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.

Predictors of use of direct oral anticoagulants in patients with venous thromboembolism: Findings from the Registro Informatizado Enfermedad Tromboembólica registry

Background

Current guidelines recommend the use of direct oral anticoagulants (DOACs) for patients with venous thromboembolism (VTE). However little is known about the use of DOACs in daily practice.

Methods

We used the RIETE registry to identify predictors of use of DOACs for initial and/or long-term therapy of VTE based on patient-related factors, institution-related factors or over time.

Results

Among 41,678 patients from March 2013 to September 2021, 12,286 (29%) used DOACs: for initial therapy 6,456; for long-term therapy 12,046. On multivariable analysis, independent predictors were: age < 65 years (odds ratio [OR]: 1.30; 95% CI: 1.23-1.38), body weight <50 kg (OR: 0.54; 95% CI: 0.45-0.65) or >120 kg (OR: 0.64; 95% CI: 0.53-0.77), initial VTE presentation as pulmonary embolism (OR: 1.18; 95% CI: 1.13-1.25), recent bleeding (OR: 0.53; 95% CI: 0.45-0.63), renal insufficiency (OR: 0.44; 95% CI: 0.38-0.51), liver cirrhosis (OR: 0.32; 95% CI: 0.20-0.52), thrombocytopenia (OR: 0.40; 95% CI: 0.34-0.49), atrial fibrillation (OR: 1.58; 95% CI: 1.42-1.75) and prior VTE (OR: 1.14; 95% CI: 1.06-1.22). The DOACs were more likely used in other European countries (OR: 8.97; 95% CI: 8.49-9.49), America (OR: 6.35; 95% CI: 5.67-7.11) or in other countries of the world (OR: 2.99; 95% CI: 2.70-3.31) than in Spain, and progressively increased from 2013-2015 to 2016-2018 (OR: 2.78; 95% CI: 2.62-2.95) and 2019-2021 (OR: 6.36; 95% CI: 5.95-6.80).

Conclusion

In this large multinational VTE registry, variations were observed in the use of DOACs according to patient or country factors, and over time. The safety, costs, and influence of the DOACs on VTE-related outcomes in daily practice warrant further investigation.

Differences and similarities in comfort and discomfort experience in nine countries in Asia, the Americas and Europe

In order to investigate differences in comfort and discomfort experiences amongst different regions of the world (America, Asia and Europe), a cross cultural study was performed. A questionnaire was sent to participants out in nine countries (Brazil, Canada, the USA, China, Indonesia, Thailand, Germany, Italy and the Netherlands). In total 795 participants completed the questionnaires. All countries score the comfort of a luxurious bed higher than a simple bed, first-class seats higher than economy class and all countries rate the comfort lower when the duration of sitting increases. The study suggests that in the USA and Canada softer beds, hammocks, more luxurious seats and softer pillows are scored as more comfortable compared with the other countries. There are indications that China and Germany prefer a harder mattress than in the other countries. For pillows, the differences between countries are large, which might show that much is influenced by habitude or hesitation to use something new. The Asian countries score the comfort of a brace neck pillow higher, which might be because these participants better realise the benefits better or feel less concerned to wear something that might give the appearance of an orthotic device. Further studies are needed to confirm these suggestions. The study shows that obvious differences are seen in all countries, which makes the construct of comfort internationally comparable. Practitioner summary: In designing and manufacturing globally, it is important to know how different parts of the world experience (dis)comfort. This study did not show large cultural differences amongst nine countries. Some differences emerge regarding pillows, perhaps as differences in sleeping habits play a role. Abbreviations: MANOVA: multivariate analysis of variance; VDA: Vargha and Delaney's A statistic; USA: United States of America.

Distribution of Extended-Spectrum β-Lactamase (ESBL)-Encoding Genes among Multidrug-Resistant Gram-Negative Pathogens Collected from Three Different Countries

The incidence of Extended-spectrum β-lactamase (ESBL)-encoding genes (bla_CTX-M and bla_TEM) among Gram-negative multidrug-resistant pathogens collected from three different countries was investigated. Two hundred and ninety-two clinical isolates were collected from Egypt (n = 90), Saudi Arabia (n = 162), and Sudan (n = 40). Based on the antimicrobial sensitivity against 20 antimicrobial agents from 11 antibiotic classes, the most resistant strains were selected and identified using the Vitek2 system and 16S rRNA gene sequence analysis. A total of 85.6% of the isolates were found to be resistant to more than three antibiotic classes. The ratios of the multidrug-resistant strains for Egypt, Saudi Arabia, and Sudan were 74.4%, 90.1%, and 97.5%, respectively. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa showed inconstant resistance levels to the different classes of antibiotics. Escherichia coli and Klebsiella pneumoniae had the highest levels of resistance against macrolides followed by penicillins and cephalosporin, while Pseudomonas aeruginosa was most resistant to penicillins followed by classes that varied among different countries. The isolates were positive for the presence of the bla_CTX-M and bla_TEM genes. The bla_CTX-M gene was the predominant gene in all isolates (100%), while bla_TEM was detected in 66.7% of the selected isolates. This work highlights the detection of multidrug-resistant bacteria and resistant genes among different countries. We suggest that the medical authorities urgently implement antimicrobial surveillance plans and infection control policies for early detection and effective prevention of the rapid spread of these pathogens.

What can we learn from other countries-lessons from the CAJC Happiness Report

Most countries have their own programs and requirements for surgical residency. To investigate the differences as well as the advantages and disadvantages of the programs and to explore the happiness of the residents in the different countries, the Surgical Working Group of “Young Surgeons” of the German Society for General and Visceral Surgery has designed a questionnaire. It focuses on three parts: structural and legal requirements, operating room (OR)- and non-OR-related content of the program, and contentment of the residents. In this opinion paper, first the results are shared by the description of the programs in nine different countries. It is shown that the requirements to become a surgeon differ highly between the different countries. Nonetheless, a structured curriculum, the possibility of feedback or a surgical mentoring program, and transparency regarding the OR schedule seem to be important to all residents to reach job satisfaction.