Assuntos
Corpo Clínico Hospitalar/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Doenças Profissionais/epidemiologia , Segurança/legislação & jurisprudência , Humanos , Exposição Ocupacional/legislação & jurisprudência , Pele/lesões , Estados Unidos/epidemiologia , United States Occupational Safety and Health AdministrationRESUMO
OBJECTIVE: The purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers. METHODS: A survey on blood exposure was mailed in 2002-2003 to a national sample of paramedics. Results for California paramedics were analyzed with the national sample and also separately. RESULTS: The incidence rate for needlestick/lancet injuries was 100/1,000 employee-years [95% confidence interval (CI), 40-159] among the national sample and 26/1,000 employee-years (95% CI, 15-38) for the California sample. The highest exposure rate was for non-intact skin, 230/1,000 employee-years (95% CI, 130-329). The rate for all exposures was 465/1,000 employee-years (95% CI, 293-637). California needlestick/lancet rates, but not national, were substantially lower than rates in earlier studies of paramedics. Rates for all percutaneous injuries among paramedics were similar to the mid to high range of rates reported for most hospital-based healthcare workers. CONCLUSIONS: Paramedics in the United States are experiencing percutaneous injury rates at least as high as, and possibly substantially higher than, most hospital-based healthcare workers, as well as substantially higher rates of exposure to blood on non-intact skin.
Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Pessoal Técnico de Saúde/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Acidentes de Trabalho/prevenção & controle , Adulto , California/epidemiologia , Feminino , Humanos , Incidência , Masculino , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Recursos Humanos em Hospital/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto JovemRESUMO
To document the frequency and circumstances of bloodborne pathogen exposures among surgeons in sub-Saharan Africa, we surveyed surgeons attending the 2006 Pan-African Association of Surgeons conference. During the previous year, surgeons sustained a mean of 3.1 percutaneous injuries, which were typically caused by suture needles. They sustained a mean of 4.1 exposures to blood and body fluid, predominantly from blood splashes to the eyes. Fewer than half of the respondents reported completion of hepatitis B vaccination, and postexposure prophylaxis for human immunodeficiency virus was widely available. Surgeons reported using hands-free passing and blunt suture needles. Non-fluid-resistant cotton gowns and masks were the barrier garments worn most frequently.
Assuntos
Patógenos Transmitidos pelo Sangue , Cirurgia Geral , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Exposição Ocupacional , África Subsaariana/epidemiologia , Coleta de Dados , Vacinas contra Hepatite B/uso terapêutico , Humanos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , MédicosRESUMO
A comparison of needlestick injury surveillance data from Japan and the United States revealed a higher proportion of foot injuries to Japanese healthcare workers (HCWs), compared with US HCWs. This study investigates the underlying factors that contribute to this difference and proposes evidence-based prevention strategies to address the risk, including the use of safety-engineered needle devices, point-of-use disposal containers for sharp instruments and devices, and closed-toe footwear.
Assuntos
Características Culturais , Traumatismos do Pé/epidemiologia , Pessoal de Saúde , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Exposição Ocupacional , Síndrome da Imunodeficiência Adquirida/transmissão , Traumatismos do Pé/etiologia , Humanos , Japão , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Sistemas Automatizados de Assistência Junto ao Leito , Sapatos , Estados UnidosRESUMO
PURPOSE: The aim of the study is to estimate incidence rates of occupational blood exposure by route of exposure (needlesticks; cuts from sharp objects; mucous membrane exposures to the eyes, nose, or mouth; bites; and blood contact with nonintact skin) in US and California paramedics. METHODS: A mail survey was conducted in a national probability sample of certified paramedics. RESULTS: Proportions of paramedics who reported an exposure in the previous year were 21.6% (95% confidence interval [CI], 17.8-25.3) for the national sample and 14.8% (95% CI, 12.2-17.4) for California. The overall incidence rate was 6.0/10,000 calls (95% CI, 3.9-8.1). These rates represent more than 49,000 total exposures and more than 10,000 needlesticks per year among paramedics in the United States. Rates for mucocutaneous exposures and needlesticks were similar (approximately 1.2/10,000 calls). Rates for California were one third to one half the national rates. Sensitivity analysis showed that potential response bias would have little impact on the policy and intervention implications of the findings. CONCLUSION: Paramedics continue to be at substantial risk for blood exposure. More attention should be given to reducing mucocutaneous exposures. The impact of legislation on reducing exposures and the importance of nonintact skin exposures need to be better understood.
Assuntos
Pessoal Técnico de Saúde , Patógenos Transmitidos pelo Sangue , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Exposição Ocupacional , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Doenças Profissionais/prevenção & controle , Guias de Prática Clínica como Assunto , Medição de Risco , Inquéritos e QuestionáriosRESUMO
US policy regarding health care worker-to-patient transmission of bloodborne pathogens, issued in 1991, is flawed. We review current evidence of such nosocomial infections and conclude that a standardized national policy is needed, which includes improved surveillance and follow-up of blood exposures to patients and targeted practice restrictions for infected practitioners performing exposure-prone procedures.
Assuntos
Patógenos Transmitidos pelo Sangue , Infecção Hospitalar/transmissão , Infecções por HIV/transmissão , Política de Saúde , Hepatite B/transmissão , Transmissão de Doença Infecciosa do Profissional para o Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Infecção Hospitalar/epidemiologia , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Fatores de Risco , Estados UnidosAssuntos
Cateterismo Periférico/efeitos adversos , Remoção de Dispositivo/efeitos adversos , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Recursos Humanos de Enfermagem , Traumatismos Ocupacionais/etiologia , Cateterismo Periférico/enfermagem , Pesquisa em Enfermagem Clínica , Remoção de Dispositivo/enfermagem , Humanos , Pessoa de Meia-Idade , Medição de Risco , Inquéritos e QuestionáriosRESUMO
Injury patterns for OR staff members differ from those in other healthcare settings. For this reason, tailor safety strategies to the OR environment to reduce injuries and blood exposures in this setting.
Assuntos
Cirurgia Geral , Saúde Global , Recursos em Saúde/provisão & distribuição , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Viroses/transmissão , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Medição de Risco , Vacinas/provisão & distribuição , Recursos HumanosRESUMO
OBJECTIVE: To construct a single estimate of the number of percutaneous injuries sustained annually by healthcare workers (HCWs) in the United States. DESIGN: Statistical analysis. METHODS: We combined data collected in 1997 and 1998 at 15 National Surveillance System for Health Care Workers (NaSH) hospitals and 45 Exposure Prevention Information Network (EPINet) hospitals. The combined data, taken as a sample of all U.S. hospitals, were adjusted for underreporting. The estimate of the number of percutaneous injuries nationwide was obtained by weighting the number of percutaneous injuries at each hospital by the number of admissions in all U.S. hospitals relative to the number of admissions at that hospital. RESULTS: The estimated number of percutaneous injuries sustained annually by hospital-based HCWs was 384,325 (95% confidence interval, 311,091 to 463,922). The number of percutaneous injuries sustained by HCWs outside of the hospital setting was not estimated. CONCLUSIONS: Although our estimate is smaller than some previously published estimates of percutaneous injuries among HCWs, its magnitude remains a concern and emphasizes the urgent need to implement prevention strategies. In addition, improved surveillance could be used to monitor injury trends in all healthcare settings and evaluate the impact of prevention interventions.
Assuntos
Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Recursos Humanos em Hospital/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Vigilância da População , Gestão de Riscos/estatística & dados numéricos , Estados Unidos/epidemiologiaAssuntos
Acidentes de Trabalho/prevenção & controle , Luvas Cirúrgicas , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Técnicas de Sutura/instrumentação , Parto Obstétrico/instrumentação , Desenho de Equipamento , Falha de Equipamento , Humanos , Lacerações/cirurgia , Agulhas , Obstetrícia , Projetos de PesquisaAssuntos
Patógenos Transmitidos pelo Sangue , Controle de Doenças Transmissíveis/organização & administração , Fidelidade a Diretrizes , United States Occupational Safety and Health Administration , Controle de Doenças Transmissíveis/métodos , Exposição Ocupacional/prevenção & controle , Manejo de Espécimes/normas , Estados UnidosRESUMO
OBJECTIVE: Measuring the effect of the Needlestick Safety and Prevention Act (NSPA) is challenging. No agreement exists on a common denominator for calculating injury rates. Does it make a difference? How are the law and safety-engineered devices related? What is the effect on injuries and costs? This study examines those issues in assessing the impact of the legislation on hospital worker percutaneous injuries. METHODS: Using a historic prospective design, we analyzed injury data from 85 hospitals. Injury rates were calculated per 100 full-time equivalents, 100 staffed beds, and 100 admissions each year from 1995 to 2005. We compared changes for each denominator. We measured the proportion of the injury rate attributed to safety-engineered devices. Finally, we estimated a national change in injuries and associated costs. RESULTS: For all denominators, a precipitous drop in injury rates of greater than one-third ([Formula: see text]) occurred in 2001, immediately following the legislation. The decrease was sustained through 2005. Concomitant with the decrease in rates, the proportion of injuries from safety-engineered devices nearly tripled ([Formula: see text]) across all denominators. We estimated annual reductions of more than 100,000 sharps injuries at a cost savings of $69-$415 million. CONCLUSIONS: While the data cannot demonstrate cause and effect, the evidence suggests a reduction in hospital worker injury rates related to the NSPA, regardless of denominator. It also suggests an association between the increase in safety-engineered devices and the reduction in overall injury rates. The decreases observed translate into significant reductions in injuries and associated costs.
Assuntos
Legislação de Dispositivos Médicos , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Recursos Humanos em Hospital/legislação & jurisprudência , Desenho de Equipamento/normas , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Incidência , Agulhas/normas , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Recursos Humanos em Hospital/estatística & dados numéricos , Estudos Prospectivos , Equipamentos de Proteção , Segurança/legislação & jurisprudência , Estados Unidos/epidemiologiaRESUMO
A retrospective review of secondary injury data was used to evaluate the characteristics of percutaneous injuries from safety-engineered sharp devices. Injury rates and safety device activation rates differed by healthcare provider type. Approximately 22.8%-32% of injuries could have been prevented had an available safety feature been activated after use.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Agulhas/efeitos adversos , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Traumatismos Ocupacionais/etiologia , Equipamentos de Proteção , Distribuição de Qui-Quadrado , Humanos , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Traumatismos Ocupacionais/prevenção & controle , Estudos Retrospectivos , SegurançaRESUMO
BACKGROUND: To gauge the impact of regulatory-driven improvements in sharps disposal practices in the United States over the last 2 decades, we analyzed percutaneous injury (PI) data from a national surveillance network from 2 periods, 1993-1994 and 2006-2007, to see whether changes in disposal-related injury patterns could be detected. METHODS: Data were derived from the EPINet Sharps Injury Surveillance Research Group, established in 1993 and coordinated by the International Healthcare Worker Safety Center at the University of Virginia. For the period 1993-1994, 69 hospitals contributed data; the combined average daily census for the 2 years was 24,495, and the total number of PIs reported was 7,854. For the period 2006-2007, 33 hospitals contributed data; the combined average daily census was 6,800, and the total number of PIs reported was 1901. RESULTS: In 1992-1993, 36.8% of PIs reported were related to disposal of sharp devices. In 2006-2007, this proportion was 19.3%, a 53% decline. CONCLUSIONS: This comparison provides evidence that implementation of point-of-use, puncture-resistant sharps disposal containers, combined with large-scale use of safety-engineered sharp devices, has resulted in a marked decline in sharps disposal-related injury rates in the United States. The protocol for removing and replacing full sharps disposal containers remains a critical part of disposal safety.
Assuntos
Eliminação de Resíduos de Serviços de Saúde/métodos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Hospitais , Humanos , Estados Unidos/epidemiologiaRESUMO
PURPOSE: Understanding the risks of bloodborne pathogen transmission is fundamental to prioritizing interventions when resources are limited. This study investigated the risks to healthcare workers in Zambia. DESIGN: A survey was completed anonymously by a convenience sample of workers in three hospitals and two clinics in Zambia. Respondents provided information regarding job category, injuries with contaminated sharps, hepatitis B vaccination status and the availability of HIV post-exposure prophylaxis (PEP). RESULTS: Nurses reported the largest number of injuries. The average annual sharps injury rate was 1.3 injuries per worker, and service workers (housekeepers, laundry, ward assistants) had the highest rate of these injuries, 1.9 per year. Injuries were often related to inadequate disposal methods. Syringe needles accounted for the largest proportion of injuries (60%), and 15% of these injuries were related to procedures with a higher-than-average risk for infection. Most workers (88%) reported the availability of PEP, and only 8% were fully vaccinated against hepatitis B. CONCLUSIONS: The injury risks identified among Zambian workers are serious and are exacerbated by the high prevalence of bloodborne pathogens in the population. This suggests that there is a high risk of occupationally acquired bloodborne pathogen infection. The findings also highlight the need for a hepatitis B vaccination program focused on healthcare workers. The risks associated with bloodborne pathogens threaten to further diminish an already scarce resource in Zambia - trained healthcare workers. To decrease these risks, we suggest the use of low-cost disposal alternatives, the implementation of cost-sensitive protective strategies and the re-allocation of some treatment resources to primary prevention.
Assuntos
Patógenos Transmitidos pelo Sangue , Pessoal de Saúde/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Exposição Ocupacional , Recursos Humanos em Hospital/estatística & dados numéricos , Doenças Transmissíveis/transmissão , Humanos , Controle de Infecções , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Profilaxia Pós-Exposição , Prevalência , Fatores de Risco , Inquéritos e Questionários , ZâmbiaRESUMO
The extent of occupational injuries among health care workers in central Africa, particularly in the Democratic Republic of Congo, is not documented. We sought to determine the incidence of percutaneous injury and exposure to blood and other body fluids in Congolese urban and rural hospitals in the previous year. Our data show high rates of percutaneous injury and exposure to blood and other body fluids, reflecting poor safety conditions for most Congolese health care workers.
Assuntos
Acidentes de Trabalho/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Pessoal de Saúde , Ferimentos Penetrantes Produzidos por Agulha/complicações , Exposição Ocupacional/prevenção & controle , Precauções Universais/métodos , Viroses/epidemiologia , Patógenos Transmitidos pelo Sangue/isolamento & purificação , Estudos Transversais , República Democrática do Congo , Hospitais , Humanos , Incidência , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Medição de Risco , Viroses/prevenção & controleRESUMO
BACKGROUND: The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings. STUDY DESIGN: We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members. RESULTS: Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others. CONCLUSIONS: Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers.
RESUMO
BACKGROUND: Despite recent improvements in policies, practices, and device design, percutaneous injuries (PIs) from needles and sharp instruments continue to expose health care workers to the risk of bloodborne pathogens. METHODS: Prospective surveillance was instituted to study the epidemiologic characteristics of PIs at King Abdulaziz Medical City, Riyadh, Saudi Arabia (KAMC-R) from 2004 through 2008 and to benchmark these characteristics relative to those of a network of US hospitals participating in the Exposure Prevention Information Network (EPINet) research group (2004-2007). RESULTS: The mean PIs rate per 100 daily occupied beds in KAMC-R was significantly lower than that reported by teaching and nonteaching US EPINet hospitals. Similar to US EPINet hospitals, nurses at KAMC-R reported more PIs than physicians. Compared with US EPINet hospitals, nurses at KAMC-R experienced more PIs (52.8% vs 38.1%, respectively), whereas physicians experienced fewer PIs (18.4% vs 28.6%, respectively). The majority of PIs happened in patient wards (50.6%) in KAMC-R and operating rooms (34.1%) in US EPINet hospitals. Suturing, which was involved in only 10% of PIs at KAMC-R, was the most frequent PIs mechanism in US EPINet hospitals (23.3%). In both KAMC-R and US EPINet hospitals, disposable syringes were the most frequent devices involved, the left hand was the most common site of injury, and the source patient was largely identifiable. CONCLUSION: We have lower rates of PIs at KAMC-R relative to US EPINet hospitals. Whereas it is difficult to fully explain such differences, this could be due to variations in health care systems, underreporting, or the impact of the PIs prevention activities.