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Basham C, Cerles A, Rush M, Alexander-Scott M, Greenawald L, Chiu S, Broadwater K, Hirst D, Snawder J, Roberts J, Weber A, Knuth M, Casagrande R. Occupational Safety and Health and Illicit Opioids: State of the Research on Protecting Against the Threat of Occupational Exposure. New Solut 2021; 31:315-329. [PMID: 34407666 DOI: 10.1177/10482911211039566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The nationwide opioid crisis continues to affect not only people who use opioids but also communities at large by increasing the risk of accidental occupational exposure to illicit opioids. In addition, the emergence of highly potent synthetic opioids such as fentanyl and carfentanil increases the need to protect workers who may encounter unknown drug substances during job activities. To support the National Institute for Occupational Safety and Health Opioids Research Gaps Working Group, we examined the state of the literature concerning methods to protect workers against accidental occupational exposure to illicit opioids, and have identified unmet research needs concerning personal protective equipment, decontamination methods, and engineering controls. Additional studies are needed to overcome gaps in technical knowledge about personal protective equipment, decontamination, and control methods, and gaps in understanding how these measures are utilized by workers. Increasing our knowledge of how to protect against exposure to illicit opioids has the potential to improve occupational health across communities.
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Affiliation(s)
| | | | | | - Marissa Alexander-Scott
- Health Effects Laboratory, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Lee Greenawald
- National Institute for Occupational Safety and Health, Pittsburg, PA, USA
| | - Sophia Chiu
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Kendra Broadwater
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Deborah Hirst
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - John Snawder
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Jennifer Roberts
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Angela Weber
- National Institute for Occupational Safety and Health, Atlanta, GA, USA
| | - Martha Knuth
- Stephen B Thacker Library, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Simundic AM, Bölenius K, Cadamuro J, Church S, Cornes MP, van Dongen-Lases EC, Eker P, Erdeljanovic T, Grankvist K, Guimaraes JT, Hoke R, Ibarz M, Ivanov H, Kovalevskaya S, Kristensen GBB, Lima-Oliveira G, Lippi G, von Meyer A, Nybo M, De la Salle B, Seipelt C, Sumarac Z, Vermeersch P. Joint EFLM-COLABIOCLI Recommendation for venous blood sampling. Clin Chem Lab Med 2019; 56:2015-2038. [PMID: 30004902 DOI: 10.1515/cclm-2018-0602] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/10/2018] [Indexed: 11/15/2022]
Abstract
This document provides a joint recommendation for venous blood sampling of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE) and Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI). It offers guidance on the requirements for ensuring that blood collection is a safe and patient-centered procedure and provides practical guidance on how to successfully overcome potential barriers and obstacles to its widespread implementation. The target audience for this recommendation are healthcare staff members directly involved in blood collection. This recommendation applies to the use of a closed blood collection system and does not provide guidance for the blood collection with an open needle and syringe and catheter collections. Moreover, this document neither addresses patient consent, test ordering, sample handling and transport nor collection from children and unconscious patients. The recommended procedure is based on the best available evidence. Each step was graded using a system that scores the quality of the evidence and the strength of the recommendation. The process of grading was done at several face-to-face meetings involving the same mixture of stakeholders stated previously. The main parts of this recommendation are: 1) Pre-sampling procedures, 2) Sampling procedure, 3) Post-sampling procedures and 4) Implementation. A first draft of the recommendation was circulated to EFLM members for public consultation. WG-PRE-LATAM was also invited to comment the document. A revised version has been sent for voting on to all EFLM and COLABIOCLI members and has been officially endorsed by 33/40 EFLM and 21/21 COLABIOCLI members. We encourage professionals throughout Europe and Latin America to adopt and implement this recommendation to improve the quality of blood collection practices and increase patient and workers safety.
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Affiliation(s)
- Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital "Sveti Duh", Zagreb, Croatia, E-mail:
| | | | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Michael P Cornes
- Department of Clinical Biochemistry, Worcester Acute Hospitals NHS Trust, Worcester, UK
| | | | - Pinar Eker
- Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Tanja Erdeljanovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Joao Tiago Guimaraes
- Department of Clinical Pathology, São João Hospital Center, Department of Biomedicine, Faculty of Medicine, Porto, Portugal; and EPI Unit,Institute of Public Health, University of Porto, Porto, Portugal
| | - Roger Hoke
- National Association of Phlebotomists, London, UK
| | - Mercedes Ibarz
- Department of Clinical Laboratory, University Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Svetlana Kovalevskaya
- Clinical Laboratory Diagnostic and Pathomorphology Department, Autonomous non-profit organization of additional professional education "Institute of Laboratory Medicine", Moscow, Russia
| | | | - Gabriel Lima-Oliveira
- Section of Clinical Biochemistry, University of Verona, Verona, Italy; andLatin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Mads Nybo
- Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Barbara De la Salle
- West Hertfordshire Hospitals NHS Trust, Operating UK NEQAS for Haematology and Transfusion, Watford, UK
| | | | - Zorica Sumarac
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Pieter Vermeersch
- Department of Laboratory Medicine, University of Leuven, Leuven, Belgium
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Preventing Workplace Injuries Among Perinatal Nurses. Nurs Womens Health 2016; 20:99-108. [PMID: 26902445 DOI: 10.1016/j.nwh.2015.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/27/2015] [Indexed: 11/24/2022]
Abstract
Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized.
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Trindade JPDA, Serra JRD, Tipple AFV. INDEX OF PERFORATION OF PROCEDURE/SURGICAL GLOVES USED BY WORKERS IN THE PURGING OF A MATERIAL AND STERILIZATION CENTER. TEXTO & CONTEXTO ENFERMAGEM 2016. [DOI: 10.1590/0104-07072016001410015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The objectives of this study were to identify the types of gloves the nursing team uses for the manual cleaning of health products and to identify the perforation rates in procedure/surgical gloves used for this purpose. Cross-sectional and descriptive, descriptive study with quantitative approach was developed at a large hospital in Goiânia, Goiás, Brazil. In total, 300 procedure/surgical gloves (Group A), 100 procedure and 100 new surgical gloves (Group B), and six nitrile gloves (Group C) were analyzed. Among the gloves in Group A, 135 (45.0%) were perforated. Superposition of gloves did not prevent perforations and, the longer they were used, the higher the index of perforation (p<0.05). No perforations were identified in Group B, whereas there were four perforations in 48 hours of use in Group C. This study reinforces the idea that procedure/surgical gloves are inappropriate for cleaning health products, representing an ineffective barrier for the safety of workers.
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Seng M, Lim JW, Sng J, Kong WY, Koh D. Incidence of needlestick injuries among medical students after implementation of preventive training. Singapore Med J 2014; 54:496-500. [PMID: 24068057 DOI: 10.11622/smedj.2013171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Structured training for the prevention of needlestick injuries (NSIs) among medical students was implemented in Singapore in 1998. In this study, we determined the incidence of NSIs and the knowledge and practice of managing and reporting NSIs among first-year clinical students in a medical school in Singapore, as well as the adequacy of the training provided for these students, 14 years after preventive training was instituted. METHODS All third-year medical students (n = 257) from the Yong Loo Lin School of Medicine, National University of Singapore, Singapore, who had completed their first clinical year posting were enrolled in this cross-sectional study. A self-administered questionnaire was answered by the students one month after completion of their last clinical posting. Students who repeated their first clinical year were excluded from the study. RESULTS 237 students completed the questionnaire. However, 9 of these students were excluded because they repeated their first clinical year. The response rate was 91.9%. Although 8 (3.5%) students reported one NSI each, only 2 (25.0%) of these 8 students reported the incident to the relevant authority. Among the students surveyed, 65.8% reported using gloves at all times during venepuncture procedures, 48.7% felt that improvements could be made to the current reporting system and procedures, and 53.2% felt that the training provided before commencement of clinical posting could be enhanced. CONCLUSION There was a decrease in the incidence of NSIs among medical undergraduates in their first clinical year when compared to the incidences reported in earlier studies conducted in the same centre (35.1% in 1993 and 5.3% in 2004). The current reporting system could use a more user-friendly platform, and training on NSIs could be improved to focus more on real-life procedures and incident reporting.
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Affiliation(s)
- Melvin Seng
- National University Health System, 1E Kent Ridge Road, Singapore 119228.
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Mischke C, Verbeek JH, Saarto A, Lavoie M, Pahwa M, Ijaz S. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev 2014; 2014:CD009573. [PMID: 24610769 PMCID: PMC10766138 DOI: 10.1002/14651858.cd009573.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Healthcare workers are at risk of acquiring viral diseases such as hepatitis B, hepatitis C and HIV through exposure to contaminated blood and body fluids at work. Most often infection occurs when a healthcare worker inadvertently punctures the skin of their hand with a sharp implement that has been used in the treatment of an infected patient, thus bringing the patient's blood into contact with their own. Such occurrences are commonly known as percutaneous exposure incidents. OBJECTIVES To determine the benefits and harms of extra gloves for preventing percutaneous exposure incidents among healthcare workers versus no intervention or alternative interventions. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, NIOSHTIC, CISDOC, PsycINFO and LILACS until 26 June 2013. SELECTION CRITERIA Randomised controlled trials (RCTs) with healthcare workers as the majority of participants, extra gloves or special types of gloves as the intervention, and exposure to blood or bodily fluids as the outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and risk of bias, and extracted data. We performed meta-analyses for seven different comparisons. MAIN RESULTS We found 34 RCTs that included 6890 person-operations as participating units and reported on 46 intervention-control group comparisons. We grouped interventions as follows: increased layers of standard gloves, gloves manufactured with special protective materials or thicker gloves, and gloves with puncture indicator systems. Indicator gloves show a coloured spot when they are perforated. Participants were surgeons in all studies and they used at least one pair of standard gloves as the control intervention. Twenty-seven studies also included other surgical staff (e.g. nurses). All but one study used perforations in gloves as an indication of exposure. The median control group rate was 18.5 perforations per 100 person-operations. Seven studies reported blood stains on the skin and two studies reported self reported needlestick injuries. Six studies reported dexterity as visual analogue scale scores for the comparison double versus single gloves, 13 studies reported outer glove perforations. We judged the included studies to have a moderate to high risk of bias.We found moderate-quality evidence that double gloves compared to single gloves reduce the risk of glove perforation (rate ratio (RR) 0.29, 95% confidence interval (CI) 0.23 to 0.37) and the risk of blood stains on the skin (RR 0.35, 95% CI 0.17 to 0.70). Two studies with a high risk of bias also reported the effect of double compared to single gloves on needlestick injuries (RR 0.58, 95% CI 0.21 to 1.62).We found low-quality evidence in one small study that the use of three gloves compared to two gloves reduces the risk of perforation further (RR 0.03, 95% CI 0.00 to 0.52). There was similar low-quality evidence that the use of one fabric glove over one normal glove reduces perforations compared to two normal gloves (RR 0.24, 95% CI 0.06 to 0.93). There was moderate-quality evidence that this effect was similar for the use of one special material glove between two normal material gloves. Thicker gloves did not perform better than thinner gloves.There was moderate to low-quality evidence in two studies that an indicator system does not reduce the total number of perforations during an operation even though it reduces the number of perforations per glove used.There was moderate-quality evidence that double gloves have a similar number of outer glove perforations as single gloves, indicating that there is no loss of dexterity with double gloves (RR 1.10, 95% CI 0.93 to 1.31). AUTHORS' CONCLUSIONS There is moderate-quality evidence that double gloving compared to single gloving during surgery reduces perforations and blood stains on the skin, indicating a decrease in percutaneous exposure incidents. There is low-quality evidence that triple gloving and the use of special gloves can further reduce the risk of glove perforations compared to double gloving with normal material gloves. The preventive effect of double gloves on percutaneous exposure incidents in surgery does not need further research. Further studies are needed to evaluate the effectiveness and cost-effectiveness of special material gloves and triple gloves, and of gloves in other occupational groups.
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Affiliation(s)
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Occupational Safety and Health Review GroupPO Box 310KuopioFinland70101
| | - Annika Saarto
- Finnish Institute of Occupational HealthLemminkäisenkatu 14‐18 BTurkuFinland20520
| | - Marie‐Claude Lavoie
- University of Maryland Baltimore110 South Paca StreetRm 4‐S‐100BaltimoreMarylandUSA21201
| | - Manisha Pahwa
- University of TorontoDalla Lana School of Public Health155 College Street, 6th floorTorontoOntarioCanadaM5T 3M7
| | - Sharea Ijaz
- Finnish Institute of Occupational HealthCochrane Occupational Safety and Health Review GroupPO Box 310KuopioFinland70101
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Din SU, Tidley MG. Needlestick fluid transmission through surgical gloves of the same thickness. Occup Med (Lond) 2013; 64:39-44. [DOI: 10.1093/occmed/kqt135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Parantainen A, Verbeek JH, Lavoie MC, Pahwa M. Extra gloves or special types of gloves versus a single pair of gloves for preventing percutaneous exposure injuries in healthcare personnel. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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