Needle-stick injuries in the National Health Service: a culture of silence

Global prevalence of needle stick injuries among nurses: A comprehensive systematic review and meta-analysis

BACKGROUND

Nurses usually provide direct patient care. However, they account for the majority of healthcare workers (HCWs) injured by needles or other sharp objects.

OBJECTIVES

To assess the prevalence of needle stick injuries (NSI) among nurses worldwide; according to WHO regions, the socioeconomic development index (SDI) of countries, and the developmental status of individual countries, and in the Middle East.

DESIGN

Systematic review and meta-analysis.

METHODS

We searched PubMed, Scopus, and Web of Science databases. We calculated the pooled NSI prevalence estimates using a random-effect meta-analysis with the Comprehensive Meta-Analysis software. The report of the study was in accordance with the PRISMA 2020 statement.

RESULTS

The overall worldwide NSI prevalence pooled from our analysis was 40.97% (95% confidence interval [CI]: 31.29-50.63%, p = .00001). A subgroup analysis of NSI prevalence according to WHO regions revealed the highest prevalence in Southeast Asia (49.9%, 95% CI: [23.4-76.3%]) and the lowest in the United States of America (25.1%, 95% CI: [18.1-32.1%]), respectively. The pooled prevalence in developed and developing countries was 30.5% (95% CI: 27.3-33.8%) and 46.6% (95% CI: 33.7-59.5%), respectively. According to the SDI, NSI prevalence was highest in low-middle SDI countries (48.9% [95% CI: 30.7-67.2%]).

CONCLUSION

Our results showed a high NSI prevalence among nurses worldwide. Developing countries had a significantly higher NSI prevalence than developed countries, especially low-middle SDI countries.

RELEVANCE TO CLINICAL PRACTICE

This study highlighted the prevalence of NSI risk among nurses practising in clinical settings worldwide. The study findings suggest that continuous training programs should be implemented for nurses to enhance their knowledge, performance and attitude toward NSI prevention in clinical settings.

NO PATIENT OR PUBLIC CONTRIBUTION

Contributions from patients or the public are irrelevant because the purpose of this study was to examine the global prevalence of NSIs in nurses.

Prevalence and causes of unreported needle stick injuries among health care workers: a systematic review and meta-analysis

OBJECTIVES

Health care workers (HCWs) are exposed to needle needles daily. Despite individual studies, there is no statistics on the prevalence of unreported needle stick injuries (NSIs) have been reported. This study was performed to determine the prevalence and causes of unreported NSIs among HCWs.

CONTENT

In present systematic review and meta-analysis study, three international databases (Web of Science, Scopus, PubMed) were searched from January 1, 2000 to December 31, 2018. The random model was used to determine the prevalence of unreported needle stick among HCWs.

SUMMARY AND OUTLOOK

Forty-one studies performed on 19,635 health care workers entered the final stage. Based-on random effect model, pooled prevalence of unreported needle stick injuries was 59.9% (95% CI: 52.0, 67.7; I2=98.9%). The most common cause of unreported NSIs was: They were not worried about NSIs (n=12). The high prevalence of unreported needle sticks injuries indicates the urgency and necessity of paying attention to strategies to improve reporting among health workers.

Occupational health hazards among healthcare providers and ancillary staff in Ghana: a scoping review

OBJECTIVE

The strict implementation of occupational health and safety policy curbs exposure to occupational hazards. However, empirical evidence is lacking in the Ghanaian context. This review primarily aimed to explore exposure to occupational hazards among healthcare providers and ancillary staff in Ghana.

DESIGN

A scoping review was conducted based on Arksey and O'Malley's methodological framework and Levac et al's methodological enhancement.

DATA SOURCES

Searches were conducted of the PubMed, MEDLINE, CINAHL, Embase, PsycINFO and Scopus databases, as well as Google Scholar and websites of tertiary institutions in Ghana, for publications from 1 January 2010 to 30 November 2021.

ELIGIBILITY CRITERIA

Quantitative studies that were published in the English language and focused on occupational exposure to biological and/or non-biological hazards among healthcare professionals in Ghana were included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted the data based on the type of occupational exposure and descriptive characteristics of the studies. The data are presented in tables and graphs. A narrative summary of review findings was prepared based on the review research questions.

RESULTS

Our systematic search strategy retrieved 507 publications; however, only 43 met the inclusion criteria. A little over one-quarter were unpublished theses/dissertations. The included studies were related to biological, psychosocial, ergonomic and other non-biological hazards. 55.8% of the studies were related to exposure to biological hazards and related preventive measures. In general, health workers were reported to use and comply with control and preventive measures; however, knowledge of control and preventive measures was suboptimal.

CONCLUSION

Work is needed to address the issue of occupational health hazard exposure in Ghana's health system. More research is needed to understand the extent of these exposures and their effects on the health system.

Needlestick injuries among healthcare personnel in Qatar: A retrospective study

Background: A needlestick injury (NSI) is a serious occupational hazard among healthcare personnel (HCP), as it can cause transmission of blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). This study aimed to determine the frequency and distribution of reported NSIs, associated factors, use of post-exposure prophylaxis (PEP), and percentage of seroconversion among HCP in a major tertiary care hospital in Qatar.

Methods: This retrospective study analyzed NSIs among HCP reported in Hamad Medical Corporation facilities in Doha between May 01, 2017, and May 01, 2018. A surveillance follow-up period of 6 months commenced after the 1-year study period.

Results: A total of 130 NSIs were reported during the study period, with an overall incidence of eight injuries per 1000 HCP. The mean age was 34.6 ± 7.9 years. Among the reported cases, the proportion of female HCP (n = 72, 55.4%) was greater than that of male HCP (n = 58, 44.6%). Of 130 NSIs, 79 (60.8%) occurred in nurses, followed by 35 (26.9%) cases in doctors and 16 (12.3%) in other HCP. The total healthcare population comprised 49.6% of nurses and 18% of doctors. NSIs occurred in 10.1 per 1000 nurses and in 12.4 per 1000 doctors. Exposures mainly occurred in the operating theater, 35 (31.5%); inpatient wards, 24 (21.6%); and emergency department, 20 (18%). Common modes of injury were after use or before disposal of the device in 44 (44.4%) cases and during surgical interventions in 35 (35.4%) cases. Hollow-bore needles (64/98, 65.3%) were the most common devices involved. Source serology was documented in 71 (54.6%) cases of which 52 (73.2%) were normal, 9 (12.7%) were abnormal, and 10 (14.1%) were incomplete. Among the exposed HCP, 124 (95.4%) had adequate immunity to HBV. PEP for HBV was indicated in 6 (4.6%) and received by 4 (3.1%) HCP. NSI cases were followed up for 6 months post-exposure, and during this surveillance period, no seroconversion to HBV, HCV, or HIV was detected.

Conclusion: NSIs are common among HCP. In this study, most of the exposed HCP had adequate immunity to HBV. There was no hepatitis B, hepatitis C, or HIV transmission among the study cohort. Adherence to proper needle/sharps disposal techniques and safe practices during procedures will help prevent NSIs.

Fendrix® Vaccine Effectiveness in Healthcare Workers Who Are Non-Responsive to Engerix B® Vaccination

Hepatitis B (HBV) is a pathogen virus with transmission mechanisms that include contact with the infected blood or bodily fluids of the infected organism. Nowadays, healthcare workers are one of the most exposed groups to HBV. Conventionally, completing a vaccine series dosage with Engerix B^® lowers this risk by providing workers with immunity to the virus. However, through the years, we have encountered nonresponsive health personnel to the Engerix B^® vaccine; hence, the Occupational Health Service of Poniente Hospital studied the Fendrix^® adjuvanted vaccine as an alternative vaccine to develop immunological responses in healthcare workers who do not respond to vaccination with Engerix B^®. In our study, we employed a vaccination schedule with the Fendrix^® vaccine, performing serology tests on the cases after the application of each dose. The results obtained showed humoral immunity in 92.3% of the cases, with a remarkable increase in antibody titer after the first doses. These encouraging results support the future inclusion of this vaccine as one possible alternative for the immunization to HBV for healthcare workers nonresponsive to Engerix B^®.

Awareness About Sharps Disposal Leads to Significant Improvement in Healthcare Safety: an Audit of Compliance in the National Health Service During the COVID-19 Pandemic

Needle-stick injuries (NSIs) pose serious health risks and can transmit blood-borne diseases (BBDs), such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus from the patient to the staff member. The purpose of this study was evaluation of appropriate and safe disposal of sharps within a 730-bed acute district general hospital (DGH) in the UK. One hundred sharps containers were audited in November 2019 to assess whether they complied with the health and safety regulations across surgical, medical, and acute wards. Meetings with the appropriate staff members were organised and posters placed throughout the hospital to raise awareness. One hundred twenty-five sharps containers were re-audited in July 2020, in the midst of the COVID-19 pandemic to ascertain if there was an improvement. In November 2019, a total of 56% of sharps containers were overfilled and hence were non-compliant with safety regulations. A re-audit performed in July 2020 found only 17% of sharps containers to be overfilled, which was a significant improvement (p = 0.0064) in practice. We noted that the overall compliance improved from being 44% in 2019 to 82.64 in the year 2020. This audit showed a significant improvement in the compliance of sharps bin containers in a DGH, signifying the increased awareness. It is necessary to audit sharps management regularly to accurately assess practice and prevent exposure to BBDs.

Prevalence of needle stick injury and its associated factors among nurses working in public hospitals of Dessie town, Northeast Ethiopia, 2016

OBJECTIVE

Nurses are exposed to dangerous and deadly blood borne pathogens through contaminated needle stick injuries. This study was designed to assess prevalence of needle stick injury and its associated factors among nurses working in hospitals. Institution-based cross-sectional study design was used among 258 randomly selected nurses. Collected data was entered into Epi-Data version 3.1 and transferred to SPSS Version 20.0 for analysis. The degree of variables were assessed using adjusted odds ratio and its 95% confidence interval with P value (< 0.05).

RESULTS

Eighty-nine (34.5%) nurses self-reported receiving a needle stick injury in the previous 12 months. Work experience, working hour, personal protective, infection prevention guide line utilization and infection prevention training were significantly associated to needle stick injury.

CONCLUSIONS

The needle stick injury in this study area was prevalent. The contributing factors to the injury were duration of working hours, experience, use of personal protective equipment and training.

Work-Related Accidents and Sharp Injuries in Paramedics-Illustrated with an Example of a Multi-Specialist Hospital, Located in Central Poland

(1) Background: An analysis of work-related accidents in paramedics in Poland by presenting the model and trend of accidents, accident rates and by identifying causes and results of accidents; (2) Methods: A retrospective analysis of medical documentation regarding work-related accidents in a multi-specialist hospital, located in central Poland, in the period 2005-2015. The study group included paramedics who had an accident while being on duty; (3) Results: According to hospital records, 88 paramedics were involved in 390 accidents and 265 injuries caused by sharp instruments. The annual accident rate was 5.34/100 employed paramedics. Most of the accidents occurred at night. The most common reason for the accident was careless behaviour of the paramedic, which resulted in joint sprains and dislocations. Injuries accounted for a huge portion of the total number of events. As many as 45% of injuries were not officially recorded; (4) Conclusion: High rates of work-related accidents and injuries caused by sharp instruments in paramedics are a serious public health problem. Further studies should be conducted in order to identify risk factors of accidents, particularly injuries, and to implement preventative programmes, aiming to minimise rates of occupational hazards for paramedics.

Factors associated with loss to follow-up after occupational HIV exposure in Cape Town, South Africa: a retrospective cohort study

Background

There is limited data on factors associated with loss to follow-up (LTFU) of health care workers (HCWs) following occupational exposure to HIV, and most studies were conducted in an era when poorly tolerated antiretrovirals like zidovudine were used.

Methods

A retrospective cohort study was conducted of HCWs attending a referral hospital’s Occupational Health Clinic in Cape Town, South Africa for post-exposure prophylaxis (PEP) during a period when tenofovir was available. Our primary outcome was LTFU at the 3-month visit. We selected seven variables a priori for our logistic regression model and ensured there were at least 10 outcome events per variable to minimize bias.

Results

Two hundred and ninety-three folders were evaluated for descriptive analysis. LTFU worsened with successive visits: 36% at 6 weeks, 60% at 3 months, and 72% at 6 months. In multivariate analysis at the 3-month visit LTFU was associated with age (adjusted odds ratio (aOR), 0.6 per 10-year increase [95% CI, 0.5–0.9]), HCW category of doctor (aOR 2.7 [95% CI, 1.3–5.5]), and time from exposure to receiving PEP of more than 24 h (aOR 5.9 [95% CI, 1.3–26.9]).

Conclusion

We identified factors associated with LTFU of HCWs after occupational HIV exposure, which could be used to target interventions to improve follow-up.

Occupational exposure to sharps injury among healthcare providers in Ethiopia regional hospitals

BACKGROUND

Sharps injury is a penetrating stab wound from a needle, scalpel, or another sharp object that may result in exposure to blood or other body fluids. According to World Health Organization pooled estimate, the annual incidence of sharps injury in Africa was ranged from 2.10 to 4.68 per person per year, but research data in Ethiopia is limited. The aim of the study was to investigate sharps injury prevalence and associated risk factors.

METHODS

Institution based cross-sectional study was conducted with 200 healthcare providers (HCP) in Northeast Ethiopia. Proportionate stratified sampling was used to select HCP. Sharps injury during the last 12 months was an outcome variable whereas demographic characteristics, behavioral attributes, and job environment characteristics were independent variables. Data was collected from April to May 2016 using self-administered questionnaire; which was adapted from World Health Organization best practices for injections and related procedures toolkit. Bivariate and multivariate logistic regression analysis was carried out to identify sharps injury associated risk factors. Epi Info version 3.5.1 software package was used for data coding and entry whereas Statistical Package for Social Sciences (SPSS) version 20 software package was used for analysis.

RESULTS

In total, 195 HCP participated with a response rate of 97.5%. The prevalence of sharps injury was 32.8%. Following adjustment for covariates, lack of in-service job training and previous exposure to sharps injury were statistically significant risk factors for sharps injury. HCP who had no in-service job training were 4.7 times more likely sustained sharps injury compared with those who had in-service job training (p < 0.001, OR = 4.7, 95% CI = 2.05-10.56). HCP who had previous exposure to sharps injury were 3.7 times more likely sustained sharps injury compared with those who were not exposed (p-value = 0.002, OR = 3.7, 95% CI = 1.62-8.27).

CONCLUSIONS

This study revealed 32.8% or at least three out of ten HCP exposed to sharps injury. This was found statistically significant among HCP who had no in-service job training and who had previous exposure to sharps injury. Thus, training HCP perhaps increase their skill and curiosity to reduce exposure to sharps injury.

Occupational exposure to bodily fluids in oral and maxillofacial surgery: an evaluation of reporting practices and attitudes among staff at a major teaching hospital in the UK

Our aim was to evaluate experience, practice, and beliefs about reporting of occupational exposures to blood and other body fluids among a sample of 88 healthcare providers working in oral and maxillofacial surgery at Sheffield Teaching Hospitals. We used a cross-sectional survey to evaluate awareness of the Trust's policy for reporting occupational exposure, recent incidence of exposure, and current reporting practices. Beliefs were measured using questions derived from the theory of planned behaviour. Fifty-five people responded, 14 of whom had been exposed to bodily fluids in the previous 12 months. Of those, 10 did not report it. Fifty-three respondents were certain that the Trust had a protocol in place for reporting sharps injuries to staff. Most (n=51) said the Trust had a protocol for reporting mucocutaneous exposure to blood. Respondents placed equal importance on reporting exposures that affected both themselves and patients, but intention to report exposure of patients was significantly higher than for themselves (z score -3.18, p<0.0001). We conclude that OMFS healthcare workers generally think that occupational exposures should be reported, but there are shortcomings in practice.

"We get by with a little help from our friends": Small-scale informal and large-scale formal peer distribution networks of sterile injecting equipment in Australia

BACKGROUND

In Australia, sterile needles and syringes are distributed to people who inject drugs (PWID) through formal services for the purposes of preventing blood borne viruses (BBV). Peer distribution involves people acquiring needles from formal services and redistributing them to others. This paper investigates the dynamics of the distribution of sterile injecting equipment among networks of people who inject drugs in four sites in New South Wales (NSW), Australia.

METHODS

Qualitative data exploring the practice of peer distribution were collected through in-depth, semi-structured interviews and participatory social network mapping. These interviews explored injecting equipment demand, access to services, relationship pathways through which peer distribution occurred, an estimate of the size of the different peer distribution roles and participants' understanding of the illegality of peer distribution in NSW.

RESULTS

Data were collected from 32 participants, and 31 (98%) reported participating in peer distribution in the months prior to interview. Of those 31 participants, five reported large-scale formal distribution, with an estimated volume of 34,970 needles and syringes annually. Twenty-two participated in reciprocal exchange, where equipment was distributed and received on an informal basis that appeared dependent on context and circumstance and four participants reported recipient peer distribution as their only access to sterile injecting equipment. Most (n=27) were unaware that it was illegal to distribute injecting equipment to their peers.

CONCLUSION

Peer distribution was almost ubiquitous amongst the PWID participating in the study, and although five participants reported taking part in the highly organised, large-scale distribution of injecting equipment for altruistic reasons, peer distribution was more commonly reported to take place in small networks of friends and/or partners for reasons of convenience. The law regarding the illegality of peer distribution needs to change so that NSPs can capitalise on peer distribution to increase the options available to PWID and to acknowledge PWID as essential harm reduction agents in the prevention of BBVs.

The Frequency, Causes and Prevention of Needlestick Injuries in Nurses of Kerman: A Cross-Sectional Study

INTRODUCTION

The needlestick injuries can cause the transmission of infectious diseases. Compared to other members of the community of health care nurses are at great risk of needle stick injury because of their frequent performance with vein punctures and taking care of patients suffering from different infectious diseases.

AIM

The main aim of this study was to assess Prevalence, causes and preventive of Needle Sticks injuries among nurses in Kerman (south of Iran).

MATERIALS AND METHODS

This cross-sectional study was conducted from December 2014 to March 2015 on 240 nurses employed in two hospitals of Kerman. Sampling was performed through simple random sampling. Data gathered through a researcher made questioner. Data analysed by use descriptive analytical testes.

RESULTS

From the nurses' perspective the main physical and human causes of needlestick injuries were syringe needles (82) and crowded wards (74). The majority of the nurses believed the most effective method to prevent needlestick were training (82).

CONCLUSION

Due to the high prevalence of injuries caused by sharp objects in nurses, needlestick injuries are suggested to be recorded in special forms and their causes to be checked by the Infection Control Committee. Since syringe needle heads and angiocatheter are the main causes of needlestick injuries, providing safe medical equipment should also be emphasized.

Trends in needlestick injury incidence following regulatory change in Ontario, Canada (2004-2012): an observational study

BACKGROUND

A number of jurisdictions have used regulation to promote the adoption of safety-engineered needles as a primary solution to reduce the risk of needlestick injuries among healthcare workers. Regulatory change has not been complemented by ongoing efforts to monitor needlestick injury trends which limits opportunities to evaluate the need for additional investment in this area. The objective of this study was to describe trends in the incidence of needlestick injuries in Ontario prior to and following the establishment of regulation to promote the adoption of safety-engineered needles.

METHODS

An observational study of needlestick injuries obtained from two independent administrative data sources (emergency department records for the treatment of work-related disorders and workers' compensation claims) for a population of occupationally-active adults over the period 2004-2012.

RESULTS

Comparing the year prior to the regulation being established (2006) to three years after the regulation came into effect (2011), needlestick injury rates in the health and social services sector that were captured by workers' compensation claims declined by 31% and by 43% in the work-related emergency department records. Rates of workers' compensation claims associated with needlestick injuries declined by 31% in the hospital sector, by 67% in the long-term care sector and have increased by approximately 1% in nursing services over the period 2004-2012.

CONCLUSIONS

Two independent administrative data sources documented an overall reduction in needlestick injuries in the province of Ontario following a regulatory requirement to adopt safety-engineered needles; however, a substantial burden of occupational needlestick injuries persists in this setting.

Management of occupational blood exposures: looking at progress

Occupational blood exposure (OBE) is a well-recognised hazard in the healthcare setting. A 4-year review of OBE in a large Irish teaching hospital over 2008-2011 found encouraging results, but identified deficits in documentation, communication and follow-up. The process was repeated 1 year later to determine if improvements were achieved and recommendations implemented. In 2012, 110 OBEs were reported, of which 81% were reported within 72 hours of the injury. The administration of first aid was adequately documented in 85% of cases and confirmation of the provision of appropriate information and/or counselling in 72% of the cases. Attendance for follow-up was broadly in line with the previous review. The findings and recommendations contributed to improvements in practice. However, to ensure these are ongoing, the reinforcement of an educational strategy in a systematic way is fundamental.

The value of childhood combination vaccines: From beliefs to evidence

Although vaccination is one of the most cost-effective health care interventions, under-vaccination and variation in coverage rates lower than policy targets is rising in developed countries, partly due to concerns about vaccination value and benefits. By merging various antigens into a single product, combination vaccines represent a valuable tool to mitigate the burden associated with the numerous injections needed to protect against vaccine preventable infectious diseases and increase coverage rate, possibly through various behavioral mechanisms which have yet to be fully explored. Beyond their cost-effectiveness in protecting against more diseases with fewer injections, combination vaccines also have several other benefits, for children, their parents/carers, as well as for the health system and the population as a whole. The objectives of this review are to identify and illustrate the value of combination vaccines for childhood immunization. Evidence was classified into 2 groups: benefits for society and benefits for public health and healthcare systems. This article also highlights the value of innovation and challenges of combination vaccine development as well as the need for an increased number of suppliers to mitigate the impact of any potential vaccine shortage. Increasing public confidence in vaccines and combination vaccines is also critical to fully exploit their benefits.

Occupational exposure to blood and body fluids among health-care workers in Serbia

OBJECTIVES

The aim of this study was to examine the epidemiology of occupational accidents and self-reported attitude of health-care workers (HCWs) in Serbia.

SUBJECTS AND METHODS

A cross-sectional study was conducted among HCWs in selected departments of five tertiary care hospitals and in one secondary care hospital in February 2012. A previously developed self-administered questionnaire was provided to HCWs who had direct daily contact with patients. χ(2) test and Student's t test were used for statistical analysis of the data.

RESULTS

Of the 1,441 potential participants, 983 (68.2%) completed the questionnaire: 655 (66.7%) were nurses/medical technicians, 243 (24.7%) were physicians and 85 (8.6%) were other personnel. Of the 983 participants, 291 (29.6%) HCWs had had at least one accident during the previous year and 106 (40.2%) of them reported it to the responsible person. The highest prevalence (68.6%) of accidents was among nurses/technicians (p = 0.001). Accidents occurred more often in large clinical centers (81.1%; p < 0.001) and in the clinical ward, intensive care unit and operating theater (p = 0.003) than in other departments. Seventy-six (13.1%) nurses/medical technicians had an accident during needle recapping (p < 0.001). Of all the HCWs, 550 (55.9%) were fully vaccinated, including significantly more doctors (154, 63.4%) than participants from other job categories (p < 0.001).

CONCLUSION

There was a relatively high rate of accidents among HCWs in our hospitals, most commonly amongst nurses and staff working in clinical wards, intensive care units and operating theaters. The most common types of accidents were needlestick injuries and accidents due to improper handling of contaminated sharp devices or occuring while cleaning instruments or by coming into contact with blood through damaged skin or through the conjunctiva/mucous membranes.

Sharps injuries amongst healthcare workers: review of incidence, transmissions and costs

BACKGROUND

Sharps injuries and the related risk of infections such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) represent one of the major occupational health risks for healthcare workers (HCWs).

LITERATURE REVIEW

An overview of available data on the incidence of sharps injuries and the related HBV, HCV and HIV infections and ensuing costs is provided.

RESULTS

Literature reported incidence rates of sharps injuries ranging from 1.4 to 9.5 per 100 HCWs, resulting in a weighted mean of 3.7/100 HCWs per year. Sharps injuries were associated with infective disease transmissions from patients to HCWs resulting in 0.42 HBV infections, 0.05-1.30 HCV infections and 0.04-0.32 HIV infections per 100 sharps injuries per year. The related societal costs had a mean of €272, amounting to a mean of €1,966 if the source patient was HIV positive with HBV and HCV co-infections.

CONCLUSION

Sharps injuries remain a frequent threat amongst HCWs. The follow-up and treatment of sharps injuries and the deriving consequences represent a significant cost factor.

Occupational exposures in healthcare workers in University Hospital Dubrava--10 year follow-up study

Occupational hazardous exposure in healthcare workers is any contact with a material that carries the risk of acquiring an infection during their working activities. Among the most frequent viral occupational infections are those transmitted by blood such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Therefore, they represent a significant public health problem related to the majority of documented cases of professionally acquired infections. Reporting of occupational exposures in University Hospital Dubrava has been implemented in connection with the activity of the Committee for Hospital Infections since January 2002. During the period of occupational exposures' monitoring (from January 2002 to December 2011) 451 cases were reported. The majority of occupational exposures were reported by nurses and medical technicians (55.4%). The most common type of exposure was the needlestick injury (77.6%). 27.9% of the accidents occurred during the blood sampling and 23.5% during the surgical procedure. In 59.4% of the exposed workers aHBs-titer status was assessed as satisfactory. Positive serology with respect to HBV was confirmed in 1.6% of patients, HCV in 2.2% of patients and none for HIV. Cases of professionally acquired infections were not recorded in the registry. Consequences of the occupational exposure could include the development of professional infection, ban or inability to work further in health care services and last but not least a threat to healthcare workers life. It is therefore deemed necessary to prevent occupational exposure to blood-borne infections. The most important preventive action in respect to HBV, HCV and HIV infections is nonspecific pre-exposure prophylaxis.

Psychosocial factors at work and blood-borne exposure among nurses

BACKGROUND

Exposure to human blood and body fluids is a common risk for nurses. Many factors can affect the prevalence and incidence of this occupational hazard. Psychosocial factors at work may be a risk factor for the exposure.

OBJECTIVE

To assess needle stick, sharp injury and mucus exposure to blood-borne pathogens among nurses in Iran and to determine the association between these exposures and psychosocial factors at work.

METHODS

A cross-sectional study was conducted on nurses in a public hospital, Tehran, Iran. 364 nurses received and 339 completed and returned a self-reported questionnaire containing demographic data, history of exposure to blood-borne pathogens at work during previous year and the General Nordic questionnaire for psychological and social factors at work (QPS Nordic 34+ Questionnaire).

RESULTS

Of 339 participants, 197 (58.1%) reported needle-stick injury, 186 (54.6%) reported another type of sharp injury, and 112 (33%) reported a mucous membrane exposure during the previous year. More than half of the participants who had history of exposure, had not reported it. Those with middle or high level of stress had higher crude and adjusted odds than those with lower stress for all kinds of exposure. Adjusted odds ratios for high stress group (ranging from 2.8 to 4.4) were statistically different from 1.

CONCLUSION

There is a high prevalence of needle-stick and sharp injury and mucous membrane exposure to patients' blood or body fluids among studied nurses. There is a significant association between increasing psychosocial factors at work and exposure to blood-borne pathogens among this group of nurses.

Reducing the risk of needlestick injuries in hospital

After performing procedures involving sharps, many wards in St George's Hospital have no quick and accessible ‘point of care’ sharps bin for their safe disposal. Instead one must transport potentially hazardous equipment away from the bedside, risking injury and exposure to persons en route.

Results from a questionnaire showed that 73% felt they were indeed poorly placed, 95% felt a portable sharps bin system was a good idea, and 95% felt their introduction would be safer. A one month trial of portable sharps bins on the Acute Medical Unit (AMU) showed that 97% felt that the portable sharps bin system reduced risk to themselves and others, 81% felt safer using them, and 90% felt safer knowing their colleagues were using them too.

A recent audit in a six month period within 2012 established there were 148 reported needlestick injuries in St George's Hospital. This quality improvement project showed that a majority consensus felt that a portable sharps bin system would be safer than the system currently used and could potentially help reduce these numbers. This project also comes at a time when new EU legislation calls for safer sharps use and disposal and thus offers a solution to ultimately provide better, safer and more advanced safety practices when disposing of sharp equipment.

Adverse incidents resulting in exposure to body fluids at a UK dental teaching hospital over a 6-year period

Background:

The safety and protection of patients and health care workers is of paramount importance in dentistry, and this includes students in training who provide clinical care. Given the nature of dental care, adverse incidents can and do occur, exposing health care workers to body fluids and putting them at risk of infection, including contracting a blood-borne virus. The aim of this research was to analyze trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teaching hospital from 2005 to 2010.

Methods:

Descriptive analysis of trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teaching hospital over a six-year period was undertaken in relation to the level of outpatient and day surgery activity.

Results:

In total, 287 incidents were reported over a six-year period, which amounted to 0.039% of outpatient or day surgery appointments. Nearly three quarters of all the incidents (n = 208, 72%) took place during treatment or whilst clearing away after the appointment. The most frequent incidents were associated with administration of local anesthetic (n = 63, 22%), followed by burs used in dental hand pieces (n = 51, 18%).

Conclusion:

This research confirms that adverse incidents are a feature of dental hospitals and reports the common sources. The importance of accurate and consistent reporting of data to ensure that these issues are monitored to inform action and reduce risks to staff, students, and patients are highlighted.

Needlestick and sharp object injuries among health care workers in Hamadan Province, Iran

INTRODUCTION

Exposure to septic fluids through mucus and needlestick injuries is of great concern among health care workers (HCWs). The purpose of this study was to acquire epidemiological data, including occupation, level of education, and mode of exposure, in HCWs.

METHODS

The data on this group was gathered during 6 months and analyzed using SPSS version 16.

RESULTS

In this study, we detected 89 cases of needlestick injuries and exposure to septic body fluids in the health care centers. Nurses were the most exposed group (39.3%). The most exposed age group was 25-34 years (51.6%). Of those injured, 51.7% were evaluated for antibody titration after vaccination, and of them, 47.2% had titration above 10 mIU/mL and the remaining had titration below 10 mIU/mL.

DISCUSSION

Numerous educational programs on care are still necessary to inform active workers in the health system about the warning trends and consequences in this part of Iran.

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.

Sharps injuries and job burnout: a cross-sectional study among nurses in China

The present study investigated the relationship between sharps injuries and job burnout in nurses. Sharps injury questionnaires and the Maslach Burnout Inventory (MBI) questionnaires were used to investigate and analyze job burnout among 468 nurses, of which 458 effective questionnaires were collected, for a response rate of 97.86%. A total of 292 nurses had at least one sharps injury (63.76% of the 458 nurses). The dimension scores were higher for injured nurses compared with non-injured nurses. The difference between the dimensions of emotional exhaustion and depersonalization for nurses with sharps injuries was statistically significant (P < 0.05). A rank correlation analysis showed that these two dimensions had a positive correlation with sharps injuries (r = 0.69-0.78). The prevalence of sharps injuries in nursing is associated with depersonalization, as measured by the MBI. Nursing administrators should pay more attention to clinically burned-out nurses, and provide more opportunity to nurses for training and education to reduce the prevalence of sharps injuries.

New HIV diagnosis after occupational exposure screening: the importance of reporting needlestick injuries

We describe three new diagnosis of HIV infection as a direct result of testing following occupational exposures (NSIs) in a low-prevalence setting. In each case the finding was unexpected. Our series provides a reminder of the importance of prompt reporting of NSIs by healthcare workers, access to rapid HIV testing and post-exposure prophylaxis with antiretrovirals to prevent transmission.

Incidence of percutaneous injuries and non-reporting rates among first-aid responders in Taiwan

We determined the incidence of percutaneous (needlestick and sharps) injuries among emergency medical technicians (EMTs) in one county in Taiwan, compared this with the official reporting rate, and sought reasons for non-reporting. An anonymous questionnaire was distributed to all EMTs in that county, eliciting percutaneous injuries occurrences, reasons why, and reporting data. Data were analyzed by logistic regression. A total of 329 out of 353 EMTs completed the questionnaire, giving a response rate of 93.2%. Thirty-nine EMTs (11.9%) experienced at least one percutaneous injury in the preceding 12 months. Older, less experienced EMTs were at greater risk of percutaneous injuries. None of the EMTs officially reported their percutaneous injuries primarily because they thought reporting was not mandatory and that the reporting process was too complicated. About one in eight EMTs had experienced at least one percutaneous injury in the preceding year. None of these injuries was officially reported to their organization. Ways to make reporting more user friendly are required, along with resources to minimize percutaneous injuries among EMTs in Taiwan.

Percutaneous exposure incidents in nurses: Knowledge, practice and exposure to hepatitis B infection: Percutaneous exposure incidents in nurses

BACKGROUND

Nurses are at risk of percutaneous exposure incidents (PEIs), which may lead to serious or even fatal blood-borne infections.

OBJECTIVES

To determine the prevalence of PEIs in the last year, among nurses and to assess their knowledge about and frequency of safe method of practice in exposure to blood-borne pathogens (especially, to HBV).

MATERIALS AND METHODS

A cross-sectional study in 2008 was conducted on 138 nurses working in general surgery and obstetrics/gynecology services of Qazvin University of Medical Sciences, Qazvin, Central Iran. A questionnaire for assessment of risk factors for contracting HBV infection was completed by nurses.

RESULTS

Overall, the prevalence of needle stick injury (NSI) and direct exposure to body fluids were 52.9% (95% CI: 44.5%-61.3%) and 65.4% (95% CI: 57.4% - 73.8%), respectively. There was no statistically significant difference between the two studied centers in terms of sharp injuries; however, the rate of repeated NSI (number per each year ≥3) and mucocutaneous exposures were significantly higher in the general surgery ward. The overall coverage of vaccination in the two studied centers was 96.3%, but the rate of accurate answers to many questions pertaining to knowledge and practice were less than 50%.

CONCLUSIONS

Nurses are still at significant risk for developing NSI and mucocutaneous exposure. Continuous educational programs (especially by highlighting the seriousness of the problem) are necessary for improving this situation because inadequate education might increase unsafely practice.

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.

Evaluation of needle stick injuries among nurses of Khanevadeh Hospital in Tehran

BACKGROUND

Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Nursing workers are at high risk for occupational exposure to blood-borne pathogens (such as HBV, HCV and HIV) via sharp injuries of needle stick.

METHODS

This descriptive analytical cross-sectional study was done on 158 nursing workers of Khanevadeh Hospital in Tehran to assess needle stick injuries prevalence and related factors via a questionnaire in 2008. Data were processed through SPSS (16.0)software using Pearson's correlation coefficient, chi-square, independent t, and Fisher exact tests.

RESULTS

About 40.5% of all participants were men and 59.5% were women. Mean age was 33.26 (8.03) years; 56.96% of participants had history of at least one needle stick injury and 22.15% of them had needle stick injury during last year. Injections were the most common action resulted to exposure (24.44%) and recapping of needles was at the second order (21.11%). Operation room had the highest prevalence (18.9%) of needle stick injuries among all wards of hospital. Emergency ward and ICU were next orders (15.6%). Exposed people believed that the most important and basic reason for needle stick injuries was patients crowdedness and hospital chaos (37.8%). There was no relation between ages, gender, years of professional life, education level and needle stick injuries but men used latex gloves less than women and did recapping needles more than them.

CONCLUSIONS

The needle-stick injuries in nursing workers of Khanevadeh hospital (Tehran) were significantly less than other similar studies in Iran.

Sharps injury reporting amongst surgeons

INTRODUCTION

The aim of this study was to evaluate the level of sharps injury reporting amongst surgeons.

SUBJECTS AND METHODS

A total of 164 surgeons completed a questionnaire on the reporting of sharps injuries, on the reasons for not reporting and their practise of universal precautions.

RESULTS

Out of 164 surgeons, only 25.8% had reported all their injuries, 22.5% had reported some and 51.7% had reported none. The top three reasons for not reporting their injuries included perception of low risk of transmission, not being concerned and no time. Of the respondents, 15.9% practised all three universal precautions of double-gloving, face shields and hands-free technique.

CONCLUSIONS

We showed that despite local trust adherence to Department of Health policy, sharps injury reporting rates are inadequate. Further investment into healthcare worker education as well as a facilitation of the process of reporting may be necessary to improve reporting rates.

An investigation into the impact of safety features on the ergonomics of surgical scalpels

In the case of surgical scalpels, blade retraction and disposability have been incorporated into a number of commercial designs to address sharps injury and infection transmission issues. Despite these new designs, the traditional metal reusable scalpel is still extensively used and this paper attempts to determine whether the introduction of safety features has compromised the ergonomics and so potentially the take-up of the newer designs. Examples of scalpels have been analysed to determine the ergonomic impact of these design changes. Trials and questionnaires were carried out using both clinical and non-clinical user groups, with the trials making use of assessment of incision quality, cutting force, electromyography and video monitoring. The results showed that ergonomic performance was altered by the design changes and that while these could be for the worse, the introduction of safety features could act as a catalyst to encourage re-evaluation of the ergonomic demands of a highly traditional product.

Occupational blood and body fluid exposure of university health care workers

BACKGROUND

Occupational exposure to bloodborne pathogens caused by percutaneous injuries or mucosal contamination is common in hospital settings.

METHODS

Reports of exposures to human blood and body fluids from Padua university health care workers since 2004 to 2006 and compliance with follow-up after injury according to the patients' source were analyzed.

RESULTS

The injury reports were 497. The residents in surgery and anesthesiology were significantly more injured than others, and the compliance with follow-up was low: from 26.3% (hepatitis B virus) to 40% (hepatitis C virus) with a positive source, less than 30% with a negative source, as far as 40% with an unknown source. No seroconversion was observed in subjects completing the follow-up.

CONCLUSION

We suspect underestimation of injury reports and low compliance with the follow-up requests that health care workers adhere to the protocols and follow the standard procedures to prevent exposures to bloodborne pathogens.

The incidence and reporting rates of needle-stick injury amongst UK surgeons

INTRODUCTION

Needle-stick injuries are common. Such accidents are associated with a small, but significant, risk to our career, health, families and not least our patients. National guidelines steer institution-specific strategies to provide a consistent and safe method of dealing with such incidents. Surgeon-specific guidelines are not currently available. We have observed that hospital sharps policy is often considered cumbersome to the surgeon, resulting in on-the-spot decision making with potential long-term implications. By their essence, these decisions are inconsistent, not reproducible and, thus, we believe them to be unsafe. The under-reporting to occupational health departments is well documented. Current surgical practice has the potential to expose the surgeon to unnecessary risk. The aims of this study were to establish the true incidence of contaminations caused by needle-stick injury in our hospital and to assess how well current protocols are really implemented.

SUBJECTS AND METHODS

We identified all surgeons of consultant, non-career staff grade (NCSG) and registrar grade working in a large 687-bed district general hospital serving a population of 550,000, in the UK. We designed a retrospective, anonymous 30-second survey. Surgeons' awareness and opinion of local policy was sought in a free-text section.

RESULTS

Of the 98 surgeons in the hospital, 77% responded to the questionnaire and 44% anonymously admitted to having a needle-stick injury. Only 3 of the 33 (9%) who sustained an needle-stick injury said that they followed the agreed local policy. Twenty-three surgeons (70%) performed first aid type procedures such as informing scrub nurse, changing needle and gloves. Seven surgeons (21%) simply ignored the incident and continued. Forty-three surgeons commented on the policy's nature with only 9 who regarded it as 'user friendly'.

CONCLUSIONS

Needle-stick injury is still a common problem, particularly in the surgical cohort and remains significantly under-reported. The disparity between hospital sharps policy and actual surgical practice is considered and an explanation for the difference sought. Without this awareness of 'real-life' surgical practice, the occupational health figures for sharps injury will always tell a rosy story under-estimating a real problem. We strongly advocate universal precautions in the operating theatre. However, we acknowledge that sharps injuries will occur. We should remain vigilant and act upon contaminations without surgical bravado but with mater-of-fact professionalism. This includes regular review of policy and, particularly, promotion of surgical awareness.

Costs of needlestick injuries and subsequent hepatitis and HIV infection

BACKGROUND

Physicians, nurses and other healthcare workers (HCWs) are at risk of bloodborne pathogens infection from needlestick injuries, but costs of needlesticks are little studied.

METHODS

We used the cost-of-illness and incidence approaches. We used the perspective of the medical provider (medical costs) and the individual (lost productivity). Data on needlesticks, infections from hepatitis B and C (HBV, HCV) and human immune-deficiency (HIV) among HCWs, as well as data on per-unit costs were culled from research literature, Centers for Disease Control and Prevention reports, and Bureau of Labor Statistics reports. We also generated estimates based upon industry employment and scenarios for source-patients. These data and estimates were combined with assumptions to produce a model that generated base-case estimates as well as one-way and multi-way probabilistic sensitivity analyses. Future costs were discounted by 3%.

RESULTS

We estimated 644,963 needlesticks in the healthcare industry for 2004 of which 49% generated costs. Medical costs were $107.3 million of which 96% resulted from testing and prophylaxis and 4% from treating long-term infections (34 persons with chronic HBV, 143 with chronic HCV, and 1 with HIV). Lost-work productivity generated $81.2 million, for which 59% involved testing and prophylaxis and 41% involved long-term infections. Combined medical and work productivity costs summed to $188.5 million. Multi-way sensitivity analysis suggested a range on combined costs from $100.7 million to $405.9 million.

CONCLUSION

Detailed methodology was developed to estimate costs of needlesticks and subsequent infections for hospital-based and non-hospital-based health care workers. The combined medical and lost productivity costs comprised roughly 0.1% of all occupational injury and illness costs for all jobs in the economy. We did not account for lost home production or pain and suffering costs, however, nor did we estimate benefit/cost ratios of specific interventions to reduce needlesticks.

Needlestick injuries and other occupational exposures to body fluids amongst employees and medical students of a German university: incidence and follow-up

The aim of this study was to obtain data concerning the incidence, reporting and follow-up of occupational exposure to blood or other body fluids (OEB). A questionnaire was distributed to employees and medical students (N=787) and official reports of OEB during the year 2003 (N=203) and their consequent follow-up (N=100) were evaluated. The percentages of needlestick injuries were 29.5% for students and 22.5% for employees. Incidence rates per 1000 employee days were 0.61 for needlestick injuries or sharp object injuries and 0.27 for mucocutaneous exposure to body fluids. The mean rate of underreporting was approximately 45%. Contrary to expectations, only 4.3% of nurses and 3.9% of doctors officially reported an OEB in 2003. The number of persons who did not attend for a serological test increased during the follow-up period. Considering all documented test results, 35 out of 100 affected persons were lost to follow-up due to default of appearance. As a consequence, the employer should provide safety devices and enforce didactical interventions with practical training and incident reporting. Periodical occupational health medicals, including serological testing, should be mandatory for all employees, including medical students and student nurses. To increase compliance after OEB, a short follow-up period using improved laboratory tests requires further discussion.

Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital

The epidemiology of needlestick and sharps injuries (NSIs) was investigated among a complete cross-section of 1,162 nurses from a large hospital in southern Japan (response rate 74.0%). Forty-six percent had experienced an NSI in the previous year. Most were caused by ampoules or vials, which injured 32.3% of all nurses and accounted for 42.9% of all NSI events. Twenty-two percent of all NSIs involved a device that had been used on a patient prior to the NSI (contaminated device), while the usage status of a further 2.8% of devices was unknown. Logistic regression indicated that nurses younger than 25 years of age were 2.18 times more likely to have sustained a single NSI in the past 12 months [odds ratio (OR) 2.18, 95% confidence intervals (CI) 1.15-4.17] and 2.39 times more likely to have sustained multiple NSIs (OR 2.39, 95% CI 1.08-5.34). Working mixed shifts (rotating day and night, as opposed to day shifts alone) was associated with a 1.67-fold increased risk of sustaining any NSI (OR 1.67, 95% CI 1.01-2.85) and a 2.72 times greater risk of sustaining an NSI from a contaminated device (OR 2.72, 95% CI 1.71-4.44). Nurses who reported significant fatigue after work were 1.87 times more likely to sustain multiple NSIs (OR 1.87, 95% CI 1.13-3.13) and 1.94 times more likely not to report their NSIs (OR 1.94, 95% CI 1.03-3.71). Perceived high mental pressure was associated with a 1.75-fold increased risk of sustaining an NSI from a contaminated device (OR 1.75, 95% CI 1.07-2.88). Nurses who reported suboptimal staffing levels in their wards were 2.21 times more likely not to report any NSIs they sustained in the previous year (OR 2.21, 95% CI 1.06-4.89). Overall, this study suggests that NSIs represent a complex and multi-faceted problem for Japanese nurses. Intervention strategies should consider the emerging complicity of psychosocial factors on NSI among hospital staff in Japan, as elsewhere.