Costs of management of occupational exposures to blood and body fluids.

OBJECTIVE: To determine the cost of management of occupational exposures to blood and body fluids. DESIGN: A convenience sample of 4 healthcare facilities provided information on the cost of management of occupational exposures that varied in type, severity, and exposure source infection status. Detailed information was collected on time spent reporting, managing, and following up the exposures; salaries (including benefits) for representative staff who sustained and who managed exposures; and costs (not charges) for laboratory testing of exposure sources and exposed healthcare personnel, as well as any postexposure prophylaxis taken by the exposed personnel. Resources used were stratified by the phase of exposure management: exposure reporting, initial management, and follow-up. Data for 31 exposure scenarios were analyzed. Costs were given in 2003 US dollars. SETTING: The 4 facilities providing data were a 600-bed public hospital, a 244-bed Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a 3,500-bed healthcare system. RESULTS: The overall range of costs to manage reported exposures was $71-$4,838. Mean total costs varied greatly by the infection status of the source patient. The overall mean cost for exposures to human immunodeficiency virus (HIV)-infected source patients (n=19, including those coinfected with hepatitis B or C virus) was $2,456 (range, $907-$4,838), whereas the overall mean cost for exposures to source patients with unknown or negative infection status (n=8) was $376 (range, $71-$860). Lastly, the overall mean cost of management of reported exposures for source patients infected with hepatitis C virus (n=4) was $650 (range, $186-$856). CONCLUSIONS: Management of occupational exposures to blood and body fluids is costly; the best way to avoid these costs is by prevention of exposures.

Public attitudes and opinions toward physicians and dentists infected with bloodborne viruses: results of a national survey.

BACKGROUND: There has been no recent assessment of public attitudes and opinions concerning risk of bloodborne virus transmission during health care. METHODS: Seven items in the 2000 annual Healthstyles survey were used to assess current attitudes and opinions about health care providers infected with human immunodeficiency virus (HIV) and the risk of bloodborne virus transmission during health care in a sample of approximately 3000 US households. RESULTS: Of the 2353 respondents, 89% agreed that they want to know whether their doctor or dentist is infected with HIV; 82% agreed that disclosure of HBV or HCV infection in a provider should be mandatory. However, 47% did not believe that HIV-infected doctors were more likely to infect patients than doctors infected with HBV or HCV. Opinions were divided on whether HIV-infected providers should be able to care for patients as long as they use good infection control: only 38% thought that infected providers should be allowed to provide patient care. CONCLUSIONS: These findings suggest that improved public education and risk communication on health care-associated bloodborne infections is needed.

Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.

OBJECTIVE: To help facilities prepare for potential future cases of severe acute respiratory syndrome (SARS). DESIGN AND PARTICIPANTS: The Centers for Disease Control and Prevention (CDC), assisted by members of professional societies representing public health, healthcare workers, and healthcare administrators, developed guidance to help facilities both prepare for and respond to cases of SARS. INTERVENTIONS: The recommendations in the CDC document were based on some of the important lessons learned in healthcare settings around the world during the SARS outbreak of 2003, including that (1) a SARS outbreak requires a coordinated and dynamic response by multiple groups; (2) unrecognized cases of SARS-associated coronavirus are a significant source of transmission; (3) restricting access to the healthcare facility can minimize transmission; (4) airborne infection isolation is recommended, but facilities and equipment may not be available; and (5) staffing needs and support will pose a significant challenge. CONCLUSIONS: Healthcare facilities were at the center of the SARS outbreak of 2003 and played a key role in controlling the epidemic. Recommendations in the CDC's SARS preparedness and response guidance for healthcare facilities will help facilities prepare for possible future outbreaks of SARS.

Nurse staffing and health care-associated infections: Proceedings from a working group meeting.

The nation is facing a nursing shortage that is creating a crisis for quality health care and patient safety. Research has documented that problems with nurse staffing are associated with health care-associated infections and other adverse events that affect patient outcomes. These ominous facts, stated during the opening of an expert consultants meeting convened by the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, laid the foundation for a day-long discussion and a call to action to address a growing crisis in health care. The authors summarize the proceedings of this meeting and present the consultants' suggestions for drawing national attention to this issue.

Evaluation of institutional practices for prevention of phlebotomy-associated percutaneous injuries in hospital settings.

BACKGROUND: To reduce the incidence of phlebotomy-related percutaneous injuries (PIs), factors that contribute to these injuries must be identified. This study examined institutional phlebotomy practices, policies, perceptions, and culture to identify facilitators and barriers that appear to have the greatest impact in preventing injuries. METHODS: During site visits at study hospitals, observational data were collected during the performance of phlebotomy. In addition, interviews and focus groups were conducted with hospital personnel involved in phlebotomy procedures. RESULTS: Nine hospitals participated in the study. A total of 126 phlebotomy procedures were observed. Health care personnel chose devices with safety features for the majority of observed procedures (n = 122, 97%). Recommended phlebotomy practices for handling needles after use were observed in 42% to 92% of procedures. Adherence varied by type of device, occupation, and facility PI rate. In the 23 interviews and 9 focus groups, participants identified factors that facilitated PI prevention such as the availability and use of devices with safety mechanisms, adherence to recommended safe needle-handling practices, and institutional phlebotomy training. CONCLUSION: The quantitative and qualitative data indicate that a wide array of factors can affect phlebotomy-related practices and perceptions. Prevention of PIs may require comprehensive, multifaceted intervention efforts to improve the safety culture and reduce PIs and exposure to bloodborne pathogens in health care facilities.

Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections.

OBJECTIVE: To draw up evidence-based guidelines to make injections safer. METHODS: A development group summarized evidence-based best practices for preventing injection-associated infections in resource-limited settings. The development process included a breakdown of the WHO reference definition of a safe injection into a list of potentially critical steps, a review of the literature for each of these steps, the formulation of best practices, and the submission of the draft document to peer review. FINDINGS: Eliminating unnecessary injections is the highest priority in preventing injection-associated infections. However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the prevention of access to used needles. CONCLUSION: The availability of best infection control practices for intradermal, subcutaneous, and intramuscular injections will provide a reference for global efforts to achieve the goal of safe and appropriate use of injections. WHO will revise the best practices five years after initial development, i.e. in 2005.

Nurse staffing and healthcare-associated infections: proceedings from a working group meeting.

The nation is facing a nursing shortage that is creating a crisis for quality healthcare and patient safety. Research has documented that problems with nurse staffing are associated with healthcare-associated infections and other adverse events that affect patient outcomes. These ominous facts, stated during the opening of an expert consultants meeting convened by the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, laid the foundation for a day-long discussion and a call to action to address a growing crisis in healthcare. The authors summarize the proceedings of this meeting and present the consultants' suggestions for drawing national attention to this issue.