination program among HCWs. Voluntary HCWs from a children's hospital and a general hospital were included in the study between March and May 2005. The specific IgG antibodies against MMRV viruses were screened by ELISA. Three hundred sixty-three HCWs participated in the study; 186 (51%) were physicians, 118 (33%) were nurses, 36 (10%) were housekeeping staff, and 23 (6%) were medical technicians. The proportion of HCWs who had antibodies against measles was 98.6%; rubella, 98.3%; mumps, 92.2%; and varicella, 98%. No association was found between the susceptibility to at least 1 of MMRV virus infections and gender, age, duration of work, profession, and department of work in analysis either among the whole study group, or each hospital. The positive predictive value for the history of varicella was 100%, whereas it was 92% for MMR. The cost of vaccination for varicella was significantly expensive without screening before vaccination. However, there was not much difference for MMR infections. A policy based on obtaining the history of varicella infection from the staff and then screening the ones with negative history and vaccination of only seronegative HCWs was found to be appropriate.

Mental Health of Healthcare Workers who Experience Needlestick and Sharps Injuries

Healthcare workers (HCWs) are exposed daily to the risk of injury by needlesticks and other medical instruments. However, the psychiatric impacts of such injuries have not been evaluated. The aim of this study was to evaluate the mental health status of HCWs with experiences of needlestick and sharps injuries. A cross-sectional written survey was performed. The psychological symptoms before injury and current status were measured using the Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Perceived Stress Scale (PSS). The proportions of HCWs with and without needlestick and sharps injuries were 71.1% (n=263) and 28.9% (n=107), respectively. HAM-A and BDI scores were significantly higher among HCWs with injury experiences (p<0.01). HCWs with injury experiences exhibited higher PSS and BDI scores after the injury and higher levels of anxiety and depression. Particular attention should be directed towards the psychological consequences of needlestick and sharps injuries in HCWs.

Occupational Diseases on Health Care workers Approved by Korea Labor Welfare Corporation

OBJECTIVES: This study was carried out to analyze the characteristics of occupational diseases among health care workers in Korea.METHODS: Using the database of the Korea Labor Welfare Corporation (KLWC), 5, 460 approved occupational disease cases, between Jan 1, 1999 and Dec 31, 2000, and approved by the Jun 30, 2001, were collected. Of these, the 142 health care worker cases were investigated.RESULTS: The proportion of health care workers among the total cases reported in 1999 and 2000 was 2.6%, respectively. The diseases were infectious in 61 (43.0%), cerebro-cardiovascular in 60 (42.3%) and musculoskeletal in 18 cases (12.6%). The distributions of the occupational diseases by sex were 59 (41.5%) and 83 cases (58.5%), in males and females, respectively. The distributions of the occupational diseases by age were 64 (45.1%), 30 (21.1%), 25 (17.6%) and 17 cases (12.0%), in their 20s, 30s, 40s and 50s, respectively. For the cases of infectious diseases by age there were 48 (78.7%) in their 20s and 12 (19.7%) in their 30s, for the cases of cerebro-cardiovascular diseases by age there were 17 (28.3%) in their 40s, 16 (26.7%) in their 50s and 12 (20.0%) in their 20s, and for the cases of musculoskeletal diseases there were 7 (38.9%) in their 30s and 4 (22.2%) in their 20s. The distributions of the cases of occupational diseases by department were 64 (45.1%), 19 (13.4%), 18 (12.7%), and 10 (7.0%) in the nursing, doctors, officers, and food services departments, respectively.CONCLUSIONS: The major occupational diseases of health care workers, as approved by the KLWC, were the infectious, cerebro-cardiovascular and musculoskeletal diseases. A special management policy must be considered to prevent occupational diseases of health care workers in Korea.

Irritancy of the skin disinfectant n‐propanol

Hand disinfection with short-chain aliphatic alcohols, so-called "rub-ins" is the method of choice for cross-infection prevention in health care environments, but their irritant potential is not well known. Skin tolerance is a major compliance factor, and a high proportion of health care workers suffer from low-grade irritant contact dermatitis. Therefore, assessment of the irritancy of the skin disinfectant n-propanol 60%, and comparative 100% and 0% solutions, was performed in the setting of experimental low-grade ICD. ICD was induced by overnight patch exposure to H2O, and to 0.3% sodium dodecyl sulfate (SDS), in 12 probands, followed by repeated open exposure to the test substances. Outcome variables were transepidermal water loss (TEWL), and skin surface capacitance. On skin sites pre-irritated by SDS, all n-propanol concentrations (100%, 60%, 0%) increased TEWL. However, a clear divergence appeared between pure n-propanol, and the lower concentrations. In contrast to pure n-propanol, n-propanol 60% and 0% had no significant effect on TEWL on H2O-pre-irritated skin sites. Capacitance of pre-irritated skin sites was increased by exposure to H2O-containing n-propanol solutions (60% and 0%). These results show a clear difference between the irritant potential of n-propanol 100% on one side, and n-propanol 60% and 0% on the other side. The level of pre-existent skin irritation is a pertinent factor in susceptibility to irritation, as the irritant potential of n-propanol 60%, the concentration used in daily practice, and n-propanol 0% (water) became significant only on detergent-irritated skin. Thus, preventive skin care may be a constructive approach in increasing tolerance of modern hand disinfection practices.

Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. The CDC Cooperative Needlestick Surveillance Group.

To study the risk for human immunodeficiency virus (HIV) infection and the patterns of use and associated toxicity of zidovudine among health care workers after an occupational exposure to HIV. An ongoing, prospective surveillance project conducted by the Centers for Disease Control and Prevention. Exposed workers voluntarily reported by 312 U.S. health care facilities from August 1983 to June 1992. Four of 1103 enrolled workers with percutaneous exposure to HIV-infected blood seroconverted (HIV seroconversion rate, 0.36%; upper limit of the 95% Cl, 0.83%); no enrolled workers with mucous membrane (n = 75) or skin (n = 67) contact seroconverted. During October 1988 to June 1992, 31% of 848 enrolled workers used zidovudine after exposure; this proportion increased from 5% during October through December 1988 to 43% during January through June 1992. Despite using zidovudine after exposure, one worker became infected with a strain of HIV that was apparently sensitive to zidovudine. Adverse symptoms, most commonly nausea, malaise or fatigue, and headache, were reported by 75% of workers using zidovudine; 31% of workers did not complete planned courses of zidovudine because of adverse events. The risk for HIV seroconversion after percutaneous exposure to HIV-infected blood is 0.36%, which is similar to previous estimates. Zidovudine is used after exposure by a sizable proportion of health care workers enrolled in the project despite frequent, minor, associated symptoms. Documented failures of postexposure zidovudine prophylaxis, including in one worker enrolled in this study, indicate that if zidovudine is protective, any protection afforded is not absolute. Postexposure zidovudine, if used, requires careful consideration of possible risks and benefits.

Hepatitis B vaccine: immunogenicity and follow-up including two year booster doses in high-risk health care personnel in a London teaching hospital.

One hundred forty-four adult health care personnel (aged 18-62 years, median 33 years) considered at high risk of future HBV infection were vaccinated with a plasma-derived hepatitis B vaccine (20 micrograms HBVax at 0, 1, and 6 months) and followed-up for 2 years. Anti-HBs was present in only 6.9% prior to vaccination, and prescreening to detect this group would not have been cost-effective. At 9 months, 8.3% were nonresponders and a further 9% had anti-HBs levels less than 50 mIU/ml. Multivariate analysis showed that age was the single most important determinant of a poor response. In 47 of 52 individuals retested 2 years later, anti-HBs levels had fallen by 80% or more, and in four it had become undetectable. Response to a booster dose at this stage was excellent, with anti-HBs levels 3 months later much higher than at the end of the initial course. Additional booster doses of vaccine in two of the initial nonresponders at 14 and 22 months, respectively, also led to seroconversion. Although a significant proportion of health care workers in this study did not make a satisfactory response to the hepatitis B vaccine, later booster doses were very effective in subsequently increasing anti-HBs levels.