Sharp Instrument Injury Research Articles

A Survey of Needlesticks and Sharp Instrument Injuries in Emergency Health Care in Turkey

A Survey of Needlesticks and Sharp Instrument Injuries in Emergency Health Care in Turkey

Retrospective investigation on sharp instrument injury among medical staffs and prevention measures

目的 了解医务人员在医疗工作中发生利器损伤的原因,探讨有效防护对策.方法 采用回顾性问卷调查,对近5年来医务人员利器损伤事件进行调查.结果 医务人员中发生损伤率为77.13%,医务人员发生针刺伤后上报率只有24.39%.结论 医务人员利器损伤发生率高,必须建采取有效措施防止利器损伤,保障医务人员安全。

Prewarning management for sharp instrument injury among medical workers

Objective To explore the incidence,causes,circumstances and protection and safe handling management of injury by sharp instrument in medical staff.Furthermore to design precaution project to alert medical staff. Methods Retrospective questionnaire investigation was carried out in 704 medical staffs in our hospitaL Results 543 of the investigated staff had been injured by sharp instrument at their work (77.11%),totally 1740 times.The incidence rate of nurses was even more,which reached 93.29%.The leading sharp instrument which caused injury were needle,infusion needle and glass ampul.Injuries often happened in morning work time when most treatments should be accomplished.When injuries happened only 24.71% of the victims had worn gloves at work,and only 24.3% of the victims had filed a repert. Conclusions The incidence of injury by sharp instrument is high in medical staffs,but they have little awareness of protection.h is an urgent topic to establish precaution mechanisms to prevent occupation injuries. Key words: Sharp instrument injury; Protection; Medical staff; Precaution mechanism

Risk factor analysis of sharp medical instrument injuries

随着现代医疗技术的快速发展,各种有创检查治疗手段不断增加,在为患者提供更加先进的医疗服务的同时,医护人员在工作中被各种医疗锐器损伤的机会也随之增多.锐器伤后血源性传染病的危险远大于其他途径,可达800/[1].一次污染锐器损伤引起艾滋病及丙型肝炎的可能为0.3%～0.5%及4%～10%,有些疾病一次锐器损伤就可以传播[2]。

Analysis on the incidence of sharp instrument injuries among student nurses

目的 了解临床实习护生医疗锐器伤的发生状况并探讨相应的对策.方法 对2005--2(107年在我院实习期间发生锐器伤的进行填表登记的58例实习护生受伤情况进行统计分析.结果 实习护生医疗锐器伤发生率为9.16%,锐器物中头皮针和注射器针头占72.42%;静脉输液占50.00%;拔针和用物整理环节占52.48%,受伤后伤口处理不规范占44.82%.结论 护生自我防护意识淡漠,防护知识匮乏.必须加强护生职业防护教育与管理。

Postmortem biochemistry and immunohistochemistry of adrenocorticotropic hormone with special regard to fatal hypothermia

Adrenocorticotropic hormone (ACTH) is involved in systemic reactions to stress. The aim of the present study was a comprehensive analysis of serum and cerebrospinal fluid (CSF) levels of ACTH, and the pituitary immunohistochemistry with special regard to fatal hypothermia in routine forensic autopsy cases ( n = 162: 5–97 years of age; 114 males and 48 females; 4 h to 3 days postmortem, median, 19.2 h). The ACTH concentrations were independent of the postmortem time, gender, or age of the subjects. The serum ACTH level was similar to the clinical reference value for sharp instrument injury, fire fatality, and hypothermia, but was lower in other groups including hyperthermia, in particular for asphyxia and poisoning. The CSF level was usually much higher than the serum level, but was significantly lower for hypothermia and hyperthermia than in other groups ( p < 0.01). The rate of ACTH-immunopositivity in the anterior pituitary was low in cases of fatal hypothermia and hyperthermia, while it was high in cases of blunt injury, fire fatality, and acute ischemic heart disease. These observations showed that ACTH levels in the serum and CSF depended on the cause of death. The serum level was maintained despite a low CSF level and pituitary immunopositivity for fatal hypothermia, while the serum and CSF levels as well as pituitary immunopositivity were decreased for hyperthermia.

Comparative evaluation of postmortem serum concentrations of neopterin and C-reactive protein

The cellular immune response is accompanied by the release of neopterin. The level of neopterin in serum is increased in patients suffering from viral infections, autoimmune diseases, systemic inflammation, allograft rejection and malignant diseases, while that of C-reactive protein (CRP) is known to rise during inflammatory diseases and traumas. To investigate postmortem neopterin and CRP concentrations with regard to the cause of death, we examined cardiac and peripheral blood samples in 474 autopsy cases without advanced decomposition (0–96 years of age, 343 males and 131 females), 2.8 h to 3 days (median, 18.0 h) after death. Survival time was 0.1 h to 5 months (median, 3.0 h) for traumatic death, and 0.1–1, 440 h (median, 2.5 h) for natural death. In autopsied subjects, neopterin concentrations were higher than the clinical reference, independent of the time after death, and depended on the survival time. In cases of acute and subacute death due to trauma, the neopterin level in right heart blood was mildly to moderately elevated (about 50–200 nmol/l) except for sharp instrument injury, whereas the CRP concentration usually remained low (<1 mg/dl). However, a moderate rise in the CRP level (around 1–10 mg/dl) was observed in fatal cases of hypothermia (cold exposure). Markedly elevated serum CRP and neopterin levels (>10 mg/dl and >500 nmol/l, respectively) were detected in cases of delayed death due to trauma involving systemic inflammatory response syndrome (SIRS) and of fatal bacterial infections. For sepsis, the serum CRP level was markedly elevated but the neopterin level was low in some cases. Fatal viral infections usually resulted in a marked elevation in the serum neopterin level (>500 nmol/l) with a mild to moderate rise in the CRP level. Combined analyses of neopterin and CRP may be useful to investigate viral infections and delayed traumatic death involving SIRS to support pathological findings.

Tissue-specific differences in mRNA quantification of glucose transporter 1 and vascular endothelial growth factor with special regard to death investigations of fatal injuries

Glucose transporter 1 (GLUT1) and vascular endothelial growth factor (VEGF) have been established as being responsible for cellular adaptation to oxygen deficiency in tissue ischemia and hypoxia mediated by hypoxia-inducible factor 1. We hypothesized that mRNA quantification of these factors in autopsy tissue specimens could have diagnostic significance for investigating the pathology of death, especially after injury. Various cases (total, n = 119; less than 48 h postmortem) were examined, including fatal blunt injury ( n = 71) and sharp instrument injury ( n = 18), as well as asphyxia (strangulation/hanging, n = 12) and acute myocardial infarction/ischemia ( n = 18) as controls. Quantification of mRNA by TaqMan real-time RT-PCR and immunostaining were performed for GLUT1 and VEGF in lung, kidney, and skeletal muscle specimens. The postmortem interval showed no significant influence on the relative quantification of mRNA during the early postmortem period. Characteristic results were found in blunt injury cases: both GLUT1 and VEGF mRNAs decreased in the lung but increased in the skeletal muscle depending on survival time. In the kidney, subacute deaths showed higher GLUT1 mRNA levels compared with acute deaths from blunt injury, but no significant change was found for VEGF mRNA. Immunohistochemistry showed visually predominant GLUT1 immunoreactivity in the renal cortex for cases with a longer survival time, coincident with the results at the mRNA level. Tissue-specific differences in mRNA quantification of GLUT1 and VEGF shed light on tissue ischemia/hypoxia and subsequent tissue-dependent pathophysiological changes leading to death after injury.

Analysis of related factors of sharp instrument injury of nurses in certain city

目的 了解医院锐器伤情况,为采取干预措施提供依据.方法 用统一设计的调查表对医院护理人员进行调查.结果 在锐器伤发生的诸多因素中,回套针头占45.4%,注射后清理工作占45.1%,冬季发生率最多为28.7%,病人躁动不配合引起为34.5%,自我防范意识淡薄发生率为31.65%.结论 调查显示护理人群中锐器伤发生率非常普遍,危险因素多.为医疗卫生机构建立健全注射管理制度提供参考依据。

Postmortem pericardial natriuretic peptides as markers of cardiac function in medico-legal autopsies

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the blood are clinical markers for the diagnosis of cardiac failure. This study was a comprehensive analysis of the postmortem pericardial levels of the natriuretic peptides in serial medico-legal autopsy cases (n=263, within 72 h postmortem) to assess their validity in investigating cardiac function. There was no significant relationship of pericardial ANP or BNP levels with postmortem time or the age of the subjects. The ANP and BNP levels showed negative correlations with the pericardial cardiac troponin T level. The ANP level was significantly elevated in drowning cases. Pericardial BNP and the BNP/ANP ratio were significantly higher for chronic congestive heart disease. However, asphyxiation, sharp instrument injury, hyperthermia, and fatal MA poisoning cases showed lower levels for both markers. These observations suggest that elevations in the postmortem pericardial ANP and BNP may mainly depend on acute atrial overload and subacute or chronic cardiac failure, respectively, and may be reduced by advanced myocardial damage.

Investigation about the compliance of education about how to preventing sharp instrument injuries among clinical nurses

目的 了解护理人员的职业安全,以及护理人员锐器伤的防护、教育、依从性的现状,探讨防范措施.方法根据锐器伤的发生方式和自身防护的要求,设计调查表,对全市22所医院的1 291名护理人员进行问卷调查,并对调查结果进行分析.结果自身防护的依从性较差:11.93%的护理人员对防护知识一无所知,接触患者前后经常洗手的比例为33.23%,有潜在血液接触中经常戴手套占23.01%,976例锐器伤中上报的比例为23.16%.结论只有强化护理人员对血源性疾病防护知识的教育,提高工作中自身防护的依从性,才能有效地避免或减少护理人员被血源性疾病感染。

Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 1. Analysis with special regard to traumatic causes of death

In forensic pathology, previous studies have suggested the possible application of cardiac troponins in the diagnosis of myocardial infarction. However, there appears to be insufficient practical data on other causes of death. The present study was a comprehensive analysis of the cardiac, peripheral blood and pericardial levels of cardiac troponin T (cTnT) in serial medicolegal autopsy cases ( n=405) with a survival time <24 h and within 48 h postmortem to assess the validity of investigating myocardial damage with special regard to traumatic causes of death. These included blunt and sharp instrument injury ( n=122 and 21, respectively), asphyxiation ( n=35), drowning ( n=27), fire fatalities ( n=94), hyperthermia ( n=13), hypothermia ( n=6), fatal methamphetamine (MA) abuse ( n=12) and carbon monoxide (CO) poisoning ( n=5) in comparison with myocardial infarction (MI, n=57) and cerebrovascular diseases ( n=13). Cases within 12 h postmortem usually showed lower cardiac and pericardial cTnT levels than did those of longer postmortem time of 12–48 h. In the early postmortem period of <12 h, significantly elevated serum cTnT levels were observed for hyperthermia. Thereafter, fatal MA abuse, CO poisoning and MI cases also showed higher levels. However, cTnT remained at lower levels for hypothermia and drowning. The elevation of cTnT was associated with the pathology of advanced myocardial damage involving swelling and liquefactive necrosis. The above-mentioned differences were the smallest for peripheral blood. These findings suggest that elevations in postmortem serum and pericardial cTnT levels depend on the severity of myocardial damage at the time of death and are related to the pathological findings, although postmortem interference should be taken into consideration.

Immunohistochemical distribution of S-100 protein in the cerebral cortex with regard to the cause of death in forensic autopsy

S-100 protein (S100) is an acidic calcium-binding protein, which is abundantly found in the brain. The aim of the present study was to investigate the immunohistochemical distribution of S100 in the cerebral cortex in forensic autopsy cases with regard to the cause of death and relationship to its serum levels. The cases ( n=286, 3–48 h postmortem) included fatal head injuries ( n=89), acute death from other blunt injuries ( n=29), sharp instrument injuries ( n=20), asphyxiation ( n=29: strangulation/hanging, n=22; aspiration, n=7), drownings ( n=22), fire fatalities ( n=68), cerebrovascular diseases ( n=9) and acute myocardial infarction/ischemia (AMI, n=20). S100-immunopositivity was mainly observed in the gliacytes, in part, in the neurons and myelins. For S100B-immunostaining, the gliacytes and myelins were positive, whereas the neurons were negative. Positivity in astrocytes was dependent on the cause of death, and was significantly lower in acute deaths due to strangulation/hanging and drowning, and mildly low in those due to injuries. Positivity in neurons and myelins was frequently observed in delayed head injury deaths and fire fatalities, showing an inverse relationship with the positivity in astrocytes in head injury cases. For cases of acute death, there was an inverse relationship between S100-positivity in the astrocytes and the serum S100B level. These observations suggest that astrocytes are more rapidly and severely injured than neurons during fatal brain damage, thereby causing an elevation in the serum S100B level.

Postmortem serum protein S100B levels with regard to the cause of death involving brain damage in medicolegal autopsy cases

The protein S100 is an acidic calcium-binding protein, and the subunit S100B is the most abundantly found in the brain. The aim of the present study was a comprehensive analysis of serum S100B levels in medicolegal autopsy cases (within 48 h postmortem, n=283) including victims with head and non-head injuries and also non-injury fatalities with regard to the cause of death involving brain damage. The serum level was usually higher in the subclavian vein than in the right heart and external iliac vein, and the lowest in the left heart blood, showing no significant postmortem influence. The serum level in the right heart and subclavian vein was markedly higher for acute deaths from head injury and asphyxiation due to neck compression (strangulation and hanging), and moderately and mildly elevated for other blunt and sharp instrument injury cases, respectively. For head injury, the serum levels were lower for subacute deaths than for acute deaths. These observations suggest that the elevation of serum S100B may mainly be caused by leakage following massive brain damage due to injury and cerebral hypoxia/ischemia, and in part by systemic hypoxic/traumatic tissue damage, depending on the survival time.

Evaluation of postmortem urea nitrogen, creatinine and uric acid levels in pericardial fluid in forensic autopsy

In postmortem biochemistry, there is insufficient data available for the practical analysis of factors in the pericardial fluid. The aim of the present study was to examine postmortem pericardial fluid for urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels to investigate the pathophysiology of death in forensic autopsy cases (total, n=409; within 48 h postmortem), which included blunt, sharp instrument injury, asphyxiation, drowning, fire fatalities, hyperthermia, hypothermia, methamphetamine-related fatalities, other poisoning, delayed death from trauma and natural diseases. There was a significant elevation in the three markers for chronic renal failure, gastrointestinal bleeding, hyperthermia, hypothermia, methamphetamine fatalities and delayed traumatic death, which was comparable with the clinical criteria for their serum levels. These postmortem findings showed azotemia due to renal failure, elevated protein catabolism and rhabdomyolysis. Although the pericardial levels were otherwise similar to the clinical serum reference ranges, only the drowning fatalities showed significantly lower levels for each marker. These observations suggested the stability of UN, Cr and UA in the pericardial fluid within 48 h postmortem and their usefulness for the pathophysiological investigation of death involving azotemia.

Postmortem serum endotoxin level in relation to the causes of death

Serum endotoxin is a clinical marker of sepsis. However, it is vulnerable to bacterial contamination, and the postmortem stability has not been established. In the present study, to evaluate the forensic pathological significance of postmortem endotoxemia in relation to the causes of death, we investigated a series of 111 autopsy cases (postmortem interval<48 h), in part, using bacteriological investigations. Systemic endotoxemia involving both the cardiac and peripheral blood was observed in some specific causes of death, including pneumonia ( n=1/3), peritonitis ( n=2/5), delayed traumatic death with severe secondary infection ( n=7/33), drownings (freshwater, n=3/9; saltwater, n=3/16), fire deaths ( n=3/16), and also in protracted deaths under critical medical care ( n=2). Most cases of fatal blunt injury ( n=4/5) showed sporadic endotoxemia in cardiac or peripheral blood, whereas there was no elevation of serum endotoxin in acute hemorrhagic death from sharp instrument injury ( n=6). The bacteriological investigation showed some characteristic profiles in infections and drownings. These observations suggested that, although endotoxin is a vulnerable serum marker to ante and postmortem interference, systemic postmortem endotoxemia involving peripheral blood may be a possible indicator of antemortem bacteremia related to some specific causes of death accompanied by advanced infection or pulmonary alveolar damage in the dying process especially due to drownings and fires.

Histomorphometric analysis of aortic medial structural elements in cases with an apparently normal aortic wall

Pulmonary microvascular injury is involved in severe trauma or disease. The present study investigated the immunohistochemical distribution of von Willebrand factor (vWF) and platelet CD61 factor in forensic autopsy cases (n = 157, >18 years of age, within 48 h postmortem), which comprised fatalities from blunt and sharp instrument injuries, strangulation, fire fatality and acute cardiac death (ACD). vWF immunoreactivity was clearly detected in the endothelia of large vessels (LV, ϕ > 200 μm), small vessels (SV, ϕ 40–200 μm) and capillaries (Cap, ϕ < 40 μm). Cap-vWF positivity was also detected in microthrombi with CD61 immunopositivity. The vWF positivity was higher in non-edema areas than in the edema area in the lungs. For acute deaths, Cap-vWF positivity of non-edema areas was frequently detected for strangulation (n = 8/13, 61.5%), fire fatality (n = 11/26, 42.3%) and ACD (n = 8/15, 53.3%), but was infrequent for blunt and sharp instrument injuries (n = 6/27, 22.5%, and n = 2/15, 13.3%, respectively), irrespective of the complication of chest injury. However, for non-acute deaths, Cap-vWF positivity was more frequent for non-chest blunt injury (n = 12/27, 44.4%) than for blunt chest injury (n = 3/13, 23.1%) and sharp instrument injury (n = 0/10, 0%). For fire fatality, Cap-vWF positivity was relatively frequent in cases with a lower blood carboxyhemoglobin (COHb) level of <60% (n = 6/14, 42.8%) than in cases with a higher COHb level of >60% (n = 3/12, 25.0%). These findings suggest that Cap-vWF positivity is closely related to the death process involving pulmonary microvascular injury.

Injury-related deaths among women aged 10–50 years in Bangladesh, 1996–97

Few studies have examined injury-related deaths among women in Bangladesh. We did a case-finding study to identify causes and the impact of intentional and unintentional injury-related deaths among women aged 10-50 years in Bangladesh. Between 1996 and 1997, health care and other service providers at 4751 health facilities throughout Bangladesh were interviewed about their knowledge of deaths among women aged 10-50 years. In addition, at all public facilities providing inpatient service, medical records of women who died during the study period were reviewed. The reported circumstances surrounding each death were carefully reviewed to attribute the most likely cause of death. 28,998 deaths among women aged 10-50 years were identified in our study, and, of these, 6610 (23%) were thought to be caused by intentional or unintentional injuries. About half (3317) of the injury deaths were attributable to suicide, 352 (5%) to homicide, 1100 (17%) to accidental injuries, and the intent was unknown for 1841 (28%) deaths. The unadjusted rate of suicides were higher in the Khulna administrative division (27.0 per 100,000) than the other four administrative divisions of Bangladesh (range 3.5-11.3 per 100,000). Poisoning (n=3971) was the commonest cause of injury-related death--60% of all injury deaths (6610) and 14% of all deaths (28,998). Other common causes of injury deaths in order of frequency were hanging or suffocation, road traffic accidents, burns, drowning, physical assault, firearm or sharp instrument injury, and snake or animal bite. Intentional and unintentional injuries are a major cause of death among women aged 10-50 years in Bangladesh. Strategies to reduce injury-related deaths among women need to be devised.

Needlestick and Sharp Instrument Injuries in Hospital Personnel

Needlestick and Sharp Instrument Injuries in Hospital Personnel

The Epidemiology of Needlestick and Sharp Instrument Accidents in a Nigerian Hospital

To characterize the epidemiology of percutaneous injuries of healthcare workers (HCWs) in Ile-Ife, Nigeria. A cross-sectional survey of a random sample of HCWs regarding details of needlestick and sharp instrument injuries within the previous year. University hospital and clinics in Ile-Ife, Nigeria. Hospital personnel with potential occupational exposure to patients' blood. Needlestick accidents during the previous year were reported by 27% of 474 HCWs, including 100% of dentists, 81% of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff. The rate of needlestick injuries was 0.6 per person-year overall: 2.3 for dentists, 2.3 for surgeons, 0.4 for nonsurgical physicians, and 0.6 for nursing staff. Circumstances associated with needlestick injuries included unexpected patient movement in 29%, handling or disposal of used needles in 23%, needle recapping in 18%, accidental stick by a colleague in 18%, and needle disassembly in 10%. Sharp instrument injuries were reported by 15% of HCWs and most commonly involved broken glass patient specimen containers (39%). Almost all HCWs were aware of the potential risk of HIV transmission through percutaneous injuries, and 91% considered themselves very concerned about their occupational risk of HIV acquisition. The high frequency of percutaneous exposure to blood among HCWs in this Nigerian hospital potentially could be reduced by simple interventions at modest cost.