Needlestick injuries among medical students

National Survey of Sharps Injuries Incidence Amongst Healthcare Workers in the United States

Purpose

Reporting sharps injuries is crucial for healthcare worker occupational safety. However, these incidents are often underreported, thus posing potentially dangerous working environments. Previous small and limited studies have quantified this underreporting in specific groups of healthcare workers. This study aims to expand on these studies by further quantifying sharps injury incidences through a national study, thus better understanding healthcare reporting behaviors and the reasons for underreporting.

Patients and Methods

This is a national, multi-center, cross-sectional study conducted via an online anonymous survey distributed through email among United States attending physicians, fellows, residents, medical students, and nurses of all specialties (ie, surgery, medicine, pediatrics). Data analysis used descriptive statistics and regressive modeling with significance defined as p<0.05.

Results

Of over 3000 surveys emailed, 460 (15.3%) healthcare workers responded. The most vulnerable cohort to report sharps injuries were medical students (0.87 injuries per year ±0.69, n=92) and Postgraduate Year (PGY) 1 (0.67±0.81, n=71), PGY2 (0.86±-0.82, n=48), and PGY3 (0.92±0.8, n=45) resident physicians. Healthcare workers in surgical fields reported significantly higher likelihoods (odds ratio=4.61, p<0.001, 95% confidence interval 2.83-7.26) of sharps injuries. Medical students reported sharps injuries the least (40%) and nurses reported sharps injuries the most frequently (71%). The three most common reasons for not reporting sharps injuries included (1) healthcare workers perceiving low infection risk based on patient medical history, (2) fear of peer perception, and (3) belief of lack of reporting utility or that reporting is inconsequential.

Conclusion

Medical students and physicians early in training, especially those in surgical fields, are more vulnerable to sharps injuries, but are less likely to report, while nurses are the most likely to report. Dedicated sharps training, education to reduce stigma around injury, and implementing a simplified reporting process may help encourage reporting as well as consistency in reporting, leading to improved workplace safety.

What were the changes during the COVID-19 pandemic era concerning occupational risks among health care workers?

BACKGROUND

Accidental exposure to percutaneous needle stick and sharp injuries (NSSIs) and blood and other body fluids is the unintended contact with risky medical instruments or patient secretions during a medical intervention. During the COVID-19 pandemic, the significance of occupational injuries in healthcare professionals was revealed once again. To assess the occupational injuries, we compared rates, distribution and type of exposure to blood and body fluids and NSSIs of health care workers for 2019 (pre-pandemic era) and 2020 (pandemic era) years, respectively.

MATERIAL AND METHODS

Our study included data collected by the 'Hospital Infection Control Committee' for the years 2019-2020. Data collected using the active surveillance method were analyzed retrospectively.

RESULTS

During 2019 (pre-pandemic period) and 2020 (pandemic period), 112 (27.65%₀) and 82 (21.4%₀) NSSIs reported, respectively. Of the exposed HCWs in 2019 (pre-pandemic period), 16.8%₀ (14) were doctor, 53.6%₀ (60) were nurse and 47.4%₀ (14) were intern doctors. In the 2020 (pandemic period), NSSIs were observed most frequently in nurses and cleaning staff, 50.24%₀ and 33.64%₀, respectively. Concerning the total percentage of exposure to blood and other body fluids, a slight increase was revealed from 1.48%₀ to 2.62%₀ in 2019 and 2020, respectively. A significant decrease in exposure rate was reported among the doctors between the pre-pandemic and pandemic era; 3.6%₀ and 1.19%₀ at 2019 and 2020, respectively. A significant increase in exposure rate was reported among the nurses between pre-pandemic and pandemic era; 0.8%₀ and 6.89%₀, respectively.

CONCLUSION

In conclusion, the exposure to NSSIs during the pandemic period decreased; however, there was no severe difference at pre-pandemic and pandemic periods concerning exposure to blood and body fluids. Well-designed training and awareness programs can be effective in preventing exposure to NSSIs and blood and other body fluids and exposure to respiratory acquired viruses.

Physical Enhancement? Nanocarrier? Current Progress in Transdermal Drug Delivery

A transdermal drug delivery system (TDDS) is a method that provides drug adsorption via the skin. TDDS could replace conventional oral administration and blood administration because it is easily accessible. However, it is still difficult to design efficient TDDS due to the high barrier property of skin covered with stratum corneum, which inhibits the permeation of drug molecules. Thus far, TDDS methods by applying physical stimuli such as microneedles and chemical stimuli such as surfactants have been actively developed. However, it has been hard to avoid inflammation at the administration site because these methods partially destroy the skin tissue. On the other hand, TDDS with nanocarriers minimizing damage to the skin tissues has emerged together with the development of nanotechnology in recent years. This review focuses on current trends in TDDS.

Interdisciplinary differences in needlestick injuries among healthcare professionals in training: Improving situational awareness to prevent high-risk injuries

BACKGROUND

Needlestick injuries among healthcare professionals continue to be an occupational hazard, frequently and incorrectly regarded as low-risk, and exacerbated by underreporting. We aimed to investigate rates of needlestick injury, reasons for underreporting, and how explicit announcements that patients are "high-risk" (i.e., human immunodeficiency virus, hepatitis, or intravenous drug abuse history) might affect the actions of those at risk of sustaining an injury.

METHODS

A cross-sectional survey was administered to medical students (MS), nursing students (NS), and residents.

RESULTS

30/224 (13%) of MS, 6/65 (9%) of NS, and 67/126 (53%) of residents experienced needlestick injuries. 37% of MS, 33% of NS, and 46% of residents attributed "lack of concentration" as cause of injury. Residents had the lowest percentage of underreporting (33%), with rates of 40% and 83% among MS and NS, respectively. Top reasons for non-reporting included the injury being perceived as "trivial" (22%) and patient being "low-risk" (18%). A majority stated pre-operative "high-risk" announcements should be required (91%), and would promote "culture of safety" (82%), reporting of injuries (85%), and increased concentration during procedures (70%).

CONCLUSIONS

We recommend routine announcements during pre-operative time-out and nursing/resident hand-offs that state a patient is "high-risk" if applicable. We hypothesize such policy will promote a "culture of safety," situational awareness, and incident reporting.

Clinical Outcomes of Post-exposure Prophylaxis following Occupational Exposure to Human Immunodeficiency Virus at Dental Departments of Hiroshima University Hospital

Background

Dental professionals have so many opportunities to use injection needles and sharp instruments during dental treatment that they face an increased risk of needlestick injuries. This retrospective study reports the utilization and clinical outcomes of occupational post-exposure prophylaxis (PEP) with anti-retroviral agents after being potentially exposed to HIV at the dental departments of Hiroshima University Hospital.

Objective

This study reports the utilization and clinical outcomes of occupational post-exposure prophylaxis (PEP) with antiretroviral agents after being potentially exposed to HIV at dental departments of Hiroshima University Hospital.

Methods

Data on the clinical status of HIV-infected source patients and information on HIV-exposed dental professionals from 2007 to 2018 were collected.

Results

Five dentists with an average experience of 5.6 years (1-15 years) were exposed. The averaged CD4-positive cell number and HIV-RNA load were 1176 (768-1898) /μl and less than 20 copies/ml, respectively, in all the patients. Two of the five HIV exposed dentists received PEP. Three months after the exposures, all of their results were negative in HIV antibody/antigen tests.

Conclusion

These data might support the concept of “undetectable equals untransmittable”, although HIV exposure in this study was not through sexual transmission.

Systematic Review of Blood-Borne Pathogen Exposure Rates Among Medical Students

BACKGROUND

Blood-borne pathogen exposures (BBPEs) pose a risk to health care workers (HCWs). Needlestick injuries (NSIs) have declined overall, but not for surgical HCWs. There are limited data regarding BBPEs among medical students (MSs) in their clinical years. We aimed to quantify this risk for third- and fourth-year MSs.

METHODS

A literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PUBMED database was searched to identify studies of third- and fourth-year MSs using the terms BBPE, NSI, and MS. Studies of other HCWs were excluded if MS data were not extractable. Additional studies were identified from references. Descriptive analysis was performed.

RESULTS

Seven of 171 articles published from 2002 to 2018 met study criteria. All used self-reported data from surveys/questionnaires. One-third of MSs reported BBPEs (n = 194/600, 32.3%) with a mean of 1 in 3.09 and a median of 1 in 3.53 (range: 1 in 1.9-8.3 students). Most events were NSIs (144/194, 74%) with a mean of 1 NSI per 4.05 MSs and median of 1 in 4.625 (range: 1 in 2.47-10.71). The remaining BBPEs reported included blood and bodily fluid splashes (n = 37, 19%), other mucocutaneous exposures (n = 7, 3.6%), and uncategorized injuries (n = 2, 1%).

CONCLUSIONS

One-third of senior MSs reported BBPEs during clinical rotations. Most BBPEs were NSIs. Quantifying this risk allows for anticipatory education and protocol development to protect students and other new HCWs. Educational efforts focused on NSI prevention before and during clinical rotations may help reduce BBPEs.

Prevalence of Needlestick Injuries, Attitude Changes, and Prevention Practices Over 12 Years in an Urban Academic Hospital Surgery Department

OBJECTIVE

Needlestick injury prevalence, protection practices, and attitudes were assessed. Current medical students were compared with 2003 data to assess any changes that occurred with engineered safety feature implementation.

BACKGROUND

Risk of occupational exposure to bloodborne pathogens is elevated in the operating room particularly with surgeons in training and nurses.

METHODS

A cross-sectional survey was distributed to medical students (n = 358) and Department of Surgery staff (n = 247).

RESULTS

The survey response rate was 24.8%. Needlestick injuries were reported by 38.7% of respondents (11% high risk), and the most common cause was "careless/accidental." Needlestick injury prevalence increased from medical students to residents and fellows (100%). Thirty-three percent of injured personnel had at least one unreported injury, and the most common reason was "inconvenient/too time consuming." Needlestick injury prevalence and double-glove use in medical students did not differ from 2003, and 25% of fellows reported always wearing double gloves. The true seroconversion rate for bloodborne pathogens was underestimated or unknown. The concern for contracting a bloodborne pathogen significantly decreased (65%) compared to 2003, and there were significantly less medical students with hepatitis B vaccinations (78.3%). Level of concern for contracting a bloodborne pathogen was predictive of needlestick injury.

CONCLUSIONS

Needlestick injury and occupational exposure to bloodborne pathogens are significant hazards for surgeons and nurses. Attitudes regarding risk are changing, and the true seroconversion risk is underestimated. Educational efforts focused on needlestick injury prevalence, seroconversion rates, and double-glove perforation rates may be effective in implementing protective strategies.

Evaluating the Effectiveness of a Continuing Education Program for Prevention of Occupational Exposure to Needle Stick Injuries in Nursing Staff Based on Kirkpatrick's Model

BACKGROUND

Nurses are the most vulnerable group that are faced with occupational injuries caused by exposure to needle stick injuries. This study evaluated the effectiveness of a continuing education program about the prevention of occupational exposure to needle stick injuries in the nursing staff, based on the Kirkpatrick model.

METHODS

In this study, 120 nurses were selected in the experimental and control groups. A continuing education program for experimental group was performed. After the education program, its effectiveness has been evaluated across four levels (Reaction, Learning, Behavior, Results) of the Kirkpatrick model. Data analysis was conducted using Pearson's correlation coefficient, chi-square test, paired t-test, independent samples t-test, and descriptive statistics. The data were analyzed using the SPSS statistical software (V. 22).

RESULTS

The mean score for knowledge in the experimental group improved significantly from 8.32 ± 2.17 to 13.98 ± 1.2 (p < 0.05). The experimental group of 24 nurses (40%) were exposed to needle stick injury before education, but this number was reduced to 9 (15%) after intervention. The chi-square test showed a significant difference (P = 0.013). However in the experimental group, 15 nurses (25%) were exposed to blood and body fluids before intervention, but again it was reduced to 6 (10%) after education. The chi-square test showed a significant difference (P = 0.002).

CONCLUSION

The results from the execution of continuing education program showed that through designing training programs and raising awareness in nursing personnel, we can reduce occupation exposure to needle stick injuries.

Sharp instrument injuries among hospital healthcare workers in mainland China: a cross-sectional study

OBJECTIVES

To determine the prevalence of sharp instrument injuries in hospital-based healthcare workers (HCWs) in mainland China and the contributing factors.

DESIGN

Cross-sectional study.

SETTING

The data were derived from public hospitals.

PARTICIPANTS

A total of 360 hospitals were recruited in the study, including 289 general hospitals and 71 specialised hospitals. Among them, 194 are tertiary-level hospitals and 166 are secondary level. The study population finally consisted of 223 149 hospital HCWs.

PRIMARY OUTCOME MEASURES

A questionnaire was designed based on the aim of the study. Profession of HCWs, workplace, circumstance and medical apparatus and instrument were covered in the survey. HCWs completed a self-administered questionnaire regarding details of sharp instrument injuries within the previous month. Prevalence estimates for the injuries were calculated for the overall HCWs and for subgroups according to profession, workplace, circumstance or instrument.

RESULTS

Within the included HCWs, the prevalence of sharp instrument injuries was 0.08 per person-month. Only 4.6% of the HCWs reported to their hospitals after injury. The highest number of injuries occurred in nursing staff (10.3%). Injuries took place most frequently on general wards (44.5%). The circumstances that involved most frequent injuries include surgical needle insertion, removing an arteriovenous needle from a patient and recapping the needle. Single-use syringe caused more injuries incidents than other instruments.

CONCLUSIONS

These results indicate that sharp instrument injuries have become a major occupational problem of HCWs in mainland China. Attentions need to be paid to the issue and strategies for preventing such injuries are needed.

Bloodborne pathogen exposures: Difference in reporting rates and individual predictors among health care personnel

BACKGROUND

Employees in health care settings are at varying risk for bloodborne pathogen (BBP) exposures. We compared differences in reporting rates of BBP exposures among health care personnel during 2 different time periods, assessing job category, years of experience, and sex as potential predictors for exposure.

METHODS

A retrospective review of the employee health department BBP database at 2 time periods (September 1, 2012-April 30, 2013, and September 1, 2013-April 30, 2014) in which 2 different reporting protocols (call center vs pager) was used. A survey was administered to assess reported and unreported exposures within a 12-month period.

RESULTS

BBP exposures were highest among residents and lowest among students. Physicians' reporting rate doubled when the call center was no longer used (relative risk, 2.40; 95% confidence interval [CI], 1.04-5.52). Percutaneous injuries were the most common (78.3%), and most occurred in the operating room or postanesthesia unit (30.8%) and patient rooms (28.9%). Of 1,105 survey respondents, 103 (9.3%) recalled some type of exposure, but only 80 (77.7%) reported these exposures. When accounting for years of experience and sex, job category was significantly associated with injury or exposure within the previous 12 months (P < .001). Risk of exposure among residents was 3 times higher (odds ratio, 3.10; 95 CI, 1.60-6.00) than nurses.

CONCLUSIONS

Risk and reporting behaviors of BBP exposures vary widely across different providers. Training and education to prevent BBP exposures may need to be tailored toward different provider types.

Analysis of Needlestick and Similar Injuries over 10 Years from April 2004 at Tokyo Dental College Chiba Hospital

Here we investigated needlestick and similar injuries reported over a 10-year period between April 2004 and March 2014. The purpose of this study was to prevent recurrence and reduce the incidence of such injuries at Tokyo Dental College Chiba Hospital. The Division of Medical Risk Management at Chiba Hospital anonymized the data to protect personal information prior to analysis. A total of 213 injuries occurred over the 10-year period investigated, but the number of cases decreased yearly. Many cases involved dental undergraduate students and dentists, followed by trainee dentists, students at the school of dental hygiene, nurses, dental hygienists, and cleaners. Suture needles, followed by injection needles, were the top two most common injury-causing instruments, contributing to approximately 50% of the total number of such cases. Many injection needle injuries occurred during tidying up, while those caused by suture needles occurred during dental treatment. Taken together, these findings suggest the importance of strict adherence to guidelines provided in safety manuals on error-free procedures and handling of instruments. Improvement in the ability to sense potential risk is essential if such injuries are to be avoided.

Compliance with standard precautions among baccalaureate nursing students in a Saudi university: A self-report study

Meticulous observance of standard infection control precautions by health care providers is strongly recommended for every patient encounter. Assessment of nursing students' compliance should be carried out regularly in order to ensure adherence to protocols. Thus, this study was conducted to assess self-reported compliance with standard precautions among baccalaureates in nursing students in a Saudi university. A convenience sample of 236 nursing students was surveyed in this cross-sectional, self-reported study, using the Compliance with Standard Precaution Scale Arabic version (CSPS-A). Independent t-test and one-way analyses of variance (ANOVA) were performed to examine the differences on compliance. A multiple regression analysis was performed to identify the factors affecting compliance. The overall compliance rate was 61.0%. The students reported highest compliance in disposing used sharp instruments and other sharp objects into sharps-only boxes, while the lowest compliance rate in using water only for hand washing. Significant differences in compliance were observed when respondents were grouped according to their demographic characteristics. Cultivating a supportive culture of adherence to infection control precautions among nursing students is of paramount importance. The clinical environment should be supportive of a culture where strict compliance with the control and prevention of infection is of prime importance.

Knowledge and practices of healthcare workers in relation to bloodborne pathogens in a tertiary care hospital, Western Saudi Arabia

To assess knowledge and practices of healthcare workers (HCWs) in relation to bloodborne pathogens in a tertiary care hospital, western Saudi Arabia. Self-administered questionnaire was distributed assessing demographic characteristics, knowledge and practices of physicians, nurses and technicians on risks of exposure and prophylaxis against human immunodeficiency virus, hepatitis B virus and hepatitis C virus infections. A total of 466 participants (151; 32.4 % physicians and 315; 67.6 % nurses/technicians) completed the questionnaire. Almost two thirds of the physicians (60.9 %) and half of the nurses/technicians (47.6 %) had history of exposure to risks of bloodborne infection. Although both physicians and nurses/technicians showed acceptable level of knowledge about risks of bloodborne infections, modest proportion knew the correct actions including reporting following exposure. Behavioral-based in-service training interventions and strict policy should be implemented to promote compliance of HCWs to the protective measures against hazards of bloodborne infection.

Sharp Injuries Among Medical Students

Introduction:

Sharp injuries threaten the health of healthcare employees. They cause the transmission of many diseases such as hepatitis B and C, AIDS, etc., which can increase the associated costs associated with them. The aim of this study was to investigate the frequency of sharp injuries among the students of Hormozgan University of Medical Sciences.

Method:

This cross-sectional study was conducted during 2012-2013 in Hormozgan University of Medical Sciences, IR Iran. The target population consisted of the medical, nursing, midwifery, operating room technician, and medical laboratory students in the 2012-2013 academic year. Census sampling was conducted, and accordingly, 500 students participated in the study Data was collected using modified questionnaire of the University of San Diego’s injury report form. The collected data were entered into SPSS V.19 and analyzed using descriptive statistical tests.

Findings:

Finally 377 students (75.4%) returned the questionnaire. Among the studied students, 184 students (39.3%) had had sharp injuries. The frequency of damaging Vein puncture was the most common mechanism of injury

Discussion and Conclusion:

The prevalence of sharp injuries is high among students which can increase the risk of disease and its subsequent risks, and thus, increase the cost and stress among students. It seems that holding workshops and increasing students’ awareness and skills to face these risks can be effective in mitigating them.

Prevention of Nosocomial Infection and Standard Precautions: Knowledge and Source of Information Among Healthcare Students

Objective.

To evaluate the knowledge of healthcare students after four curricula on infection control and to identify sources of information.

Design.

Cross-sectional study.

Setting.

Four healthcare schools at Rouen University (Rouen, France).

Participants.

Medical students, nursing students, assistant radiologist students, and physiotherapist students taking public health courses.

Methods.

To measure students' knowledge of infection control and their sources of information, 6 multiple-choice questions were asked about 3 specific areas: standard precautions, hand hygiene, and nosocomial infection. Each questionnaire section had 10 possible points, for an overall perfect score of 30. The sources of information for these 3 areas were also recorded: self-learning, practice training in wards, formal training in wards, and teaching during the curriculum. A logistic regression analysis was performed to identify factors associated with acceptable level of knowledge.

Results.

Three hundred fifty students (107 medical students, 78 nursing students, 71 physiotherapist students, and 94 assistant radiologist students) were included in the study. The mean overall score (±SD) was 21.5 ± 2.84. Nursing students had a better mean overall score (23.2 ± 2.35) than did physiotherapist students (21.9 ± 2.36), medical students (21.1 ± 2.35), and assistant radiologist students (20.5 ± 3.04; P < .001). The mean scores (±SD) for the component sections of the questionnaire were 8.5 ±1.4 for standard precautions, 7.4 ± 1.26 for hand hygiene, and 5.7 ± 1.55 for nosocomial infections (P < .001). The main source of information was material taught during the curriculum. Results of multivariate analysis indicate that the probability of attaining acceptable knowledge in each area was smaller for medical students and assistant radiologist students than for nursing students.

Conclusion.

The overall score for infection control indicated that instruction was effective; however, knowledge levels were different by area (the best scores were results of tests of standard precautions) and curriculum (nursing students achieved the best overall score). Ward training for daily infection control practice (ie, bedside instructions training and course work) could be improved for healthcare students.

Reducing risk and enhancing education: U.S. medical students on global health electives

This study assessed the impact of several interventions, including predeparture simulation training and procedure logs, on incidence needlestick injuries (NSIs) among U.S. medical students on global health (GH) elective in Botswana. Review of NSI incident reports before and after introduction of these interventions demonstrated a reduction in the number of splash and body fluid exposures (n = 5 [6%] vs n = 21 [23%]; P < .001), respectively. Simple predeparture training is highly effective in reducing NSIs among students participating in GH electives.

Hepatitis B vaccination coverage and postvaccination serologic testing among medical students at a public university in Brazil

The aim of this cross-sectional study was to determine the hepatitis B vaccination coverage among medical students at a public university in Rio de Janeiro, Brazil, and their compliance with the postvaccination serologic testing recommendations. Of the total of 858 students, 675 (78.7%) participated in the study. Among the participants, 48.9% (95% CI: 45.1% to 52.7%) were vaccinated against hepatitis B (received ≥ 3 doses of the vaccine), 31.6% were not (received 0, 1 or 2 doses), and 19.6% did not know their vaccination status. Hepatitis B vaccination coverage increased from 26.0% among first-year students to 70.6% among sixth-year students while the prevalence of unknown vaccination status decreased from 39.7% among first-year students to 2.4% among sixth-year students. The frequency of unvaccinated students ranged from 23.7% among fifth-year students to 34.4% among first-year students. Only 34.8% of the vaccinated students performed the anti-HBs testing after vaccination. Among these medical students, we found a low adherence to the hepatitis B vaccination and to the postvaccination serologic testing. A comprehensive hepatitis B immunization program should be offered to students at this medical school.

Occupational exposures to body fluids and behaviors regarding their prevention and post-exposure among medical and nursing students at a Brazilian public university

A cross-sectional study was conducted to assess the frequencies and characteristics of occupational exposures among medical and nursing students at a Brazilian public university, in addition to their prevention and post-exposure behavior. During the second semester of 2010, a self-administered semi-structured questionnaire was completed by 253/320 (79.1%) medical students of the clinical course and 149/200 (74.5%) nursing students who were already performing practical activities. Among medical students, 53 (20.9%) suffered 73 injuries, which mainly occurred while performing extra-curricular activities (32.9%), with cutting and piercing objects (56.2%), in the emergency room (39.7%), and as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%) in the operating room or wards (72.2%), and as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instructions on previously received exposure prevention; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 49.3% and 35.1% did not bother to find out the source patient's serological results post-exposure; and 1.4% and 18.9% officially reported injuries. In conclusion, this study found high frequencies of exposures among the assessed students, inadequate practices in prevention and post-exposure, and, consequently, the need for training in “standard precautions” to prevent such exposures.

Occupational safety training and education for needlestick injuries among nursing students in China: intervention study

OBJECTIVES

To confirm the effect of occupational safety training and education programs (OSTEP) on needlestick injuries (NSIs) among nursing students in China.

METHODS

Compare the rates and the nature of NSIs before and after OSTEP among the nursing students in China. Firstly, questionnaires were delivered to 248 randomly selected nursing students from seven training hospitals to obtain basic information concerning relevant occupational NSIs. Then regular intervention measures through OSTEP on 246 nursing students had been introduced for four years. And the resultant information concerning relevant occupational NSIs was obtained afterwards. Finally, the data analysis was performed using SPSS software, version 11.5.

RESULTS

The rate of NSIs among these nursing students was relatively high before the OSTEP in China (average, 4.65 events/nurse). However, it decreased rapidly to 0.16 events/nurse average after the OSTEP. Occupational safety awareness and behavior in handling NSIs was improved in China. There was a significant difference in the results of Chi-square value (P<0.005).

CONCLUSIONS

NSIs are common in nursing students in China. The OSTEP can reduce NSIs and change practical behavior markedly among nursing students in China. We should perform OSTEP on nurse students before and during the clinical practice. We must also provide effective preventive measures to reduce this kind of problem in future.

Sharps injuries: the risks and relevance to plastic surgeons

Surgeons are at risk for injury in the operating room daily. Because of the ubiquity of occupational hazards, injuries remain prevalent and expensive. Although occupational hazards can include musculoskeletal conditions, psychosocial stress, radiation exposure, and the risk of communicable diseases, sharps injuries remain the most common among surgeons in practice and the most frequent route of transmission of blood-borne pathogens. Therefore, increased attention to the health, economic, personal, and social implications of these injuries is essential for appropriate management and future prevention.

Do nursing students know and practise the Universal Precautions to prevent transmission of infectious agents?

Background: Nursing students, like other healthcare students, are at high risk of occupational exposure to blood and bodily fluids. Studies have shown that use of the Universal Precautions(UPs) lowers this risk, but do students know and practise these precautions?Objectives: This study investigated the knowledge and practice of undergraduate nursing students regarding the UPs, and whether there was a correlation between knowledge of the UPs and their practice.Method: This was a descriptive quantitative study amongst undergraduate nursing students in years 2–4 (n = 253), who were selected by means of stratified random sampling. A questionnaire was administered to the participants by the researcher. The data collected were analysed through use of the Statistical Package for Social Sciences (SPSS 16.0) and content analysis.Results: It was established that there was indeed a lack of knowledge regarding the UPs,and that the students’ self-reported practice of the UPs was poor. There was no statistically significant correlation between knowledge and practice of the UPs.Conclusion: More structured educational programmes are needed to improve both knowledge and practice of the UPs. These programmes should be offered across all nursing student study years as continuous professional development.

Occupational Exposure to Blood and Body Fluids among Health Care Workers in Teaching Hospitals in Tehran, Iran

BACKGROUND

Health care workers (HCWs) are vulnerable populations for infection with blood borne pathogens. This study was conducted to determine occupational exposure to blood and body fluids among HCWs in teaching hospitals in Tehran, Iran.

METHODS

A self-structures questionnaire was used to study 650 HCWs during 2006 -2007 in some teaching hospitals in Tehran, Iran.

RESULTS

occupational exposure to blood and body fluids to blood and body fluids of patients was noticed in 53.4%. Recapping was the most common cause of niddle stick injuries (26.5%) and 19.9% of HCWs with a history of needlestick or mucosal exposure had sought medical advice from a specialist, 79.4% of these visited a doctor in the first 24 hours after exposure. Twenty percent of people with a history of needlestick or mucosal exposure to human immune deficiency virus positive (HIV(+)) patients received post-exposure prophylaxis and 46.7% tested themselves for seroconversion. 25.8% of HCWs with a history of needlestick or mucosal exposure with HBsAg(+) patients received hepatitis B immunoglobuline (HBIG), all of these had received it in the first 72 hours after exposure. History of vaccination, and reassurance about the effective serum antibody titer was the most frequent reason mentioned in case the individuals did not receive HBIG (56.5%).

CONCLUSION

There is a need for further research to investigate why many HCWs do not take prophylactic and essential actions after needle stick or mucosal exposure to body fluids of infected patients.

Sharps injuries among medical students in the Faculty of Medicine, Colombo, Sri Lanka

INTRODUCTION

Medical students undertake clinical procedures which carry a risk of sharps injuries exposing them to bloodborne infections.

OBJECTIVES

To study the prevalence and correlates of sharps injuries among 4th-year medical students in the Faculty of Medicine, University of Colombo, Sri Lanka.

MATERIALS AND METHODS

The survey was conducted among 4th-year medical students to find out the incidence of injuries during high-risk procedures, associated factors and practice and perceptions regarding standard precautions. A self-administered questionnaire was administered to a batch of 197 4th-year medical students.

RESULTS

A total of 168 medical students responded. One or more injury was experienced by 95% (N = 159) of the students. The majority (89%) occurred during suturing; 23% during venipuncture and 14% while assisting in deliveries. Most of the incidents (49%) occurred during Obstetrics and Gynecology attachments. Recapping needles led to 8.6% of the injuries. Thirty-five percent of students believed they were inadequately protected. In this group, adequate protection was not available in 21% of the incidences and 24% thought protection was not needed. Following the injury, 47% completely ignored the event and only 5.7% followed the accepted post-exposure management. Only 34% of the students knew about post-exposure management at the time of the incident. Only 15% stated that their knowledge regarding prevention and management was adequate. The majority (97%) believed that curriculum should put more emphasis on improving the knowledge and practice regarding sharps injuries.

CONCLUSIONS

The incidence of sharps injuries was high in this setting. Safer methods of suturing should be taught and practiced. The practice of standard precautions and post-injury management should be taught.

Prevalence of needle stick injuries among dental, nursing and midwifery students in Shiraz, Iran

Background: The risk of occupational exposure to blood borne pathogens (including hepatitis B, hepatitis C and HIV) via sharp injuries such as needle stick injuries (NSIs) among health care workers, especially dental, nursing and midwifery students is a challenging issue. Inadequate staff, lack of experience, insufficient training, duty overload and fatigue may lead to occupational sharp injuries. The aim of this prospective cross-sectional study was to evaluate the frequency of NSIs in Iranian dental, nursing, and midwifery students and their knowledge, attitude and practices regarding prevention of NSIs.

Methods: A questionnaire was provided to 264 dental and 435 nursing and midwifery students during their under graduate clinical training. 52% of dental students and 48% of nursing and midwifery students responded to the questionnaire. The questionnaire was pre-tested for reliability on 9.2% of the 55 sample population and found to have a high (r=0.812) test-retest reliability.

Results: 73% of students reported at least one NSI during the past year. Activities most frequently associated with injuries involved use of a hollow-bore needle during venous sampling or IV injection in both groups, followed by wound suturing in nursing and midwifery students and recapping in dental students. NSIs and non-reporting of NSIs were highly prevalent in these participants. The reason for not reporting injuries included not knowing the reporting mechanism or not knowing to whom to report.

Conclusion: Education about transmission of blood borne infections, standard precaution and increasing availability of protective strategies must be enforced. Furthermore, an optimization of the management for reporting is warranted.

Occupational Exposure to Sharp Instrument Injuries among Dental, Medical and Nursing Students in Mahatma Gandhi Mission's Campus, Navi Mumbai, India

Background

Sharp instrument injuries among health care students significantly increase the risk of transmission of different blood-borne pathogens which can lead to serious consequences including death.

Objectives

The study was carried out to determine the prevalence and factors associated with sharp instrument injuries among the health care students in the Mahatma Gandhi Mission's Campus, Navi Mumbai and to make recommendations to the institutional authorities about measures to be undertaken to prevent such injuries among the students.

Materials and Methods

A cross-sectional questionnaire study was conducted among 700 health care students which included dental, medical and nursing students during their clinical training at Mahatma Gandhi Mission's Campus, Navi Mumbai from May 2012 to July 2012. It was a self-administered questionnaire with a 1-year recall period for sharp instrument injury. The data was analyzed using descriptive statistics and Chi-square test.

Results

The questionnaire was completed by 627 students of which 76.4% of nursing, 75.4% of dental and 48.7% of the medical students had experienced sharp instrument injuries in the past 1 year with hollow-bore needle being the most common instrument causing such injuries. Overall, 77.4% of the students had not reported the incident of the injury and only 34.4% of the students had taken postexposure prophylaxis.

Conclusion

Educational interventions with effective training on proper handling and disposal of sharp instruments and postexposure prophylaxis along with the formation of a reporting center are some of the recommendations which can reduce the occupational exposure to sharp instrument injuries among the health care students.

How to cite this article

Hussain JSA, Ram SM, Galinde J, Jingade RRK. Occupational Exposure to Sharp Instrument Injuries among Dental, Medical and Nursing Students in Mahatma Gandhi Mission's Campus, Navi Mumbai, India. J Contemp Dent 2012;2(2):1-10.

Blood and body fluid exposures among US medical students in Botswana

INTRODUCTION

Medical students from resource-rich countries who rotate in resource-limited settings have little pre-departure experience performing procedures, and lack familiarity with local equipment. The risk of blood and body fluid exposures during such rotations is significant.

AIM

1) Determine whether a simulation-based intervention reduced exposures among US medical students on a rotation in Botswana; 2) determine whether exposures were underreported; 3) describe exposures and provision of human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP).

SETTING

University of Pennsylvania medical students who traveled to Botswana for a clinical rotation from July 2007 to February 2010 were eligible to participate.

PROGRAM DESCRIPTION

Twenty-two students participated in the simulation-based intervention.

PROGRAM EVALUATION

To evaluate the intervention, we used a pre/post quasi-experimental design and administered a retrospective survey. The response rate was 81.7% (67/82). Needlesticks were eliminated [8/48 (16.7%) to 0/19 (0.0%), p = 0.07]. Splashes were unchanged (6/48 [12.5%) to 3/19 (15.8%), p=>0.99]. Three students did not report their exposure. Fifteen exposures were reported to an attending, who counseled the student regarding HIV PEP. Three students did not take PEP because the exposure was low-risk.

DISCUSSION

Our intervention was associated with a decrease in needlestick exposures. Medical schools should consider training to reduce exposures abroad.

Underreporting of blood and body fluid exposures among health care students and trainees in the acute care setting: a 2007 survey

BACKGROUND

It has been estimated that more than 8 million health care workers (HCWs) in the United States may be exposed to blood and body fluids via sharp and mucocutaneous exposures.

METHODS

An anonymous questionnaire was distributed among 505 HCWs. The target sample population included all the medical students; nursing professionals; dental professionals; and residents in internal medicine, emergency medicine, surgery, and obstetrics and gynecology at the University of Illinois Medical Center, Chicago, Illinois, a metropolitan tertiary care and referral center for Northern Illinois and Northwest Indiana. The sample was limited by the number of HCWs who were available to take the survey. The number and the characteristics of occupational exposures and reporting practices were recorded and compiled. Subsequently, a review of the English literature was performed using PubMed to analyze reasons for underreporting. Secondary and tertiary articles were located based on findings from the initial searches.

RESULTS

One hundred three of 455 (22.6%) HCWs reported a sharps exposure during their career, including their student years; thirty-four (33.0%) of these were not reported. One hundred five of 455 (23.1%) HCWs reported a mucocutaneous exposure during their career; 87 (82.9%) of these were not reported. The most common year of exposure was the intern year. The most common reason for not reporting was the belief that the exposure was not significant, followed by the combination of believing the exposure was not significant and being too busy.

CONCLUSION

Underreporting of blood and body fluid exposures is common because of a belief that most exposures are not significant. More education of HCWs is needed to change this perspective.

Frequency of hepatitis B immunity and occupational exposures to body fluids among brazilian medical students at a public university

In the present study the frequencies of immunity against hepatitis B (HB) and of potentially contaminating accidents among medical students of a Brazilian public university were evaluated. Of all the 400 students who should have been immunized, 303 (75.7%), 66.3% of whom were women, answered an anonymous, self-administered questionnaire. Serum anti-HBs were determined in 205 of them and titers > 10 UI/L were considered to be protective. A total of 86.8% of students had received three doses of HB vaccine. The frequency of immunity among women (96.4%) was higher (p = 0.04) than that among men (87.7%). Among those who did not have immunity, 12/13 (92.3%) had been vaccinated before entering medical school. Only 11% of the students with complete vaccination had previously verified serological response to the vaccine. A total of 23.6% reported having been somehow exposed to blood or secretions. Among final-year students, this frequency was 45.0%, being similar among men (47.8%) and women (43.2%). Of all these accidents, 57.7% were due to body fluids coming in contact with mucosa and 42.3% due to cut and puncture accidents. The results from this study show that: 1) the frequency of immunity against HB is high among the evaluated medical students, although verification of response to vaccination is not a concern for them; 2) anti-HBs titers should be verified after complete vaccination and on a regular basis, especially by men; and 3) the frequency of potentially contaminating accidents is high.

Needlestick injuries among nursing students in China

OBJECTIVES

To describe and characterize the rates and the nature of needlestick injuries among nursing students in China.

METHODS

A questionnaire was delivered to 248 randomly selected nursing students from seven training hospitals to obtain information relevant occupational needlestick injuries.

RESULTS

A total of 1144 incidents of needlestick injuries were reported among the 246 nurses during the time period of internship. The overall rate of needlestick injuries among these nurses was 100%, according to this survey. Insufficient awareness of occupational safety and limited work experience with handling needlestick injuries in these nurse students were significantly reported. In addition, when stratified by departments, the highest rate of needlestick injuries was seen in the surgery department. The occurrence of needlestick injuries is significantly related to clinical practice behaviors.

CONCLUSIONS

Needlestick injuries are commonly reported in nursing students in China. Enhanced awareness of occupational safety in nursing students is expected to reduce the risk of needlestick injuries.

Occupational exposure of health care personnel to hepatitis B and hepatitis C: prevention and surveillance strategies

Ensuring the safety of personnel working in health care environments can be challenging and requires a multifaceted approach to target reductions in occupational exposures to blood-borne pathogens, such as hepatitis B or hepatitis C. This article reviews the epidemiology of occupational exposures to hepatitis B and hepatitis C in health care personnel in hospital settings. The nature and likelihood of risk to health care personnel are evaluated along with estimates of seroconversion risk. The review focuses on prevention programs and available surveillance programs to aid in monitoring and reducing occupational exposures to blood-borne pathogens.

Needlestick injuries among medical students: incidence and implications

PURPOSE

To determine the incidence of needlestick injuries in medical school and to examine the behaviors associated with reporting injuries to an occupational health office. Medical students have underdeveloped surgical skills and are at high risk of needlestick injuries.

METHOD

Recent medical school graduates enrolled in a surgery residency at 17 medical centers were surveyed regarding needlestick injuries that they sustained during medical school. The survey asked about the circumstances and cause of injury and postinjury reporting.

RESULTS

Of 699 respondents, 415 (59%) reported having sustained a needlestick injury as a medical student; the median number of injuries per injured respondent was 2 (interquartile range: 1-2). Respondents who sustained a needlestick injury in medical school were more likely to sustain a needlestick injury during residency than those who did not experience a needlestick injury in medical school (odds ratio [OR]: 2.57; 95% CI: 1.84, 3.58). Of 89 residents who sustained their most recent needlestick injury during medical school, 42 (47%) did not report their injury to an employee health office.

CONCLUSIONS

Needlestick injuries and underreporting of these injuries are common among medical students and place them at risk for hepatitis and human immunodeficiency virus. Strategies aimed at improving reporting systems and creating a culture of reporting should be implemented by medical centers.

Operating room assist: surgical mentorship and operating room experience for preclerkship medical students

BACKGROUND

Despite the importance of preclerkship experiences, surgical education has essentially remained confined to the third-year operating room experience. According to experience-based learning theory, the acquisition of new clinical knowledge is a dynamic process of social enculturation and professional identity development that requires active participation, clinical applicability, and direct interaction with doctors and other members of the medical team. In conjunction with a previously described surgical skills elective, we created a new clinical elective in which preclerkship medical students were assigned a surgical mentor and invited into the operating room to assist in surgeries.

METHODS

The elective paired 36 first-year students with 24 surgeons and instructed students to participate in at least 2 surgeries over the 3-month elective period. Students, surgeons, and operating room nurses filled out questionnaires after each surgery.

RESULTS

Although 6 students failed to enter the operating room, 30 students scrubbed and gowned for a total of 62 procedures during the elective period. Although most students reported the operating room to be a comfortable learning environment in which they were actively included, students consistently underrated their performance and contribution to the surgical team compared with the surgeons' and nurses' ratings. With 75% of students who reported using a previously learned surgical skill during each surgery, this elective succeeded in allowing preclerkship medical students the opportunity to participate actively in the operating room.

CONCLUSIONS

Early surgical exposure is critical for attracting student interest in careers in surgery. We believe that these early clinical experiences, combined with strong mentorship from the surgical faculty, will eventually lead to greater success during clerkships and greater interest in surgery as a career.

The national study to prevent blood exposure in paramedics: exposure reporting

BACKGROUND

This survey was conducted to provide national incidence rates and risk factors for exposure to blood among paramedics. The present analysis assesses reporting of exposures to employers.

METHODS

A questionnaire was mailed in 2002-2003 to a national sample of paramedics selected using a two-stage design. Information on exposure reporting was obtained on the two most recent exposures for each of five routes of exposure.

RESULTS

Forty-nine percent of all exposures to blood and 72% of needlesticks were reported to employers. The main reason for under-reporting was not considering the exposure a "significant risk." Females reported significantly more total exposures than males. Reporting of needlesticks was significantly less common among respondents who believed most needlesticks were due to circumstances under the worker's control. Reporting was non-significantly more common among workers who believed reporting exposures helps management prevent future exposures. Reporting may have been positively associated with workplace safety culture.

CONCLUSIONS

This survey indicates there is need to improve the reporting of blood exposures by paramedics to their employers, and more work is needed to understand the reasons for under-reporting. Gender, safety culture, perception of risk, and other personal attitudes may all affect reporting behavior.