Assessment of sharps penetrating injury, mucosal exposure and compliance with standard precautions of health workers at a University Hospital in Turkey.

OBJECTIVES: To evaluate the compliance with standard precautions in healthcare workers who experienced a sharps penetrating injury or mucosal exposure using the compliance with Standard Precautions Scale, Turkish version. METHODS: This descriptive cross-sectional study was conducted in a tertiary hospital. The occupational health and safety unit records of healthcare workers who were injured by a sharps penetrating injury or experienced mucosal exposure between January 2018 and July 2020 were examined. Compliance with the Standard Precautions Scale was assessed by having participants answer a questionnaire. RESULTS: Of the 100 participants, 59% were men. Of all healthcare workers in the university hospital, 4.5% (n=100) were injured by sharps penetrating injuries or mucosal exposure. Of the participants, 95% were wounded by a sharps penetrating injury and 5% had mucosal exposure. The mean Compliance with Standard Precautions Scale score of participants with a sharps penetrating injury was 16.36±2.39 and with mucosal exposure was 16.80±3.03. There was no significant difference between the mean Compliance with Standard Precautions Scale scores of the sharps penetrating injury and mucosal exposure groups regardless of training on occupational health and safety (p=0.794). CONCLUSION: In conclusion, the frequency of a sharps penetrating injury and mucosal exposure in healthcare workers was similar to the literature. The compliance level of the healthcare workers measured with the Compliance with Standard Precautions Scale was high.

The Influence of PDCA Process Management on the Incidence of Stab Wound and Psychological Anxiety of Nursing Interns.

Objective: To research the influence of PDCA (Plan-Do-Check-Act) process management on the incidence of needle injury and psychological anxiety of nursing interns. Methods: This study belonged to the experimental study. A total of 180 nursing interns who practiced in the hospital from March 2020 to April 2022 were studied. A total of 135 interns from March 2020 to March 2021 were selected as the control group and 175 interns from April 2021 to April 2022 as the research group. PDCA process management was carried on in the research group. The control group did not make any intervention only following the routine teaching plan. The incidence of needle injury, theoretical knowledge, behavior score, self-rating anxiety scale (SAS), professional self-efficacy questionnaire score, and nursing practice satisfaction score were evaluated before and after 12 months of management. Results: After management, the incidence of needle injury in the research group was lower compared to that in the control group, and there are statistically significant differences between groups (P < 0.05). The scores of theoretical knowledge, attitude, and behavior in the research group were higher compared to those in the control group, and there are statistically significant differences between groups (P < 0.05) after management. After 12 months of management, the SAS score of the research group was lower compared to that of the control group, and there are statistically significant differences between groups (P < 0.05). The score of occupational self-efficacy questionnaire in the research group was higher compared to that in the control group, and there are statistically significant differences between groups (P < 0.05) after PDCA process management. After 12 months of management, the satisfaction score of nursing practice in the research group was higher compared to that in the control group, and there are statistically significant differences between groups (P < 0.05). Conclusion: Through PDCA process management, we can keep abreast of the situation of needlestick injuries among nursing students in practice and analyze in more detail the root cause of each nursing student's occupational exposure and the outcome of treatment. The nursing students not only learn more practical knowledge in clinical practice but also feel that the hospital values and cares for them, which greatly increases their satisfaction.

Eastern Mediterranean Health Journal [2022; Vol.28, Issue 3] / [المجلة الصحية لشرق المتوسط [2022; المجلد 28 , العدد 3

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région.

Occupational percutaneous injuries and exposures in a dental teaching environment: A 10-year report.

PURPOSE: Percutaneous injuries (PIs) are woefully underreported and the risk at dental academic institutions is higher due to lack of knowledge and experience of students. The aims of this study are to (1) present data on the prevalence of PIs and exposures over a 10-year period in a dental teaching institution; (2) provide information on areas with increased risk as it relates to personnel and instruments; and (3) improve the awareness of the risk of occupational PIs and exposures in dentistry. METHODS: Data presented were collected as a part of an infection control program. A description of the incident reporting and collecting methodology is provided. Distribution tables and confidence intervals for injuries by year were calculated. Overall associations were produced using either Fisher's exact or Chi-square test. RESULTS: Between 2009 and 2019, a total of 342 PIs (338) and mucosal exposures (4) were reported. A significant number of injuries occurred while reaching for an instrument (15.2%), injecting local anesthetic (13.2%), and cleaning an instrument (11.7%). About 31% of the injuries were caused by needlesticks followed by burs (22.8%). There was a statistically significant association between work practice controls and activity type (p < 0.001) and position (p = 0.01). PIs and compliance issues were higher among the third-year dental students. CONCLUSIONS: There was a declining trend in incidents over the years, which could be attributed to the extra-protective measures that were implemented. Uncovered dental burs and needlesticks continue to be the predominant cause of PIs in academia. We found that collection of data on such occupation-related injuries to be useful in observing any trends and implementation of corrective actions.

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.

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.

Needlestick injuries: a density-equalizing mapping and socioeconomic analysis of the global research.

BACKGROUND: Needlestick injuries have caused a deleterious effect on the physical and mental health of millions of health-care workers over the past decades, being responsible for occupational infections with viruses such as HIV or hepatis C. Despite this heavy burden of disease, no concise studies have been published on the global research landscape so far. METHODS: We used the New Quality and Quantity Indices in Science platform to analyze global NSI research (n = 2987 articles) over the past 115 years using the Web of Science and parameters such as global versus country-specific research activities, semi-qualitative issues, and socioeconomic figures. RESULTS: Density-equalizing mapping showed that although a total of n = 106 countries participated in NSI research, large parts of Africa and South America were almost invisible regarding global participation in NSI research. Average citation rate (cr) analysis indicated a high rate for Switzerland (cr = 25.1), Italy (cr = 23.5), and Japan (cr = 19.2). Socioeconomic analysis revealed that the UK had the highest quotient QGDP of 0.13 NSI-specific publications per bill. US-$ gross domestic product (GDP), followed by South Africa (QGDP = 0.12). Temporal analysis of HIV versus hepatitis research indicated that NSI-HIV research culminated in the early 1990s, whereas NSI-hepatitis research increased over the observed period from the 1980s until the last decade. CONCLUSION: Albeit NSI research activity is generally increasing, the growth is asymmetrical from a global viewpoint. International strategies should be followed that put a focus on NSI in non-industrialized areas of the world.

Process improvement to effectively manage and reduce sharps injuries in a Tertiary Hospital in Northern India.

INTRODUCTION AND OBJECTIVES: Needle stick injuries are associated with a 0.3-30% risk of transmission of Human Immunodeficiency virus, Hepatitis C virus, and Hepatitis B virus. Despite causing psychological trauma they also involve a huge financial burden. A robust process improvement (RPI) toolkit was introduced in order to effectively manage and reduce needle stick injuries, as well as an attempt to report prevalence, post-exposure management, and associated economic burden. MATERIALS AND METHODS: Prospective Observational Study (2015-2018) has been design in a Corporate Tertiary Care Hospital. The participants included were needle stick injuries exposed staff. RPI toolkit was implemented (2015-2018) focusing on root cause analysis, availability of safety engineered devices, immunization and post-exposure management of needle stick injuries exposed staff. The main outcome measure was needle stick injuries incidence. RESULTS: A total of 211 needle stick injuries were reported (mean - 52.72/year, needle stick injury incidence - 13.18/year/100 beds). Yearly trends showed a decrease of 21.3% in injuries from 2015 (61) to 2018 (48). Half (106, 50%) of the total injuries were reported among nurses. Use of hypodermic needles was involved in 116 (55%) injuries, with 114 (54%) occurring due to nonadherence to hospital policies. Overall, 204 staff had protective immunity, and 135 (64%) of these had completed their Hepatitis B immunizations. The source was known in 165 (78%) cases, and 113 of these cases had an injury from a source with negative viral markers. A 6-month follow-up was completed in 90 cases. No seroconversion was reported. Overall costs incurred in post-exposure prophylaxis was approximately €30,000 (mean cost €143.50/needle stick injury). CONCLUSION: Nurses are most at risk of needle stick injury in healthcare settings. Implementation of RPI toolkit led to a 21.3% reduction in sharps injury incidences. These injuries incur huge financial burden on the hospital. Appropriate immunization strategies saved about €1360 expenditure on post-exposure prophylaxis.

Economic burden of needlestick injuries among healthcare workers in China.

Objective: To estimate the economic burden of needlestick injuries (NSIs) among healthcare workers (HCWs) in China.Design: A model was built to evaluate the economic burden of NSIs.Methods: The cost model was developed from a societal perspective, including both direct and indirect costs, with lifetime horizon. The direct costs were categorized into infection prevention and treatment of infections. The indirect cost included productivity loss of both HCWs and his/her family members due to the blood-borne infections. Sub-group analyses were conducted to estimate the cost per NSI when the source patient (SP) was confirmed with hepatitis B virus/hepatitis C virus/human immunodeficiency virus (HBV/HCV/HIV) infection. One-way and probabilistic sensitivity analyses were conducted for all parameters to examine the robustness of the result.Results: The model projected a total cost of ¥699 for each NSI (direct and indirect cost were ¥553 and ¥146, respectively). The cost per NSI when the SP was confirmed with HBV/HCV/HIV was ¥4,238, ¥18,404, and ¥6,152, respectively. The total economic burden of NSIs among HCWs in China was estimated to be ¥5.8 billion, and about half of the cost was associated with NSIs in nurses, at ¥2.8 billion.Limitations: This study did not incorporate the costs of litigation/psychological, and the prevalence of the infections was based on the general population, so the actual costs per NSI may be underestimated. More real-world studies of treatment cost about HBV/HCV are needed to further supporting this study.Conclusions: The economic burden of NSIs among HCWs in China is substantial. Comprehensive NSI prevention programs, including implementation of safety needles and devices, have high potential for healthcare institutions to achieve downstream cost savings and cost offsets.

Job stress and needlestick injuries in nurses: a retrospective observational study.

BACKGROUND: The prevention of needlestick injuries (NSIs) in nurses employed in Emergency Departments (EDs) represents a special issue for healthcare organizations globally. Stressful working conditions, lack of organizational arrangements and lack of supporting one another at work, may contribute to increase the risk of NSIs. METHODS: We conducted an observational study to analyze: 1) the effectiveness of organizational interventions to minimize the occurrence of NSIs in ED nurses; 2) to measure the impact of such interventions on the safety budget. RESULTS: The occurrence of NSIs detected after organizational level interventions was significantly lower than the occurrence observed previously such interventions (p<0,05). By results, cost saving from managing fewer NSIs than the previous period was found. CONCLUSION: The study shows that the proactive, integrated and comprehensive management of organizational features at workplace brings benefits to employees and reduces the burden of the occurrence of NSIs. As result of the reduced NSIs frequency, the overall costs for follow-up of injured workers were reduced. (www.actabiomedica.it).

Budget impact analysis of introducing a non-reconstituted, hexavalent vaccine for pediatric immunization in the United Kingdom.

Objectives: Non-reconstituted, hexavalent vaccines (HV-NRs) can facilitate clinical practice by shortening vaccine preparation and administration time and by reducing the risk of vaccination errors compared to combination vaccines requiring reconstitution. The aim of this study was to determine the budget impact of introducing an HV-NR into the United Kingdom's (UK) pediatric immunization program, which currently uses a hexavalent vaccine requiring reconstitution (HV-R). Methods: Abudget impact model covering a 10-year time horizon was developed. The target population constituted closed UK birth cohorts from 2020 to 2029. Total direct costs from the payer's perspective consisted of four main categories: vaccine acquisition and management, healthcare provider's service provision, (non-)contaminated needle-stick and sharps injury (NSI), and non-NSI vaccination error costs. The net budget impact was calculated by comparing the costs in two different market share scenarios. Results: The use of HV-NR instead of HV-R was estimated to save £9,079,927 over a 10-year time horizon (i.e. £907,993 per year). Assuming all other vaccine criteria are equivalent the budget impact was most sensitive to changes in time spent by the healthcare provider and management costs. Conclusion: Results suggest, introducing an HV-NR into the UK's pediatric immunization program is potentially cost saving for the healthcare system.

Estimating the national cost burden of in-hospital needlestick injuries among healthcare workers in Japan.

BACKGROUND: Needlestick injury (NSI) is one of the most burdensome professional hazards in any medical setting; it can lead to transmission of fatal infectious diseases, such as hepatitis B, hepatitis C and human immunodeficiency virus. In the United States, the annual cost burden was estimated as somewhere between $118 million to $591 million; in the United Kingdom it is approximated to be £500,000 (US$919,117.65) per the National Health Service. METHOD: This is the first published paper on the national cost burden of NSIs in Japan. A systematic literature review was conducted to review previous study design in global studies and to extract parameter values from Japanese studies. We conducted abstract searches through PubMed and the Japan Medical Abstracts Society (Ichushi), together with grey literature and snowball searches. A simple economic model was developed to calculate cost burden of NSIs from a societal perspective over a one-year time horizon. We assumed all NSIs are reported and perfect adherence in post NSI management that presented in the labour compensation scheme. Local guidelines were also referenced to extract resource utilization. Lastly, a deterministic sensitivity analysis was conducted and a scenario analysis which considered a payer perspective was also included. RESULT AND CONCLUSION: The national cost burden of in-hospital NSIs is estimated as ¥33.4 billion (US$302 million) annually, based on an average cost per NSI of ¥63,711 (US$577) and number of NSIs at 525,000/year. 70% of the cost is due to initial laboratory tests, followed by productivity loss, estimated at 20% of the total cost. Cost of contaminated NSIs remains at 5% of the total cost. Change in number of NSIs significantly influences outcomes. Variation in post-exposure management practices suggests a need for NSI specific National guidelines and holistic labour compensation scheme development in Japan.

Where are we in patient safety in the ED in Turkey?

Near misses and unsafe conditions have become more serious for patients in emergency departments (EDs). We aimed to search the near misses and unsafe conditions that occurred in an ED to improve patient safety.This was a retrospective analysis of a 10-year observational period from January 1, 2007 to December 31, 2016. We gained access to the adverse event notification forms (AENFs) sent to the hospital quality department from the ED. Patient age, sex, and date of presentation were recorded. The near misses and unsafe conditions were classified into 7 types: medication errors, falls, management errors, penetrative-sharp tool injuries, incidents due to institution security, incidents due to medical equipment, and forensic events. The outcome of these events was recorded.A total of 220 AENF were reported from 294,673 ED visits. The median age of the 166 patients was 60 (21-95) years. Of these, 57.1% of the patients were females and 47.9% were males. The most commonly reported events were medication errors (32.7%) and management errors (27.3%). The median age of falling patients was 67.5 years. The nurse-patient ratio between 2007 to 2011 and 2011 to 2016 were 1/10 and 1/7, respectively. We found that when this ratio increased, the adverse events results were less significant (P < .003).This was the 1st study investigating the adverse events in ED in Turkey. The reporting ratio of 0.07% for the total ED visits was too low. This showed that adverse events were under-reported.

Assessment of needle stick and sharp injuries among health care workers in central zone of Tigray, northern Ethiopia.

OBJECTIVE: Accidental occupational injuries to health care workers (HCWs) continue to have a significant problem in the healthcare system. Thus, the aim of this study was to assess prevalence of needle sticks and sharp injury and associated factors among health care workers working in Central Zone Tigray northern Ethiopia. RESULT: The prevalence of needle stick and sharp injury in the past 12 months preceding the study and entire job were 25.9% and 38.5% respectively. Nearly one-third (31%) of the injuries occurred in emergency unit and 122 (71.3%) of the materials caused injury were used on patients. Practice of needle recap, ever used cigarette in last 12 months, training, work hours > 40 per week, job dissatisfaction and work experience less than 5 years were found factors significantly associated with needle stick and sharp injury for health care workers. The magnitude of Needle stick and sharp injury is high in the study area. Policy makers should formulate strategies to improve the working condition for healthcare workers and increase their adherence to universal precautions.

Needlestick and sharps injuries in orthopedic surgery residents and fellows.

OBJECTIVE: Needlestick and sharps injury (NSSI) is a common occupational hazard of orthopedic surgery training. The purpose of this study was to examine the incidence and surrounding circumstances of intraoperative NSSI in orthopedic surgery residents and fellows and to examine postexposure reporting. DESIGN: A 35-question cross-sectional survey. SETTING: The study was conducted by orthopedic surgery residents and faculty at a nonprofit regional hospital. PARTICIPANTS: The questionnaire was distributed to US allopathic orthopedic surgery residency and fellowship programs; 300 orthopedic surgery trainees participated in the survey. RESULTS: Of 223 trainees who had completed at least 1 year of residency, 172 (77.1%) sustained an NSSI during residency, and 57 of 63 trainees (90.5%) who had completed at least 4 years sustained an NSSI during residency. The most common causes of NSSI were solid needles, followed by solid pins or wires. The surgical activity most associated with NSSI was wound closure, followed by fracture fixation. The type of surgery most frequently associated with NSSI was orthopedic trauma, followed by hip and knee arthroplasty. Of 177 trainees who had sustained a prior NSSI, 99 (55.9%) failed to report all events to their institution's occupational health department. CONCLUSIONS: The incidence of NSSI during residency training is high, with >90% of trainees in their fifth year or later of training having received an injury during their training, with a mean of >4 separate events. Most trainees with an NSSI did not report all of their events, which implies that changes are needed in the incident reporting process universally.

Knowledge, attitudes and behaviour towards needlestick injuries among junior doctors.

BACKGROUND: Needlestick injuries (NSIs) are common healthcare-related injuries and possible consequences include blood-borne infections. Despite that, a large proportion of NSIs are not reported. AIMS: To estimate the prevalence of under-reporting of NSIs and to evaluate the knowledge, attitude and behaviour towards NSIs among junior doctors in a tertiary hospital in Singapore. METHODS: An explanatory sequential mixed-methods design was employed. Quantitative data were collected through questionnaires completed by 99 junior doctors. Descriptive statistics and bivariate analysis were performed to evaluate socio-demographic characteristics, NSI history and NSI reporting practices. Qualitative data were collected through 12 in-depth interviews. Participants were purposively recruited, and semi-structured topic guides were developed. Data were analysed using a thematic approach. RESULTS: Fifty-two per cent of respondents had history of NSI. Of those with history of NSI, 31% did not report injury. NSI reporters were 1.52 times as likely to be aware of how to report injury (P < 0.05), and 1.63 times as likely to feel that reporting benefits their health (P < 0.01) compared with non-reporters. NSI reporters were 83% more likely to report a clean NSI (P = 0.05). For non-reporters, the main reasons for not reporting were perceived low risk of transmission (41%) and lack of time to report (35%). Themes identified in the qualitative data include perceived benefits, perceived barriers, perceived threats, cues to action and organizational culture. CONCLUSION: Under-reporting of NSIs may have significant implications for patients and healthcare workers. Addressing identified factors and instituting targeted interventions will help to improve reporting rates.

Burden of insulin injection-related needlestick injuries in mainland China-prevalence, incidence, and healthcare costs.

OBJECTIVE: To estimate the prevalence and incidence of needlestick injuries associated with insulin injection among nurses working in hospitals in China and to quantify the direct healthcare costs associated with insulin injection-related needlestick injuries. METHODS: We conducted a large online survey among hospital nurses from 31 provinces, municipal cities, and autonomous regions in China from October 2016 to February 2017. The survey covered a wide range of questions, including geographical location, years of experience, insulin injection practice, number of insulin injection-related needlestick injuries in the past 12 months, interventions for needlestick injuries, and treatment costs. We developed a cost estimate model and categorized costs into two major components: infection prevention and treatment of infections. RESULTS: We received a total of 10,447 questionnaires, of which 9873 were complete and validated. 39.1% of the nurses reported at least one needlestick injury while administering diabetic injections at some point in the past. The incidence of needlestick injuries involving injection pens was 139.5 per 1000 nurses per year and, with adjustment for exposure, 10.2 needlestick injuries per 100,000 injections. Among the respondents, 3.2% reported of having hepatitis B virus infection and 0.9% having hepatitis C virus infection as a result of needlestick injuries. The total costs of one insulin injection-related needlestick injury was estimated to range from ¥1,884 - ¥2,389. CONCLUSIONS: Insulin injection-related needlestick injuries were common in nurses working in hospitals in China and imposed a significant economic burden. More resources should be allocated for preventive efforts for needlestick injuries, including adoption of injection devices with advanced safety features.

Assessment of Knowledge, Attitude and Vaccination Status of Hepatitis B among Nursing Training Students in Ho, Ghana.

BACKGROUND: Viral hepatitis B is a disease condition of the liver caused by the hepatitis B virus, and it leads to complications such as cancer and cirrhosis. This poses an occupational hazard because about 66,000 health care workers get infected with the virus annually. Adequate knowledge and right attitude of health workers are required to prevent the disease. Compared to average health care workers, trainee nurses are more vulnerable to the disease due to inadequate knowledge on infection control guidelines. PURPOSE OF THE STUDY: The study assessed the knowledge, attitude and vaccination status of hepatitis B among nursing training students in Ho, Ghana. METHOD: A descriptive cross-sectional study was carried out between September and December 2017 in which 358 student nurses were randomly selected to participate in this study. A self-administered structured questionnaire was used as a data collection tool to get information from the students. Data were then entered into SPSS version 20 for cleaning and analysis. RESULT: The majority of participants were between the ages of 20-26 years with the mean age 21.56 (SD ± 2.65). About 78.2% knew the disease is caused by a virus. Also, 69.8% reported transmission through needle stick injuries, and the mean knowledge score was 29.6 (SD ± 6.98). Also, 68.8% recapped needles (P = 0.012), and 49.4% have taken the full three doses of vaccines. CONCLUSION: The study points to a satisfactory knowledge and vaccination status of hepatitis B among the trainee nurses but poor attitude toward the disease, hence the need for massive health education among the nurses.

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.