Sharp Devices Research Articles

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

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

Sharps-related injuries in health care workers: a case-crossover study

Injuries caused by sharp medical devices are common among health care workers in the United States. The best available data suggest that between 400,000 and 800,000 such injuries occur in hospitals each year (1–3). These injuries are a source of concern because of their potential to transmit various infectious agents, including hepatitis B virus (4), hepatitis C virus (5), and human immunodeficiency virus (HIV) (6,7). The evaluation and treatment of these injuries and subsequent illnesses impose a heavy societal burden in terms of economic cost (8), worker anxiety and distress (9,10), and future morbidity (1,3–5,11–13).

Fatigue in anesthesia: implications and strategies for patient and provider safety.

HEALTHCARE delivery takes place 24 h a day, 7 days a week, and is colloquially termed a “24/7” operation. Anesthesia providers are required to deliver critical around-the-clock care to a variety of patients. This parallels the situation in many other domains that provide such services, e.g., transportation, law enforcement, communications, fire fighting, technology, manufacturing, and the military. Even “convenience” industries (e.g., gas stations and grocery stores) now provide uninterrupted access. These continuous operational demands present unique physiologic challenges to the humans who are called on to provide safe operations within these systems. Human physiologic design dictates circadian patterns of alertness and performance and includes a vital need for sleep. Human requirements for sleep and a stable circadian clock can be, and often are, in direct opposition to the societal demand for continuous operations. Recently, patient safety has taken center stage in health care. The Institute of Medicine’s report “To Err Is Human: Building a Safer Health System,” revealed that medical errors contribute to many hospital deaths and serious adverse events. The response to this report was widespread and included the Quality Interagency Coordination Task Force’s response to the President of the United States, “Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact.” 2 This report listed more than 100 action items to be undertaken by federal agencies to improve quality and reduce medical errors. One action promised by the Agency for Healthcare Research and Quality was “the development and dissemination of evidence-based, best safety practices to provider organizations.” In addition to the multiple recommendations to improve patient safety, the report from the Agency for Healthcare Research and Quality included a review chapter on sleep, fatigue,# and medical errors.** There is evidence that the issue of fatigue in health care is coming to prominence on a national level. In April 2001, Public Citizen (a consumer and health advocacy group) and a consortium of interested parties petitioned the Occupational Safety and Health Administration to implement new regulations on resident work hours (table 1). The primary intent of the regulations is to provide more humane working conditions, which the petitioners declare will result in a better standard of care for all patients. Also, the Patient and Physician Safety and Protection Act of 2001, which would limit resident physician work hours, was introduced in Congress. Recently, the Accreditation Council on Graduate Medical Education, the accrediting organization for residency training programs in the United States, has approved common program requirements for resident duty and rest hours that will take effect in July 2003.†† This article is accompanied by an Editorial View. Please see: Lydic R: Fact and fantasy about sleep and anesthesiology. ANESTHESIOLOGY 2002; 97:1050–1.

Willingness to pay to avoid sharps-related injuries: A study in injured health care workers

Background: Injuries caused by sharp medical devices are common among health care workers and may result in the transmission of human immunodeficiency virus and hepatitis C virus. Objective: The direct medical costs associated with treating these injuries are well characterized but fail to capture the costs of such intangible factors as worker anxiety and distress. The objective of this study was to estimate these intangible costs. Subjects: Subjects included health care workers reporting sharps-related injuries to 2 hospital occupational health services. Method: A contingent valuation approach was used to assess willingness to pay to avoid sharps-related injuries among recently injured health care workers. Workers were presented with the option of paying out of pocket for a hypothetical injury-prevention device. The median amount of money subjects were willing to pay was estimated with logistic regression, and multivariable regression was performed to assess confounding by worker characteristics and circumstances surrounding injuries. Results: Study interviews were conducted for 116 subjects; median time from injury to interview was 3 days (range, 0-15). Most subjects were women (73%), and most were nurses (44%) or trainees (32%). The crude median amount subjects were willing to pay to avert injury was $850 (US); when adjusted for patient risk status (human immunodeficiency virus and hepatitis C virus status), and working with an uncooperative patient at the time of injury, median amount increased to $1270. Conclusion: The high median amount sujects were willing to pay to avoid a sharps-related injury suggests that the costs of “intangible” aspects of worker injury, such as anxiety and distress, may equal costs associated with the medical evaluation of these injuries. These costs should be incorporated in economic analyses of sharps-injury prevention. (Am J Infect Control 2002;30:283-7.)

Risks to health care workers in developing countries.

The first report of a health care worker infected with the human immunodeficiency virus (HIV) by a needle stick, published in the medical literature in 1984,1 launched a new era of concern about the occupational transmission of blood-borne pathogens. In the United States, universal precautions were implemented,2 regulations such as the Bloodborne Pathogens Standard were issued,3 and the rate of vaccination against hepatitis B virus (HBV) among health care workers increased dramatically.4 After a decade of phenomenal technological advances in sharp devices engineered for safety, the federal Needlestick Safety and Prevention Act, requiring the use of safer devices, became law . . .

Preventing needlesticks in emergency medical system workers.

Emergency medical system (EMS) workers frequently use sharp devices in injury-prone circumstances that involve limited visibility, confined spaces, rapidly moving vehicles, and uncooperative victims. This study examined the efficacy of an automatic self-retracting lancet in reducing needlestick injuries and related direct and indirect costs. Subjects were 477 active-duty EMS workers. Counseling, laboratory testing (hepatitis B and C, hepatic function enzymes, and human immunodeficiency virus), antiviral prophylaxis, and immunizations were provided according to US Public Health Service guidelines. Baseline and biennial laboratory testing for hepatitis B and C and liver function enzymes were conducted. After the introduction of a spring-loaded automatic-retracting type glucometer lancet device, needlestick injuries decreased from 16 per 954 EMS worker-years to 2 per 477 EMS worker-years. The annualized cost of treatment declined from $8276 to $2068. The change to a self-retracting device decreased the number of needlestick injuries and was cost-effective with a minimal increase in device cost (annualized $366 per year).

Infection Control in Physicians' Offices

Infection control is an integral part of pediatric practice in outpatient settings as well as in hospitals. All employees should be educated regarding the routes of transmission and techniques used to prevent transmission of infectious agents. Policies for infection control and prevention should be written, readily available, updated annually, and enforced. The Centers for Disease Control and Prevention standard precautions for hospitalized patients with modifications from the American Academy of Pediatrics are appropriate for most patient encounters. As employers, pediatricians are required by the Occupational Safety and Health Administration (OSHA) to take precautions to protect staff likely to be exposed to blood or other potentially infectious materials while on the job. Key principles of infection control include the following: hand-washing before and after every patient contact, separation of infected, contagious children from uninfected children, safe handling and disposal of needles and other sharp medical devices, appropriate use of personal protection equipment such as gloves, appropriate sterilization, disinfection and antisepsis, and judicious use of antibiotics.

Occupational exposure to human immunodeficiency virus: what healthcare providers should know.

The author reviews the risks of occupational exposure to HIV and provides a rationale for new postexposure guidelines for healthcare workers. Approximately 50,000 percutaneous exposures occur yearly among healthcare workers in the United States. Of these, approximately 5000 involve exposures to blood that is known to be infected with HIV. The risk of transmission after percutaneous exposure to HIV-tainted blood has been estimated to be 0.3%, but the risk may be considerably higher to the healthcare worker if any of the following is present: a deep injury; visible blood on the sharp device; a procedure that involves a needle placed in the patient's artery or vein; and a patient with advanced AIDS. The increasing resistance of HIV strains to antiretroviral therapy continues to make treatment more difficult. Postexposure prophylaxis with zidovudine may reduce the risk of occupational infection by 80%. Advances in the ability to ameliorate HIV transmission rates and to treat individuals with resistant disease through innovations in drug therapy, engineering of controls for injury prevention, and more focused postexposure evaluation offer the hope of reducing this infrequent, but dangerous, occupational threat.

Sharps Disposal Containers: Selection, Evaluation, and Use

Occupational transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) has been documented. The risk of infection with HIV following one needlestick exposure is approximately 0.3% and ranges from 6% to 30% for FMV and from 3.3% to 10% for hepatitis C. The diversity of health care settings makes selection of a single sharps disposal container design inappropriate in many cases. No single sharps disposal container design meets all the disposal containment needs for an entire facility. Selection of any specific container(s) should be based on a comprehensive site-specific hazard analysis. Criteria for the design, selection, and appropriate use of sharps containers were developed. The sharps disposal container safety performance criteria are divided into four areas. First, containers should remain functional during their entire usage. Second, containers must be accessible to workers who use, maintain, or dispose of sharp devices. Third, containers should be visible o the workers who must use them. Last, container designs should provide accommodation to the user, the facility, and the environment. Although engineering controls, such as needleless IV systems and “safety” needles, will reduce injuries, proper selection and use of disposal containers is still important. Prevention strategies include implementation of engineering controls, use of personal protective equipment, training, and the involvement of occupational health professionals and workers.

Percutaneous Injuries in Anesthesia Personnel

Anesthesia personnel are at risk for occupationally acquired blood-borne infections from human immunodeficiency virus, hepatitis viruses, and others after percutaneous exposures to infected blood or body fluids. The risk is greater after an infected, blood-contaminated, percutaneous injury, especially from a hollow-bore blood-filled needle, than from other types of exposures. Few data are available on the specific occupational hazards to anesthesia personnel from needles and other sharp devices. Fifty-eight percutaneous injuries (PIs) from anesthesia personnel in nine hospitals were analyzed. Thirty-nine of 58 PIs were from contaminated devices (all needles), and 19 were from uncontaminated devices or of unknown contamination status. Forty-three percent of contaminated percutaneous injuries (CPI) were classified as moderate (some bleeding) or severe (deep injury with profuse bleeding), and most were to health-care workers' hands. Fifty-nine percent of CPI were potentially preventable. Eighty-seven percent of CPI were from hollow-bore needles, and 68% of these were potentially preventable. The largest categories of devices causing CPI were needle on syringe, intravenous (IV) or arterial catheter needle-stylet, suture needle, and standard hollow-bore needle for secondary IV infusion. Most CPI occurred between steps of a multistep procedure (8%), were recapping related (13%), or occurred at other times after use (41%). No CPI were reported from use of needlestick-prevention safety devices. The devices and mechanisms of injury identified in this study provide specific data that may lead to prevention strategies to reduce the risk of PI. (Anesth Analg 1996;83:273-8)

Percutaneous injuries in anesthesia personnel.

Anesthesia personnel are at risk for occupationally acquired blood-borne infections from human immunodeficiency virus, hepatitis viruses, and others after percutaneous exposures to infected blood or body fluids. The risk is greater after an infected, blood-contaminated, percutaneous injury, especially from a hollow-bore blood-filled needle, than from other types of exposures. Few data are available on the specific occupational hazards to anesthesia personnel from needles and other sharp devices. Fifty-eight percutaneous injuries (PIs) from anesthesia personnel in nine hospitals were analyzed. Thirty-nine of 58 PIs were from contaminated devices (all needles), and 19 were from uncontaminated devices or of unknown contamination status. Forty-three percent of contaminated percutaneous injuries (CPI) were classified as moderate (some bleeding) or severe (deep injury with profuse bleeding), and most were to health-care workers' hands. Fifty-nine percent of CPI were potentially preventable. Eighty-seven percent of CPI were from hollow-bore needles, and 68% of these were potentially preventable. The largest categories of devices causing CPI were needle on syringe, intravenous (i.v.) or arterial catheter needle-stylet, suture needle, and standard hollow-bore needle for secondary i.v. infusion. Most CPI occurred between steps of a multistep procedure (8%), were recapping related (13%), or occurred at other times after use (41%). No CPI were reported from use of needlestick-prevention safety devices. The devices and mechanisms of injury identified in this study provide specific data that may lead to prevention strategies to reduce the risk of PI.

Analytic expressions for emission characteristics as a function of experimental parameters in sharp field emitter devices

An analytical treatment of elliptical field emitting structures which includes image charge effects off axis and the variation of field along the tip is given. The angular distribution of electron emission along the tip, the total emitted current, and the area factor are calculated as a function of emitter to anode distance, tip radius, tip height, and the anode-tip voltage difference. Errors arise if the planar Fowler–Nordheim (FN) equation is used to govern electron emission; we show how to correct this by a modification of the FN equation which includes changes in fields and image charge due to curvature. An analytic form of the area factor is given and compared to a calculation based on the exact transmission coefficient and various Wentzel–Kramers–Brillouin-based approximations to it. The analysis is extended beyond diode geometries with the inclusion of additional electrodes, allowing devices such as triodes to be modeled.

Preventing HIV transmission. Strategies to protect clinicians and patients.

Human immunodeficiency virus (HIV) transmission to healthcare workers arises primarily from percutaneous injury by sharp devices recently contaminated with infected blood. The danger is small but real, and substantial effort to reduce this risk is justified. The risk of transmission to patients from HIV-infected healthcare workers is much smaller. Attempts to accommodate measures to control this risk in standard protocols has engendered considerable debate. The discrimination and loss of insurability attendant to HIV infection also complicate the application of control measures. Where possible, procedures appropriate in cases involving known HIV infection should be applied in all situations. Acquiring tuberculosis from HIV-infected patients probably presents a greater hazard to healthcare workers than becoming infected with HIV itself.

Impact of a needleless intravenous system in a university hospital

Needlestick injuries are a serious, but preventable problem in the healthcare industry. Industry has developed better devices to protect the healthcare worker. This study evaluates the impact of a intravenous system on needlestick exposures and whether the increased cost of this new system could be justified. Exposures were defined and injury reports analyzed retrospectively and following introduction of the needleless IV system. This study indicates that the introduction of a needleless IV system can significantly reduce the number of IV-related injuries that occur in an institution, and is economically feasible. Other categories of exposure (needle-related, related to other sharps, and trash-related) also showed a drop, whereas exposure from the disposal of sharp devices into needle boxes showed a significant increase. This seems to support other findings that in-room needle-box containers have not thus far reduced the number of injuries related to sharps disposal.

Splenic Tissue Autotransplantation

Letters to the EditorSplenic Tissue Autotransplantation Bernd Domres, MD, Facharzt Ram N. Goel, FRCS, MD M. Heitham Schammut, and MD, Facharzt Robert R. ToussaintMD, Facharzt Bernd Domres Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author , Ram N. Goel Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author , M. Heitham Schammut Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author , and Robert R. Toussaint Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author Published Online:1 Jul 1988https://doi.org/10.5144/0256-4947.1988.297aSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionAsplenic patients are at an increased risk of overwhelming bacterial infection. It appears as pneumococcal sepsis in about 2% of splenectomized patients and may occur as late as 20 years after the splenectomy. Mortality in infected patients exceeds 50%, and this high mortality rate is related to the absent splenic functions. Therefore, we autograft removed ruptured spleen into an omentum pouch. This procedure does not extend the operation time more than 10 minutes.After removal of the ruptured spleen, its capsule is removed. The organ is shredded with sharp sterile device (of the type used in the kitchen to shred vegetables). The site of splenic implantation is important. It should be placed in an area that will drain into the portal venous system when neovascularization occurs. Implants function better in an omentum pouch than in a subcutaneous or peritoneal pouch. To avoid the main complications of the procedure (splenosis of the abdominal cavity or adhesions) the omental pouch should be sutured tightly so that it will not leak.We try to reimplant as much tissue of the ruptured spleen as possible. Research into splenic autotransplantation could prove that the minimum total weight of the grafted spleen should exceed 100 g, about a third of the total organ, to preserve satisfactory splenic function.Autotransplantation of ruptured spleen was performed in 49 cases. Eleven of the 49 patients died as a result of accompanying multiple injuries and not due to the splenectomy or autotransplantation.The progress of spleen regeneration in the omental pouch can be monitored by splenic scans, and postoperatively 30 patients were followed with regular thrombocyte counts, blood smears for RBC morphology such as Howell-Jolly bodies and pitted RBCs, and quantitative immunoelectrophoresis of IgM levels. After an initial increase in the numbers of thrombocytes, Howell-Jolly bodies, and pitted RBCs in the first 4 weeks, the levels returned to near normal after 8 weeks. The decreased IgM fraction returned to normal after 6 months.These results encourage us to continue autotransplantation of splenic tissue after splenectomy. Previous article Next article FiguresReferencesRelatedDetails Volume 8, Issue 4July 1988 Metrics History Published online1 July 1988 InformationCopyright © 1988, Annals of Saudi MedicinePDF download