Sharp Devices Research Articles

The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: The critical role of safety-engineered devices

In the United States (U.S.), federal legislation requiring the use of safety-engineered sharp devices, along with an array of other protective measures, has played a critical role in reducing healthcare workers' (HCWs) risk of occupational exposure to bloodborne pathogens over the last 20 years. We present the history of U.S. regulatory and legislative actions regarding occupational blood exposures, and review evidence of the impact of these actions. In one large network of U.S. hospitals using the Exposure Prevention Information Network (EPINet) sharps injury surveillance program, overall injury rates for hollow-bore needles declined by 34%, with a 51% decline for nurses. The U.S. experience demonstrates the effectiveness of safety-engineered devices in reducing sharps injuries, and the importance of national-level regulations (accompanied by active enforcement) in ensuring wide-scale availability and implementation of protective devices to decrease healthcare worker risk.

Infection Prevention and Control in Pediatric Ambulatory Settings

Since the American Academy of Pediatrics published a statement titled "Infection Control in Physicians' Offices" (Pediatrics. 2000;105[6]:1361-1369), there have been significant changes that prompted this updated statement. Infection prevention and control is an integral part of pediatric practice in ambulatory medical settings as well as in hospitals. Infection prevention and control practices should begin at the time the ambulatory visit is scheduled. All health care personnel should be educated regarding the routes of transmission and techniques used to prevent transmission of infectious agents. Policies for infection prevention and control should be written, readily available, updated annually, and enforced. The standard precautions for hospitalized patients from the Centers for Disease Control and Prevention, with a modification from the American Academy of Pediatrics exempting the use of gloves for routine diaper changes and wiping a well child's nose or tears, are appropriate for most patient encounters. As employers, pediatricians are required by the Occupational Safety and Health Administration to take precautions to identify and protect employees who are likely to be exposed to blood or other potentially infectious materials while on the job. Key principles of standard precautions include hand hygiene (ie, use of alcohol-based hand rub or hand-washing with soap [plain or antimicrobial] and water) before and after every patient contact; implementation of respiratory hygiene and cough-etiquette strategies for patients with suspected influenza or infection with another respiratory tract pathogen to the extent feasible; separation of infected, contagious children from uninfected children when feasible; safe handling and disposal of needles and other sharp medical devices and evaluation and implementation of needle-safety devices; appropriate use of personal protective equipment such as gloves, gowns, masks, and eye protection; and appropriate sterilization, disinfection, and antisepsis.

Use of the Haddon Matrix as a Tool for Assessing Risk Factors for Sharps Injury in Emergency Departments in the United Arab Emirates

We investigated the epidemiology and prevention of sharps injuries in the United Arab Emirates. Among 82 emergency nurses and 38 doctors who responded to our questionnaire, risk factors for sharp device injuries identified using the Haddon matrix included personal factors (for the pre-event phase, a lack of infection control training, a lack of immunization, and recapping needles, and for the postevent phase, underreporting of sharps injuries) and equipment-related factors (for the pre-event phase, failure to use safe devices; for the event phase, failure to use gloves in all appropriate situations). Nearly all injuries to doctors were caused by suture needles, and among nurses more than 50% of injuries were caused by hollow-bore needles.

<b>Preventing Needlestick Injuries</b>

Inadvertent puncture during use, disassembly, or disposal of needles or sharp devices (called collectively, "sharps") creates risk beyond a simple puncture. Sharps injury has always been a risk for health care workers, but emergence of certain blood-borne pathogens has intensified the need to act. Three- hepatitis B, hepatitis C, and HIV-are of utmost concern because they can cause significant morbidity or death. The incidence of sharps injury remains unacceptably high. Injury analysis at long-term care facilities and at the national level reveals several trends that can be used to shape policy and select interventions. Policy, practice, and training need to address new devices engineered to prevent sharps injuries, sharps disposal containers, and prophylaxis after percutaneous injury.

Sharp-Device Injuries to Hospital Staff Nurses in 4 Countries

To compare sharp-device injury rates among hospital staff nurses in 4 Western countries. Cross-sectional survey. Acute-care hospital nurses in the United States (Pennsylvania), Canada (Alberta, British Columbia, and Ontario), the United Kingdom (England and Scotland), and Germany. A total of 34,318 acute-care hospital staff nurses in 1998-1999. Survey-based rates of retrospectively-reported needlestick injuries in the previous year for medical-surgical unit nurses ranged from 146 injuries per 1,000 full-time equivalent positions (FTEs) in the US sample to 488 injuries per 1,000 FTEs in Germany. In the United States and Canada, very high rates of sharp-device injury among nurses working in the operating room and/or perioperative care were observed (255 and 569 injuries per 1,000 FTEs per year, respectively). Reported use of safety-engineered sharp devices was considerably lower in Germany and Canada than it was in the United States. Some variation in injury rates was seen across nursing specialties among North American nurses, mostly in line with the frequency of risky procedures in the nurses' work. Studies conducted in the United States over the past 15 years suggest that the rates of sharp-device injuries to front-line nurses have fallen over the past decade, probably at least in part because of increased awareness and adoption of safer technologies, suggesting that regulatory strategies have improved nurse safety. The much higher injury rate in Germany may be due to slow adoption of safety devices. Wider diffusion of safer technologies, as well as introduction and stronger enforcement of occupational safety and health regulations, are likely to decrease sharp-device injury rates in various countries even further.

Occupational Exposure to Blood or Body Fluids as a Result of Needlestick Injuries and Other Sharp Device Injuries Among Medical Residents in Japan

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There’s No Place Like Home: A Qualitative Study of the Working Conditions of Home Health Care Providers

Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures. The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts. HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands. The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.

Needlestick Injuries to the Feet of Japanese Healthcare Workers: A Culture-Specific Exposure Risk

A comparison of needlestick injury surveillance data from Japan and the United States revealed a higher proportion of foot injuries to Japanese healthcare workers (HCWs), compared with US HCWs. This study investigates the underlying factors that contribute to this difference and proposes evidence-based prevention strategies to address the risk, including the use of safety-engineered needle devices, point-of-use disposal containers for sharp instruments and devices, and closed-toe footwear.

Effect of the Introduction of an Engineered Sharps Injury Prevention Device on the Percutaneous Injury Rate in Healthcare Workers

To evaluate the effect of introducing an engineered device for preventing injuries from sharp instruments (engineered sharps injury prevention device [ESIPD]) on the percutaneous injury rate in healthcare workers (HCWs). We undertook a controlled, interventional, before-after study during a period of 3 years (from January 1998 through December 2000) at a major medical center. The study population was HCWs with potential exposure to bloodborne pathogens. HCWs who sustain a needlestick injury are required by hospital policy to report the exposure. A confidential log of these injuries is maintained that includes information on the date and time of the incident, the type and brand of sharp device involved, and whether an ESIPD was used. Introduction of an intravenous (IV) catheter stylet with a safety-engineered feature (a retractable protection shield), which was placed in clinics and hospital wards in lieu of other IV catheter devices that did not have safety features. No protective devices were present on suture needles during any of the periods. The incidence of percutaneous needlestick injury by IV catheter and suture needles was evaluated for 18 months before and 18 months after the intervention. After the intervention, the incidence of percutaneous injuries resulting from IV catheters decreased significantly (P<.01), whereas the incidence of injuries resulting from suture needle injuries increased significantly (P<.008). ESIPDs lead to a reduction in percutaneous injuries in HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens.

Fatigue Increases the Risk of Injury From Sharp Devices in Medical Trainees Results From a Case-Crossover Study

Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers. Case-crossover study. Five academic medical centers in the United States and Canada. Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue. Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week (P<.001) and slept less the night before an injury (P<.001) than did other healthcare workers. Fatigue increased injury risk in the study population as a whole (incidence rate ratio [IRR], 1.40 [95% confidence interval {CI}, 1.03-1.90]), but this effect was limited to medical trainees (IRR, 2.94 [95% CI, 1.71-5.07]) and was absent for other healthcare workers (IRR, 0.97 [95% CI, 0.66-1.42]) (P=.001).Conclusions. Long work hours and sleep deprivation among medical trainees result in fatigue, which is associated with a 3-fold increase in the risk of sharps injury. Efforts to reduce trainee work hours may result in reduced risk of sharps-related injuries among this group.

Caring for Healthcare Workers A Global Perspective

From the International Healthcare Worker Safety Center, University of Virginia Health System, University of Virginia, Charlottesville. Received December 6, 2006; accepted December 6, 2006; electronically published January 3, 2006. Infect Control Hosp Epidemiol 2007; 28:1-4 2006 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2007/2801-0001$15.00. This issue of the journal reflects broadly upon the risks of bloodborne pathogen exposure—risks faced by healthcare workers (HCWs) everywhere. The articles cover an array of issues, including the impact of work schedules, healthcare settings, culture-specific practices, and the implementation of safety-engineered sharp devices on the occupational risk of injuries from sharp devices and blood contact. It is a fitting occasion to reflect on the state of the art in providing a safe working environment for HCWs and to consider a future path towards equitable access to its basic elements. It has been more than 2 decades since the first case of needlestick-transmitted infection with human immunodeficiency virus (HIV; then referred to as “human T-lymphotropic virus III”) was reported in The Lancet, triggering a high alert for the exposure risk faced by HCWs. Although lifethreatening bloodborne pathogens had been a recognized risk to HCWs for at least a century, it was the epidemic of acquired immunodeficiency syndrome (AIDS) that delivered the wakeup call leading to remedial action. Today, infection from bloodborne pathogens, primarily HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), remains the most lifethreatening occupational risk for HCWs. Despite this fact, we can take heart from the dramatic reduction that has occurred in the magnitude of this risk as a direct result of effective prevention initiatives during the past 20 years. It constitutes one of the remarkable success stories in the annals of public health practice. As a public health target, HCWs are usually considered to be (and treated as) a narrow subset of the general population. But globally, their numbers are large and their impact is felt everywhere. The total number of HCWs worldwide is estimated to be 35.7 million, which is greater than the population of Morocco, the 35th most populous nation in the world. HCWs provide care in every country and to every social and cultural group, in sophisticated and humble settings alike. Their global reach is matched only by the significance of their work. In all corners of the globe we depend on them for lifesustaining services. The effective assault on bloodborne pathogens that plague HCWs began with the availability of the hepatitis B vaccine in 1982. In the United States in 1983, the incidence of HBV among HCWs was 3 times higher than the incidence in the general population; by 1995, it was 5 times lower. The annual incidence fell from 386 to 9 infected HCWs per 100,000. In the early 1980s, it was estimated that more than 12,000 HCWs were occupationally infected with HBV annually, resulting in an estimated 250 deaths per year. Between 1990 and 1998, during which time high rates of HCW vaccination were achieved in the United States, only 13 cases of acute HBV infection in HCWs were reported. The advent of the hepatitis B vaccine was a major advance in preserving the health and lives of HCWs. The risk of occupational infection with HIV, although alarming, has never reached the scale of hepatitis B. As of 1997, a total of 94 documented and 170 possible cases of occupational HIV infection had been identified worldwide; nearly two-thirds of cases were reported from the United States. Since then, 15 more documented cases have been identified. However, most countries, especially those with a high population prevalence of HIV infection, have never instituted surveillance systems that would capture data on such cases. Although the development of an AIDS vaccine still eludes us, new treatments for HIV infection appear to have had an appreciable impact on the risk of occupational exposure and infection. In 1997, it was shown that postexposure prophylaxis with zidovudine alone after occupational blood exposure to HIV reduced the risk of seroconversion by more than 80%. Combination antiretroviral drug regimens, introduced in 1997, are believed to be even more effective at preventing seroconversion in HIV-exposed individuals. Combination treatment has altered the risk equation for HCWs in other ways, as well. Shortly after these drugs became widely available in 1997, there was a precipitous drop in the number of HIV-positive in-patients in US hospitals. The risk of HCWs being exposed to HIV dropped in direct proportion to the decline in the number of HIV-infected patients in hospitals. Furthermore, a low viral load, which is common in patients receiving combination drug therapies, is associated with reduced transmission risk when an occupational exposure to

Occupational exposure to biological fluids among a cohort of Brazilian dentists

To evaluate the epidemiology of percutaneous occupational exposure to biologic fluids and the level of compliance with some recommendations contained in the 'Standard Precautions' among dentists. Sertãozinho city, Brazil. All dentists who were currently working in public or private offices in the study city, and who agreed to participate, resulting in a study population of 135 dentists. All participants were personally interviewed from August 2001 to April 2002. Of the dentists interviewed, 31.1% reported accidents, with a mean incidence of 2.02 accidents/professional/year; 90.0% recapped needles after using them, while 8.1% re-used gloves. Injuries involved the hands and the item most frequently mentioned was a needle. Inadequate procedures were observed regarding the disposal of sharp devices and hand hygiene. Dentists evaluated do not properly obey the norms for infection control during their clinical activities, with consequent risks for their own and their patients' health. Measures must be adopted by class institutions, universities, public agencies, and especially by these professionals in order to reverse this situation.

Effects of insertion conditions on tissue strain and vascular damage during neuroprosthetic device insertion

Long-term integration of neuroprosthetic devices is challenged by reactive responses that compromise the brain–device interface. The contribution of physical insertion parameters to immediate damage is not well described. We have developed an ex vivo preparation to capture real-time images of tissue deformation during device insertion using thick tissue slices from rat brains prepared with fluorescently labeled vasculature. Qualitative and quantitative assessments of damage were made for insertions using devices with different tip shapes inserted at different speeds. Direct damage to the vasculature included severing, rupturing and dragging, and was often observed several hundred micrometers from the insertion site. Slower insertions generally resulted in more vascular damage. Cortical surface features greatly affected insertion success; insertions attempted through pial blood vessels resulted in severe tissue compression. Automated image analysis techniques were developed to quantify tissue deformation and calculate mean effective strain. Quantitative measures demonstrated that, within the range of experimental conditions studied, faster insertion of sharp devices resulted in lower mean effective strain. Variability within each insertion condition indicates that multiple biological factors may influence insertion success. Multiple biological factors may contribute to tissue distortion, thus a wide variability was observed among insertions made under the same conditions.

Sharps Injury Prevention Program: Root Cause Analysis of Sharps Injury or near Miss Event at a Multi-Facility Medical Center

ISSUE: The Detroit Medical Center implemented a Safer Sharps Committee in 1999 to reduce sharps injuries in healthcare personnel. Primary goals included improvement of work practices and evaluation and implementation of safety sharps devices. Procedures for reporting and documenting employees' exposure to blood and body fluids have been standardized. Root cause analysis is a quality tool utilized after an event in order to prevent future occurrences. A root cause analysis was performed after events or near misses that lead to sharps injuries. PROJECT: The Detroit Medical Center was awarded a CDC Foundation Grant to assess its sharps injury prevention program utilizing the tools provided in the CDC Workbook. A root cause analysis was performed by the institutions utilizing the CDC sample form for performing a root cause analysis. The events analyzed included safety butterfly injury, Huber needle leak and disconnect, safety insulin syringe injury and hand passing sharps in the OR. RESULTS: The multidisciplinary teams were led by a facilitator to assist the group in identifying causation and a leader who was clinically familiar with the event. Staff were able to verbalize their thoughts without judgement in a no fault environment. Each question relatiing to contributing factors in the sample form was reviewed by the team to deterimine if they were related to the event. Risk factors were identified and action plans were developed for risk reduction strategies. LESSONS LEARNED: Root cause analysis is an effective tool to use when evaluating sharps injuries. The CDC Workbook form is a short concise tool for initiating a root cause analysis. Further expansion of the contributing factors in more detail and use of a fishbone diagram may be useful in facilitating a more in depth analysis. Healthcare worker participation in discussion of the events may lead to increased awareness of the importance of safety in their clinical practice and improved compliance with safety devices.

Ocular trauma in Turkey: A 2-year prospective study

This 2-year prospective study was conducted to identify those at risk for ophthalmologic emergencies, to define the risk factors and reasons for eye injuries, to analyze treatment options, and to compare findings with those of previous studies. A total of 203 patients (74% male, mean age 27.3+/-13.9 y, 51% right eye injuries, 44% left eye injuries, 5% bilateral injuries) with injury to 208 eyes who presented to the emergency department for treatment were included in this study. All patients were evaluated by an ophthalmologist, who completed a formal questionnaire. Information recorded included demographic data, details of the eye injury, whether eye protection was used, and the type, location, and mechanism of injury to the eye. Mechanism of injury was categorized as blunt, sharp, or a combination. The ophthalmologist reported the time that had passed between occurrence of injury and presentation for treatment. Each patient was examined by the ophthalmologist, and findings, diagnosis, and treatment were documented. Of treated patients, 93% were hospitalized, most of whom required surgical treatment. One hundred (48%) injuries were related to blunt trauma and 86 (41%) to sharp device trauma. Only 10 (4%) patients were wearing protective eyewear when injured. Ruptured globe was the most common diagnosis of hospitalized patients and the most frequent cause of this was corneal lesions; subconjunctival hemorrhage was the most common diagnosis among nonhospitalized patients. In this study, the leading cause of eye injury was workplace accidents, probably attributable to growing industrialization in the region. Ocular trauma continues to be an important health problem in Turkey. Investigators believe that with education about and use of proper eye protection, 90% of eye injuries could be prevented.

The Posterior-Medial Portal

Abstract Repair of the posterior superior labrum usually involves placing an anchor posterior to the biceps attachment through an anterior-superior or Wilmington portal. Access to the posterior-superior labrum can be accomplished by establishing a portal medial to the posterior viewing portal. The initial posterior arthroscopic viewing portal is established slightly lateral to a traditional position to allow viewing of the posterior labrum and maintain separation from the posterior-medial portal. The suture anchor can be placed behind the biceps attachment through an anterior portal. The posterior-medial portal is started approximately 3 cm medial to the viewing portal with an 18-gauge needle. The needle is directed anterolateral into the intra-articular space under arthroscopic visualization to determine the appropriate course of the suture retriever. The needle is replaced with a sharp suture retrieval device. The suture from the anchor is pulled through the labrum to achieve a simple or mattress type repair. The suture is retrieved through the anterior-superior portal by finding it medial to the labrum. The sutures can be tied through the anterior-superior portal. The posterior-medial portal can be safely established with attention to technical considerations.

OBJN index 2004

EDITORIAL A scientific evidence: the OBJN has more quantitative and qualitative links. (text in English) Aurora de Afonso Costa School of Nursing - from 1944 to 2004: 60 years preparing nurses to care people´s responses to health and illness and to leader the health system. (text in English) The OBJN upgrade: now it is the official journal of the Professional Master in Nursing Program at the Fluminense Federal University Nursing School. (text in English)ORIGINAL ARTICLESClowns doctors: the child talk. (text in Portuguese) Interfaces of geriatric nursing and dental care.(text in Portuguese)Mortality for Accidents of Traffic in Rio Branco – Acre - Brazil, 2001 to 2003.(text in Portuguese)Nursing diagnosis of patients with myocardial infarction, according to the conceptual model of Florence Nightingale. (text in Portuguese)Nursing process: application to the professional practice. (text in Portuguese)Participation of nursing students in the network for the prevention of occupational accidents - REPAT. (text in Portuguese)The american tegumentary leishmaniasis in the perspective of who lives it. (text in Portuguese)The nurse’s leadership: challenges of the practice. (text in Portuguese)Understanding functional health literacy in experiences with prostate cancer: older men as consumers of health information. (text in English)Vancomycin administration in an universitary hospital at general surgical units inpatients (text in Portuguese)We have needs, too: parental needs during a child’s hospitalisation.(text in English)Work accidents with needles and other sharp medical devices in the nursing team at public hospitals - Rio Branco, Acre - Brazil.(text in Portuguese)REVIEW ARTICL ESGender, health and nursing: The male inclusion in the nursing care. (text in Portuguese)Influence of psychosociais needs in the mental health of the children.(text in Portuguese)Literature review on ineffective thermoregulation – OBNJ Club Journal.(text in Portuguese)Literature review on Neonatal Pain – OBJN Club Journal. (text in Portuguese)Literature review on newbons care – OBJN Club Journal.(text in Portuguese)Literature review on risk for impaired parenting – OBJN Club Journal. (text in Portuguese)Literature review on risk of infection in intravenous catheter related to the dialysis treatment – OBJN Club Journal. (text in Portuguese)Public policies regarding family, institutional requirement from the politics philosophy of Hegel and Marx.(text in Portuguese)Review of research about parish nursing practice (text in English)The civil responsibility of nurse as a public agent. (text in Portuguese)The contribution of philosophy, ethics, and bioethics in the Ribeirão Preto School of Nursing – USP(text in Portuguese)The importance of the insert of the thematic " violence against the woman " in the curriculum of nursing. (text in Portuguese)Work of nursing in the family health program of and its relation with the non-institucionalization.(text in Portuguese)ABSTRACTSConstruction and validation of an instrument of collection of data of the aged one in the Program of Health of the Family.Construction and validation of data collection instrument for children from 0 - 5 years.Interaction among teachers and students in the construction of the nurses professional identityKnowledge and practice of beginner and veteran (men and women) nurses in the hospital scenarioNursing in field from training: “ Natural Lab” a professional learningPsycossocial Necessities of the Client at the Unit of Chest Pain: issues for caring in the Emergency Room.The social representation of family: expectation and meaning of cardiac surgery.(text in English)PROFESSIONAL ISSUES2004 Brazilian Women Year: Visual reflections related to the female sexuality in a feminine (sexy) Brazil focusing the female nurse.(pps in Portuguese) 5th European Conference of ACENDIO: Association for Common European Nursing Diagnoses, Interventions and Outcomes (text in English)NURSES: Working with the Poor; Against Poverty. Message from ICN (text in English)OBJN 2004 thanks to the Editorial and Peer-Review Board (text in English)The Professional Master in Nursing Website (EEAAC/UFF): linking knowledge to nursing practice (text in Portuguese)Thirteen National Brazilian Nursing Research Congress (SENPE) June 2005, São Luiz, Maranhão.World Health Organization: Forum 8 + World Summit on Health Research Mexico City, November 6-10, 2004 (text in English)

Dangers of Dermatologic Surgery: Protect Your Feet

Dermatologists frequently utilize scalpels, which are reported to be to culprit in around seven percent of the 385,000 sharps-related injuries sustained by healthcare personnel a year. Injuries from sharp devices are associated with the occupational transmission of more than 20 pathogens. Dropped scalpels may penetrate unprotected lower extremity skin, and there is no published data regarding what a shoe's actual degree of protection is against the danger of falling sharps. The purpose of this study was to evaluate and determine which types of shoes will protect their wearers. Although every shoe decreased falling sharp's degree of penetration into the feet, shoes cannot be relied on to prevent injury. More than half of the shoes allowed the scalpel blade to pass through the shoes and penetrate into the meat.

Work accidents with needles and other sharp medical devices in the nursing team at public hospital - Rio Branco, Acre - Brazil

Researches accomplished with 126 workers of the nursing team of the medical and surgical of the general hospitals of Rio Branco Clinics - Acre - Brazil, to lift the occurrence of work accidents, caused by cutting and piercing A questionnaire was used contends open and shut questions. It was verified that 82,5% are of the feminine gender, 56,4% married or joined, 44,4% possessed the 2nd complete degree and 30,9% the third complete degree, 72,3% exercised the 6-20 year-old profession. For its time, 50,8% already suffered accidents cutting and piercing, being the Medical Clinic with 66,7% and in the morning period with 45,3%, with syringe needle in 52,2%, where 48,1% acidentaram-if for inattention and 26,6% for negligence. The conduct after the accident for 21,0%, went accomplish to asepsis in the place and to communicate the Commission of Control of Infecção Hospital, while 60,9% didn't accomplish the notification for ignorance.

A review of needle-protective devices to prevent sharps injuries.

The risk of occupational transmission of blood-borne pathogens via sharp devices remains a significant hazard to both healthcare and ancillary workers. Previously, education, training, universal precautions and hepatitis B vaccination have been implemented in an attempt to reduce the risk. However, the most recent preventive strategy is needle-protective devices. These have been developed from conventional products but incorporate a safety mechanism that, when activated, covers the needletip and thus assists in the prevention of needlestick injuries and potential seroconversion to blood-borne pathogens. To date, a number of studies have been undertaken to evaluate these products, the majority of which show these devices to be safe and reliable in addition to potentially reducing associated needlestick injuries. However, to encourage the introduction of these devices in the UK, further studies are needed to either support or refute initial findings and to encourage the evaluation and subsequent implementation of needle-protective devices.