Prevalence of Percutaneous Injuries and Associated Factors Among a Sample of Midwives in Hunan Province, China.

Background: Percutaneous injuries and blood-borne-related infections pose occupational hazards to healthcare professionals. However, the prevalence and associated factors for these hazards among midwives in Hunan Province, China are poorly documented. Methods: A cross-sectional study was conducted among a sample of 1,282 eligible midwives in the cities of Yongzhou, Chenzhou, Hengyang, and Changsha in Hunan Province, China, from January 2017 to July 2017. The association of selected independent variables with percutaneous injuries was investigated using binary logistic regression. Results: 992 participants responded (77.3%), and within the previous 12 months, 15.7% experienced percutaneous injuries. In multivariate analysis, hospital size, age, length of employment as a midwife, weekly working hours, and three aspects of Hospital Safety Climate Scale were associated with percutaneous injuries. The risk of percutaneous injuries among the midwives working in hospitals with ≤399 beds was higher than that among those working in hospitals with ≥400 beds by nearly 3 times. Furthermore, the percutaneous injury prevalence of midwives decreased as age increased. Moreover, the probability of percutaneous injuries among the midwives with weekly working hours of >40 was 4.35 times higher compared with that among midwives with weekly working hours of ≤40. Conclusion/Application to practice: The prevalence of percutaneous injuries among midwives in the study hospitals was substantial. Our results further proved that risk mitigation strategies tailored to midwives are needed to reduce this risk. These strategies include ensuring a positive organizational climate, providing highly safe devices, and reducing the workload.

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.

Risk of professional accidental exposure to biological agents in health care workers: a retrospective analysis carried out in a southern Italian tertiary hospital.

Worldwide the needlestick injuries of health care workers (HCWs) still represent a major health problem. The authors aimed to evaluate the risk of HCW needlestick injuries in a tertiary university hospital in southern Italy in relation to some HCW characteristics (age, sex, professional profile, work department) and the source of infection. All HCWs of the University Hospital "Federico II" in Naples, Italy, attending the Infectious Diseases Unit after potential accidental contact to blood-borne viruses through needlestick injuries were enrolled during a 22-year period. HCWs underwent clinical analysis and were administered a specific questionnaire to collect (in anonymous fashion) data about age, sex, professional profile and work department. From 1995 to 2016 1,477 needlestick injuries in the same number of people (one accident per person) were recorded by our service. The HCWs were predominately males (n = 806, 55%) and the mean age was 39.4 years (±10.1 SD). The job categories most involved were: physicians (41%), followed by nurses (33%) and healthcare assistants (HCAs, 10%). The incidence proportion was calculated for these highest-risk categories in three defined time points (at the beginning, in the middle and at the end of the study period): 104/2149 (4.86%) in 1995, 41/2498 (1.64%) in 2005 and 25/2057 (1.22%) in 2015. Most injuries occurred in General Surgery (14.21%), Gynecology and Obstetrics (9%) and Pediatrics (6.49%). In about 34% the HCWs had been exposed to HCV infected fluids. Over time, a significant decrease in accidental exposure was recorded for physicians (p= 0.019), nurses (p< 0.0001) and HCAs (p< 0.0001). Our results confirm that some profiles, namely physicians, nurses and healthcare assistants, are still at risk of needlestick injuries, especially in surgical areas, including obstetric wards. Further primary and secondary prevention strategies are needed to decrease the incidence of new cases of needlestick injuries.

Needlestick injuries in a healthcare setting in New Zealand.

AIM: The aim of this study was to quantify the extent of needlestick underreporting, to examine factors which may contribute to underreporting, and to optimise the relevant risk management strategy. METHOD: An 11-item structured postal questionnaire was adapted from an existing CDC design. RESULTS: The survey results showed that 9% of respondents had experienced at least one needlestick injury in the past year, and three practitioners had five or more injuries in the same period. The overall underreporting rate for needlestick injuries was 33%, which is consistent with internationally-reported figures. More than one in six respondent doctors (17.8%) had sustained one or more needlestick injuries in the past year, compared with nurses (7.6%) or midwives (6.7%). CONCLUSION: The survey identified the level of underreporting and the factors that influence needlestick reporting. This has resulted in a series of recommendations that will help our DHB to formulate an appropriate strategy to manage needlestick incidence and impact.

Injected with controversy: sales and administration of injectable contraceptives in drug shops in Uganda.

CONTEXT: Informal drug shops are the first line of health care in many poor countries. In Uganda, these facilities commonly sell and administer the injectable contraceptive depot medroxyprogesterone acetate (DMPA), even though they are prohibited by law from selling any injectable drugs. It is important to understand drug shop operators' current practices and their potential to provide DMPA to hard-to-reach populations. METHODS: Between November 2007 and January 2008, 157 drug shops were identified in three rural districts of Uganda, and the operators of the 124 facilities that sold DMPA were surveyed. Data were analyzed with descriptive methods. RESULTS: Only 35% of operators reported that the facility in which they worked was a licensed drug shop and another 9% reported that the facility was a private clinic; all claimed to have some nursing, midwifery, or other health or medical qualification. Ninety-six percent administered DMPA in the shop. Operators gave a mean of 10 injections (including three of DMPA) per week. Forty-three percent of those who administered DMPA reported disposing of used syringes in sharps containers; in the previous 12 months, 24% had had a needle-stick injury and 17% had had a patient with an injection-related abscess. Eleven percent said they had ever reused a disposable syringe. Overall, contraceptive knowledge was low, and attitudes toward family planning reflected common traditional biases. CONCLUSION: Provision of DMPA is common in rural drug shops, but needs to be made safer. Absent stronger regulation and accreditation, drug shop operators can be trained as community-based providers to help meet the extensive unmet demand for family planning in rural areas.

Occupational exposure to blood and body fluids among a group of Turkish nursing and midwifery students during clinical practise training: frequency of needlestick and sharps injuries.

AIM: To ascertain the number of needlestick and sharps injuries (NSSIs) in nursing and midwifery students and to assess the use of universal precautions among injured and non-injured students. METHODS: A survey of a representative sample of nursing and midwifery students who did clinical practise in a hospital was conducted. In total, 203 students met the inclusion criterion of the study. Of these, 141 (69.46%) provided useable data. The survey form was designed by the researcher after reviewing the relevant literature. The data frequency, percentages, and χ(2) -values were examined. RESULTS: According to the data, 35.5% of the participating students had experienced a NSSI, 54% of the students had received one NSSI, and 36.0% had two NSSIs. Sixty-six percent of the injured students had been injured by an ampoule and the majority of injuries occurred in the treatment room. Most of the students had washed their injury with antiseptic solution and 84% had not told anyone about their injury. While 86.5% of the students threw away used needles in the special sharps containers disposal box, 89.4% also stated that they always recapped used needles. Almost all the students had received the hepatitis B vaccine. Only 14% of the students stated that they always wore gloves. CONCLUSIONS: This study shows that a significant percentage of nursing and midwifery students receive NSSIs. It is very important to frequently review information about preventive measures so that the students practise them during clinical practise every semester. Moreover, the instructors should monitor if the students are taking the necessary preventive measures without fail.

The prevalence of needle stick injuries in medical, dental, nursing and midwifery students at the university teaching hospitals of Shiraz, Iran.

BACKGROUND: Medical, dental, nursing and midwifery students are at high risk for occupational exposure to blood-borne pathogens (BBPs) via sharp injuries such as needle stick injuries (NSIs). AIMS: The aim of this study was to determine the frequency of NSIs and the knowledge, attitude and practices of these students regarding their prevention. SETTINGS AND DESIGN: The clinical students at Shiraz University of Medical Sciences, Iran, were eligible to participate in a survey conducted by a self-administered questionnaire in 2004, asking them about NSIs during their clinical training undergraduate years. MATERIALS AND METHODS: A cross-sectional study evaluated NSIs and practices regarding protective strategies against BBPs in medical, dental, nursing and midwifery students at Shiraz University, Iran, in 2004. These students completed a self-administered questionnaire. STATISTICAL ANALYSIS: The data were entered into a personal computer using Epi-Info (version 2000). Chi-square and Fisher's exact tests for categorical variables and student t-test for continuous variables were performed, where appropriate, using SPSS version 10. Alpha was set at the 5% level. RESULTS: The questionnaire was completed by 688 (53%) students. 71.1% (489/688) of the students had NSIs that most commonly (43.6%) occurred in patient rooms. 82% (401/489) of NSIs were not reported. 87.8% (604/688) of the students received information about standard isolation precautions and 86.2% of them had been vaccinated against hepatitis B. CONCLUSION: NSIs and non-reporting of NSIs were highly prevalent in these students. Education about the transmission of blood-borne infections, standard precautions and increasing availability of protection strategies must be provided.

[Accidental exposure to blood by midwives in French maternity units: results of the national surveillance 2003]. / Les accidents d'exposition au sang chez les sages-femmes dans les maternités françaises: résultats de la surveillance nationale en 2003.

OBJECTIVE: Midwives appear to be the health care workers exposed to the highest rates of bloodborne injury. In this paper - based on a national survey - we describe the bloodborne injuries occurring in this profession. MATERIAL AND METHOD: During the year 2003, 241 hospitals took part in a national survey of bloodborne injuries. Employees registered anonymous standardized reports of bloodborne events with the Occupational Medicine Unit. The data were processed by the coordination center for the fight against nosocomial infections (C. CLIN) which is in charge of the national analysis of all the events reported in this database. RESULTS: 169 of the 6973 bloodborne events reported during 2003 (2.4%), were signed by midwives or midwife students. The first three most frequent accidents reported were: ocular projections during childbirth, pricks when repairing episiotomy, pricks or cuts when handling soiled instruments. CONCLUSION: Improving knowledge of risk as well as promotion of protection/prevention measures well adapted to this profession should be helpful in optimizing future attitudes.

[Exposure to blood during midwifery operations--a questionnaire study].

A self-administered questionnaire was mailed to all midwives working in Nara Prefecture to investigate blood exposure events at delivery and to consider protective measures for the exposure. Out of the 203 midwives 193 responded to the questionnaire. The median number of deliveries in which the midwives had assisted within the past one year was 35 after excluding those who had not assisted in deliveries at all. The incidence of needle-stick injuries was estimated to be 86.2 per 100 persons within the past one year. The occurrence in the subgroup who had worked as midwife for less than 5 years was 2-3 times higher than that in those who worked for more than 5 years. Over 90% of the midwives had experiences of direct blood contact events to the skin while assisting in their 10 most recent deliveries. Blood contact events occurred in the finger-hand-arm area in 85% of the midwives, on the legs in 62%, in the face in 20% and in the eyes in 1%. Around 20% of the midwives had unintentionally sucked amniotic fluid when using a tracheal catheter on a newborn. The most common occasion where direct blood contact events occurred was while bathing an infant for removing blood and amniotic fluid. The midwives wore a disposal gown more often when assisting in labors of parturient women infected with blood-born infectious diseases than without the diseases, and similarly for wearing gloves when measuring blood loss and for usage of a mechanical device for sucking amniotic fluid in the tracheae of an infant. Based on the results obtained in this questionnaire study and our previous study about blood contact events observed in a delivery room, protective measures for midwives against exposure to blood at delivery are required and some ideas are presented.