Sharps Disposal Research Articles

P297: Increasing needle stick injuries amongst the radiology team-needs attention!

Needle-stick injuries and blood contacts pose a risk of pathogen transmission during invasive procedures. As interventional radiological procedures for diagnostics and therapeutics are on rise, reinforcing importance of sharp disposal in this population is mandatory.

The Sticking Point: Diabetic Sharps Disposal Practices in the Community

The Sticking Point: Diabetic Sharps Disposal Practices in the Community

Preventing exposure to blood and body fuids

Gail Beckett and Janice Bright summarise the correct procedures involved in the safe use and disposal of sharps and of cleaning up after potentially contaminated or infectious spillages of blood or body fuids

Reducing the risk of needlestick injuries in hospital.

After performing procedures involving sharps, many wards in St George's Hospital have no quick and accessible ‘point of care’ sharps bin for their safe disposal. Instead one must transport potentially hazardous equipment away from the bedside, risking injury and exposure to persons en route.Results from a questionnaire showed that 73% felt they were indeed poorly placed, 95% felt a portable sharps bin system was a good idea, and 95% felt their introduction would be safer. A one month trial of portable sharps bins on the Acute Medical Unit (AMU) showed that 97% felt that the portable sharps bin system reduced risk to themselves and others, 81% felt safer using them, and 90% felt safer knowing their colleagues were using them too.A recent audit in a six month period within 2012 established there were 148 reported needlestick injuries in St George's Hospital. This quality improvement project showed that a majority consensus felt that a portable sharps bin system would be safer than the system currently used and could potentially help reduce these numbers. This project also comes at a time when new EU legislation calls for safer sharps use and disposal and thus offers a solution to ultimately provide better, safer and more advanced safety practices when disposing of sharp equipment.

Infection control and practice of standard precautions among healthcare workers in northern Nigeria

Background:Healthcare-associated infections (HAIs) have been reported to be a serious problem in the healthcare services as they are common causes of illness and mortality among hospitalized patients including healthcare workers (HCWs). Compliance with these standard precautions has been shown to reduce the risk of exposure to blood and body fluids.Aims:This study therefore assesses the level of knowledge and compliance with standard precautions by the various cadre of HCWs and the factors influencing compliance in hospital environment in Nasarawa State, Northern Nigeria.Settings and Design:Nasarawa State has a current human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevalence rate of 10.0%, which was higher than most states in Nigeria with a high level of illiteracy and ignorance. Majority of the people reside in the rural areas while a few are found in the towns, informal settlements with no direct access to healthcare facilities are common.Materials and Methods:This study is an analytical, cross-sectional study. Proportional sampling technique was used to obtain a representative sample and a structured self-administered questionnaire was used to collect relevant information from the healthcare providers working in Nasarawa State from January to February 2009.Statistical analysis used:To describe patient characteristics, we calculated proportions and medians. For categorical variables, we compared proportions using chi-square tests. A logistic regression model was produced with infection control as outcome variable to identify associated factors.Results:A total of 421 HCWs were interviewed, Majority (77.9%) correctly describe universal precaution and infection control with 19.2, 19.2, and 28.0%, respectively unable to recognize vaccination, postexposure prophylaxis, and surveillance for emerging diseases as standard precaution for infection control. About 70.1% usually wear gloves before handling patients or patients’ care products, 12.6% reported wash their hand before wearing the gloves, 10.7% washed hands after removal of gloves, and 72.4% changed gloves after each patient. Only 3.3% had a sharp disposal system in their various workplaces. Majority (98.6%) of the respondents reported that the major reason for noncompliance to universal precautions is the nonavailability of the equipments. There was a statistically significant difference in the practice of standard precaution among those that were exposed to blood products and body fluid compared to those that had not been exposed in the last 6 months (χ2 = 3.96, P = 0.03), public healthcare providers when compared to private health workers (χ2 = 22.32, P = 0.001), among those working in secondary and tertiary facilities compared to primary healthcare centers (χ2 = 14.64, P = 0.001) and urban areas when compared to rural areas (χ2 = 4.06, P = 0.02). The only predictor of practice of standard precaution was exposure to blood and body fluid in the last 6 months odds ratio (OR) = 4.56 (confidence interval (CI) = 1.00-21.28).Conclusions:This study implies that inadequate workers’ knowledge and environment related problems, including the lack of protective materials and other equipments and utilities required to ensure safety of HCWs is a crucial issue that need urgent attention. Institution of a surveillance system for hospital acquired infection to improve consistent use of standard precautions among health workers is recommended in Nigeria and other low income countries in Africa.

Blood supply safety in Afghanistan: a national assessment of high‐volume facilities

Little information is available regarding blood supply safety in Afghanistan. The purpose of this study was to assess blood safety through serologic and observational measures in Afghanistan. This cross-sectional assessment included the 40 highest-volume facilities collecting and transfusing blood nationally identified in a previous survey. At each facility, study representatives completed a standardized instrument assessing staff performance of transfusion-related activities and performed rapid testing for human immunodeficiency virus, syphilis, and hepatitis B and C with rapid diagnostic tests on clinically discarded specimens. Reactive samples received confirmatory testing. Descriptive statistics were generated, with differences analyzed using chi-square or Fisher's exact tests. Between November 2010 and May 2011, a total of 332 blood donor collection procedures were observed. Only 52.4% of observed encounters correctly screened and deferred donors by international criteria. Public and private facilities demonstrated glove use, proper sharps disposal, and patient counseling and relayed screening test results in less than 75% of observed events, significantly less likely than military facilities (p < 0.01). Of 1612 specimens assessed, confirmed cases of hepatitis B (n = 6), hepatitis C (n = 1), and syphilis (n = 3) were detected among units already prescreened and accepted for transfusion. Lapses in proper donor screening contributed to the presence of confirmed-positive units available for transfusion, as detected in this study. Steps must be taken to ensure standardization of testing kits requirements, documentation, and mandatory training and continuing education for blood bank staff with regard to counseling, drawing, processing, and transfusion of blood products.

Healthcare worker safety: a vital component of surgical capacity development in low-resource settings

A disparate number of occupational exposures to bloodborne pathogens occur in low-income countries where disease prevalence is high and healthcare provider-per-population ratios are low. In an effort to highlight the important role of healthcare worker safety in surgical capacity building in Rwanda, we measured self-reported presence of safety materials and compliance with personal protective equipment in the operating theatre as part of a nationwide survey to characterize emergency and essential surgical capacity in all government hospitals. We surveyed 44 hospitals. While staff report general availability of safe disposal of sharps and hazardous waste, presence of and compliance with eye protection was lacking. Staff were cognizant of prevention measures such as double-gloving and 'safe receptacles', as well as hospital policies for post-exposure prophylaxis for HIV following needlesticks, but there was little awareness of hepatitis exposure. Healthcare worker safety should be a key component of hospital-level surgical capacity.

Providing Patient Care and Safety Beyond the Laboratory Setting: Developing a Community-Based Medical Sharps Disposal Program

Providing Patient Care and Safety Beyond the Laboratory Setting: Developing a Community-Based Medical Sharps Disposal Program

Hand-powered microfluidics: A membrane pump with a patient-to-chip syringe interface

In this paper, we present an on-chip hand-powered membrane pump using a robust patient-to-chip syringe interface. This approach enables safe sample collection, sample containment, integrated sharps disposal, high sample volume capacity, and controlled downstream flow with no electrical power requirements. Sample is manually injected into the device via a syringe and needle. The membrane pump inflates upon injection and subsequently deflates, delivering fluid to downstream components in a controlled manner. The device is fabricated from poly(methyl methacrylate) (PMMA) and silicone, using CO2 laser micromachining, with a total material cost of ∼0.20 USD/device. We experimentally demonstrate pump performance for both deionized (DI) water and undiluted, anticoagulated mouse whole blood, and characterize the behavior with reference to a resistor-capacitor electrical circuit analogy. Downstream output of the membrane pump is regulated, and scaled, by connecting multiple pumps in parallel. In contrast to existing on-chip pumping mechanisms that typically have low volume capacity (∼5 μL) and sample volume throughput (∼1-10 μl/min), the membrane pump offers high volume capacity (up to 240 μl) and sample volume throughput (up to 125 μl/min).

Occupational Exposure to Blood and other Body Fluids among Health Care Workers at a University Hospital in Iran

Occupational exposure to sharp items or body fluid splash is a hazard for health care personnel via transmission of blood-borne viruses through such exposures. To determine the occurrence of needlestick injuries and other high-risk exposures among health care workers at a hospital in Iran, data collected for 2 years were reviewed. During this period, 171 occupational exposures were self-reported. Approximately 20% of all exposed personnel were men and 80% were women. One hundred twenty-six (74%) of the exposed personnel had needlestick injuries, 13 (8%) had sharp instrument injuries, and 32 (19%) had mucosal contact with potentially infectious fluids. Thirty-two percent of injuries occurred during or after sharp instrument disposal and 67% during operative procedures. Appropriate blood tests were performed for 55 (32%) and postexposure prophylaxis was administered to 31 (18%) of the exposed personnel.

AVALIAÇÃO DA IMPLANTAÇÃO DA NORMA REGULAMENTADORA 32 EM UM HOSPITAL UNIVERSITÁRIO

Este estudo teve como objetivo verificar a implantação da Norma Regulamentadora 32 em um hospital do Norte do Paraná. Realizou-se um estudo de caso do tipo exploratório e descritivo, por meio entrevista gravada com uma enfermeira da Comissão de Controle de Infecção Hospitalar, em junho de 2010. Percebeu-se que a instituição tem dificuldades em relação à implantação desta norma, entre elas a indisponibilidade e não utilização de equipamentos de proteção individual, estrutura física inadequada e sobrecarga nas caixas de descarte de resíduos perfurocortantes. Concluiu-se que, apesar destas dificuldades, foram adotados alguns quesitos em relação à norma e instituiu-se uma comissão com o objetivo de implantá-la de acordo com a regulamentação governamental.

Knowledge, attitude and behavior of primary health care workers about hepatitis C, Kuwait.

Background: Hepatitis C virus (HCV) infection can lead to much morbidity and mortality , and health care workers (HCWs) are at high-risk for acquiring infection and transmission to their patients and close contacts. Objective: The aim of this study is to reveal HCWs' knowledge, attitudes and behavior towards HCV transmission and protection. Methods: This study was a cross-sectional survey that was conducted in all primary health centers located in two randomly selected health regions in Kuwait. An anonymous self-administered questionnaire was distributed to all currently working health care workers in the selected centers. Results: The overall percentage knowledge score was 44%. The study revealed that about three-quarters of the respondents (72.7%) were aware that HCV infection can be acquired from patient to HCW compared to 54.5% knew that infection can be transmitted from HCW to patients. Correct knowledge about blood and blood products as well as needles and sharps as modes of transmission were above 90%. However, 30.0% and 25.7% respectively claimed that avoiding drinking contaminated water and food not well cooked were ways of preventing HCV . Participants' knowledge was reflected on their attitude as 35.2% , 22.1% , 19.3%, 11.4% respectively believed that wearing of goggles, avoidance of diagnosed patients, use of multivitamin/blood tonic, and use of antibiotics after contact are measures taken to protect them against HCV infection. Although more than 90% of participants were aware that blood and needles and sharps are routes of infection and that avoiding these sharps is a protecting measure, only 80% of them believed in wearing gloves and proper disposal of sharps. Female physicians older than 30 years were better informed about HCV. Conclusions: Knowledge, attitudes and practices about hepatitis C among primary HCWs were fair, with important gaps which need to be strengthened especially among those with unsound knowledge.

Factors associated with needlestick and sharp injuries among hospital nurses: A cross-sectional questionnaire survey

BackgroundThe current status of needlestick or sharp injuries of hospital nurses and factors associated with the injuries have not been systematically examined with representative registered nurse samples in South Korea. ObjectiveTo examine the incidence to needlestick or sharp injuries and identify the factors associated with such injuries among hospital nurses in South Korea. Design, settings and participantsA cross-sectional survey of hospital nurses in South Korea. Data were collected from 3079 registered nurses in 60 acute hospitals in South Korea by a stratified random sampling method based on the region and number of beds. MethodsThe dependent variable was the occurrence of needlestick or sharp injuries in the last year, and the independent variables were protective equipment, nurse characteristics, and hospital characteristics. This study employed logistic regression analysis with generalized estimating equation clustering by hospital to identify the factors associated with needlestick or sharp injuries. ResultsThe majority (70.4%) of the hospital nurses had experienced needlestick or sharp injuries in the previous year. The non-use of safety containers for disposal of sharps and needles, less working experience as a registered nurse, poor work environments in regards to staffing and resource adequacy, and high emotional exhaustion significantly increased risk for needlestick or sharp injuries. Working in perioperative units also significantly increased the risk for such injuries but working in intensive care units, psychiatry, and obstetrics wards showed a significantly lower risk than medical–surgical wards. ConclusionsThe occurrence of needlestick or sharp injuries of registered nurses was associated with organizational characteristics as well as protective equipment and nurse characteristics. Hospitals can prevent or reduce such injuries by establishing better work environments in terms of staffing and resource adequacy, minimizing emotional exhaustion, and retaining more experienced nurses. All hospitals should make safety-engineered equipment available to registered nurses. Hospitals as well as specific units showing higher risk for needlestick and sharp injuries should implement organizational strategies to prevent such injuries. It is also necessary to establish a monitoring system of needlestick and sharp injuries at a hospital level and a reporting system at the national level in South Korea.

Disposal of syringes, needles, and lancets used by diabetic patients in Pakistan

To assess the use, handling and disposal of insulin injection equipment by diabetic patients in Pakistan. We conducted a cross-sectional study at diabetic clinics in five tertiary centers in Pakistan. All diabetic patients (type 1/type 2) who were on insulin for more than 1 month, were included. An Urdu (local language)-translated questionnaire was used to collect information on insulin administration equipment, the site and frequency of needle use, insulin syringe/pen/lancet disposal, sharing of needles and knowledge about diseases that are spread by sharing contaminated needles. Of 375 patients, 58% were female. The mean (SD) duration of diabetes was 12.3 (7.3) years, and the duration of insulin use was 4.4 (4.3) years. The majority of the patients used syringes (88.3%) for insulin administration. Additionally, the majority of the patients disposed of used devices (syringes, 92%; pens, 75%; and lancets, 91%) in the household garbage collection bin. About half of the patients (n=185) reported being educated by their physicians about the disposal of sharps. Those who were educated by a physician (adjusted odds ratio (adjOR): 0.36; 95%CI: 0.16-0.81) or could read/write English (adjOR: 0.32; 95%CI: 0.11-0.92) were less likely to dispose of syringes and needles in the household garbage. The common disposal of sharps in the household garbage has implications for disease transmission. Education on the safe disposal of sharps may improve the disposal practices.

Sharps disposal practices among diabetic patients using insulin

Insulin-dependent diabetic patients are not educated on safe sharps disposal methods, so leading to unsafe disposal of needles. Appropriate education on the correct disposal of sharps should be an integral part of their diabetic counseling. Doctors, nurses and pharmacists should all take responsibility for educating and reinforcing information about correct sharps disposal methods. Patients should be advised to either discard sharps into puncture resistant containers placed into their household refuse, or return them in secure containers for disposal by the dispensing institutions. Patients should also be educated regarding health risks associated with used needles. The South African Metabolic and Endocrine (SEMDSA) Guidelines and the South African Standard Treatment Guidelines (STG) should also give clear guidance on the safe disposal of needles.

Knowledge of Health Care Providers of Standard Precautions and Infection Control at Students and #8217; Hospital, Mansoura University, Egypt

Abstract Aim: to assess knowledge of Standard Precautions and infection control by health care providers (HCPs) at the Students’ Hospital, Mansoura University, Egypt. Methods: All HCPs were targeted for a cross-sectional study. A previously validated self-administered questionnaire was used to gather information regarding basic characteristics and the following knowledge domains; the general concept of standard precautions, hand hygiene, personal protective equipments, sharp disposal, environmental sanitation and care of health workers. Scoring system was assigned for different responses, with a total score of 50. Results: The mean (minimum, maximum) knowledge scores are: 28.5 (13,44) for the total score, 3.6 (0,5) for general concepts, 5.0 (0,9) for hand hygiene, 6.9 (1,10) for personal protective equipment, 2.1 (0,5) for sharp injuries and occupational infection, 5.0 (0,10) for sharp disposal and environmental sanitation, and 6.0 (1,10) for care of health care workers (HCW) domains. The mean total score and most of the domain scores show significant variation with specialty, educational level and duration of work. Compared to physicians/dentists/pharmacists, nurses are about 12 times more likely to have poor knowledge (Adjusted Odds Ratio [AOR]=11.8, CI=6.2-22.7) and technicians/health inspectors are about 31 times more likely to have poor knowledge (AOR=31.4, CI=11.2-88.3). Conclusion: In-service training and education curricula need to be revised.

The safe insertion of peripheral intravenous catheters: a mixed methods descriptive study of the availability of the equipment needed.

BackgroundIntravenous cannulation is undertaken in a high proportion of hospitalised patients. Much international attention has been given to the use of care bundles to reduce the incidence of infection in these patients. However, less attention has been given to the systems required to ensure availability of the equipment needed to support these care bundles. Our objectives were to assess how reliably the equipment recommended for a peripheral intravenous care bundle was available for use, and to explore factors which contributed to its non-availability.MethodsWe studied 350 peripheral cannula insertions in three NHS hospital organisations across the UK. Staff inserting cannulae were asked to report details of all equipment problems. Key staff were then interviewed to identify the causes of problems with equipment availability, using semi-structured qualitative interviews and a standard coding frame.Results47 equipment problems were recorded during 46 of 350 cannulations, corresponding to a reliability of 87%, or 94% if problems with sharps disposal were excluded. Overall reliability was similar in all three organisations, but the types of problem varied. Interviews revealed a variety of causes including issues associated with purchasing policies, storage facilities, and lack of teamwork and communication in relation to reordering. The many human factors related to the supply chain were highlighted. Often staff had adopted work-arounds to deal with these problems.ConclusionsOverall, 87% of cannulations had the correct and functional equipment available. Different problems were identified in different organisations, suggesting that each had resolved some issues. Supply chain management principles may be useful to support best practice in care bundle delivery.

Knowledge, attitude and perceived adherence with universal precaution among health care workers in the obstetrics and gynaecology department of an Indonesian teaching hospital

Health care workers (HCWs) are at a high risk of occupational blood-borne infections, which may be increased in low and middle income countries by low adherence to Universal Precautions (UP). A baseline survey of Knowledge, Attitudes and Perceived adherence (KAP) was executed to design evidence-based tailor made interventions. A cross-sectional, descriptive study using self-administered questionnaires was conducted among HCWs in the obstetrics and gynecology department of an Indonesian teaching hospital from September-October 2007. The survey included 524 HCWs with a response rate of 72% (n=377). The results indicated that the level of knowledge regarding hand washing, personal protective equipment, medical waste disposal and post exposure prophylaxis was high, over mean score of 71.8. However, level of knowledge regarding instrument processing and medical sharps disposal was low. Perceived adherence was low as reported by majority of respondents (95%). There was significant association between knowledge and attitude (r=0.235; P< 0.001); knowledge and perceived adherence (r=0.314; P< 0.001); attitude and perceived adherence (r=0.233; P< 0.001). This study suggest tailor made interventions were needed to improve adherence to UP.

Disposal of sharps medical waste in the United States: Impact of recommendations and regulations, 1987-2007

To gauge the impact of regulatory-driven improvements in sharps disposal practices in the United States over the last 2 decades, we analyzed percutaneous injury (PI) data from a national surveillance network from 2 periods, 1993-1994 and 2006-2007, to see whether changes in disposal-related injury patterns could be detected. Data were derived from the EPINet Sharps Injury Surveillance Research Group, established in 1993 and coordinated by the International Healthcare Worker Safety Center at the University of Virginia. For the period 1993-1994, 69 hospitals contributed data; the combined average daily census for the 2 years was 24,495, and the total number of PIs reported was 7,854. For the period 2006-2007, 33 hospitals contributed data; the combined average daily census was 6,800, and the total number of PIs reported was 1901. In 1992-1993, 36.8% of PIs reported were related to disposal of sharp devices. In 2006-2007, this proportion was 19.3%, a 53% decline. This comparison provides evidence that implementation of point-of-use, puncture-resistant sharps disposal containers, combined with large-scale use of safety-engineered sharp devices, has resulted in a marked decline in sharps disposal-related injury rates in the United States. The protocol for removing and replacing full sharps disposal containers remains a critical part of disposal safety.

Needlestick injuries: a prickly need for improving prevention

Health Care Workers (HCWs) are at high risk for needlestick injuries (NI). Many NI occur because of inappropriate management of devices or instruments. Improved education and appropriate sharps disposal after use would help reduce NI for HCWs involved in everyday practice.