Occupational vaccination of health care workers: uptake, attitudes and potential solutions.

OBJECTIVES: Occupational vaccination of health care workers is strongly recommended to prevent health care associated transmission but coverage in general remains suboptimal. The aim of this survey was to: 1. Estimate levels vaccination coverage for annual flu and MMR vaccines among hospital-based health care workers; 2. Explore the reasons behind low vaccination rates; and 3. Identify potential practical and policy solutions. STUDY DESIGN: A cross-sectional study. METHODS: An opportunistic survey was used to estimate MMR and flu vaccination coverage, and review attitudes and explore solutions. Staff from eight randomly selected wards, stratified by ward-level patient susceptibility, were invited to participate. RESULTS: In total 133 staff responded, an approximate response rate of 68%. Seventy one percent had ever received an MMR and 42% had received the most recent flu vaccination. Actively declining vaccination was more common for flu than MMR (29% and 7% respectively). Side-effects, insufficient knowledge and vaccine ineffectiveness were popular justifications for declining flu vaccination but not MMR. Not seeing vaccination as a professional responsibility was associated with declining flu vaccination (P < 0.001). Improving vaccination coverage with booster vaccines for new staff and immunity testing received strong support from staff working with vulnerable groups (82% and 74% respectively); 70% of this staff group also supported compulsory vaccination. CONCLUSIONS: Improving staff education may increase coverage. Clarification of the benefits of vaccination in specific staff groups may also improve uptake. Routine booster vaccinations and immunity testing were generally acceptable and compulsory vaccination of certain staff groups warrants further investigation.

Needlestick fluid transmission through surgical gloves of the same thickness.

BACKGROUND: Using two gloves during surgical procedures is more protective than one in relation to percutaneous needle injuries, but it remains unclear whether the use of two thin-walled gloves is equally as protective as a single thicker-walled glove. AIMS: To compare the volume of contaminant transmitted from fluid-coated solid cutting suture needles through the same thickness of the same glove material made up of differing numbers of layers during simulated needlestick injuries. METHODS: A colorimetric enzyme assay was used to determine the volume of fluid transferred through identical glove materials in mechanized simulated needlestick injuries. The needles were mechanically transferred through varying glove layers [zero (control), one and two] where the cumulative thickness of the double layer was equal to the single thicker layer. The force required to puncture the test mater ials was also recorded. RESULTS: In simulated 'needlestick' injury experiments, significantly less fluid was transmitted through the double, thin glove layer compared with the single thick layer (P < 0.05). The double, thin glove layer transmitted 16% of needle fluid compared with 21% for the single thicker glove layer. Significantly more force was required to puncture the double layer compared with the single thicker layer (P < 0.05), but for any individual puncture there was no association between the puncture force and the volume of fluid transmitted. CONCLUSIONS: A double layer of glove material was more resistant to puncture and removed more enzyme contaminant from a solid cutting suture needle compared with an equivalent single thick layer of glove material.

Comparison of blood transmission through latex and nitrile glove materials.

AIMS: To compare blood transmission through nitrile, single and double layer latex glove materials in simulated needlestick injuries. METHODS: Experiments involved nitrile, single and double layer latex gloves. A cutting suture needle was dipped into a specimen of blood and then immediately jabbed through the glove material into a cell containing saline. This process was repeated using the same blood specimen with different glove materials, plus a control experiment with no glove material. Other factors, including the angle, speed and depth of needle penetration, were controlled through the use of a testing machine. Following needle punctures, samples were taken from the suspension contained in each cell and examined under blind conditions. Median red blood cell (RBC) count was used as a measure of the quantities of blood transmitted through the different gloves. RESULTS: Nitrile glove material was associated with reduced transmission of RBCs compared to single layer latex. Double layer latex gloves provided better protection than single layer latex or nitrile gloves. CONCLUSIONS: These findings suggest that in protecting against blood transmission in the context of needlestick injuries, single layer nitrile gloves are superior to single layer latex gloves, but double gloving with latex gloves provides better protection than either single layer latex or nitrile.

Portable peak flow meters: physical characteristics, influence of temperature, altitude, and humidity.

Little is known about the linearity of portable peak flow meters, or about physical gas factors affecting peak expiratory flow (PEF) readings. We therefore tested five portable peak flow meters of three types in an altitude chamber (sea level to 5,500 m) and in a climate chamber at sea level (7-37 degrees C) to determine the influence of the physical conditions of the gas on the reading of the meters. The nonlinear response of the variable orifice meters was confirmed and, when this was corrected for, the readings of these meters were found to be significantly reduced by higher altitude and lower temperature. The readings from a turbine type of peak flow meter were not affected by altitude but were reduced at low temperature. A mathematical model for the variable orifice meters could correct for both their nonlinear behaviour and the effect of gas density (altitude, temperature and humidity). The model showed that correction is not necessary for the differences in gas conditions between calibration and taking of measurements under normal laboratory conditions. All the meters tested had impedances higher than recommended (0.05 kPa.l-1.s) and this may influence PEF at high flows. The mean uncorrected PEF of six healthy subjects when measured with a Mini Wright peak flow meter at sea level and at 3,000 m fell by 5%, but the mean corrected PEF increased by 12%. This increase in PEF was about 60% of that predicted for fully density-dependent flow and agreed with the findings of other similar studies.(ABSTRACT TRUNCATED AT 250 WORDS)