Seroprevalence of hepatitis C virus infection among surgical nurses, their patients and blood donation candidates in Poland.

OBJECTIVES: To assess the prevalence of anti-hepatitis C virus (HCV) in surgical nurses and midwives, to compare the rate with other female groups (their patients from the same hospitals and blood donation candidates) in a cross-sectional serosurvey, and to evaluate the alleged risk factors for acquiring an occupational infection. METHODS: Between February 2008 and June 2009, participants from 16 hospitals selected at random in West Pomerania, Poland completed a written questionnaire detailing potential risk factors for HCV infection. Serum samples were assayed for anti-HCV using third-generation testing methods. RESULTS: Of 414 staff members, six were found to be anti-HCV positive [1.4%, 95% confidence interval (CI) 0.7-3.1%]. The seropositive status of staff was discovered during this one-off screening. A logistic regression model indicated that for anti-HCV seropositivity, only the length of employment was associated with increased odds of being infected [odds ratio (OR) 2.8; P < 0.006]. The prevalence of anti-HCV was 1.1% (12/1118, 95% CI 0.6-1.9%) in 1118 female patients, and 0% (0/801, 95% CI 0-1.1%) in 801 female blood donation candidates. A significant staff/patient difference in anti-HCV prevalence was observed among those aged >50 years (6.9% vs 1.0%; P < 0.007). For this age group, being a nurse was associated with higher odds (OR 8.8; P < 0.005) of being infected with HCV. CONCLUSIONS: Comparison of HCV prevalence rates pointed to a decreasing trend in the order: surgical nurses/midwives, patients and blood donation candidates; this may indicate occupational risk. The greatest risk factor for contracting HCV infection was length of employment, suggesting a possible effect of accumulated exposure to contaminated blood and other body fluids. There is a need for better recognition of HCV infection as a consequence of prolonged blood exposure among surgical and gynaecological staff.

A complete HBV vaccination coverage among Polish surgical nurses in the light of anti-HBc prevalence: A cross-sectional sero-prevalence study.

To determine the vaccination coverage for HBV and the prevalence of anti-HBc, an anonymous sero-survey of surgical/gynecologic nurses from 16 randomly selected hospitals in West Pomerania, Poland, was conducted. Among the 403 participants of whom HBV vaccination had been indicated, the vaccination coverage was 100%. The anti-HBc prevalence was 16.4%; with length of employment being associated with increased odds of being infected. The data obtained underscore the importance of hepatitis B vaccination for HCWs. This study documents the ability to obtain 100% vaccination coverage in nursing staff, an important goal in reducing the risk of HBV infection in this and other health care worker populations.

Surgical nurses and compliance with personal protective equipment.

The study objectives were to evaluate self-reported compliance with personal protective equipment (PPE) use among surgical nurses and factors associated with both compliance and non-compliance. A total of 601 surgical nurses, from 18 randomly selected hospitals (seven urban and 11 rural) in the Pomeranian region of Poland, were surveyed using a confidential questionnaire. The survey indicated that compliance with PPE varied considerably. Compliance was high for glove use (83%), but much lower for protective eyewear (9%). Only 5% of respondents routinely used gloves, masks, protective eyewear and gowns when in contact with potentially infective material. Adherence to PPE use was highest in the municipal hospitals and in the operating rooms. Nurses who had a high or moderate level of fear of acquiring human immunodeficiency virus (HIV) at work were more likely (P<0.005 and P<0.04, respectively) than staff with no fear to be compliant. Significantly higher compliance was found among nurses with previous training in infection control or experience of caring for an HIV patient; the combined effect of training and experience exceeded that for either alone. The most commonly stated reasons for non-compliance were non-availability of PPE (37%), the conviction that the source patient was not infected (33%) and staff concern that following locally recommended practices actually interfered with providing good patient care (32%). We recommend wider implementation, evaluation and improvement of training in infection control, preferably combined with practical experience with HIV patients and easier access and improved comfort of PPE.

Use of the Haddon matrix as a tool for assessing risk factors for sharps injury in emergency departments in the United Arab Emirates.

We investigated the epidemiology and prevention of sharps injuries in the United Arab Emirates. Among 82 emergency nurses and 38 doctors who responded to our questionnaire, risk factors for sharp device injuries identified using the Haddon matrix included personal factors (for the pre-event phase, a lack of infection control training, a lack of immunization, and recapping needles, and for the postevent phase, underreporting of sharps injuries) and equipment-related factors (for the pre-event phase, failure to use safe devices; for the event phase, failure to use gloves in all appropriate situations). Nearly all injuries to doctors were caused by suture needles, and among nurses more than 50% of injuries were caused by hollow-bore needles.

Surgical nurses and their concerns of acquiring HIV infection at the workplace.

A study was conducted to identify pertaining to the care of HIV infected patients among nurses in the County of West Pomerania. Most of the respondents (43.2%) were working in municipal hospitals, 38.7% in hospitals located in the country and 18% in academic hospitals. The responding nurses ranged in age from 20 to 58 (median 38 years). Median of work experience was 16 (1-28) years. The respondents were divided into 3 groups: A--the nurses who expressed serious concern about HIV infection, 62.9%; B--some degree of concern, 31.3%; C--not concerned, 4.3%. An HIV/AIDS workshop was attended by 74.6% of respondents from group A and 76.6% from group B (p > 0.85). The occupational exposure reported 49.5% nurses from group A, 39.9% from group B and 42.4% from group C (p > 0.3). The gloves were "always" used by 82.5% respondents from group A, 87.8% from group B and 76.9% from group C (p > 0.07). 79.9% of nurses from group A, 53.2% from group B and 42.3% (p < 0.0001) favored HIV antibodies testing of all patients.

[HIV infection in the operating room conditions]. / Zakazenie HIV w warunkach pracy bloku operacyjnego.

Several cases of occupational HIV transmission during surgical procedures have been reported all over the world in the last few years. Orthopaedic surgeons are at particularly high risk for blood contamination and skin injuries. This article addresses the risk of HIV transmission in the surgical setting with a focus on specific risk factors: the prevalence of the infection in general population, the stage of the disease, virulence, inoculum size, the nature and frequency of blood contacts. It also shows how the last two factors depend on surgical specialty, duration and kind of the procedure, role of each person, number of needles used and amount of blood loss. The recommended safer surgical techniques as well as personal protective equipment are presented as the strategy to prevent health care worker--to patient transmission. The importance of compliance with universal precautions is pointed as a way to achieve a successful outcome in preventing infection with HIV.

[Hepatitis B virus vaccination among Polish surgeons from the county of Western Pomerania]. / Lekarze specjalnosci zabiegowych województwa zachodniopomorskiego, a szczepienia przeciw wzw typu B.

UNLABELLED: Orthopaedic surgeons are at risk of acquiring hepatitis B virus, so preventive measures, including the vaccination, are important. OBJECTIVE: To determine surgeons" prevention through vaccination against hepatitis B and to access the frequency of "sharps" injuries during surgery. METHODS: An anonymous questionnaire prepared by A. Lowenfels from New York Medical College, USA was distributed between May and July 2001 to 182 members of surgical staff. Twelve hospitals located in the city of Szczecin (4 academic, 4 municipal) as well as located within a 45-mile radius in the county of Western Pomerania, Poland took part. RESULTS: 9.3% of the surgeons who responded had been infected with hepatitis B virus (group I), 79.7% had been immunised against hepatitis B (group II). The rest 11%, mainly of the age > 47 years, had never been vaccinated nor infected (group III). The median number of puncture injuries was 10 per year and the number of hours spent in the operating room--59 per month. There was no statistically significant difference in the variables such as: sex, surgical status, sub-specialty or type of hospital between the groups. CONCLUSIONS: The coverage with the vaccine should be improved. A lot of surgeons who replied take high risk of percutaneous blood exposure and thus possibility of infection with HBV, but every tenth has never been vaccinated nor infected. The complete information on the risk of hepatitis B and on the safety and efficiency of active immunisation should be supplied not only among medical students, but surgical experienced staff as well.

[HIV-testing of patients and operating room staff: myths and facts]. / Badania pacjentów i czlonków zespolu operacyjnego w kierunku przeciwcial anty-HIV--mity i fakty.

Orthopedic surgeons are at risk of acquiring HIV. Multi-center studies have estimated the risk of infection related with exposure to blood and other body fluids. New discussion concerning mandatory testing of patients who require invasive procedures has arisen as several reports on occupationally acquired HIV infections have been published. The case of the French surgeon highlighted the high risk of infection by blood-born pathogens related to certain surgical techniques. Cases of patients infected by HIV by medical personnel (by an American dentist and the mentioned before French surgeon) are also discussed. Basing on these two cases, the procedures with the highest infection risk are discussed, along with HIV testing policies towards surgeons of health care authorities in different countries. The importance of preventive measures, considering no cure for HIV infections is available is also stressed.

[Intracranial tumors simulating neurological infections]. / Guzy wewnatrzczaszkowe imitujace neuroinfekcje.

The clinical manifestations were analysed in 16 patients with expanding intracranial lesions hospitalized in the period from Jan 1 1980 to Aug 31 1990. They had been admitted to hospital with the diagnosis of suspected neuroinfection. The initial manifestations and abnormalities in neurological examination might have suggested inflammatory processes in the central nervous system. Only further diagnostic procedures, especially emergency ones such as angiography and CT of the brain made possible establishing of final diagnosis and qualifying the patient for surgical intervention. The authors stress that expanding intracranial lesions should be always taken into account in patients with clinical and CSF abnormalities persisting despite ruling out of neuroinfection.

[Brain abscess complicated by suppurative meningitis in a patient with cyanotic heart defect. A case report]. / Ropien mózgu powiklany ropnym zapaleniem opon mózgowo-rdzeniowych u chorego z sinicza wada serca. Opis przypadku.

A case is reported of occipital lobe abscess complicated with purulent meningitis in a boy aged 16 years with Fallot's syndrome. The authors stress the necessity of taking into consideration the possibility of this complication in cases of congenital heart diseases and describe diagnostic difficulties due to scant signs of the abscess despite its large size.