The Economic Impact of Extensor Tendon Lacerations of the Hand in the United States.

PURPOSE: Extensor tendon lacerations (ETLs) are a common and debilitating injury for thousands of Americans annually. No study has attempted to estimate their economic impact. The objective of this study was to estimate the economic impact of ETLs in America. METHODS: The cost of ETLs to society was estimated using a validated prevalence-based cost of illness model. The primary cohort was defined as all patients with complete ETLs in the United States undergoing surgical repair and, secondarily, the imputed number of patients requiring reoperation within 1 year. For these groups, both direct and indirect costs (lost income, missed workdays, and disability payments) were measured. RESULTS: The total annual direct medical costs amounted to $14,095.28 per injury and 100,000 population. The total annual indirect labor costs were found to range between $80,842.90 and $150,136.82 per injury and 100,000 population. Hence, the estimated total costs of ETLs are $307 million per year in the United States alone and could be as high as $531 million annually depending on the effects of worker absenteeism on the core production-based industries. CONCLUSIONS: Extensor tendon lacerations incur a significant economic burden to our health care system and are more costly when compared with many other common hand conditions. Specifically, indirect costs are the major contributor toward the total cost these injuries incur on society, accounting for an upward of 91% of the total cost. These results suggest efforts be focused on improving rehabilitation protocols and treatments. LEVEL OF EVIDENCE: Level II-economic and decision analyses.

Head injuries in professional football (soccer): Results of video analysis verified by an accident insurance registry.

BACKGROUND: Video analysis is one of the most commonly applied methods for analysing football injuries. PURPOSE: The objective of this study was to assess the accuracy of video analysis for recording head injuries in professional football from official matches in the four highest men's professional football leagues in Germany. METHODS: In this cohort study, head injuries detected by means of video analysis of all official matches over one season (2017-18) were compared to head injuries registered with the German statutory accident insurance. RESULTS: Our video analysis yielded 359 head injuries of 287 players. The comparison of head injuries found in our video analysis to those registered with the accident insurance only yielded a match in 23.1% (n = 83), which presents a rather low verification rate. The verification rates varied between the leagues (7.0-30.8%). All injuries documented in the accident insurance registry were found in the video analysis (100%). The types of head injury most often verified by the accident insurance registry (n = 83) were contusion (43.4%), bone fractures (19.3%) and skin lacerations (18.1%). Only 66 of the 359 head injuries (18.4%) resulted in absence from at least one training session and involved a mean time loss of 18.5 days (1-87 days). CONCLUSION: The mismatch between the number of head injuries found in the video analysis and head injuries registered with the accident insurance is an important methodological issue in scientific research. The low verification rate seems to be due to the unclear correlation between injury severity and clinical consequences of head injuries detected by means of video analysis and the failure of football clubs to register minor head injuries with the accident insurance.

National level data analysis of facial lacerations in Korea using the National Health Insurance Service (NHIS) database.

ABSTRACT: No national epidemiological investigations have been conducted recently regarding facial lacerations. The study was performed using the data of 3,634,229 people during the 5-year period from 2014 to 2018 archived by the National Health Information Database (NHID) of the Health Insurance Review and Assessment Service. Preschool and children under 10 years old accounted for about one-third of patients. Facial lacerations were concentrated in the "T-shaped" area, which comprised forehead, nose, lips, and the perioral area. The male to female ratio for all study subjects was 2.16:1. Age and gender are significantly related with each other (P < .001). Mean hospital stays decreased, and numbers of outpatient department visits per patient were highest for hospitals and lowest for health agencies. Over the study period, hospital costs per patient in tertiary and general hospitals increased gradually. Preschool and school-aged children are vulnerable to trauma. Male patients outnumbered female patients by a factor of more than 2. The "T-shaped'" area around forehead is vulnerable to injury. Total cost of medical care benefits per patient in tertiary hospitals was about 7 times on average than in health agencies. Regarding functional, behavioral, and aesthetic outcomes, more attention should be paid to epidemiologic data and hospital costs for facial lacerations.

Incidental Durotomy During Endoscopic Stenosis Lumbar Decompression: Incidence, Classification, and Proposed Management Strategies.

OBJECTIVE: We sought to review the types of incidental durotomies (IDs) that occurred during the endoscopic stenosis lumbar decompression through interlaminar approach (ESLD) and discuss the management strategies according to our classification. METHODS: A retrospective evaluation was performed for patients with spinal stenosis who underwent ESLD. Out of 330 patients, 27 patients of ID were clinically evaluated preoperatively and postoperatively on the basis of a visual analog scale score, Oswestry Disability Index, and MacNab's criteria. ID patterns are classified according to the size, location, and involvement of neural elements. Intraoperative and postoperative surgical management was evaluated. RESULTS: Intraoperative incidence of ID was 8.2%. According to lumbar levels, 11 (40.7%) occurred at L3-4, 12 (44.4%) at L4-5, and 4 (14.8%) at L5-S1 ID cases. IDs were divided into 4 types: 29.6% are type 1, 70% are type 2, 7.4% are type 3, and 3.7% are type 4. Overall for mean and standard deviation preoperative, 1 week postoperative, 3 months, and final follow-up for visual analog scale are 7.6 ± 1.4, 3.3 ± 1.1, 2.6 ± 1.1, and 1.9 ± 1.3, and for Oswestry Disability Index are 74.5 ± 9.0, 32.3 ± 9.4, 27.3 ± 7.2, and 24.4 ± 6.5 after patch blocking dura repair of ID. CONCLUSIONS: ID is a more common surgical complication in ESLD compared with the transforaminal approach. The endoscopic patch blocking dura repair technique should be considered in type 1 to type 3A of dura tear with good prognosis and clinical outcome. Consideration is made for conversion to open repair in types 3B, 3C and 4 dura tears with fair to poor outcome.

A Global Rating Scale and Checklist Instrument for Pediatric Laceration Repair.

Introduction: Laceration repair is a core procedural skill in which pediatric residents are expected to attain proficiency per the Accreditation Council for Graduate Medical Education. Restricted trainee work hours have decreased clinical opportunities for laceration repair, and simulation may be a modality to fill that clinical gap. There is a therefore a need for objective measures of pediatric resident competence in laceration repair. Methods: We created a global rating scale and checklist to assess laceration repair in the pediatric emergency department. We adapted the global rating scale from the Objective Structured Assessment of Technical Skills tool used to evaluate surgical residents' technical skills and adapted the checklist from a mastery training checklist related to infant lumbar puncture. We tested both tools in the pediatric emergency department. Eight supervising physicians used the tools to evaluate 30 residents' technical skills in laceration repair. We performed validation testing of both tools in the simulation environment. Based on formal evaluation, we developed a video to train future evaluators on the use of the global rating scale. Results: The global rating scale and checklist showed fair concordance across reviewers. Both tools received positive feedback from supervising physicians who used them. Discussion: We found that the global rating scale and checklist are more applicable to formative, rather than summative, training for resident laceration repair. We recommend using these educational tools with trainees in the simulation environment prior to trainees performing laceration repairs on actual patients.

Labour outcomes in caseload midwifery and standard care: a register-based cohort study.

BACKGROUND: Research on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care. METHODS: A historical register-based cohort study was carried out using routinely collected data about all singleton births 2013-2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses. RESULTS: Compared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06-1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13-1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03-1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84-1.28). Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11-2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital. For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06-1.29). CONCLUSIONS: For most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.

Estimating the incidence and the economic burden of third and fourth-degree obstetric tears in the English NHS: an observational study using propensity score matching.

OBJECTIVE: Obstetric care is a high-risk area in healthcare delivery, so it is essential to have up-to-date quantitative evidence in this area to inform policy decisions regarding these services. In light of this, the objective of this study is to investigate the incidence and economic burden of third and fourth-degree lacerations in the English National Health Service (NHS) using recent national data. METHODS: We used coded inpatient data from Hospital Episode Statistics (HES) for the financial years from 2010/2011 to 2013/2014 for all females that gave birth during that period in the English NHS. Using HES, we used pre-existing safety indicator algorithms to calculate the incidence of third and fourth-degree obstetric tears and employed a propensity score matching method to estimate the excess length of stay and economic burden associated with these events. RESULTS: Observed rates per 1000 inpatient episodes in 2010/2011 and 2013/2014, respectively: Patient Safety Indicator-trauma during vaginal delivery with instrument (PSI 18)=84.16 and 91.24; trauma during vaginal delivery without instrument (PSI 19)=29.78 and 33.43; trauma during caesarean delivery (PSI 20)=3.61 and 4.56. Estimated overall (all PSIs) economic burden for 2010/2011=£10.7 million and for 2013/2014=£14.5 million, expressed in 2013/2014 prices. CONCLUSIONS: Despite many initiatives targeting the quality of maternity care in the NHS, the incidence of third and fourth-degree lacerations has increased during the observed period which signals that quality improvement efforts in obstetric care may not be reducing incidence rates. Our conservative estimates of the financial burden of these events appear low relative to total NHS expenditure for these years.

Fingertip Injuries in Children: Epidemiology, Financial Burden, and Implications for Prevention.

BACKGROUND: Although fingertip injuries are common, there is limited literature on the epidemiology and hospital charges for fingertip injuries in children. This descriptive study reports the clinical features of and hospital charges for fingertip injuries in a large pediatric population treated at a tertiary medical center. METHODS: Our hospital database was queried using International Classification of Diseases, Revision 9 (ICD-9) codes, and medical records were reviewed. Frequency statistics were generated for 1807 patients with fingertip injuries who presented to the emergency department (ED) at Boston Children's Hospital (BCH) between 2005 and 2011. Billing records were analyzed for financial data. RESULTS: A total of 1807 patients were identified for this study; 59% were male, and the mean age at time of injury was 8 years. Most commonly, injuries occurred when a finger was crushed (n = 831, 46%) in a door or window. Average length of stay in the ED was 3 hours 45 minutes, 25% of cases needed surgery, and, on average, patients had more than 1 follow-up appointment. About one-third of patients were referred from outside institutions. The average ED charge for fingertip injuries was $1195 in 2014, which would amount to about $320 430 each year (in 2014 dollars) for fingertip injuries presenting to BCH. CONCLUSION: Fingertip injuries in children are common and result in significant burden, yet are mostly preventable. Most injuries occur at home in a door or window. Although these patients generally heal well, fingertip injuries pose a health, time, and financial burden. Increased awareness and education may help to avoid these injuries.

[Assessment of restrictive episiotomy use and impact on perineal tears in the Burgundy's Perinatal Network]. / Évaluation de la pratique restrictive de l'épisiotomie et de l'impact sur les déchirures périnéales au sein du Réseau périnatal de Bourgogne.

OBJECTIVES: To analyse episiotomy and perineal tears rates in Burgundy after French National College of Obstetricians and Gynecologists (CNGOF) guidelines in 2005. MATERIALS AND METHOD: Multicenter retrospective study, between 2003-2005 (period 1) et 2012-2014 (period 2), conducted on singletons vaginal deliveries, in cephalic presentation from 37 weeks. We compared the episiotomy rate (ER), and perineal lesions in normal deliveries (ND) and instrumental deliveries (ID) between the two periods. RESULTS: A total of 74,268 women were included. The overall ER significantly decreased from 35.8 to 16.7% (P<0.01), without increasing third degree perineal tears (0.73% vs. 0.66%) or fourth degree (0.14% vs 0.14%). First degree perineal tears rose (42.1% vs 17.6%, P<0.001), second degree decreased (13.5% vs 20.5%, P<0.001). ER decreased whatever the level of motherhood, healthcare ward, vaginal delivery type, or the instrument used. CONCLUSION: Our study found a strong impact in Burgundy of the French guidelines for the practice of restrictive episiotomy for both ND and for ID without increasing sphincter tears and in decreasing spontaneous morbidity.

Suicide risk among perinatal women who report thoughts of self-harm on depression screens.

OBJECTIVE: To estimate the incidence and clinical significance of suicidal ideation revealed during perinatal depression screening and estimate the associated suicide risk. METHODS: Retrospective cohort study of women completing the Edinburgh Postnatal Depression Scale at 24-28 weeks of gestation and 6 weeks postpartum through a suburban integrated health system with approximately 5,000 annual deliveries on two hospital campuses. Suicidal ideation on the Edinburgh Postnatal Depression Scale and prediction of suicide risk were examined through multivariable modeling and qualitative analysis of clinical assessments. RESULTS: Among 22,118 Edinburgh Postnatal Depression Scale questionnaires studied, suicidal ideation was reported on 842 (3.8%, 95% confidence interval [CI] 3.5-4.1%) and was positively associated with younger maternal age (antepartum mean age 30.9 compared with 31.9 years, P=.001), unpartnered relationship status (antepartum 29.5% compared with 16.5%, P<.001 and postpartum 25.0% compared with 17.5%, P<.01), non-Caucasian race (antepartum 62.1% compared with 43.8%, P<.001 and postpartum 62.4% compared with 45.2%, P<.001), non-English language (antepartum 11.0% compared with 6.6%, P<.001 and postpartum 12.4% compared with 7.7%, P<.01), public insurance (antepartum 19.9% compared with 12.5%, P<.001 and postpartum 18.2% compared with 14.2%, P<.001), and preexisting psychiatric diagnosis (antepartum 8.4% compared with 4.2%, P<.001 and postpartum 12.0% compared with 5.8%, P<.001). Multivariable antepartum and postpartum models retained relationship status, language, relationship status by language interaction, and race; the postpartum model also found planned cesarean delivery negatively associated with suicidal ideation risk (odds ratio [OR] 0.56, 95% CI 0.36-0.87) and severe vaginal laceration positively associated with suicidal ideation risk (OR 2.1, 95% CI 1.00-4.40). A qualitative study of 574 women reporting suicidal ideation indicated that 330 (57.5%, 95% CI 53.5-61.5%) experienced some degree of suicidal thought. Six patients (1.1%, 95% CI 0.2-1.9%) demonstrated active suicidal ideation with plan, intent, and access to means. Within this highest risk group, three patients reported a suicide attempt within the perinatal period. CONCLUSION: Among perinatal women screened for depression, 3.8% reported suicidal ideation, but only 1.1% of this subgroup was at high risk for suicide. These findings support the need for systematic evaluation of those who report suicidal ideation to identify the small subset requiring urgent evaluation and care.

Occupational injuries in Ohio wood product manufacturing: a descriptive analysis with emphasis on saw-related injuries and associated causes.

BACKGROUND: Stationary sawing machinery is often a basic tool in the wood product manufacturing industry and was the source for over 2,500 injury/illness events that resulted in days away from work in 2010. METHODS: We examined 9 years of workers' compensation claims for the state of Ohio in wood product manufacturing with specific attention to saw-related claims. For the study period, 8,547 claims were evaluated; from this group, 716 saw-related cases were examined. RESULTS: The sawmills and wood preservation sub-sector experienced a 71% reduction in average incidence rate and an 87% reduction in average lost-time incidence rate from 2001 to 2009. The top three injury category descriptions for lost-time incidents within saw-related claims were fracture (35.8%), open wounds (29.6%), and amputation (14.8%). CONCLUSIONS: For saw-related injuries, preventing blade contact remains important but securing the work piece to prevent kickback is also important.

Epidemiologic comparison of injured high school basketball athletes reporting to emergency departments and the athletic training setting.

CONTEXT: Basketball is a popular US high school sport with more than 1 million participants annually. OBJECTIVE: To compare patterns of athletes with basketball-related injuries presenting to US emergency departments from 2005 through 2010 and the high school athletic training setting from the 2005-2011 seasons. DESIGN: Descriptive epidemiology study. SETTING: Data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission and the High School Reporting Information Online database. MAIN OUTCOME MEASURE(S): Complex sample weights were used to calculate national estimates of basketball-related injuries for comparison. PATIENTS OR OTHER PARTICIPANTS: Adolescents from 13 to 19 years of age treated in US emergency departments for basketball-related injuries and athletes from 13 to 19 years of age from schools participating in High School Reporting Information Online who were injured while playing basketball. RESULTS: Nationally, an estimated 1,514,957 (95% confidence interval = 1,337,441, 1,692,474) athletes with basketball-related injuries reported to the emergency department and 1,064,551 (95% confidence interval = 1,055,482, 1,073,620) presented to the athletic training setting. Overall, the most frequent injuries seen in the emergency department were lacerations and fractures (injury proportion ratios [IPRs] = 3.45 and 1.72, respectively), whereas those seen in the athletic training setting were more commonly concussions and strains/sprains (IPRs = 2.23 and 1.19, respectively; all P values < .0001). Comparisons of body site and diagnosis combinations revealed additional differences. For example, athletes with lower leg fractures more often presented to the emergency department (IPR = 6.53), whereas those with hand fractures more frequently presented to the athletic training setting (IPR = 1.18; all P values < .0001). CONCLUSIONS: Patterns of injury differed among high school basketball players presenting for treatment in the emergency department and the athletic training setting. Understanding differences specific to clinical settings is crucial to grasping the full epidemiologic and clinical picture of sport-related injuries. Certified athletic trainers play an important role in identifying, assessing, and treating athletes with sport-related injuries who might otherwise present to clinical settings with higher costs, such as the emergency department.

Home injuries in Italy: patterns of injury and the most exposed people.

Home injuries are a significant public health problem in developed and developing countries. To support future policies for reducing their occurrence and controlling their consequences, this study investigated the home injuries situation in Italy in 1999, using a nation-representative sample. The weighted correspondence analysis showed four different patterns of injury and seven profiles of the people most exposed to them. As results of this study falls were followed by bumps and cuts requiring specialist assistance then burns. Women were the most exposed to burn and fall risks and men to the risk of cuts and bumps. Among the elderly and children, falls and bumps leading to fractures, wounds or other consequences were frequent. The risks were highest for people with a lower level of education. Bumps and cuts were prevalent among unmarried and with the highest education level subjects. These injury risks were higher for young males. Cuts in adults doing do-it-yourself jobs had the worst consequences, while domestic work cuts generally did not need medical treatment. Burns occurred almost exclusively in the kitchen (90%) and did not need specialist assistance. Because home injuries are largely preventable, an efficient public health policy could promote and disseminate home safety culture.

Extent, nature and hospital costs of fireworks-related injuries during the Wednesday Eve festival in Iran.

BACKGROUND: Fireworks are commonly used in local and national celebrations. The aim of this study is to explore the extent, nature and hospital costs of injuries related to the Persian Wednesday Eve festival in Iran. METHODS: Data for injuries caused by fireworks during the 2009 Persian Wednesday Eve festival were collected from the national Ministry of Health database. Injuries were divided into nine groups and the average and total hospital costs were estimated for each group. The cost of care for patients with burns was estimated by reviewing a sample of 100 patients randomly selected from a large burn center in Tehran. Other costs were estimated by conducting semi structured interviews with expert managers at two large government hospitals. RESULTS: 1817 people were injured by fireworks during the 2009 Wednesday Eve festival. The most frequently injured sites were the hand (43.3%), eye (24.5%) and face (13.2%), and the most common types of injury were burns (39.9%), contusions/abrasions (24.6%) and lacerations (12.7%). The mean length of hospital stay was 8.15 days for patients with burns, 10.7 days for those with amputations, and 3 days for those with other types of injury. The total hospital cost of injuries was US$ 284 000 and the average cost per injury was US$ 156. The total hospital cost of patients with amputations was US$ 48 598. Most of the costs were related to burns (56.6%) followed by amputations (12.2%). CONCLUSIONS: Injuries related to the Persian Wednesday Eve festival are common and lead to extensive morbidity and medical costs. © 2013 KUMS, All rights reserved.

Annual prostatectomy volume is related to rectal laceration rate after radical prostatectomy.

OBJECTIVE: To examine the effect of annual prostatectomy volume (APV) on contemporary intraoperative rectal laceration (RL) rates after radical prostatectomy. METHODS: From 1999 to 2008, 36 699 radical prostatectomy procedures were performed in Florida. First, logistic regression models predicting the RL rate were fitted. Second, other logistic regression models were used to examine the association between RL and 2 other secondary outcomes: prolonged length of stay (>3 days) and increased hospital charges (>$37 621). The covariates included APV quintiles, surgical approach (minimally invasive vs open radical prostatectomy), lymph node dissection status, age, year of surgery, race, and baseline Charlson comorbidity index. RESULTS: The overall RL rate was 0.7%. The RL rate was 0.3%, 0.6%, 0.7%, 0.9%, and 1.0% for the very high, high, intermediate, low, and very low APV quintiles, respectively (P < .001). In multivariate analyses predicting RL, patients treated by intermediate (odds ratio 2.39, P = .003), low (odds ratio 2.95, P < .001), and very low (odds ratio 3.26, P < .001) APV surgeons had a greater likelihood of experiencing an RL relative to patients treated by very high APV surgeons. Second, in the multivariate analyses, patients with a RL were 9.1-fold more likely to have a prolonged length of stay (P < .001) and were 3.4-fold more likely to have increased total hospital charges (P < .001). CONCLUSION: A greater APV exerts a protective effect on RL rates. Additionally, RL increases the length of stay and hospital charges.

[Biological fluid-related accidents amongst professionals working in clinical laboratories in Maracaibo, Venezuela]. / Accidentalidad por fluidos biológicos en profesionales de laboratorios clínicos de Maracaibo, Venezuela.

OBJECTIVE: Determining the occupational exposure to biological fluids of medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure biological measures. METHODS: This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures. RESULTS: There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p<001) between percutaneous exposure and level of compliance with post-exposure management. CONCLUSION: The magnitude and characteristics of exposure to biological fluids detected in this work represents a problematic situation which can affect staff health and must be approached by institutions to ensure effective prevention management and risk control.

Accidentalidad por fluidos biológicos en profesionales de laboratorios clínicos de Maracaibo, Venezuela / Biological fluid-related accidents amongst professionals working in clinical laboratories in Maracaibo, Venezuela

Objetivo Determinar la exposición laboral accidental a fluidos biológicos por contacto percutáneo en el personal Bioanalista de Laboratorios Clínicos públicos, sus factores asociados y el cumplimiento de medidas post exposición biológica. Métodos Se realizó un estudio descriptivo transversal, la muestra fue de 156 bioanalistas adscritos a laboratorios clínicos del área metropolitana del estado Zulia. Para la recolección de datos se aplicó un instrumento de escalas que exploró la exposición percutánea, los factores vinculados y el cumplimiento de medidas post exposición biológica. Resultados Se evidenció exposición por accidentes percutáneos, representados principalmente por pinchazos y cortaduras, detectados en razón de su ocurrencia en un nivel moderado (media entre 2-3,99). Como factores vinculados a la accidentabilidad percutánea, se registra la ocurrencia en nivel moderado con diversas agujas huecas, con sangre y hemoderivados, en manos y dedos, con una severidad superficial, en áreas de toma y procesamiento de muestras durante el re-encapuchado de objetos punzo cortantes. Un nivel de mediano cumplimiento se obtuvo para el manejo post exposición. Existe relación entre la exposición percutánea con el nivel de cumplimiento detectado para el manejo post exposición p <0,001. Conclusión La magnitud y características de la exposición a fluidos biológicos detectada en este colectivo laboral reviste una problemática que puede impactar en la salud del personal y debe ser abordada institucionalmente para una efectiva gestión de prevención y control de riesgo.

Objective Determining the occupational exposure to biological fluids of medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure biological measures. Methods This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures. Results There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p<001) between percutaneous exposure and level of compliance with post-exposure management. Conclusion The magnitude and characteristics of exposure to biological fluids detected in this work represents a problematic situation which can affect staff health and must be approached by institutions to ensure effective prevention management and risk control.

An evaluation of costs and effects of a nutrient-based skin care program as a component of prevention of skin tears in an extended convalescent center.

PURPOSE: A decision model was developed in a pilot study comparing a regimen using a skin care product line containing active ingredients and nutrients with a commercially available alternative skin care regimen in an elderly convalescent care hospital-based center. METHODS: Using a decision-tree model, skin treatment with a nutrient-based skin care (NBSC) formulation was compared with products without nutrients. The number of skin-tear-free days was the primary outcome measure. A cost-effectiveness ratio was calculated for each skin treatment as the average cost for reaching a particular outcome. Incidence of skin tear data was collected from residents in a convalescent center from 2004 to 2005. An independent t test was used to compare differences in the number of skin tears between periods when NBSC and other formulations were used. All costs in the decision model were adjusted to 2007 dollars. Sensitivity analysis was used to test uncertain data. RESULTS: The NBSC provided more skin-tear-free days and was less costly than the use of non-NBSC products. The expected skin-tear-free days for a patient in the model treated with NBSC were 179.7 days compared with 154.6 days for non-NBSC products, yielding an incremental effect of 25.1 days. The expected cost of preventing skin tears and treatment via skin treatment per patient in the NBSC group was $281.00 versus $324.10 for periods when other products were used. CONCLUSION: The NBSC had a lower projected cost for prevention of skin tears and more skin-tear-free days when compared with non-NBSC products.

The Agency for Healthcare Research and Quality (AHRQ) pediatric quality indicators (PDIs): accidental puncture or laceration during surgery in children.

CONTEXT: The Agency for Healthcare Research and Quality (AHRQ) pediatric quality indicators (PDIs) are measures designed to evaluate the quality of pediatric healthcare. They specifically focus on adverse events that are potentially avoidable, including complications and iatrogenic events. PDI 1 refers to accidental puncture or laceration. OBJECTIVE: To determine risk factors and outcomes associated with PDI 1 in a population of pediatric surgical patients. DESIGN, SETTING, AND PATIENTS: The Nationwide Inpatient Sample and Kids Inpatient Database were used to identify hospitalized pediatric surgical patients in the United States (age: 0-18) from 1988 to 2005. The data from these 1,939,540 patients was linked to the AHRQ PDIs using AHRQ WinQI software, and 7,033 pediatric patients with PDI 1 were identified. A 1:3 matched case control design was implemented with 6,459 cases (patients with PDI 1) and 19,377 controls (patients without PDI 1) matched on age, race, gender, and hospital ID. Cases and controls were stratified into procedure categories based on diagnosis related group procedure codes. MAIN OUTCOME MEASURES: To examine the relationship between PDI 1 and procedure category, as well as the outcomes of in-hospital mortality, length of stay, and total hospital charges for cases compared with controls. RESULTS: Of the 4,627 patients with PDI 1 stratified into procedure categories, the highest proportion of PDI 1 cases occurred in the gastrointestinal (30.19%), cardiothoracic (19.6%), and the orthopedic (11.13%) categories. Logistic regression analysis for PDI 1, controlling for admission type and insurance status, revealed a statistically significant higher odds of PDI 1 in the gynecology (OR: 1.69, P < 0.001) and transplant (OR: 1.45, P: 0.026) procedure categories. Multivariable regression analysis revealed patients with PDI 1 were more likely to die (OR: 1.91, P < 0.001), had a 4.81 day longer length of stay (95% CI: 4.26-5.36, P < 0.001) and had USD 36,291 higher total hospital charges (95% CI: USD 32,583-USD 40,000, P < 0.001) compared with patients without PDI 1. CONCLUSIONS: Cases of PDI 1 were most commonly associated with the gastrointestinal, cardiothoracic, and orthopedic procedure categories, and these were also 3 of the most common procedure categories overall. Controlling for type of procedure and other variables, the procedure categories having the highest likelihood of PDI 1 were gynecology and transplant. PDI 1 was found to be associated with greater mortality, longer length of stay, and greater total hospital charges.