Systematic Review of Blood-Borne Pathogen Exposure Rates Among Medical Students.

BACKGROUND: Blood-borne pathogen exposures (BBPEs) pose a risk to health care workers (HCWs). Needlestick injuries (NSIs) have declined overall, but not for surgical HCWs. There are limited data regarding BBPEs among medical students (MSs) in their clinical years. We aimed to quantify this risk for third- and fourth-year MSs. METHODS: A literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PUBMED database was searched to identify studies of third- and fourth-year MSs using the terms BBPE, NSI, and MS. Studies of other HCWs were excluded if MS data were not extractable. Additional studies were identified from references. Descriptive analysis was performed. RESULTS: Seven of 171 articles published from 2002 to 2018 met study criteria. All used self-reported data from surveys/questionnaires. One-third of MSs reported BBPEs (n = 194/600, 32.3%) with a mean of 1 in 3.09 and a median of 1 in 3.53 (range: 1 in 1.9-8.3 students). Most events were NSIs (144/194, 74%) with a mean of 1 NSI per 4.05 MSs and median of 1 in 4.625 (range: 1 in 2.47-10.71). The remaining BBPEs reported included blood and bodily fluid splashes (n = 37, 19%), other mucocutaneous exposures (n = 7, 3.6%), and uncategorized injuries (n = 2, 1%). CONCLUSIONS: One-third of senior MSs reported BBPEs during clinical rotations. Most BBPEs were NSIs. Quantifying this risk allows for anticipatory education and protocol development to protect students and other new HCWs. Educational efforts focused on NSI prevention before and during clinical rotations may help reduce BBPEs.

Pseudomonas aeruginosa endophthalmitis caused by accidental iatrogenic ocular injury with a hypodermic needle.

Iatrogenic traumatic endophthalmitis is a rare but serious ocular infection that can lead to severe vision loss. A 44-year-old man presented with pain and decreased vision in the right eye 4 hours after injury with a hypodermic needle during irrigation of his eye. Slit-lamp examination revealed a penetrating corneal puncture and iris hole in the right eye. Twenty hours later, his visual acuity had decreased to hand motion, and severe fibrinoid uveitis was noted. He immediately underwent irrigation of the anterior chamber and intravitreal antibiotic injection. The right eye became painful again, and emergent vitrectomy combined with lensectomy was performed along with intravitreal antibiotic administration. The patient remained stable during the 2-month follow-up. Standard practice should be adopted when irrigating the eye to prevent this type of injury, and emergent surgical intervention is very important to preserve visual function.

Knowledge, attitude and practice of dentists towards prophylaxis after exposure to blood and body fluids.

BACKGROUND: Post-exposure prophylaxis plays an important role in prevention of bloodborne diseases after occupational exposures. OBJECTIVE: To evaluate the knowledge, attitude and practice of dentists towards post-exposure prophylaxis. METHODS: In a cross-sectional study, 140 dentists in Shiraz were selected through a systematic randomized sampling. They filled out a self-made questionnaire including 30 knowledge, 4 attitude and 10 practice questions. Mean of knowledge and percentage of various items of attitude and practice were reported. RESULTS: The mean±SD knowledge score of dentists was 18.5±6.2. Knowledge had a significant relationship with the level of education (p<0.001), attending infection control seminars (p<0.001), and working in public clinics (p<0.001). A total of 63 (43%) dentists believed that immediate washing of the exposed area has no effect on the prevention of hepatitis and AIDS. Of the studied dentists, 13%, 11%, and 34% believed that prophylaxis after exposure to patients' blood had no effect on prevention of human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus infections, respectively. Only 170 (53%) exposed dentists immediately washed the exposed area and only 43 (13.4%) of them evaluated the source patient for risk factors of hepatitis and AIDS. CONCLUSION: Knowledge, attitude and practice of dentists working in Shiraz towards postexposure prophylaxis are not desirable. Interventions to raise their awareness are therefore warranted.

Injection safety among primary health care workers in Jazan Region, Saudi Arabia.

BACKGROUND: Occupational exposure to percutaneous injuries is a substantial source of infections with blood-borne pathogens among health-care workers. Few studies evaluated injection safety practices in Saudi Arabia. OBJECTIVE: To examine the structure and process of injection safety at primary health care level in Jazan health district, to evaluate knowledge, attitudes, and practices of primary health care physicians and nurses towards injection safety, and to determine the incidence of needle stick injuries among health care workers in Jazan region, Saudi Arabia. METHODS: A cross-sectional study was conducted in Jazan primary health care centers (PHCCs), Saudi Arabia from September 2011 to March 2012. Data were collected using an observational checklist and data collection sheet. Jazan city health district was chosen at random from the 14 health sectors in Jazan region. All the 33 (10 urban, and 23 rural) PHCCs of Jazan city were included in this study to get the predetermined sample size of health care workers. 200 health care workers (HCWs) were recruited (29% physicians, and 71% nurses). RESULTS: Syringes in the PHCCs were disposable (100%), individually packed (92%), and available at all volumes (98%). Methods of safe disposal of needles and sharps were also operated through contracting with professional companies in 84.8% of instances. Urban PHCCs had more posts for injection safety promotion than rural centers (p=0.02). Continuous Medical Education (CME) programs on infection control were present in only 60% of PHCCs. At least 95% of HCWs in Jazan believed that sharp objects should be kept in a puncture-proof container, kept in a closed container, or disposed by a professional company. More than 80% of HCWs washed their hands by soap and water and cleaned them by alcohol before giving injection, and also got the three doses of hepatitis B vaccine.The rate of needle stick injury in the past year was 14%, without a significant difference between nurses and physicians (p=0.8). CONCLUSION: Jazan PHCCs have reasonable facilities that prevent needle-stick injuries. We need to design and implement more educational programs on safety injection, and increase promotion of safety injection posters, especially in rural PHCCs.

Needles and the damage done: reasons for admission and financial costs associated with injecting drug use in a Central London Teaching Hospital.

OBJECTIVES: To establish the clinical reasons for inpatient admissions among injecting drug users. To determine the frequency of behavioural issues during their care and to estimate the financial implications of injecting drug use to the health service. METHODS: Retrospective cohort study at University College London Hospital. Clinical, laboratory and financial data were extracted from case notes and electronic records. The cost of each admission was compared to the income received for the period of care. RESULTS: 124 injecting drug users required 191 admissions between 2005 and 2009. Skin and soft tissue infections (58%) and pneumonia (18%) were the commonest reasons for admission. Bacteraemia at admission was often not accompanied by an inflammatory response. Exposure to HIV (4%), hepatitis B (49%) and C (84%) was common. Drug misuse (16%) during admission was frequent. The cost to the NHS of treating soft tissue infections in drug users was approximately £77 million per annum. After a median follow-up of 40 months, 10 patients (8%) had died. All deaths were attributable to drug use. CONCLUSIONS: Bacterial and viral infections are largely responsible for the significant mortality and morbidity of injecting drug users presenting to secondary care. The financial burden to the NHS is substantial.

Incidence and severity of Arcanobacterium pyogenes injection site abscesses with needle or needle-free injection.

Nursery-age pigs (n=198) were used to evaluate the difference in abscess formation at needle-free jet and conventional needle-and-syringe injection sites. Needle-free jet injection was used to administer injections in the neck and ham on one side of the animal whereas needle-and-syringe was used for neck and ham injections on the opposite side. Immediately prior to injection, the injection site surfaces were contaminated with an inoculum of Arcanobacterium pyogenes. Each pig was humanely euthanized 27 or 28 days after injections. Histopathological results showed that needle-free jet injection was associated with more abscesses than needle-and-syringe injection at both neck (P=0.0625) and ham (P=0.0313) injection sites. Out of 792 injection sites, only 13 abscesses were observed, with 12 of those present at needle-free jet injection sites. Needle-free jet injection may increase the occurrence of injection site abscesses that necessitate carcass trimming at pork processing plants.

Unknown fever and back pain caused by Bartonella henselae in a veterinarian after a needle puncture: a case report and literature review.

Bartonella henselae, the etiologic agent of cat-scratch disease, rarely causes back pain and is considered to be transmitted through animal scratches and bites. Here we report a cat-scratch disease case possibly with an unusual route of transmission. The patient was a 32-year-old man, and he was working as a veterinarian in a private veterinary clinic. He sought for clinical help because of unknown fever and persistent back pain for at least a month after an accidental needle puncture. Through serological testing and molecular identifications, this clinical case was confirmed to be caused by B. henselae.

Primary inoculation skin tuberculosis by accidental needle stick.

A 42-year-old female laboratory worker presented with a left index finger skin lesion after an accidental prick while handling samples of a cultural exam of Mycobacterium tuberculosis. Surgical excision was performed and pathology analysis revealed a dermic chronic inflammatory process with no granulomas. Later, a non-painful lymphadenopathy appeared in the left axilla as well as brownish indurated skin lesions in the lower limbs consistent with erythema nodosum. Fine needle aspiration biopsy of the lymph node revealed epithelioid granulomas, Langhans' multinucleated giant cells and the presence of acid-fast bacilli. Standard tuberculosis treatment resulted in regression of lesions and no relapses occurred in the 2-year follow-up period.

Blood and body fluid exposures among US medical students in Botswana.

INTRODUCTION: Medical students from resource-rich countries who rotate in resource-limited settings have little pre-departure experience performing procedures, and lack familiarity with local equipment. The risk of blood and body fluid exposures during such rotations is significant. AIM: 1) Determine whether a simulation-based intervention reduced exposures among US medical students on a rotation in Botswana; 2) determine whether exposures were underreported; 3) describe exposures and provision of human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP). SETTING: University of Pennsylvania medical students who traveled to Botswana for a clinical rotation from July 2007 to February 2010 were eligible to participate. PROGRAM DESCRIPTION: Twenty-two students participated in the simulation-based intervention. PROGRAM EVALUATION: To evaluate the intervention, we used a pre/post quasi-experimental design and administered a retrospective survey. The response rate was 81.7% (67/82). Needlesticks were eliminated [8/48 (16.7%) to 0/19 (0.0%), p = 0.07]. Splashes were unchanged (6/48 [12.5%) to 3/19 (15.8%), p=>0.99]. Three students did not report their exposure. Fifteen exposures were reported to an attending, who counseled the student regarding HIV PEP. Three students did not take PEP because the exposure was low-risk. DISCUSSION: Our intervention was associated with a decrease in needlestick exposures. Medical schools should consider training to reduce exposures abroad.

[A rare case of tubercular tenosynovitis in hospital surgeon as a result of an occupational accident caused by puncture with an infected needle. Prevention aspects and legal-medical evaluation]. / Un raro caso di tenosinovite tubercolare in operatore sanitario a seguito di incidente occupazionale per puntura da ago cavo infetto. Aspetti di prevenzione e valutazione medico legale.

BACKGROUND: The subject was a hospital surgeon who, in the course of routine outpatient surgery with aspiration to collect right lumbar material in a patient with suspected TB infection, accidentally punctured the fifth finger of the left hand with the needle used for this procedure. This led to involvement of the fifth finger of the left hand restricted to the soft tissue with preservation of joint and bone and tenosynovial involvement of the entire extremity. OBJECTIVES: To draw attention to the repercussions for insurance with resulting absence from work for 126 days and an assessment of biological impairment of 2% by the Insurance Institute (INAIL). METHODS: A case report is described of rare occupational tubercular synovitis. CONCLUSIONS: A rare event is reported that occurred in a senior staff member with particular insurance repercussions.

[Management of needlestick injuries for healthcare workers in hospitals].

The needlestick injury (NSI) has been one of the major issues in the protection of the healthcare workers from the occupationally related blood borne pathogen infection, and vigorous preventive action has been practiced worldwide. In the United Sates, its preventive practices have been proposed nationwide by Centers for Disease Control and Prevention (CDC) providing the guidelines since mid-1980s when HBV and especially HIV infections were reported amomg healthcare workers. The hospitals were required to prepare the hard system to discard the blood contaminated sharp instruments and needles and to keep the official records of related injuries. It has been well recognized in Japan that we are facing a large numbers of NSIs, and the occupational infection from bloodborne pathogens is one of the serious problems in medical care.

Potential work-related exposures to bloodborne pathogens by industry and occupation in the United States Part II: A telephone interview study.

BACKGROUND: The companion surveillance portion of this study [Chen and Jenkins, 2007] reported the frequency and rate of potential work-related exposures to bloodborne pathogens (BBP) treated in emergency departments (EDs) by industry and occupation, but it lacks details on the circumstances of the exposure and other relevant issues such as BBP safety training, use of personal protective equipment (PPE) or safety needles, or reasons for seeking treatment in a hospital ED. METHODS: Telephone interviews were conducted with workers who had been treated in EDs for potential work-related exposures to BBP in 2000-2002. Respondents were drawn from the National Electronic Injury Surveillance System. RESULTS: Of the 593 interviews, 382 were from hospitals, 51 were from emergency medical service/firefighting (EMS/FF), 86 were from non-hospital healthcare settings (e.g., nursing homes, doctors' offices, home healthcare providers, etc.), 22 were from law enforcement (including police and correctional facilities), and 52 were from other non-healthcare settings (i.e., schools, hotels, and restaurants). Needlestick/sharps injuries were the primary source of exposure in hospitals and non-hospital healthcare settings. Skin and mucous membrane was the primary route of exposure in EMS/FF. Human bites accounted for a significant portion of the exposures in law enforcement and other non-healthcare settings. In general, workers from non-hospital settings were less likely to use PPE, to have BBP safety training, to be aware of the BBP standards and exposure treatment procedures, and to report or seek treatment for a work-related exposure compared to hospital workers. CONCLUSIONS: This study suggests that each industry group has unique needs that should be addressed.

Infection risks following accidental exposure to blood or body fluids in health care workers: a review of pathogens transmitted in published cases.

Hospital staff and all other human or veterinary health care workers, including laboratory, research, emergency service, or cleaning personnel are exposed to the risk of occupational infection following accidental exposure to blood or body fluids (BBF) contaminated with a virus, a bacteria, a parasite, or a yeast. The human immunodeficiency virus (HIV) or those of hepatitis B (HBV) or C (HCV) account for most of this risk in France and worldwide. Many other pathogens, however, have been responsible for occupational infections in health care workers following exposure to BBF, some with unfavorable prognosis. In developed countries, a growing number of workers are referred to clinicians responsible for the evaluation of occupational infection risks following accidental exposure. Although their principal task remains the evaluation of the risks of HIV, HBV, or HCV transmission and the possible usefulness of postexposure prophylaxis, these experts are also responsible for evaluating risks of occupational infection with other emergent or more rare pathogens and their possible timely prevention. The determinants of the risks of infection and the characteristics of described cases are discussed in this article.

[Hepatitis D virus superinfection--a rare cause of occupational disease]. / Nadkazenie wirusem zapalenia watroby typu D jako rzadka przyczyna choroby zawodowej.

The authors present a case of occupational HDV infection in a 38-year-old nurse, HBsAg carrier, injured by a needle contaminated with blood of a drug user infected with HIV, HBV and HCV. After 2 months she developed acute viral hepatitis. HBV, HCV, HIV, CMV, EBV and other non-viral liver diseases were excluded. Finally, based on the source of exposure with high probability of HDV infection, the patient's positive serological test for HDV, and the result of histological examination of the liver, the diagnosis of viral hepatitis type D was established. Our case report suggests the need to consider possible occupational HDV infection in certain circumstances as described above.