Negative Pressure Assisted Microenvironment Surgical Hood: A Novel Cost-Effective Device to Minimize Aerosol Contamination During Neurosurgical Procedures in Times of COVID-19.

OBJECTIVE: Present guidelines on reducing aerosol generation during neurosurgical procedures are futile. The aim of this article was to describe a novel device to contain aerosol within a small localized environment around the operative field-the negative pressure assisted microenvironment surgical hood (NEPA-MESH). METHODS: This device can be assembled using easily available materials-steel wires, image intensifier cover, surgical drape, and three-dimensional-printed self-locking copolyester double hoops. Large-bore pipes in continuity with a high-volume suction apparatus create a constant negative pressure microenvironment around the operative field. The CEM DT-9880 particle counter was used to estimate particle concentration inside the NEPA-MESH during various stages of a neurosurgical procedure as well as outside. The NEPA-MESH was tested in different craniotomies and endoscopic procedures. RESULTS: Mean particle concentration inside the NEPA-MESH and outside during drilling in various procedures was calculated and compared using unpaired t test. Significant reduction in particle concentrations was recorded for particles sized 0.3 µm (t = 17.55, P < 0.0001), 0.5 µm (t = 11.39, P < 0.0001), 1 µm (t = 6.36, P = 0.0002), 2.5 µm (t = 2.04, P = 0.074), 5.0 µm (t = 7.026, P = 0.0008), and 10 µm (t = 4.39, P = 0.0023). CONCLUSIONS: As definitive evidence demonstrating the presence of coronavirus disease 2019 (COVID-19) in aerosol particles is awaited, we describe a cost-effective strategy to reduce aerosol contamination. Significant reduction in particle concentrations was seen outside the NEPA-MESH compared with inside it during various stages of neurosurgical procedures.

From lionizing to protecting health care workers during and after COVID-19-systems solutions for human tragedies.

During the COVID-19 pandemic, health care workers (HCWs) have been lauded as heroes, yet both before and during the pandemic, they lacked the protections needed to keep them safe. We summarize data on HCW infections and deaths during previous epidemics, the costs of the failure to protect them, and provide recommendations for strengthening HCW protections by investments in and implementation of infection prevention and control and water, sanitation, and hygiene programs, training and career development, and national and global monitoring of HCW infections. We must move from placing individuals at undue risk to accepting collective responsibility and accountability for the well-being of our HCWs and take concrete actions to protect HCWs who risk their lives to protect patients and populations.

A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers.

BACKGROUND: Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW. METHODS: We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings. RESULTS: Thirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness. DISCUSSION: Our findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.

[Exposure to risk fluids in health personnel. Evaluation of direct costs in their management]. / Exposiciones a fluidos de riesgo en el personal de salud. Evaluación de gastos directos en su manejo.

BACKGROUND: Health personnel are exposed to accidents with blood and other potentially infectious biological fluids in their clinical practice. Management of these events has high costs that are likely to be reduced. AIM: To give a general description of work accidents and their associated costs. MATERIAL AND METHOD: All healthcare workers reports of exposure to blood or risk fluids between 2010 and 2015, were included. Health care costs were calculated. Records were analyzed in a retrospective manner. RESULTS: 189 exposures to risk fluids were reported during the study period with an average of 31 accidents per year. 83.5% of the studied sources were negative for HIV, HBV and HCV, 12.6% was with unknown source and only 3.7% was positive for any of them. The costs associated with management of risk exposures was $ 2,765,890 Chilean pesos/year (4,274 USD). The average cost per event was $ 73,171 Chilean pesos (113 USD). Approximately 80% of this figure corresponds to basic management protocol. CONCLUSION: Exposure to risk fluids in health personnel is frequent and has a high cost. This cost can be reduced by the application of prevention measures to give the healthcare workers a safer environment for their daily practice.

Exposiciones a fluidos de riesgo en el personal de salud. Evaluación de gastos directos en su manejo / Exposure to risk fluids in health personnel. Evaluation of direct costs in their management

Resumen Introducción: El personal de salud está expuesto a experimentar accidentes con sangre y otros fluidos biológicos potencialmente infectantes en su práctica clínica; la atención de estos eventos implica costos importantes, los que son susceptibles de reducir. Objetivo: Describir aspectos generales de los accidentes laborales y los costos asociados al manejo. Material y Método: Estudio descriptivo, retrospectivo. Se tomaron las notificaciones de exposición a fluidos en el personal de salud entre los años 2010 y 2015 y se calcularon los costos por concepto de atención de los afectados. Resultados: Se reportaron 189 exposiciones a fluido de riesgo durante el período estudiado con un promedio de 31 accidentes anuales. El 83,5% de las fuentes estudiadas fueron negativas para VIH, VHB y VHC, 12,6% fue accidente con fuente desconocida y sólo 3,7% fue positivo a alguno de estos virus. Los costos asociados al manejo de las exposiciones de riesgo fueron de $2.765.890 anuales (4,274 USD) y un costo medio de $ 73.171 por evento manejado (113 USD); cerca de 80% de esta cifra corresponde al protocolo de manejo básico. Conclusión: Las exposiciones a fluidos de riesgo en el personal de salud son frecuentes, y la atención de los afectados tiene un costo importante. Estas cifras son susceptibles de reducir en la medida que se previenen las exposiciones a fluidos, a través de las distintas estrategias validadas y al otorgar al trabajador de la salud un escenario seguro para su práctica diaria.

Background: Health personnel are exposed to accidents with blood and other potentially infectious biological fluids in their clinical practice. Management of these events has high costs that are likely to be reduced. Aim: To give a general description of work accidents and their associated costs. Material and Method: All healthcare workers reports of exposure to blood or risk fluids between 2010 and 2015, were included. Health care costs were calculated. Records were analyzed in a retrospective manner. Results: 189 exposures to risk fluids were reported during the study period with an average of 31 accidents per year. 83.5% of the studied sources were negative for HIV, HBV and HCV, 12.6% was with unknown source and only 3.7% was positive for any of them. The costs associated with management of risk exposures was $ 2,765,890 Chilean pesos/year (4,274 USD). The average cost per event was $ 73,171 Chilean pesos (113 USD). Approximately 80% of this figure corresponds to basic management protocol. Conclusion: Exposure to risk fluids in health personnel is frequent and has a high cost. This cost can be reduced by the application of prevention measures to give the healthcare workers a safer environment for their daily practice.

Sharps injuries amongst healthcare workers: review of incidence, transmissions and costs.

BACKGROUND: Sharps injuries and the related risk of infections such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) represent one of the major occupational health risks for healthcare workers (HCWs). LITERATURE REVIEW: An overview of available data on the incidence of sharps injuries and the related HBV, HCV and HIV infections and ensuing costs is provided. RESULTS: Literature reported incidence rates of sharps injuries ranging from 1.4 to 9.5 per 100 HCWs, resulting in a weighted mean of 3.7/100 HCWs per year. Sharps injuries were associated with infective disease transmissions from patients to HCWs resulting in 0.42 HBV infections, 0.05-1.30 HCV infections and 0.04-0.32 HIV infections per 100 sharps injuries per year. The related societal costs had a mean of €272, amounting to a mean of €1,966 if the source patient was HIV positive with HBV and HCV co-infections. CONCLUSION: Sharps injuries remain a frequent threat amongst HCWs. The follow-up and treatment of sharps injuries and the deriving consequences represent a significant cost factor.

Political commitment to tuberculosis control in Ghana.

As part of expanding and sustaining tuberculosis (TB) control, the Stop TB Partnership of the World Health Organization initiative has called for strong political commitment to TB control, particularly in developing countries. Framing political commitment within the theoretical imperatives of the political economy of health, this study explores the existing and the expected dimensions of political commitment to TB control in Ghana. Semi-structured in-depth interviews were conducted with 29 purposively selected staff members of the Ghana Health Service and some political officeholders. In addition, the study analysed laws, policies and regulations relevant to TB control. Four dimensions of political commitment emerged from the interviews: provision of adequate resources (financial, human and infrastructural); political authorities' participation in advocacy for TB; laws and policies' promulgation and social protection interventions. Particularly in respect to financial resources, donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria presently give more than 60% of the working budget of the programme. The documentary review showed that laws, policies and regulations existed that were relevant to TB control, albeit they were not clearly linked.

Blood and body fluid exposures: consent for source patient testing.

BACKGROUND: Exposure to blood and body fluids (BBF) remains a major occupational hazard in health care. Routine testing of source patients for blood borne viruses where exposure has occurred is recommended in the UK. Whilst in practice source patient identification may be challenging the reasons why identified individuals are not tested, including issues relating to consent and procedure compliance, are not fully understood. AIMS: To identify the frequency of serological testing in identified source patients and the reasons for not testing, including refusal and absence of consent. METHODS: A review of all BBF exposure incidents reported to the Sheffield Occupational Health Service between 1 January 2009 and 31 December 2009. RESULTS: Of 490 reported BBF exposure incidents source patients were identified in 87% of cases and tested in 56% of the incidents. Rates of source patient testing were higher following incidents affecting medical (76%) and nursing staff (69%) than those involving non-clinical (36%) and dental staff (17%). Reasons for not testing source serology among identifiable patients (151) were not recorded in 66% of incidents, in 20% there was incapacity to give consent and in 5% testing was refused. CONCLUSIONS: This study found that despite guidance, routine source testing is not universal. Incapacity to consent is a contributory factor for some source serology not being tested and clarification of the ethical and legal position would be helpful. Larger studies should explore other reasons why identified source patients are not tested in practice and explore the policy implications of those findings.

[Biological risk accidents among undergraduate healthcare students: five years experience]. / Accidentes de riesgo biológico entre estudiantes de carreras de la salud: Cinco años de experiencia.

Undergraduate healthcare students are exposed to bloodborne pathogens, and data from developing countries is scarce. We report the experience of a comprehensive program dedicated to the management of this risk. The program includes financial coverage, a 24-hour attention system, HIV, HBV, HCV testing, and free provision of post-exposure antiretroviral drugs. During 2003-2007, incidence rates of these exposures reached 0.9 per 100 student-years. Events were only observed among medicine, nursing, and midwifery students, with rates highest among nursing students (RR 3.5 IC95 1.93 - 6.51). Cuts and needle stick injuries predominated (74.7% of accidents). Three students were exposed to HIV patients (1.9%), all of them received prophylactic drugs, infection was discarded after follow up, and also discarded after exposures to HBV or HCV (0.6% of all accidents). Cost per 1000 student-year was less than 2000 USD. Healthcare students are exposed to biological risks during their studies and a comprehensive program is feasible in a developing country.

Accidentes de riesgo biológico entre estudiantes de carreras de la salud: Cinco años de experiencia / Biological risk accidents among undergraduate healthcare students: Five years experience

Undergraduate healthcare students are exposed to bloodborne pathogens, and data from developing countries is scarce. We report the experience of a comprehensive program dedicated to the management of this risk. The program includes financial coverage, a 24-hour attention system, HIV, HBV, HCV testing, and free provisión of post-exposure antiretroviral drugs. During 2003-2007, incidence rates of these exposures reached 0.9 per 100 student-years. Events were only observed among medicine, nursing, and midwifery students, with rates highest among nursing students (RR 3.5 IC95 1.93 - 6.51). Cuts andneedle stick injuries predominated (74.7 percent of accidents). Three students were exposed to HIV patients (1.9 percent), all of them received prophylactic drugs, infection was discarded after follow up, and also discarded after exposures to HBV or HCV (0.6 percent of all accidents). Cost per 1000 student-year was less than 2000 USD. Healthcare students are exposed to biological risks during their studies and a comprehensive program is feasible in a developing country.

Los estudiantes de pregrado de las carreras de la salud están expuestos a riesgos biológicos con agentes de transmisión sanguínea. En este trabajo se reporta la experiencia acumulada con un programa integral para este tipo de accidentes y que incluye atención gratuita las 24 horas, estudio serológico de la fuente para VIH, VHC y VHB, y entrega de anti-retrovirales post-exposición a pacientes infectados por VIH. Desde el año 2003 al 2007 la tasa de incidencia alcanzó una cifra de 0,9 eventos por 100 estudiantes-año. Las exposiciones de riesgo fueron observadas sólo entre estudiantes de medicina, enfermería y obstetricia, siendo la mayor tasa en alumnos de enfermería (RR 3,5 IC95 1,93 a 6,51). Tres alumnos estuvieron expuestos a pacientes con infección por VIH (l,9 por cientoo de todos los accidentes), todos ellos recibieron profilaxis, descartándose seroconversión en el seguimiento, al igual que en casos con exposición ante VHB y VHC (0,6 por cientoo del total de accidentes). El costo del programa fue menor a US$ 2000 por 1.000 estudiantes-año. Los estudiantes de las carreras de la salud están expuestos a riesgos biológicos durante sus estudios y requieren de un programa de manejo, el que es posible de lograr en un país en desarrollo.

A low-dose intradermal hepatitis B vaccine programme in health-care workers and students is highly effective and cost saving: a retrospective follow-up survey in the clinical setting.

OBJECTIVE: To evaluate compliance, serologic response and the cost-benefit of a low-dose intradermal hepatitis B vaccination programme, followed by intramuscular boosters in non-responders. MATERIAL AND METHODS: The study comprised a retrospective survey of 1521 health-care workers and 968 students. Response was defined as hepatitis B antibody titres > or =10 IU/L. Non-response included vaccinees with undetectable antibodies and a hypo-response if antibodies were detectable. RESULTS: Overall, 2145/2489 (86%) subjects completed the intradermal series, whereof 1840/2489 (74%) complied with the serological check-up. Response was achieved in 1517/1840 (82.5%), whereas 107/1840 (5.8%) had a hypo-response and 216/1840 (11.7%) had an undetectable response. In a logistic regression model, younger age (odds ratio 0.73 (95% CI: 0.65-0.82, p<0.001)) and female gender (odds ratio 2.16 (95% CI: 1.67-2.80; p<0.001)) were predictive of response. In hypo-responders and those with undetectable responses, 43/46 (94%) and 71/136 (52%), respectively, had a response after the first intramuscular booster. Hence, in compliant vaccinees an overall seroprotection rate of 94% was reached after a single intramuscular booster. A cost-benefit analysis indicated a cost reduction exceeding 50% compared to a standard intramuscular vaccine regimen. CONCLUSIONS: In the clinical setting, a low-dose intradermal hepatitis B vaccination programme, followed by intramuscular boosters to non-responders, is effective and cost saving.

Resource consumption in the infection control management of pertussis exposure among healthcare workers in pediatrics.

OBJECTIVE: To assess consumption of resources in the infection control management of healthcare workers (HCWs) exposed to pertussis and to assess avoidability of exposure. SETTING: Tertiary care children's medical center. METHODS: Analysis of the extent of and reasons for HCW exposure to pertussis during contact with children with the disease, whether exposures were avoidable (because of the failure to recognize a case or to order or adhere to isolation precautions) or unavoidable (because the case was not recognizable or because another diagnosis was confirmed), and the cost of implementing exposure management. INTERVENTIONS: Interventions consisted of an investigation of every HCW encounter with any patient who was confirmed later to have pertussis from the time of hospital admission of the patient, use of azithromycin as postexposure prophylaxis (PEP) for exposed HCWs, performance of 21-day surveillance for cough illness, testing of symptomatic exposed HCWs for Bordetella pertussis, and enhanced preexposure education of HCWs. RESULTS: From September 2003 through April 2005, pertussis was confirmed in 28 patients (median age, 62 days); 24 patients were admitted. For 11 patients, pertussis was suspected, appropriate precautions were taken, and no HCW was exposed. Inadequate precautions for 17 patients led to 355 HCW exposures. The median number of HCWs exposed per exposing patient was 9 (range, 1-86 HCWs; first quartile mean, 2; fourth quartile mean, 61). Exposure was definitely avoidable for only 61 (17%) of 355 HCWs and was probably unavoidable for 294 HCWs (83%). The cost of 20-month infection control management of HCWs exposed to pertussis was $69,770. The entire cohort of HCWs involved in direct patient care at the facility could be immunized for approximately $60,000. CONCLUSIONS: Exposure of HCWs to pertussis during contact with children who have the disease is largely unavoidable, and management of this exposure is resource intensive. Universal preexposure vaccination of HCWs is a better utilization of resources than is case-based postexposure management.

Tuberculin reactivity among health care workers in nonhospital settings.

BACKGROUND: We used workers' compensation data to identify health care workers at risk of tuberculosis exposure in the hospital and nonhospital environment. METHODS: We identified State Fund workers' compensation claims having a documented tuberculin skin test (TST) conversion (size >or=10 mm) with a previous negative skin test between 1996 and 2000 in the State of Washington. RESULTS: Health care workers experienced an overall accepted workers' compensation claim rate of 2.3 claims/10,000 full-time equivalent employees (FTEs) per year for tuberculin reactivity. Receptionists accounted for the largest number, with 18.4% tuberculin reactivity claims. The number of tuberculin reactivity claims was the highest for offices and clinics of doctors of medicine (3.7 per 10,000 FTEs), followed by medical laboratories (2.6 per 10,000 FTEs). CONCLUSION: This study allowed characterization of employees in various nonhospital health services locations with higher number of tuberculin reactivity.

Financial and economic costs of scaling up the provision of HAART to HIV-infected health care workers in KwaZulu-Natal.

OBJECTIVES: To provide new information on the financial and economic costs of providing highly active antiretroviral therapy (HAART) to health care workers in public-sector hospital settings in KwaZulu-Natal. DESIGN: An Excel model was used to estimate the cost of providing HAART to health care workers at two state-subsidised hospitals in Durban. Staff members were interviewed and protocols reviewed to identify the time and resources used to provide HAART to health care workers. The cost of the programme was estimated for various patient numbers. RESULTS: The financial cost of treating a patient for a year ranged from R5697 to R8762 depending on the hospital and the number of patients treated. The economic cost of treating a patient for a year ranged from R6123 to R8893. These costs were shown to be robust to changes in key variables. CONCLUSIONS: This study provides evidence on the cost of providing HAART to health care workers and suggests that this strategy could reduce absenteeism and alleviate future staff shortages at moderate cost to hospitals. This is crucial, given the impending human resources crisis in health care in South Africa and the growing burden of HIV/AIDS. These cost estimates should be good indicators of the costs of extending antiretroviral therapy to health care workers in public-sector hospitals in KwaZulu-Natal.

Needlestick injuries in the United States. Epidemiologic, economic, and quality of life issues.

Best evidence from prospective studies with aggressive monitoring suggests that the incidence of needlestick injuries is significantly higher than reported through passive surveillance, ranging from 14 to 839 needlestick injuries per 1,000 health care workers per year. The economic cost of managing these injuries is substantial, ranging from dollars 51 to dollars 3,766 (2002 U.S. dollars). This amount excludes the cost of treating the long-term complications of needlestick injuries, such as HIV and hepatitis B and C infections, each of which can cost several hundreds of thousands of dollars to manage. In addition, health care workers experience significant fear, anxiety, and emotional distress following a needlestick injury, sometimes resulting in occupational and behavior changes. Despite the availability of engineered injury prevention devices, the implementation of these new technologies has been mixed in part because of the perception that these devices are costly and cost ineffective. However, widespread use of safety devices might be more easily justified on economic grounds when the full clinical and economic benefits of these new technologies are considered, especially within the context of injury prevention.

Actualización del coste de las inoculaciones accidentales en el personal sanitario hospitalario / Update of the cost of needlestick injuries in hospital healthcare personnel

Objetivos: Actualizar el coste medio a que asciende cada seguimiento de la hepatitis B y C, así como la infección por el virus de la inmunodeficiencia humana (VIH), en el personal sanitario que ha experimentado una inoculación accidental, desagregar el coste según el estado serológico de la fuente e identificar los apartados que influyen en mayor grado en la cuantía de este resultado. Métodos: Se realizó una descripción de los costes. El programa post exposición se modelizó en un árbol de decisión que combinaba las probabilidades (porcentaje de cada tipo de fuente en función de su positividad a los 3 virus e inmunización del accidentado frente a la hepatitis B) y los costes monetarios(en euros del año 2002) relacionados con los gastos de personal, laboratorio, farmacia (incluida la profilaxis post exposición frente al VIH), energéticos, de limpieza, teléfono, material médico y de oficina, amortización y pérdidas productivas. Resultados: El coste medio de cada inoculación fue de 388 euros, con un rango de 1.502 (fuente positiva a la hepatitis C y el VIH) a 172 euros (fuente negativa a los 3 virus). Si la fuente era la hepatitis B positiva, el coste medio fue de 666 euros cuando el accidentado no estaba inmunizado, y de 467 si efectivamente lo estaba. La mayor parte del coste residió en las pruebas serológicas y la administración de profilaxis post exposición. Conclusiones: El alto coste indica una evaluación adecuada del riesgo con el fin de evitar unos seguimientos innecesarios. El modelo permite conocer el coste de cada episodio potencialmente evitable y puede aplicarse en cualquier hospital, con el objetivo de evaluar económicamente los nuevos dispositivos preventivos

Objectives: To update the mean cost of each hepatitis B, hepatitis C and HIV follow-up in health personnel accidentally exposed to blood and body fluids, to stratify the cost depending on the serological status of the source, and to identify the items that account for the main part of the cost. Methods: A cost analysis was carried out. The post exposure program was modeled on a decision tree combining probabilities(percentage of each type of source depending on positivity for the three viruses and immunization status of the health worker against hepatitis B) and monetary costs (eurosin 2002). Costs included salaries, laboratory, pharmacy (including post exposure prophylaxis), water, gas and electricity, cleaning, telephone, medical and office equipment, amortization and lost productivity. Results: The mean cost was 388 euros, ranging from 1,502 euros (source positive for hepatitis C and HIV) to 172 euros(source negative for the three viruses). If the source was hepatitis B positive, the mean cost was 666 euros when the injured worker was not immunized and was 467 euros if the worker was immunized. Serologic tests and post exposure prophylaxis accounted for the main part of the cost. Conclusions: The high cost suggests the need for appropriate risk evaluation to avoid unnecessary follow-ups. The model used allows the cost of each potentially avoidable episode to be determined and could be used in any hospital to performan economic evaluation of new preventive devices

Analysis of occupational exposures associated with emergency department thoracotomy.

BACKGROUND: Although previous studies have examined the cost effectiveness of emergency department thoracotomy (EDT), provider risk has not been included in these analyses. This study examined the costs associated with provider exposure to human immunodeficiency virus (HIV) and hepatitis from percutaneous injury during EDT. METHODS: A decision tree describing the occupational risks and costs associated with EDT was created. Exposed providers undergo initial counseling, evaluation, and HIV postexposure prophylaxis and treatment as recommended by the Centers for Disease Control. Costs are reported from a health care system perspective in year-2000 dollars. The following prevalences were assumed: HIV (7.1%), hepatitis C (18%), and provider percutaneous injury rate (10%). Sensitivity analyses were performed by varying the prevalence of disease and the probability of seroconversion. RESULTS: According to the authors' model assumptions, the probability is 0.00004 for HIV and 0.0027 for chronic hepatitis C seroconversion. The total additional cost per thoracotomy associated with an exposure is dollars 1,377. CONCLUSIONS: Emergency department thoracotomy is associated with important provider medical risks. Future analyses of EDT should include these factors in reports on the value of this procedure.

Willingness to pay to avoid sharps-related injuries: a study in injured health care workers.

BACKGROUND: Injuries caused by sharp medical devices are common among health care workers and may result in the transmission of human immunodeficiency virus and hepatitis C virus. OBJECTIVE: The direct medical costs associated with treating these injuries are well characterized but fail to capture the costs of such intangible factors as worker anxiety and distress. The objective of this study was to estimate these intangible costs. SUBJECTS: Subjects included health care workers reporting sharps-related injuries to 2 hospital occupational health services. METHOD: A contingent valuation approach was used to assess willingness to pay to avoid sharps-related injuries among recently injured health care workers. Workers were presented with the option of paying out of pocket for a hypothetical injury-prevention device. The median amount of money subjects were willing to pay was estimated with logistic regression, and multivariable regression was performed to assess confounding by worker characteristics and circumstances surrounding injuries. RESULTS: Study interviews were conducted for 116 subjects; median time from injury to interview was 3 days (range, 0-15). Most subjects were women (73%), and most were nurses (44%) or trainees (32%). The crude median amount subjects were willing to pay to avert injury was $850 (US); when adjusted for patient risk status (human immunodeficiency virus and hepatitis C virus status), and working with an uncooperative patient at the time of injury, median amount increased to $1270. CONCLUSION: The high median amount subjects were willing to pay to avoid a sharps-related injury suggests that the costs of "intangible" aspects of worker injury, such as anxiety and distress, may equal costs associated with the medical evaluation of these injuries. These costs should be incorporated in economic analyses of sharps-injury prevention.