Investigation of eye splash and needlestick incidents from an HIV-positive donor on an intensive care unit using root cause analysis.
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BACKGROUND: Two doctors working on a busy intensive care unit sustained injuries whilst removing a chest drain from an HIV-positive patient. One doctor had a needlestick injury into his finger whilst the other sustained an eyesplash when the chest drain was pulled out. METHODS: Following Department of Health format 'Doing less harm', a root cause and human factor analysis of the incident was carried out. The aim was to explore the underlying issues. RESULTS AND CONCLUSIONS: Training, cultural and organizational issues were exposed, and are now being addressed. This approach has led to a far more effective dialogue with the National Health Trust concerned than was previously experienced, and there is early evidence of progress on important aspects of health and safety management at organizational level. Lack of health and safety training of doctors at undergraduate and postgraduate level needs to be addressed. (+info)
Regulation of tattooing in Minneapolis and St. Paul, Minnesota: tattooists' attitudes and relationship between regulation and practice.
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OBJECTIVE: This study investigated tattooists' attitudes regarding government regulation and the relationship between existing tattooing regulation and tattooists' knowledge and practice of infection control. METHODS: Self-reported and observational data were collected in a cross-sectional study of professional tattooists. A written survey was used to investigate knowledge and practice of infection control and attitudes toward government regulation. Infection control practice was also examined through direct observation of tattooing. Rating scales were used to compare tattoo artists subject to local tattooing ordinances with those in areas without ordinances. RESULTS: Sixty-one tattooists (45 regulated, 16 unregulated) completed surveys and 25 (17 regulated, 8 unregulated) were observed. Attitudes toward regulation were generally positive. Most participants supported health department inspections and training requirements. The presence of local tattooing ordinances was not associated with tattooists' knowledge (p=0.53), but was associated with self-reported practices (p=0.05). A more positive attitude toward regulation was associated with the use of more self-reported infection control procedures (p<0.01). CONCLUSION: Tattoo artists in areas with local tattooing ordinances may implement more bloodborne pathogen precautions than those in areas without ordinances, despite working from a similar knowledge base. Tattooists most in need of improvement may be difficult to reach due to opposition to government intrusion. Federal guidelines, clarification of OSHA rules applying to tattooists, and statewide regulation are needed. Tattooists should be involved in the development of regulations. (+info)
Ensuring injection safety during measles immunization campaigns: more than auto-disable syringes and safety boxes.
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Measles immunization campaigns are effective elements of a comprehensive strategy for preventing measles cases and deaths. However, if immunizations are not properly administered or if immunization waste products are not safely managed, there is the potential to transmit bloodborne pathogens (e.g., human immunodeficiency virus and hepatitis B and hepatitis C). A safe injection can be defined as one that results in no harm to the recipient, the vaccinator, and the surrounding community. Proper equipment, such as the exclusive use of auto-disable syringes and safety boxes, is necessary, but these alone are not sufficient to ensure injection safety in immunization campaigns. Equally important are careful planning and managerial activities that include policy and strategy development, financing, budgeting, logistics, training, supervision, and monitoring. The key elements that must be in place to ensure injection safety in measles immunization campaigns are outlined. (+info)
Can nitroglycerine ointment facilitate newborn heelstick blood collection? A randomized controlled trial.
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Newborn heelstick blood collection can be a painful procedure in part because of the time required to obtain sufficient quantity of blood. No previous studies have determined whether local vasodilatation using topical nitroglycerine ointment (NGO) would facilitate heelstick blood collection. OBJECTIVE: To determine if the topical application of NGO would reduce the time needed to collect the required amount of blood for newborn metabolic screening and, in turn, reduce the pain/distress of the procedure. STUDY DESIGN: In a randomized, prospective, placebo controlled and blinded fashion, term newborns in a well nursery received either topical nitroglycerine or placebo ointment 10 minutes prior to heelstick. Total time and number of heelsticks required to complete the collection were measured along with crying time, heart rate and blood pressure. RESULTS: In all, 50 were studied, 25 in each group. There was no statistical difference between groups in collection time, crying time or number of heelsticks required for completion. Heart rate increased significantly and equally in both groups. Blood pressures were unchanged. CONCLUSIONS: Topical NGO did not facilitate heelstick blood collection or reduce the pain/distress of the procedure. (+info)
Evaluation of the rapid immunoassay determine HIV 1/2 for detection of antibodies to human immunodeficiency virus types 1 and 2.
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We evaluated the reliability of a rapid human immunodeficiency virus type 1 test for quick clinical decision making, such as in needle-stick accidents. The test was evaluated with 1,160 patients. It proved to be a simple and useful test with 99.6% specificity and 99.4% sensitivity. One patient with late-stage AIDS had a false-negative result. (+info)
Risk of hepatitis C virus transmission from patients to surgeons: model based on an unlinked anonymous study of hepatitis C virus prevalence in hospital patients in Glasgow.
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BACKGROUND: The risk of a surgeon acquiring the hepatitis C virus (HCV) through occupational exposure is dependent on the prevalence of HCV infection in the patient population, the probability of a percutaneous injury transmitting HCV, and the incidence of percutaneous injury during surgery. AIMS: To estimate the prevalence of HCV infection in the adult surgical patient population in North Glasgow and thereafter estimate the risk of HCV transmission to surgeons through occupational exposure. METHODS: The prevalence of HCV infection was estimated through the unlinked anonymous testing of samples from male surgical patients, aged 16-49 years, in two North Glasgow hospitals from 1996 to 1997, and adjusting these data for age and sex. Using published estimates of the incidence of percutaneous injury during surgery and percutaneous injury transmitting HCV, the risk of occupational transmission of HCV to surgeons was then derived. RESULTS: The estimated prevalence of anti-HCV infection for all adult patients in the two hospitals combined was 1.4% (cardiothoracic/cardiology 0.8%, orthopaedics/rheumatology 1.4%, general surgery/ENT 2.0%). The estimated probability of HCV transmission from an HCV infected patient to an uninfected surgeon was 0.001-0.032% per annum (0.035-1.12% risk over a 35 year professional career). CONCLUSIONS: The risk of an individual surgeon acquiring HCV through occupational exposure is low, even in an area with an extremely high prevalence of HCV among its injecting drug using population. Surgeons however should be encouraged to observe universal precautions and present for assessment after needlestick injuries to protect themselves and their patients from this insidious infection. (+info)
The risk of needlestick injuries and needlestick-transmitted diseases in the practice of anesthesiology.
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Anesthesiologists are at risk for acquiring blood-borne infections through contact with blood or body fluids. From prospective studies, the greatest risk of transmission is through a percutaneous exposure such as needlestick injury. Personal protective equipment such as gloves and gowns do not completely prevent these exposures. Although educational efforts can reduce the frequency of recapping of needles, they generally have not decreased the incidence of needlesticks. Therefore, in addition to practicing universal precautions, anesthesiologists can attempt to reduce their risk of needlestick injuries by eliminating nonessential unprotected needle use, through the use of needleless or protected needle devices (engineering controls) and by modifying anesthetic procedures requiring needles (work practice controls). Needleless or protected needle products are commercially available for use in many procedures performed by anesthesiologists. For tasks that require the use of needled devices, the practitioner should use safe techniques for handling (i.e., one-handed recapping if recapping is needed) and disposal (i.e., puncture-resistant containers) of these devices. Evaluation of the efficacy, cost, and safety of needleless or protected needle products should be continued as they are introduced into wider use. Additionally, anesthesiologists should be encouraged to report needlestick injuries so that appropriate postexposure treatment can be given and so that the incident can be studied to permit design of a work protocol or device to prevent similar accidents in the future. (+info)
Percutaneous injury, blood exposure, and adherence to standard precautions: are hospital-based health care providers still at risk?
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To examine factors associated with blood exposure and percutaneous injury among health care workers, we assessed occupational risk factors, compliance with standard precautions, frequency of exposure, and reporting in a stratified random sample of 5123 physicians, nurses, and medical technologists working in Iowa community hospitals. Of these, 3223 (63%) participated. Mean rates of hand washing (32%-54%), avoiding needle recapping (29%-70%), and underreporting sharps injuries (22%-62%; overall, 32%) varied by occupation (P<.01). Logistic regression was used to estimate the adjusted odds of percutaneous injury (aOR(injury)), which increased 2%-3% for each sharp handled in a typical week. The overall aOR(injury) for never recapping needles was 0.74 (95% CI, 0.60-0.91). Any recent blood contact, a measure of consistent use of barrier precautions, had an overall aOR(injury) of 1.57 (95% CI, 1.32-1.86); among physicians, the aOR(injury) was 2.18 (95% CI, 1.34-3.54). Adherence to standard precautions was found to be suboptimal. Underreporting was found to be common. Percutaneous injury and mucocutaneous blood exposure are related to frequency of sharps handling and inversely related to routine standard-precaution compliance. New strategies for preventing exposures, training, and monitoring adherence are needed. (+info)