Did safety-engineered device implementation contribute to reducing the risk of needlestick and sharps injuries? Retrospective investigation of 20 years of observation in a Specialist Tertiary Referral Hospital

OBJECTIVES

In Poland, there are numerous cases of injuries caused by sharp instruments annually, still significantly more than in other European Union countries. The aim of this study was to analyze work-related injuries among healthcare workers in a selected hospital before and after the implementation of safety-engineered devices (SED).

MATERIAL AND METHODS

Retrospective analysis of medical documentation regarding occupational needlestick and sharps injuries (NSSI) in a tertiary referral surgical hospital in 1998-2018. The study group consisted of nurses and doctors who had been injured and reported the incident. The frequency of injury reports, injury rate, and characterization of circumstances surrounding NSSI are presented.

RESULTS

Over the period of 20 years, a total of 257 NSSI incidents were reported. The average injury rate was statistically significant for nurses (p = 0.004) and was higher before the introduction of SED. Moreover, the number of injuries among nurses showed a downward trend during the study period. However, for doctors, there was no statistically significant difference in the median puncture rate (p = 0.099), and the number of injuries showed an increasing trend.

CONCLUSIONS

In this study, the authors' have demonstrated not only the occurrence of injuries and punctures in the daily work of medical personnel but also the potential for their reduction through the use of safety equipment at every workstation where healthcare services are provided using sharp medical instruments. Int J Occup Med Environ Health. 2024;37(2):234-43.

Time to consider blunt needles for implant surgery? A systematic review and meta-analysis shows that blunt suture needles reduce glove perforation

BACKGROUND

Despite a recent Cochrane Review demonstrating blunt suture needles are safer for surgeons, the use of blunt suture needles has not become widely adopted. In the 'Implant Era', with the value of medical implant companies to surpass $145 billion by 2027, should we re-examine the use of blunt suture needles, especially to reduce infection in implant surgery? We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing whether blunt suture needles reduce risks to surgeons and patients.

METHODS

A systematic review and meta-analysis was performed per PRISMA guidelines. PubMed, Cochrane and EMBASE databases were searched for RCTs. Dichotomous variables were pooled as risk ratios (RR) and associated 95% confidence intervals (CI) using the MH method. Random or fixed effects modelling use was based on statistical heterogeneity (I2).

RESULTS

14 RCTs were identified with 2488 patients. The RCTs included laparotomies, caesarean sections, episiotomies, and orthopaedic surgeries. Blunt suture needles when compared with sharp needles resulted in a significant reduction in glove perforation; RR: 0.47, 95% CI [0.37 to 0.60] and needlestick injuries, RR: 0.50, 95% CI [0.26 to 0.97]. Sharp needles caused more wound infections, but the result was not statistically significant; RR: 2.73, 95% CI [0.54 to 13.76], p 0.22. Surgeon's satisfaction decreased with blunt needles compared with sharp (RR: 1.22, 95% CI [1.09 to 1.37]).

CONCLUSION

Blunt suture needles are safer than sharp needles for surgeons and likely reduce risks to patients. This, however, comes at the cost of decreased ease of use. The authors recommend the routine use of blunt suture needles, especially in implant surgery.

Combatting the occurrence of needle-stick injuries in a medical school: why is it still an issue?

BACKGROUND

Needle-stick injuries (NSIs) pose a safety risk for healthcare workers with great potential for serious infections. The aim was to determine numbers and causes of NSIs as well as the frequency with which medical students report NSIs in the final stages of study.

METHODS

An online questionnaire was developed and made available in January and February 2023 to all undergraduate medical students (n = 423) in the last 1.5 years of their degree course at Würzburg University, Germany.

RESULTS

The response rate was 19.6% (n = 84). Among respondents, 27.4% (n = 23) reported at least one NSI. Occurrence was particularly frequent in surgery, obstetrics and gynaecology, and internal medicine. Assisting with procedures, suturing, and blood sampling were considered high-risk activities. Lack of concentration, distraction, and time pressure played a role in incidents. Respondents did not report 18.8% of NSIs with the main reasons being fear of the consequences, self-assessment of the injury as minor, or the opinion of supervisors that reporting was unnecessary. Students with previous practice on simulators or patients were significantly more likely to suffer NSIs. Instructions from occupational health specialists beforehand correlated with fewer NSIs.

CONCLUSION

We assume that trained students are more experienced in handling invasive procedures, leading to a greater adoption of corresponding activities and thus an increased risk of injuries in absolute numbers. This does not counter the need for didactic interventions prior to workplace-based training to raise awareness of NSI risks. Simultaneously, concepts must be developed and implemented to support reporting and alleviate fears regarding consequences.

A simple technical innovation to prevent needle stick injuries among dental professionals

OBJECTIVE

Dental healthcare personnel face the potential danger of being exposed to infectious patients while administering local anesthesia injections during dental operations. This could lead to unintentional transfer of infectious diseases from patients to physicians. Although safety measures such as the One-hand-scoop technique and the use of safety syringes, plastic needle cap holders, and needles with safety caps are in place, there have been instances of needle stick injuries reported in clinics. This might be due to the lack of adherence to conventional safety measures or the impracticality of safety techniques and safety syringes. This article aims to demonstrate the utilization of dental tweezers, specifically London College tweezers or dental forceps, for the secure recapping of needles, eliminating the requirement for extra equipment or devices.

SUBJECTS AND METHODS

After obtaining ethical approval (Approval No.: 024-01-2024) from the College of Dentistry, Dar Al Uloom University, 67 dental professionals, with consent for participation in the study, were included. They were requested to use dental tweezers/London College tweezers and dental extraction forceps such as maxillary anterior, mandibular anterior, and maxillary bayonet root forceps individually to recap the local anesthetic needles. The efficacy of these techniques was evaluated against the one-hand scoop technique for its ease, convenience, and reliability in preventing needle stick injuries.

RESULTS

The evaluation of dental professionals regarding the ease of using dental tweezers to recap needles, compared to the one-hand scoop technique (p=0.592), maxillary bayonet root forceps (p=0.746), mandibular anterior forceps (p=0.380), and maxillary anterior forceps (p=0.808), did not yield statistically significant results. The assessment of the procedural simplicity of the one-hand scoop technique showed a satisfaction rate of over 40%, whereas the application of dental tweezers resulted in a satisfaction rate of 30%. However, the use of dental tweezers for needle recapping resulted in a satisfaction rate of over 50%, compared to a satisfaction rate of 30% for the one-handed scoop technique.

CONCLUSIONS

There is no statistically significant difference in the assessment of the efficacy of dental tweezers and the one-hand scoop technique, bayonet root forceps, mandibular anterior forceps, maxillary anterior forceps, and dental tweezers for the needle capping technique. Therefore, dental forceps can be used instead of the one-handed scoop approach. The needle recapping procedure outlined in our study, aimed at preventing needle stick injuries, is simple to implement, and all dental specialties have convenient access to the required instruments.

Bloodborne viral infections: Seroprevalence and relevance of preoperative screening in Indian eye care system - A retrospective study

PURPOSE

To report the seroprevalence of bloodborne viral infection (BBVI) in patients undergoing ophthalmic surgeries and assess the utility and feasibility of preoperative screening for BBVI in India's current eye care system.

METHODS

This retrospective, hospital-based, descriptive study included data from patients undergoing preoperative screening for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and human immunodeficiency virus (HIV) at a tertiary eye care institute from 2018 to 2022. Rapid diagnostic tests (RDTs) were performed on the blood samples after obtaining informed consent from the patients. Seroreactive patients underwent surgery with additional safety precautions. The demographic data and surgical details of these patients were collected and analyzed. ANOVA was used to carry out statistical analysis between groups. During the study period, the number of healthcare workers (HCWs) sustaining needle stick injury (NSI) and accidental sharp injury (ASI) in the operating theater (OT) and details of these injuries were recorded.

RESULTS

Samples from 28,563 patients were included. The seroprevalence of BBVI was 1.87% (536/28563). Hepatitis B virus (322, 60.1%) was the most commonly detected infection, and HIV (59, 11%) was the least detected infection. The mean age of the seroreactive patients was 60.3 ± 30.8 years. The incidence of NSI was 0.49/1000 surgeries. Nurses (11) and technicians (4) in the OT sustained maximum NSI. None of the HCWs had seroconversion after NSI.

CONCLUSION

The overall seroprevalence of BBVI in the current study is lower than that reported in previously published studies from eye care organizations. Currently, mandatory preoperative screening for BBVI to prevent transmission of these infections to HCWs working in the eye care sector in India appears to be less cost-effective.

Needle Stick Injury: A Decade Retrospection Among Health Care Workers in a Tertiary Care Center

Needle stick injury (NSI) is a common incidence in a health care facility which can have a great impact on the psychological status of a health care worker (HCW). In the present study, over a decade, 76 incidents of NSI were reported. Nurses (47.3%) were at high risk followed by doctors (28.94%). Recapping (30.2%) was the major activity associated with NSI. Percutaneous injury (97.3%) with a hollow bore needle to the fingers was the most common type of injury. Three (3.9%) of the sources were positive for Hepatitis B virus (HBV), and one (1.3%) for human immunodeficiency virus (HIV). Postexposure prophylaxis was administered to eight (10.5%) HCWs with high-risk exposure. The incidence of NSI is low, as there exists an underreporting which cannot be denied. Following stringent universal precautions and adoption of safety-guided devices can reduce the rate of injury to a great extent. Regular training, monitoring, auditing, and adequate control modalities are the core strategies to reduce the incidence of NSI.

Investigation ways of causes needle sticks injuries, risk factors affecting on health and ways to preventive

Needle sticks injuries (NSIs) has caused many health concerns, including the widespread infection disease. Needle sticks injuries can have high threaten health human especially, all those who are in contact with health and medical centers. The purpose of this review study was the determination the effects of needle sticks injuries (NSIs) on health care worker and patents. In this a review study of literature studied conducted on international databases included Google Scholar, ISI/WOS (Web of Science), Springer, Scopus, Medline/PubMed. The literature signs a notable undesirable affect from potential needle sticks injuries related to ways to preventive and risks factors among patents and health care worker. The literature was shown needle stick injuries can cause with a variety of ways including needle recapping, non-standard safety boxes, thin gloves, and inadequate personal protective equipment. According to the result this study, needle stick injuries can transfer infectious disease (Human Immunodeficiency viruses [HIV], Hepatitis C virus [HCV]) and increase risk health on health care worker and patients. According to research related to the subject, the ways to prevent reduce needle sticks include personal protective equipment, holding retraining courses for medical staff in the direction to raise awareness can significantly reduce cases of needle sticks injuries. Further research using more sophisticated methodology is warranted.

Direct Care Nurses' Needlestick Injury Experiences: A Qualitative Descriptive Study

BACKGROUND

Even when education and the use of safety equipment are emphasized, nurses frequently experience needlestick injuries. Understanding the risk situations and coping mechanisms for needlestick injuries experienced by nurses facilitates their prevention.

OBJECTIVES

We aimed to explore and describe the phenomenon of needlestick injuries through the research questions: (1) What causes nurses to suffer from needlestick injuries? (2) How to cope after a needlestick injury? and (3) What are the recommendations for needlestick injury prevention?

METHODS

This qualitative descriptive study involved focus group interviews with 31 direct care nurses in 6 groups who had experienced needlestick injuries while working in different acute care hospitals across 3 regions in South Korea. Data were collected from January 29 to March 29, 2022, and analyzed using thematic analysis.

RESULTS

The average age of the participating nurses was 29.7 years. The following 3 themes were identified: various needlestick injury experiences, post-needlestick injury coping, and expectations regarding needlestick injuries.

CONCLUSIONS

Risk situations and coping mechanisms of nurses who experienced needlestick injuries were diverse. Emergency situations and novice nurses were the causes of most of the needlestick injuries. Often, personal protective equipment was found cumbersome. Reporting needlestick injuries depended on the work environment.

A large-scale survey on epidemiology and underreporting of needlestick and sharp injuries among healthcare workers in China

Background

Needlestick and sharp injuries (NSI) carry the risk of transmitting numerous bloodborne pathogens, leading to both health and economic burdens. The underreporting of NSIs among healthcare workers (HCWs) is a global issue of concern, as timely treatment and prevention of complications rely on proper reporting. Underreporting further impedes accurate surveillance and appropriate resource allocation, with developed and developing nations facing disparities due to differences in healthcare policy.

Purpose

The purpose of this research is to examine the epidemiology of NSIs and NSI underreporting, as well as to identify the determinants associated with the occurrence of NSIs and the underreporting of such injuries.

Method

A retrospective online survey was conducted from January 15 to January 31, 2022 among healthcare workers (HCWs) across Gansu Province, China.

Results

A total of 7,283 healthcare workers (HCWs) from various institutions participated in this study. After quality assurance checks, 6,464 (88.77%) responses were included in the final analysis. Results revealed a 32.86% self-reported needlestick and sharp injury (NSI) incidence among respondents, with 28.53% of NSIs going unreported. Contrary to common belief, more experienced HCWs exhibited higher rates of both NSIs and underreporting compared to their less experienced peers. The primary reasons cited for NSIs and underreporting were lapses in concentration and not perceiving patients as infectious. Multivariate regression analysis exposes the significant influence of training frequency, occupation, department and years of services on the occurrence of NSIs. Conversely, the reporting of NSIs is primarily influenced by training, reimbursement,occupation, department and hospital grade. Compared to HCWs with no training, those who received ≥3 training sessions per year showed a 12.16% lower NSI incidence (27.12% vs. 39.28%, p < 0.001) and a 55.68% lower underreporting rate (14.61% vs. 70.29%, p < 0.001).

Conclusion

There is a pressing need for enhanced surveillance, tailored training programs, and more efficient reporting mechanisms to combat this significant occupational health challenge.

A Cross-Sectional Analysis of Sharps Injuries Among Dermatologic Surgeons: A Survey of American College of Mohs Surgery Members

BACKGROUND

There is a paucity of data on sharps injuries and bloodborne pathogen exposure among Dermatologic Surgeons.

OBJECTIVE

Quantify occupational risks from sharps injuries among Mohs surgeons. Determine rate of injury, reporting, and confidence in staff's sharps handling.

METHODS

A cross-sectional analysis performed using survey responses from Mohs surgeons with membership in the American College of Mohs Surgery (ACMS).

RESULTS

A total of 60 ACMS members completed the survey. Overall, 56.7% reported at least 1 sharps injury within the past year, of which 14.7% resulted in a bloodborne exposure (odds of exposure: 7.5% per year). The most common type of injury was self-inflicted suture needlestick (76.5%). Forty-four-point-one percent did not report their injuries. Ninety-five percent reported access to postexposure prophylaxis at their workplace. In addition, respondents in academic and single-specialty practices were more likely to report high or moderate confidence in staff sharps handling knowledge and in injury reporting compared with respondents from multispecialty and solo practices (88% vs 54% p = .02, 76%-81% vs 27% p = .0004, respectively).

CONCLUSION

Sharps injuries and under-reporting of these injuries are common among Mohs surgeons. Despite reporting of higher confidence in staff knowledge and training in academic and single-specialty practices, there was no correlation with surgeon's rate of injury.

Behavioural video to navigate predoctoral dental students toward safer practice (revision of EJE-21-4739)

INTRODUCTION

Local anaesthesia is considered essential knowledge within the dental profession as it helps to address pain management. Operator percutaneous needlestick injuries associated with the delivery of dental anaesthesia are common for dental healthcare providers. The study proposes a supplemental technique to reduce self-inducing novice operator needlestick injury to complement existing pedagogies for the preclinical local anaesthesia curriculum. The purpose of the study is to evaluate whether a local anaesthesia behavioural video can navigate students to safer clinical practice. Further, a supplemental technique is proposed in whether assessing instrument retraction technique in clinical patient care leads to decreased self-inducing intraoral needle stick injury for novice predoctoral dental operator.

MATERIALS AND METHODS

Beginning in 2011, predoctoral dental students were asked to view a "what not to do" video within a summative assessment and identify at least five behaviours that were unacceptable errors for delivering local anaesthesia. Operator intraoral needlestick injury was also tracked per the bloodborne exposure reports within predoctoral patient clinics.

RESULTS

Data from the learners' responses identified progression in recognising unacceptable errors from behavioural video. Intraoral needlestick injury, 8 and 9 years prior and after the introduction of video showed significance with a low correlation coefficient.

CONCLUSION

More data need to be gathered and evaluated in other dental school settings to determine whether this supplemental educational video decreases needlestick injury in novice operators. Results suggest this behavioural video may guide novice operators to overall safer clinical practice.

Occupational protection behavior and its influencing factors of newly recruited nurses

AIM

Aim The objective of this study was to understand the occupational protective behaviors of newly recruited nurses and explore the influencing factors.

METHODS

A convenience sampling method was used to select newly recruited nurses in our hospital from July 2018 to November 2019. The survey was conducted using the general information questionnaire, work attitude scale (Wa), and occupational protective behavior scale.

RESULTS

The total score of occupational protective behaviors of 150 newly enrolled nurses was 18.94 ± 3.59. There was a significant negative correlation between work attitude score and occupational protective behaviors (r = -0.324, p < 0.001). Multiple linear regression analysis showed that gender, previous participation in nursing skill-based competitions, experience of needlestick injuries before recruit, work attitude score, average daily sleep time (p < 0.05) were independent factors influencing occupational protective behaviors.

CONCLUSIONS

The overall occupational protective awareness of newly enrolled nurses is relatively weak and needs to be further improved. The group's ability to improve occupational protective behaviors may be positively impacted through increased adaptability, improved sleep, active participation in nursing skill-based competitions, strengthening guidance and education on occupational protection.

Needlestick injuries in dentistry: Time to revisit

BACKGROUND

Blood-borne pathogens (BBPs) are infectious microorganisms that are found in human blood and can cause diseases in humans. Health care workers such as physicians, surgeons, nurses, dentists, dental students, dental assistants, laboratory technicians, personnel handling infectious waste, and other health care employees are at increased risk of exposure to these pathogens. Percutaneous injuries from needles or other sharp objects are the major sources of BBPs in the workplace. Needlestick injuries (NSIs) have the most potential to transmit and have the easiest mode of transmission of BBPs.

TYPES OF STUDIES REVIEWED

The authors searched electronic databases (PubMed, Web of Science, Google Scholar, Scopus, Embase, MEDLINE-Ovid) for studies and articles focused on the various aspects of NSIs, their possible causes, prevention, and management protocols.

RESULTS

There is a lack of literature on the global prevalence of NSIs among dental practitioners and underreporting of NSIs by clinicians. The authors also found that dental students and inexperienced practitioners were the most vulnerable. They found apparent inconsistencies in guidelines and recommendations from various regulatory and statutory agencies in charge of limiting and managing NSIs.

CONCLUSION

The most significant occupational risks for health care workers globally are NSIs. Dentists are recognized as one of the high-risk groups for exposure to NSIs. Although the reporting rate was noticeably low, the frequency of NSIs among dental students was alarmingly high.

PRACTICAL IMPLICATIONS

Appropriate and succinct training of dental health care workers is crucial for prevention and management of NSIs. It is recommended that dentists familiarize themselves with recommendations from such agencies and organizations as the Center for Disease Control and Prevention, Occupational Safety and Health Administration, and American Dental Association.

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.

Sharps Injuries Among Medical Trainees and Attending Physicians

PURPOSE

Sharps injuries are a particularly concerning occupational hazard faced by physicians and are largely preventable. This study compared the proportion and rate of sharps injuries among medical trainees with those among attending physicians by sharps injury characteristics.

METHOD

The authors used data reported to the Massachusetts Sharps Injury Surveillance System from 2002-2018. Sharps injury characteristics examined were department where injury occurred, device, purpose or procedure for which device was used or intended, presence of sharps injury prevention feature, who was holding the device, and how and when the injury occurred. Global chi-square was used to assess differences in the percent distribution of sharps injury characteristics between physician groups. Joinpoint regression was used to evaluate trends in injury rates among trainees and attendings.

RESULTS

From 2002-2018, 17,565 sharps injuries among physicians were reported to the surveillance system, 10,525 of which occurred among trainees. For attendings and trainees combined, sharps injuries occurred most in operating and procedure rooms and most often involved suture needles. Significant differences in sharps injuries were found between trainees and attendings with respect to department, device, and intended purpose or procedure. Sharps without engineered sharps injury protections accounted for approximately 4.4 times as many injuries (13,355, 76.0%) as those with protections (3,008, 17.1%). Among trainees, sharps injuries were highest in the first quarter of the academic year and decreased over time, while sharps injuries among attendings had a very slight, significant increase.

CONCLUSIONS

Sharps injuries are an ongoing occupational hazard faced by physicians, particularly during clinical training. Further research is needed to elucidate the etiology of the observed injury patterns during the academic year. Medical training programs need to implement a multipronged approach to prevent sharps injuries, including increased use of devices with sharps injury prevention features and robust training on safe handling of sharps.

Reducing Sharps Injuries in the Operating Rooms of an Academic Tertiary Care Center

BACKGROUND

Data on the prevalence and distribution of operating room (OR) sterile field sharps injuries sustained by attending surgeons, residents, scrub nurses, and surgical technologists are limited. The goal of this study is to understand current practices, injuries, and reporting behavior at an academic center, implement interventions, and assess their effect on sharps safety and reporting.

METHODS

An electronic survey with questions pertaining to sharps handling practices, injuries, and reporting was e-mailed to 864 staff between July and September 2014. Adjusted analyses for risk of injury were performed. A follow-up survey was sent in January 2018, following the implementation of a shorter injury reporting form and a neutral zone.

RESULTS

The overall response rate was 49.3%, with 363 completed surveys. Of respondents, 44.9% reported injuries occurring in the preceding three years. Physicians comprised 65.1% of injured staff and sustained 68.8% of the total injuries. Compared to attending surgeons, residents had a similar likelihood of injury (odds ratio 0.9, 95% confidence interval [CI] 0.37-2.2), whereas scrub nurses (odds ratio 0.3, 95% CI 0.17-0.54) and technologists (odds ratio 0.3, 95% CI 0.14-0.76) had a lower likelihood. Half of those injured reported to Occupational Health Services. Of those who did not report, 46.4% stated that time was a limiting factor. Following the interventions, the incidence of injuries among survey respondents remained unchanged. However, 54.0% of respondents stated that it was easier to report injuries.

CONCLUSION

Attending surgeons and residents sustain the majority of OR sterile field sharps injuries and are the least likely to report them. Shorter reports made it easier to report the injuries.

Saving time when preparing intravenous antibiotics

Preparation of intravenous antibiotic doses takes up a significant amount of nurse time and exposes nurses to the risk of needlestick injury. The use of the Ecoflac® Connect needle-free connector could streamline preparation, reducing the time taken as well as eliminating needlestick injury risk. Because Ecoflac Connect is a closed system, it also minimises the risk of microbial contamination. This study showed that it took 83 experienced nurses 73.6 (SD 25.0) seconds to prepare an amoxicillin injection using the Ecoflac Connect needle-free connector compared with 110.0 (SD 34.6) seconds using the standard needle and syringe method, saving 36 seconds per dose on average, reducing the time taken by one-third. Based on recent government figures, the saving in nurse time would equate to 200-300 full-time nurses in England, equivalent to £6.15 million-£9.23 million a year. Additional savings would accrue from the prevention of needlestick injuries. Where wards are understaffed, this time saving could be critical, increasing time for care.

Sharps Injuries Related to Subdermal Needles in the Orbicularis Oris During Intraoperative Neurophysiologic Monitoring

PURPOSE

Little is known about the incidence and nature of sharps injuries caused by subdermal intraoperative neurophysiologic monitoring (IONM) needle electrodes. In their institution, the authors observed a series of sharps injuries attributed to placement of needles in the orbicularis oris (OO).

METHODS

One large academic institution's sharps injury monitoring database was queried for all reported events over 3 years. The de-identified list was filtered for sharps events occurring in the operating room, and the descriptions of the sharps injuries were individually evaluated. Interventions were performed to attempt to decrease the number of sharps injuries from IONM needles, particularly those placed in OO. Similar data were then collected for 3 months post-intervention.

RESULTS

Pre-intervention, 327 sharps injuries were reported over the span of 3 years, of which 13 (4.0%) were attributed to IONM needles not in OO and 5 (1.5%) were attributed to IONM needles in OO. Post-intervention, 41 sharps injuries were reported in 3 months, of which 5 (12.2%) were attributed to IONM needles not in OO and 1 (2.4%) was attributed to needles in OO.

CONCLUSIONS

The placement of subdermal needles in the OO presents a disproportionately high risk of sharps injury. Interventions were performed to attempt to decrease the rate of sharps injuries from needles in OO; the post-intervention increase in events was likely skewed by small sample sizes. The implementation of these changes and the ongoing surveillance of injury cases may be important data to help decrease the number of sharps injuries attributed to IONM needles.

[Safety Climate in Hospitals: From Science to Policy-The Progress of Needlestick Prevention in Taiwan]

In hospitals, safety climate refers to the safety policies and regulations established by medical institutions and the measures taken to ensure medical personnel feel safe while working at these institutions. Safety climate can directly affect the overall work performance of medical personnel and indirectly affect patient care quality, which in turn impacts the rate of occupational hazards. Common occupational hazards in the medical workplace include contracting infectious diseases, overwork, irregular circadian rhythm due to working shifts, changes in sleep patterns and dietary habits, musculoskeletal discomfort, workplace violence, workplace stress, and needlestick injuries. This paper was developed to explore the history of promoting needlestick prevention in Taiwan, and discusses how to use the results of empirical research as scientific evidence and critical proofs to advocate for needlestick prevention and to establish related policies. In addition, the process of how improvements to the hospital safety climate and the prevention of occupational hazard incidents mutually influence and complement each other was examined. Future studies are encouraged to explore this topic to further elucidate the sources of workplace stress and to devise methods to ameliorate their influence on workplace stress in medical institutions. The results of these studies may be referenced by relevant government agencies and medical institutions when developing policies promoting safe environments in hospitals that improve the safe-work perceptions of nursing personnel and create comfortable and friendly medical environments.

Non-Safety and Safety Device Sharp Injuries-Risk of Incidents, SEDs Availability, Attitudes and Perceptions of Nurses According to Cross-Sectional Survey in Poland

Sharp injuries are a serious issue among healthcare workers (HCWs). The aim of the study was to examine the frequency of sharps injuries among nurses (who have the most frequent contact with infectious material) when using devices with and without safety features, then to analyse the factors associated with such injuries and to compare the risk of injuries with safety engineered devices (SEDs) and non-safety engineered devices (non-SEDs). An online cross-sectional survey was completed between October 2021 and March 2022 by 280 nurses. The incidence of exposure to sharp injury during their professional life was 51.4%. The percentage of nurses experiencing a sharp injury in the year preceding the study was 29% and 9.6% for superficially and deep injury, respectively. Ampoules and conventional hollow-bore needles caused the most injuries (25.92% and 22.64% of nurses in the last year). Factors including sex (males), age and seniority (elderly), education (higher), work exhaustion and being left-handed were associated with the occurrence of conventional hollow-bore needle injuries. In the case of SEDs: age, seniority and right/left-handed were the most frequent risk factors associated with the occurrence of sharp injuries. SEDs injuries were much less frequent than non-SEDs. There was a significant difference between the risk of injuries with safety and non-safety needles, central cannulas and ampoules. Fisher's exact test (p-value = 0.000) and positive Spearman's rho statistics (0.2319, p-value = 0.0001) confirmed that in accredited hospitals, the availability of safety needles was higher. Almost half of the nurses (n = 115, 41.07%) stated that staff had little influence on the type of medical sharp instruments supplied. To reduce the risk of nurse injuries, access to medical devices with safe protection mechanisms should be ensured, the use of sharp instruments should be limited where possible, managers should consult nurses regarding the choice of safe devices, and training programs on the proper use of SEDs should be available.

Prevalence of needle-stick injury among nursing students: A systematic review and meta-analysis

Introduction

Needle-stick injuries (NSI) are a serious threat to the health of healthcare workers, nurses, and nursing students, as they can expose them to infectious diseases. Different prevalence rates have been reported for this type of injury in different studies worldwide. Therefore, this study aimedto estimate the pooled prevalence of NSI among nursing students.

Methods

This study was conducted by searching for articles in Web of Science, PubMed, Scopus, Embase, and Google Scholar without time limitation using the following keywords: needle-stick, needle stick, sharp injury, and nursing student. The data were analyzed using the meta-analysis method and random-effects model. The quality of the articles was evaluated with Newcastle-Ottawa Quality Assessment Scale (NOS). The heterogeneity of the studies was examined using the I 2 index, and the collected data were analyzed using the STATA Software Version 16.

Results

Initially, 1,134 articles were retrieved, of which 32 qualified articles were included in the analysis. Nursing students reported 35% of NSI (95% CI: 28-43%) and 63% (95% CI: 51-74%) did not report their needle-stick injuries. The highest prevalence was related to studies conducted in Asia (39.7%; 95% CI: 31.7-47.7%). There was no significant correlation among NSI prevalence and age of samples, and article year of publication.

Conclusion

A third of nursing students reported experiencing NSI. Consequently, occupational hazard prevention training and student support measures need to be considered.

Needlestick and sharps injuries at a German university hospital: epidemiology, causes and preventive potential - a descriptive analysis

OBJECTIVES

To analyze the number, epidemiology and circumstances of needlestick and sharps injuries (NSSI) and exposures to body fluids and to identify further preventive measures to improve the occupational safety of health care workers (HCW).

MATERIAL AND METHODS

Setting: German university tertiary-care referral center. Retrospective study based on injury documentation sheets of the hospital's staff and faculty health service and, if given, on reports by continuity doctors and by the accident and emergency department in January 2014-June 2016.

RESULTS

Altogether, 567 injuries were registered with a significant decrease of cases over the study period. The majority of accidents occurred in the operating theater (35%). Stress, time pressure, overstrain, carelessness and distraction were found to be the main reasons for injuries. At least 30% of the cases were preventable, mainly by wearing personal protective equipment (PPE), by proper disposal of an item and by early replacement of overfilled sharps containers (SC). In 20% of the cases involving an item, the injury was caused by a safety-engineered device (SED). Almost one-third of these injuries were attributable to an improper use of the SED.

CONCLUSIONS

Despite many efforts made to reduce their number, NSSI still occur. Health care workers and students should be offered regular trainings to be sensitized to this topic and to learn the appropriate use of SED. Moreover, organizational measures must be taken, such as the provision of suitable PPE and safe SC. Strategies need to be established to improve the working conditions and reduce the stress level of HCW. Int J Occup Med Environ Health. 2022;35(5):497-507.

Incidence, Knowledge, Attitude and Practice Toward Needle Stick Injury Among Health Care Workers in Abha City, Saudi Arabia

Background

A needle stick injury is a serious occupational health hazard in health care settings. Health care workers are at risk of bloodborne diseases and the psychological consequences of these injuries. This study aims to estimate the incidence of needle stick injuries among healthcare workers during the previous 12 months and to assess their knowledge, attitude, and practice toward these injuries.

Methods

This cross-sectional study was conducted from 1st August 2019 till 15th February 2020, and included 786 healthcare workers in Abha city, Saudi Arabia. A structured questionnaire was used to collect the data.

Results

The incidence of needle stick injury among healthcare workers during the previous 12 months was (91/786) 11.57%. Nurses, females, and Saudis reported most needle stick injuries. More than half (52.7%) of the injuries went unreported. About 52.7% of needle stick injuries occurred during using sharp devices, and 42.9% of injuries happened in the patient room. The incidence of needle stick injury was significantly higher among those working at the secondary healthcare level (p = 0.003) and those practicing surgery (p < 0.001). Out of 786 participants, 94.7% knew the definition of needle stick injury, and 81.0% were aware of the procedure and guidelines to follow on sustaining a needle stick injury. Only 61.2% recognized that the recap of the needle is not recommended. Almost half of the participants (47.1%) agreed, and 33.6% strongly agreed that needle stick injury is preventable. A majority of healthcare workers (89.1%) had been vaccinated against Hepatitis B. Nearly 27.5% of healthcare workers incorrectly practiced recapping the needles with two hands and 8.7% bent needles before disposal. Recapping the needles was statistically significantly higher among healthcare workers who had a history of needle stick injury (p = 0. 046).

Conclusion

Needle stick injury and its under reporting among healthcare professionals is still a prevalent risk. Raising awareness among healthcare workers and improving the reporting systems for needle stick injuries to ensure more protection and early use of post-exposure prophylaxis is required. Implementation of safety precautions and safe injection practices and providing engineered safety devices may further reduce the risk.

Prevalence of Needle Stick and Sharps Injury and Hepatitis B Vaccination among Healthcare Workers in a South-East Nigerian Tertiary Hospital

BACKGROUND

Daily, HCWs are exposed to needle stick and sharps injury (NSSI) and associated risk of life-threatening infections.

AIM

A cross-sectional study was conducted to determine the prevalence of NSSI and HBV vaccination among 341 HCWs at NAUTH, Nnewi.

METHODS

Data was collected using a self-administered. questionnaire and interview of key staff.

RESULTS

The mean age of participants was 33.4±11.9 years while male: female ratio was 1:1.7. Prevalence of NSSI in the preceding 12 months was 25.5% with doctors (43.0% [34/79]), laboratory scientists (27.5%[14/51]) and nurses (21.8%[17/78]) leading (p=0.014). Noncompliance with standard precaution (SP) and non-display of relevant SP SOPs in prominent places were significantly associated with NSSI (p=0.001). Among those exposed to NSSI, only 33.7% (28/83) consulted a doctor, while 16.9%(14/83) took post-exposure prophylaxis. Two-third (68.8% [190/276]) of respondents correctly cited HBV/HCV as vaccine-preventable blood-borne healthcare-associated infection (HAI) while half (50.9% [161/316]) had received HBV vaccination. Profession (p=0.018), display of SOPs in prominent places (p=0.015), ability to cite HBV/HCV as vaccine-preventable blood-borne HAI (p=0.001), and compliance with SP (p<0.001) were significantly associated with HBV vaccination. Unit heads' responses implied lack of written policy on HBV vaccination, adequate training on NSSI prevention, and HBV vaccination support.

CONCLUSION

Among HCWs, NSSI is high but under-reported while HBV vaccination rate is unimpressive. Profession, display of relevant SOPs, and compliance with SP positively affected both NSSI occurrence and HBV vaccination while knowledge about vaccine-preventable blood-borne HAI also influence HBV vaccination status. Written policies on HBV vaccination and NSSI prevention/ management, their communication and enforcement among HCWs, adequate training/retraining, display of SOPs in prominent places, and free HBV vaccination are recommended.

Leveraging Partnerships to Reduce Insulin Needlestick Injuries: Nurse-Led System-Wide Quality Improvement Project

BACKGROUND

Percutaneous injuries from needlesticks are a major occupational hazard for nurses.

LOCAL PROBLEM

Reducing subcutaneous insulin-related needlestick injuries was part of a nurse-led comprehensive sharps injury-reduction program at an integrated, not-for-profit health system.

METHODS

The incident rate of needlestick injuries was compared between 1 year before and 1 year after introducing this quality improvement project.

INTERVENTIONS

A system-wide educational program instituting changes in subcutaneous insulin administration practices was combined with supply chain standardization using a single type of safety-engineered insulin syringe.

RESULTS

The average monthly incidence of needlestick injuries per 10 000 subcutaneous insulin injections fell significantly from year to year (incidence rate ratio, 0.49; 95% CI, 0.30-0.80; Poisson regression P = .004). One-year cost savings for supplies totaled $3500; additional annual median savings were $24 875 (2019 US dollars) in estimated costs of needlestick injuries averted.

CONCLUSIONS

The effectiveness of this multifaceted project provides a practical template to reduce subcutaneous insulin-related needlestick injuries.

A quasi-experimental trial of the clinical and economic impact of implementing of hepatitis B immunoglobulin policy post needle stick and sharp injuries in reducing its unnecessary use at a tertiary care hospital

INTRODUCTION

Hepatitis B virus infection has the highest rate of transmission out of the blood-borne viruses in health care workers. Exposure to HBsAg positive source should be managed based on Hepatitis B serology results. Given that Hepatitis B immunoglobulin (HBIG) is an expensive medication with limited stock levels, it should be given more attention to make sure of its optimum use. This trial aims to evaluate the effectiveness of a policy on the use of HBIG following needle stick and sharp injuries among health care workers.

METHODS

It is a quasi-experimental trial conducted at a Tertiary Care hospital in Saudi Arabia. The participants were health care workers who received HBIG following needle stick and sharp injuries from January 2018 to May 2020. Before and after implementing departmental guidelines and education on the post-exposure procedure, the trial re-evaluated the need for HBIG among the receivers.

RESULTS

A total of 60 health care workers received HBIG for needle stick and sharp injuries between the trial period (pre- and post-implementation). The percentage of patients who received inappropriate HBIG was significantly lower during the post-implementation of the guideline (30%) than that among the pre-implementation period (60%). Thus, the direct cost associated with the inappropriate use was reduced from SAR 30000 to SAR 13500 post-implementation.

CONCLUSION

The implementation of HBIG guidelines of use and education has led to a statistically significant decrease in its inappropriate use and led to cost reduction.

Knowledge attitude and practice regarding prevention of needle stick injuries among nursing students in Henan province, China

Nursing students are more vulnerable to needle stick injuries (NSIs) among all the nurses due to lack of work experience and poor awareness of occupational protection. A cross-sectional study of 400 nursing students was carried out to assess the participants' knowledge, attitudes, and practices regarding prevention of NSIs. The results indicated that 67% of nursing students suffered at least one NSI during their internship. The most common causes of injury were the injection process, venous catheter management process, and the process of disposal of all kinds of needle waste. Intentionally breaking the needle after injection, capping needles, and separating the needle from the syringe by hand are the risk factors for NSIs among nursing students. It is necessary to develop and increase occupational safety protection courses and establish regulations for the prevention of NSIs.

Suture Needle Injuries During Wound Closure: Examining Sources of Distraction in the OR

Despite focus on prevention of needlestick injuries, intraoperative injuries involving suture needles have increased in the past two decades. When interruptions occur during surgery, a practitioner's focus is disengaged, creating an "error space;" re-engagement of the practitioner takes exponentially longer as each subsequent interruption occurs during the procedure. Human factors studies focus on the interaction between individuals and the environment in which they work (eg, processes, equipment). Researchers use a human factors approach to understand distractions during surgery. Using this methodology, wound closure is viewed as a standalone process and the effect of distractions and interruptions on suture needle injuries is examined. Competing priorities combined with interruptions present opportunities for altered situational awareness, which can lead to injury. This article redefines wound closure as a vulnerable time with great potential for error-a time during which distractions and interruptions can lead to suture needle injuries and other unexpected outcomes.

Education and training for preventing sharps injuries and splash exposures in healthcare workers

BACKGROUND

In healthcare settings, health care workers (HCWs) are at risk of acquiring infectious diseases through sharps injuries and splash exposures to blood or bodily fluids. Education and training interventions are widely used to protect workers' health and safety and to prevent sharps injuries. In certain countries, they are part of obligatory professional development for HCWs.

OBJECTIVES

To assess the effects of education and training interventions compared to no intervention or alternative interventions for preventing sharps injuries and splash exposures in HCWs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, NHSEED, Science Citation Index Expanded, CINAHL and OSH-update (from all time until February 2016). In addition, we searched the databases of Global Health, AustHealth and Web of Science (from all time until February 2016). The original search strategy was re-run in November 2019, and again in February 2020. In April 2020, the search strategy was updated and run in CINAHL, MEDLINE, Scopus and Web of Science (from 2016 to current).

SELECTION CRITERIA

We considered randomized controlled trials (RCTs), cluster-randomized trials (cluster-RCTs), controlled clinical trials (CCTs), interrupted time series (ITS) study designs, and controlled before-and-after studies (CBA), that evaluated the effect of education and training interventions on the incidence of sharps injuries and splash exposures compared to no-intervention.

DATA COLLECTION AND ANALYSIS

Two authors (SC, HL) independently selected studies, and extracted data for the included studies. Studies were analyzed, risk of bias assessed (HL, JL) , and pooled using random-effect meta-analysis, where applicable, according to their design types. As primary outcome we looked for sharps injuries and splash exposures and calculated them as incidence of injuries per 1000 health care workers per year. For the quality of evidence we applied GRADE for the main outcomes.

MAIN RESULTS

Seven studies met our inclusion criteria: one cluster-RCT, three CCTs, and three ITS studies. The baseline rates of sharps injuries varied from 43 to 203 injuries per 1000 HCWs per year in studies with hospital registry systems. In questionnaire-based studies, the rates of sharps injuries were higher, from 1800 to 7000 injuries per 1000 HCWs per year.  The majority of studies utilised a combination of education and training interventions, including interactive demonstrations, educational presentations, web-based information systems, and marketing tools which we found similar enough to be combined. In the only cluster-RCT (n=796) from a high-income country, the single session educational workshop decreased sharps injuries at 12 months follow-up, but this was not statistically significant either measured as registry-based reporting of injuries (RR 0.46, 95% CI 0.16 to 1.30, low-quality evidence) or as self-reported injuries (RR 0.41, 95% CI 0.14 to 1.21, very low-quality evidence) In three CCTs educational interventions decreased sharps injuries at two months follow-up (RR 0.68, 95% CI 0.48 to 0.95, 330 participants, very low-quality evidence). In the meta-analysis of two ITS studies with a similar injury rate, (N=2104), the injury rate decreased immediately post-intervention by 9.3 injuries per 1000 HCWs per year (95% CI -14.9 to -3.8). There was a small non-significant decrease in trend over time post-intervention of 2.3 injuries per 1000 HCWs per year (95% CI -12.4 to 7.8, low-quality evidence). One ITS study (n=255) had a seven-fold higher injury rate compared to the other two ITS studies and only three data points before and after the intervention. The study reported a change in injury rate of 77 injuries per 1000 HCWs (95% CI -117.2 to -37.1, very low-quality evidence) immediately after the intervention, and a decrease in trend post-intervention of 32.5 injuries per 1000 HCWs per year (95% CI -49.6 to -15.4, very low quality evidence). None of the studies allowed analyses of splash exposures separately from sharps injuries. None of the studies reported rates of blood-borne infections in patients or staff. There was very low-quality evidence of short-term positive changes in process outcomes such as knowledge in sharps injuries and behaviors related to injury prevention.  AUTHORS' CONCLUSIONS: We found low- to very low-quality evidence that education and training interventions may cause small decreases in the incidence of sharps injuries two to twelve months after the intervention. There was very low-quality evidence that educational interventions may improve knowledge and behaviors related to sharps injuries in the short term but we are uncertain of this effect. Future studies should focus on developing valid measures of sharps injuries for reliable monitoring. Developing educational interventions in high-risk settings is another priority.

Have Legislative Interventions Impacted the Incidence of Needlestick Injuries?

Introduction The aim of this study was to examine the impact the EU Directive for the Prevention of Sharps injuries had on the incidence of needlestick injuries (NSI) in Ireland. Methods A five-year retrospective study prior to, and after the introduction of these regulations, was conducted. Secondary data from the Occupational Health Department's annual NSI reports were used. The population studied were healthcare workers who reported a NSI from 2013 to 2017. Results The incidence of NSI varied from 157 in 2017 to 207 in 2014. 'Miscellaneous needles' was the category which caused the most NSI (23%). 'Disposable needles with syringes' accounted for 20% of all NSI before the legislation; this figure was reduced to 12-15% after the regulations were introduced. Conclusion The EU regulations did not reduce the incidence of NSI. A lower incidence of NSI was reported from 'disposable needles with syringes' after the implementation of the regulations.

Guidelines in Practice: Sharps Safety

Perioperative personnel are at risk for sharps injuries when using devices with sharp points and edges and therefore are at risk for infection from exposure to blood and other potentially infectious body fluids. The Occupational Safety and Health Administration bloodborne pathogens standard is the regulatory document that health care employers must follow to protect personnel who are at risk for sharps injuries. The AORN "Guideline for sharps safety" provides guidance to perioperative personnel for identifying sharps hazards and implementing best practices to prevent injuries. This article discusses the guideline recommendations for developing and implementing work practice controls and administrative controls for handling sharps. A scenario describes an interdisciplinary team's efforts to decrease specific sharps injuries and develop policies and procedures based on the identified risks and practice changes. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for sharps safety.

[Requirements and Evaluation of Sharps Injury Prevention Devices]

Accidental sharps injuries are a serious problem in healthcare, many healthcare workers acquire infectious diseases from bloodborne pathogens by sharps injuries during their work. The cost of injury and exposure takes an emotional and financial toll, which has attracted worldwide attention. This paper analyzed the regulatory requirements on sharps injury prevention devices in the United States and the European Union, described the classification and basic requirements of sharps injury prevention devices, evaluation of protective functions, risk identification and control to provide references for regulation and development of such products in our country.

Economic analysis of new workplace technology including productivity and injury: The case of needle-less injection in swine

Increasing intensification in swine production has led to new and specialized technologies, but the occupational health and safety impacts are rarely quantified in the business plans for adoption. Needle-less injection has potential to increase productivity and eliminate needle stick injury in workers, but it is not clear whether these benefits offset high capital investment and potential increases in musculoskeletal loads. This economic evaluation employed probabilistic scenario analysis using injury, cost, and production data gathered from interviews with swine producers in Manitoba and Saskatchewan. After adoption of needle-less injection, rates of needle-stick injury went down with no measureable effect on upper limb musculoskeletal disorders, resulting in lower health and safety costs for needle-less injectors. Needle-less injection duration was 40% faster once workers acclimatized, but large start-up costs mean economic benefits are realized only after the first year. The incremental benefit cost ratio promoted adoption of needle-less injectors over conventional needles for the base case of a 1200 sow barn; the conventional method is beneficial for barns with 600 sows or less. Findings indicate that well-designed technologies have the potential to achieve the dual ergonomics goals of enhancing human wellbeing and system performance. We anticipate that the economic and decision models developed in this study can be applied to other new technologies in agriculture and animal production.

Development and Application of One Separation-Free Safety Tube on the Disposable Infusion Needle

OBJECTIVE

To develop a new type infusion set and apply it to the clinic, as well as explore its effectiveness in the prevention from needle stick injuries.

METHODS

A total of 200 inpatients who were in need of intravenous infusion with a disposable infusion needle were included and randomly divided into two groups: intervention group and control group. Disposable infusion needles with a separation-free safety tube were used in the intervention group, whereas conventional ones were used in the control group. Then, effects of the two types of infusion sets were observed and compared.

RESULTS

As for the operation time for infusion, it was (82.19 ± 1.80) seconds in the intervention group and (83.02 ± 1.83) seconds in the control group, with the difference statistically significant (P < 0.05). Besides, the exposure time of the needles after infusion in the intervention group was (3.36 ± 0.17) seconds while (18.85 ± 1.18) seconds in the control group; the difference between which was statistically significant (P < 0.05). In terms of the time for needle disposal, (18.60 ± 0.84) seconds was required in the intervention group, while for the control group, it took (18.85 ± 1.18) seconds, and the difference between two groups was of statistical significance as well (P < 0.05). Nevertheless, there was no statistically significant difference in the accidental slip rate of the needles as that turned out 0% in both groups (P > 0.05). It was worth noting that the block rate of the disposed needles in the intervention group was 100%.

CONCLUSION

The separation-free safety tube on the disposable infusion needle could instantly block the sharp needle after infusion, which reduces the needle exposure time and lowers the risk of needle stick injuries. In the meantime, the safety tube is convenient to use, and its application can shorten the time for infusion and needle disposal, consequently improving the working efficiency of nurses. As the new type safety tube has above advantages and would not raise the risk of needle slippage, it is worthy of clinical promotion.

Effect of virtual reality training to decreases rates of needle stick/sharp injuries in new-coming medical and nursing interns in Taiwan

PURPOSE

Senior nursing and medical interns' lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needle stick (NSI)/sharp (SI) injuries may harm themselves. Trainees' self-reported NSI/SI rate was known to be especially high during the first two months of internship in Taiwan. This prospective cohort study aimed to know the effect of new developed (virtual reality (VR) game, which uses the Gangne's learning model to improved universal precaution for NSI/SI prevention and decrease the rates of needle stick/sharp injuries in new-coming medical and nursing interns in Taiwan. .

METHODS

From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational NSI/SI prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors.

RESULTS

In comparison with medical interns, a higher proportion of nursing interns have had the past experiences of deep occupational NSI/SI. Before VR training, the familiarity and confidence for NSI/SI prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep NSI/SI exhibited better performance on the accuracy rate and time need for complete 20 decisions than those without past experiences in VR practice. The performances of all trainees were improved after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about NSI/SI prevention.

CONCLUSION

This self-developed VR game system using Gangne's flow improved universal precaution for NSI/SI prevention and reduced the NSI/SI rates in the first two months of nursing and medical internship.

Needlestick prevention devices: data from hospital surveillance in Piedmont, Italy-comprehensive analysis on needlestick injuries between healthcare workers after the introduction of safety devices

OBJECTIVE

Needlestick and sharps injuries (NSIs) involving healthcare workers (HCWs) are worldwide under surveillance since long time; the implementation of the European Directive 32/2010 regarding the mandatory use of safety-engineered devices (SEDs) seems to have reduced the number of these accidents. Our surveillance investigated the frequency and the modality of SED-related NSIs in the Piedmont region to verify changes in the epidemiology of these events.

METHODS

We analysed the exposure records of NSIs, device usage data and structural data of 42 acute care hospitals and compared conventional and safety devices. We calculated the accident rates per 100 000 needles and, as a measure of SED efficacy, the relative risk between the use of safety and non-safety devices with a 95% CI. We also described the dynamics of the NSIs and the most involved professional groups of HCWs, procedures and devices.

RESULTS

Total and specific device accident rates for 100 000 needles were lower with the use of SEDs. In 2015-2016, there were 1640 NSIs, with a decreasing absolute number during the observation period; 18% were SEDs related. Half of the total accidents with SEDs occurred in the patient's room, and nurses were involved in 78% of the cases. The most involved devices were the butterfly needles and peripheral venous catheters, and the most involved procedures were venous sampling (40%) and phlebotherapy (16%). The exposures occurred mostly during the procedure, and 45% of the SED-related injuries occurred during the disposal of the device; 92% of the SEDs involved had a manual activation mechanism.

CONCLUSION

In agreement with the results of other European studies, our results show that SEDs reduce the risk of percutaneous exposure of HCWs, but in introducing SEDs, we must select those with a higher level of safety (with a passive activation mechanism) and improve the healthcare staff training programmes.

Safety and Communication in the Operating Room: A Safety Questionnaire After the Implementation of a Blood-Borne Pathogen Exposure Checkpoint in the Surgical Safety Checklist Preprocedure Time-Out

INTRODUCTION

The Surgical Safety Checklist (SSC) decreases patient morbidity and mortality and improves operating room (OR) communication. However, the SSC does not currently include any discussion on employee safety. One institution has implemented a blood-borne pathogen exposure (BBPE) checkpoint in the SSC in order to improve employee safety and to further improve communication. The aim of this study was to determine if the implementation of a BBPE checkpoint improved caregiver safety and communication in the OR.

METHODS

This was a multidisciplinary prospective survey study in which an anonymous questionnaire was distributed to all OR personnel who handle sharps. Survey responses were analyzed for demographics and BBPE safety attitudes. The frequency of reported BBPE incidents collected from quality improvement data 12 months before and after the implementation of the BBPE checkpoint were reviewed.

RESULTS

Caregivers feel safer in the OR with the BBPE checkpoint (p < 0.001). Communication was improved. Compliance in trauma surgeries was less than elective. Reported BBPE incidents were significantly decreased based on quality improvement data (p = 0.045).

CONCLUSION

The BBPE checkpoint was implemented in the SSC at one institution in order to emphasize employee safety and improve communication. The results shed light on the attitudes of OR personnel by suggesting an improvement in safety and communication. In addition, there has been decrease of reported BBPE incidents among OR personnel. Universal implementation of a BBPE checkpoint could improve provider safety and communication in all ORs.

Interactive Versus Video-Based Training of Police to Communicate Syringe Legality to People Who Inject Drugs: The SHIELD Study, Mexico, 2015-2016

Objectives. To assess how instructional techniques affect officers' intent to communicate syringe legality during searches in Tijuana, Mexico, where pervasive syringe confiscation potentiates risk of HIV and HCV among people who inject drugs (PWID) and of occupational needle-stick injury among police. Methods. Using the SHIELD (Safety and Health Integration in the Enforcement of Laws on Drugs) model, Tijuana police underwent training to encourage communication of syringe possession legality to PWID. Trainees received either passive video or interactive role-play exercise on safer search techniques. We used logistic regression to assess the training's impact on self-reported intent to communicate syringe legality by training type and gender. Results. Officers (n = 1749) were mostly men (86%) assigned to patrol (84%). After the training, intent to communicate the law improved markedly: from 20% to 39% (video group) and 20% to 58% (interactive group). Gender and training type significantly predicted intent to communicate syringe legality. Male and female officers' adjusted odds ratios in the interactive group were 5.37 (95% confidence interval [CI] = 4.56, 6.33) and 9.16 (95% CI = 5.88, 14.28), respectively, after the training. Conclusions. To more effectively persuade police to endorse harm reduction and occupational safety practices, police trainings should include interactive elements.

Behaviors and Attitudes of Polish Health Care Workers with Respect to the Hazards from Blood-Borne Pathogens: A Questionnaire-Based Study

Blood-borne infections represent an important occupational health issue in health care settings. The aim of this study was to analyze behaviors of health care workers (HCWs) in the field of needlestick injuries (NSIs) as well as to learn about their attitudes to patients infected with blood-borne viruses. A total of 487 HCWs based at 26 hospitals in Poland completed an anonymous self-administered questionnaire in the period of October⁻December 2015. Data was analyzed using descriptive statistics and multiple logistic regression. Of the HCWs, 44.8% suffered superficial wounds, and 17.9% HCWs were cut deeply at least once. The most frequent causes of injuries were: rush (31.4%), unpredictable patient behavior (29%), and lack of attention (27%). The rate of underreporting NSIs was 45.2%. Males showed more than three times higher chance of not reporting injuries (odds ratio (OR) 3.495, 95% Confidence Interval (CI): 1.65⁻7.49). The nurses more often took off their protective gloves to make the procedure easier (p = 0.036). Taking off protective clothes was positively associated with long work experience (OR 1.16, 95% CI: 0.995⁻1.36). Recapping concerned 15.5% of doctors, 8.2% of nurses, and 11.2% of paramedics. 25.9% HCWs feared infection in the workplace, and every tenth HCW refused to help the infected patient. The longer the work experience, the greater the concern about the possibility of infection (OR 1.33, 95% CI: 0.99⁻1.78). Most HCWs were more cautious when dealing with an infected patient and in their opinion infected patients should be required to inform HCWs of their serological status and such information should be compulsorily transferred between different health institutions. The emphasis in the training of HCWs in the future should be on classes perfecting practical skills like paying more attention to reporting NSIs, improving occupational behaviors like avoiding needle recapping, and on the development of appropriate attitudes towards patients infected with HIV, HBV, or HCV.

Practice pattern of cataract surgeons when operating on seropositive patients

Purpose

The aim of this study is to know practice pattern of cataract surgeons when operating on patients, positive for blood-borne viral infections (BBVIs), namely, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. We also studied their awareness, knowledge, and attitude toward universal precautions and guidelines.

Methods

The telephonic survey enrolled practicing cataract surgeons, who were interviewed to record responses pertaining to their practice using an open-ended questionnaire. We studied statistical significance of difference of frequency of prick injuries in topical versus peribulbar anesthesia, and phacoemulsification versus manual small incision cataract surgery by employing Chi-square test. Significance of proportion was calculated using z-test. For all statistical calculations, significance level was set at 0.05%.

Results

Of 623 ophthalmologists contacted, responses of 479 (79%) ophthalmologists were analyzed. Maximum participants were in private practice (48%). During whole practicing carrier, 313 (65%; 95% confidence interval [CI]: 61-70) participants admitted having suffered injury with needle or sharp instruments; of these, 204 (65%; 95% CI: 60-70) participants did not report their injury. Wearing "double gloves" during cataract surgery was the most common barrier adopted by participants.

Conclusion

We found high prevalence of occupational-related sharp injuries among ophthalmologists in this survey. Majority of them were aware of universal precautions, but adherence to postexposure prophylaxis was lacking.

Police attitudes towards pre-booking diversion in Baltimore, Maryland

BACKGROUND

In the context of high rates of drug-related incarceration that disproportionately affect urban communities of colour, advocates for drug policy criminal justice reform have called for alternatives to mass incarceration. The Law Enforcement Assisted Diversion (LEAD) program redirects low-level drug offenders to health and social services rather than immediately into the criminal justice system. In advance of piloting LEAD in Baltimore City, we assessed police perceptions towards harm reduction and specifically pre-booking diversion in effort to inform training and implementation activities in Baltimore City and elsewhere.

METHODS

We administered a survey to Baltimore City Police Officers (N = 83) in the planned implementation district using two scales: the first measured police attitudes toward people who use drugs (PWUD), current drug policies and public health measures, and the second measured police perceptions of pre-booking diversion programs. We calculated Cronbach's alpha (α) to assess internal consistency of both scales. Bivariate χ2 tests and multivariate logistic regression examined correlates of scale items stratified by new and seasoned officers.

RESULTS

Seasoned officers were significantly less likely to believe that drug treatment is easily available (51% vs. 81%, p = 0.005). The belief that current policies are effective and that PWUD should be arrested for small drug purchases decreased significantly per year on the force (aOR: 0.92; 95%CI 0.85,0.99; aOR: 0.94, 95% CI 0.88, 0.99, respectively), as did concerns about needle-stick injuries (aOR: 0.85, 95% CI 0.74, 0.98). Seasoned officers were significantly more comfortable referring PWUD to social services (100% vs. 83%, p = 0.006), and agree that such pre-booking diversion could be effective in improving public safety within (72% vs. 43%; p = 0.009) and beyond the intervention area (56% vs. 33%, p = 0.04).

CONCLUSIONS

The study indicates the value of intervening early and consistently throughout police career trajectories and engaging seasoned officers as allies to promote recognition and support of public health and harm reduction strategies within ongoing police reform efforts. LEAD provides important and broad opportunities for training police to enhance their understanding the intersection of public safety and public health.

A microbiological study to investigate the carriage and transmission-potential of Clostridium difficile spores on single-use and reusable sharps containers

BACKGROUND

A 2015 study matching use of disposable and reusable sharps containers (DSCs, RSCs) with Clostridium difficile infection (CDI) incidence found a decreased incidence with DSCs. We conducted microbiologic samplings and examined the literature and disease-transmission principles to evaluate the scientific feasibility of such an association.

METHODS

(i) 197 RSCs were sampled for C. difficile at processing facilities; (ii) RSCs were challenged with high C. difficile densities to evaluate efficacy of automated decontamination; and (iii) 50 RSCs and 50 DSCs were sampled in CDI patient rooms in 7 hospitals. Results were coupled with epidemiologic studies, clinical requirements, and chain-of-infection principles, and tests of evidence of disease transmission were applied.

RESULTS

C. difficile spores were found on 9 of 197 (4.6%) RSCs prior to processing. Processing completely removed C. difficile. In CDI patient rooms, 4 of 50 RSCs (8.0%) and 8 of 50 DSCs (16.0%) had sub-infective counts of C. difficile (P = .27). DSCs were in permanent wall cabinets; RSCs were removed and decontaminated frequently.

CONCLUSION

With C. difficile bioburden being sub-infective on both DSCs and RSCs, sharps containers being no-touch, and glove removal required after sharps disposal, we found 2 links in the chain of infection to be broken and 5 of 7 tests of evidence to be unmet. We conclude that sharps containers pose no risk of C. difficile transmission.

Predicting needlestick and sharps injuries and determining preventive strategies using a Bayesian network approach in Tehran, Iran

OBJECTIVES

Recent studies have shown that the rate of needlestick and sharps injuries (NSIs) is unacceptably high in Iranian hospitals. The aim of the present study was to use a systematic approach to predict and reduce these injuries.

METHODS

This cross-sectional study was conducted in 5 hospitals in Tehran, Iran. Eleven variables thought to affect NSIs were categorized based on the Human Factors Analysis and Classification System (HFACS) framework and modeled using a Bayesian network. A self-administered validated questionnaire was used to collect the required data. In total, 343 cases were used to train the model and 50 cases were used to test the model. Model performance was assessed using various indices. Finally, using predictive reasoning, several intervention strategies for reducing NSIs were recommended.

RESULTS

The Bayesian network HFACS model was able to predict 86% of new cases correctly. The analyses showed that safety motivation and fatigue were the most important contributors to NSIs. Supervisors' attitude toward safety and working hours per week were the most important factors in the unsafe supervision category. Management commitment and staffing were the most important organizational-level factors affecting NSIs. Finally, promising intervention strategies for reducing NSIs were identified and discussed.

CONCLUSIONS

To reduce NSIs, both management commitment and sufficient staffing are necessary. Supervisors should encourage nurses to engage in safe behavior. Excessive working hours result in fatigue and increase the risk of NSIs.

Unreported Sharps Exposures in Orthopedic Surgery Residents A Silent Majority

Sharps-related injuries represent a significant occupational hazard to orthopedic surgeons. Despite increased attention and targeted interventions, evidence suggests that the majority of incidents continue to go unreported. The purpose of this study was to examine the incidence, attitudes, and factors that affect the reporting of sharps injuries among orthopedic surgery residents at a large academic teaching hospital in an effort to increase reporting rates and design effective interventions. This study administered an anonymous cross-sectional survey regarding intraoperative sharps exposures to current orthopedic house staff, with an 87% (54/62) response rate. Overall, 76% of surveyed residents (41/54) had at least one sharps exposure during residency. The majority of these incidents (55%) were never reported. The most common reason cited for not reporting was a "perception of low risk." Residents whose exposures were witnessed by others on the surgical team were more likely to report the incident (57% vs. 23%, p = 0.043), suggesting that peer pressure acts to improve reporting rates. While the implementation of a "needlestick hotline" and increased education has led to improved reporting rates at our institution, further improvements aimed at reducing unwitnessed incidents, and therefore unreported incidents, could comprise an increased emphasis on surgical team vigilance, positive peer pressure, the incorporation of sharps-specific surgical debriefing statements and anonymous tip lines.