Needlestick injuries among German medical students: time to take a different approach?

Context  Medical students are at risk of occupational exposure to blood-borne viruses following needlestick injuries (NSIs) during medical school. The reporting of NSIs is an important step in the prevention of further injuries and in the initiation of early prophylaxis or treatment. The objective of this study was to describe the mechanisms whereby medical students experience occupational percutaneous blood exposure through NSIs and to discuss rational strategies for prevention.
Methods  Incidents of exposure to blood-borne pathogens among medical students at a large German university were analysed. Year 6 medical students completed a written survey immediately before the clinical part of their training began, describing incidents that had occurred during the previous 5 years.
Results  In our study, 58.8% (183/311) of participating medical students recalled at least one NSI that had occurred during their studies. Overall, 284 NSIs were reported via an anonymous questionnaire.
Discussion  Occupational exposure to blood is a common problem among medical students. Efforts are required to ensure greater awareness of the risks associated with blood-borne pathogens among German medical students. Proper training in percutaneous procedures and how to act in the event of injury should be given in order to reduce the number of injuries.     

506名实习护士针刺伤的现况调查

目的了解专科护生在临床实习期间针刺伤的发生情况及影响因素,提出针对性的防护策略和措施。方法采用回顾性调查方法,对实习护生506人针刺伤的发生情况及影响因素进行问卷调查,用SPSS13.0软件对数据进行统计分析。结果实习护生中针刺伤的发生率为78.7%,其中被污染针头刺伤率为62.3%。77.9%的护生对护理职业防护知识不了解。结论实习护生针刺伤发生率高,实习护生防护知识欠缺、防护意识薄弱,要注意影响针刺伤发生状况的因素,防治针刺发生。     

Prevalence of needlestick and sharps injuries in the healthcare workers of Iranian hospitals: an updated meta-analysis

Background

Needlestick and sharps injuries (NSIs) are critical occupational risk among health care workers (HCWs), which is extremely worrying due to the potential risk of transmitting bloodborn pathogens (BBPs). This study was carried out to evaluate the prevalence of NSIs among Iranian HCWs.

Methods

In this systematic review and meta-analysis, the key terms percu* injur*, needle* stick injur*, needlestick* injur*, or sharp* injur* were searched in the Scientific Information Database (SID), MagIran, IranMedex, Google Scholar, Science Direct, PubMed, and Scopus. A prefabricated checklist, including variables: first author, publication year, study population, sample size, gender, total prevalence of needlestick in each gender, type of questionnaire, region, and type of hospitals, was used to extract data from the selected articles included which were published between 2003 and 2016.

Results

The analysis showed that the prevalence of NSIs in the Iranian HCWs was 42.5% (95% CI 37–48). Moreover, the prevalence of NSIs was more in women (47%; 95% CI 36–58) compared to men (42%; 95% CI 26–58).

Conclusion

Given the high prevalence of NSIs, it is necessary to supply safe needles and instruments, hold training programs focused on new methods of using sharp objects safely, observe safety principles and standards, reinforce the practical skills of personnel, and pay more attention to reporting and improving occupational behaviors like avoiding needle recapping in order to reduce the prevalence of NSIs and consequently reduce potential risk of transmission of BBPs.

     

Lack of risk-awareness and reporting behavior towards HIV infection through needlestick injury among European medical students

Medical students are at risk for occupational needlestick injuries (NSIs) which can result in substantial health consequences and psychological stress. Therefore, an open online survey among final year medical students from Austria, Germany, and the United Kingdom (UK) was conducted. The aim of the study was to evaluate risk-awareness and reporting behavior regarding needlestick injury (NSI), post-exposure prophylaxis, and level of education regarding the transmission of HIV through NSIs. Of 674 medical students, 226 (34%) reported at least one NSI during medical school. Respondents from Austria and Germany experienced a significantly higher number of NSIs in comparison to respondents from the UK. Seventy-six respondents (34%) did not report their most recent injury to an employee health office. Almost one third were not familiar with reporting procedures in case of a NSI and 45% of the study population feared that reporting an injury might have an adverse effect on their study success. 176 respondents (78%) who had suffered a NSI were not aware of the patient's HIV status. Education regarding NSIs and HIV transmission reduced the actual risk of experiencing a NSI significantly. These data indicate that medical students are at high risk of suffering NSIs during medical school. The rate of nonreporting of such injuries to an employee health service is alarmingly high. Improved medical curricula including precise recommendations may contribute to a more efficient prevention of occupational HIV infection in medical students.     

The effectiveness of a training program on reducing needlestick injuries/sharp object injuries among soon graduate vocational nursing school students in southern Taiwan

Needlestick/sharp injuries (NSIs/SIs) are a serious threat to medical/nursing students in hospital internships. Education for preventing NSIs/SIs is important for healthcare workers but is rarely conducted and evaluated among vocational school nursing students. We conducted an educational intervention for such students after their internship rotations before graduation. This program consisted of a lecture to the students after the internship training and a self-study brochure for them to study before their graduation. This study used the pre-test questionnaires completed by all students and the post-test questionnaires completed by 107 graduates after work experience as licensed nurses to assess the effectiveness of the intervention. After educational intervention, the incidence of NSIs/SIs decreased significantly from 50.5% pre-test to 25.2% post-test, and the report rate increased from 37.0% to 55.6%, respectively. In conclusion, this intervention significantly reduced the incidence of NSIs/SIs and increased the report rate of such events.     

Student nurses in Taiwan at high risk for needlestick injuries

PURPOSE: To describe the prevalence and characteristics of needlestick injuries (NSI) in student nurses in Taiwan. METHODS: A self-administered questionnaire was completed by 931 student nurses from 16 hospitals randomly selected from the 132 accredited hospitals. RESULTS: The questionnaire was completed by 708 of 931 students who were contacted for participation in this study. NSI during internship was reported by 61.9% (438/708) of students, of whom 14.2% (62/438) made a formal report. The majority (70.1%) of NSI occurred in the patient's room. Hollow-bored needles contributed to half (219/438) of the NSIs of which 86.8% were syringe needles. Just over half (53.2%) of those items involved in NSIs had been used on patients. Of the hollow-bored needles involved in NSIs, 21.5% had been used on a patient with an infectious disease. Vaccination against hepatitis B virus (HBV) was lacking in 47.6% of students. CONCLUSIONS: NSIs and non-reporting of NSIs were highly prevalent in nursing students. More intensive education programs should be directed at students to increase their awareness of and compliance with Universal Precautions (UP) before commencing their practical work experience. Students need to practice prompt post-exposure evaluation so that the need for early intervention can be assessed. In addition, any public health and infection control strategy should include a universal catch-up HBV vaccination program among students before commencement of internship.     

医务人员锐器伤危险因素调查及防护体系应用研究

目的 了解医务人员锐器伤危险因素,探讨防护体系的应用.方法 应用开放式问卷调查2011年1-12月医务人员锐器伤发生频次、环节、防护处理等.结果 调查1314人,发生锐器伤1071人,锐器伤发生率为81.51％,护理人员及初级医务人员锐器伤发生率为90.32％、84.23％,高于其他组别;发生科室以普通病房最多,占36.29％,其次是手术室,占19.93％;锐器伤器具以头皮针及针头最高,占54.97％,其次是玻璃片,占16.64％;操作环节以拔针及拔针后处理最高,占55.20％,双手回套针帽占11.58％,不同器具及不同操作环节之间差异有统计学意义(P＜0.01);发生锐器伤后,挤压、冲洗、消毒3项应急处理措施均实施的占38.56％,以护理组最高,为44.29％;血源性病原体暴露率为48.30％,血源性病原体损伤后护理组上报率高于其他两组,总上报率为55.93％.结论 医务人员对锐器伤导致的损害认识不到位,缺乏紧急处理知识,防护体系存在不健全现象,应建立锐器伤防护体系,积极降低发生率.     

集束化管理在手术室护士针刺伤防护中的应用

目的探讨集束化管理策略在手术室护士针刺伤防护中的应用效果。方法采用回顾性问卷调查方式,对手术室83名护理人员的针刺伤情况进行调查分析,手术室护士发生针刺伤的发生率高达86．74％。运用集束化管理策略,成立手术室针刺伤防护小组,分层进行职业安全教育培训,严格落实标准性预防和锐器的规范操作,使用安全医疗器具以及改善针刺伤报告流程。结果运用集束化管理策略后,手术室护士针刺伤的发生率由86．74％降到48．75％,标准预防的执行率由59．03％上升到91．25％,针刺伤后主动报告率由15．66％上升到88．75％。结论集束化管理策略在手术室护士针刺伤防护中具有优势作用。     

临床护理带教老师对护理专业学生职业防护意识的影响

摘要i目的探讨临床护理带教老师对护理专业学生（简称护生）职业防护意识的影响。方法采用非同期对照法,选择两组临床护理带教老师各100名,均按照教学大纲进行临床带教,其中试验组在护生进行临床实习前进行为期4天的职业防护培训,分别在2007和2008级两届护生完成9个月实习结束返校前用自行设计的问卷调查,实行师生双向评价。结果试验组带教老师针刺伤和安瓿割伤发生率、发生次数低于对照组（P〈0．05）,对护生防护教育的传授程度试验组高于对照组（P〈0．01）,临床护理带教老师对护生的职业防护诸多因子存在相关性（P〈0．05或P〈0．01）。结论临床护理带教老师对护生职业防护意识起着潜移默化的作用,加强临床护理带教老师的职业防护培训,能降低锐器伤的发生,并将职业防护融入到护理教学中,同时提高护生的职业防护意识和行为,促进护生的身心健康。     

Study of Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi, India

Background:

Because of the environment in which they work, many health care workers are at an increased risk of accidental needle stick injuries (NSI).

Objective:

To study prevalence and response to needle stick injuries among health care workers.

Materials and Methods:

Study Design: Cross-sectional study. Setting: A tertiary care hospital in Delhi. Participants: 322 resident doctors, interns, nursing staff, nursing students, and technicians. Statistical Analysis: Proportions and Chi-square test.

Results:

A large percentage (79.5%) of HCWs reported having had one or more NSIs in their career. The average number of NSIs ever was found to be 3.85 per HCW (range 0-20). 72 (22.4%) reported having received a NSI within the last month. More than half (50.4%) ascribed fatigue as a cause in their injury. Most of the injuries (34.0%) occurred during recapping. In response to their most recent NSI, 60.9% washed the site of injury with water and soap while 38 (14.8%) did nothing. Only 20 (7.8%) of the HCWs took post-exposure prophylaxis (PEP) against HIV/AIDS after their injury.

Conclusions:

The occurrence of NSI was found to be quite common. Avoidable practices like recapping of needles were contributing to the injuries. Prevention of NSI is an integral part of prevention programs in the work place, and training of HCWs regarding safety practices indispensably needs to be an ongoing activity at a hospital.     

徐州地区医务人员锐器伤现状调查分析

目的调查徐州地区各级医院医务人员锐器伤发生及上报情况,为制定本地区锐器伤防护措施、完善上报制度提供依据。方法 2016年7—8月,采用多阶段分层随机抽样方法随机抽取徐州市13所不同级别医院的医务人员,对其一般资料、锐器伤发生及上报情况等进行问卷调查。结果共收集2 694份有效问卷,医务人员锐器伤发生率为10.32%,例次发生率为12.84%,上报率为30.64%。医务人员锐器伤例次发生率一级医院为44.83%,二级医院为11.53%,三级医院为12.52%,不同级别医院锐器伤例次发生率比较,差异具有统计学意义(χ~2=55.148,P0.001)。锐器伤发生时机主要为医务人员在回套针帽时(79例次,22.83%),器具种类主要为中空针类(297例次,85.84%)。参加培训情况不同的医务人员锐器伤发生率比较,差异具有统计学意义(χ~2=66.760,P0.001)。结论本地区医务人员的锐器伤现状不容乐观,存在培训效果欠佳,上报率较低且安全器具使用率不高等问题,应进一步采取有效措施,建立有效的锐器伤监测追踪系统以减少锐器伤的发生。     

上海市虹口区一、二级医院护理人员职业伤害调查

[目的]了解虹口区一、二级医院护理人员的主要职业伤害和防护现状，为建立医务人员职业伤害防护体系提供科学依据。[方法]采用问卷调查方法调查虹口区7所医院412名护理人员的职业安全和防护情况。数据采用SPSS统计软件处理。[结果]目前护理人员面临的主要职业伤害是针刺伤、锐器损伤、消毒剂灼伤，被损伤者比例分别为92．7％，45．11％，48．45％；在调查的职业伤害中二级医院锐器损伤情况、受病人责难的情况比一级医院严重（χ^2=24．381，P〈0．05；χ^2=21．174，P〈0．05）；一级医院护理人员职业防护相对较差（χ^2=55．186，P=0．000）。[结论]医院管理者要重视对护理人员的防护教育，加强防护措施的落实，建立职业伤害报告、监测、治疗体系。     

Needle stick injuries in health care - frequency,causes und preventive strategies

Healthcare workers (HCW) are at risk for infections with blood-borne pathogens - especially hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) - resulting from occupational blood-exposure trough injuries with sharp instruments and needle sticks. Results of a study on the epidemiology of needle stick injuries (NSI) among HCW in two German hospitals indicate that 500,000 NSI occur annually in Germany. Most of these injuries occur during disposal of used syringes and "recapping". Administration of the post-exposure prophylaxis is recommended for HCW who are occupationally exposed to HBV (vaccine/immunoglobulin) and HIV (antiretroviral drugs) i.e. the immediately reporting of blood exposure is very important. Comprehensive programmes to prevent NSI - e.g. avoiding of recapping, use of disposal containers, surgical gloves and in particular safety devices - minimize a high cost of NSI due to the administration of PEP, developing of chronic hepatitis, cirrhosis and liver cancer.     

Needlestick injuries and other occupational exposures to body fluids amongst employees and medical students of a German university: incidence and follow-up

The aim of this study was to obtain data concerning the incidence, reporting and follow-up of occupational exposure to blood or other body fluids (OEB). A questionnaire was distributed to employees and medical students (N=787) and official reports of OEB during the year 2003 (N=203) and their consequent follow-up (N=100) were evaluated. The percentages of needlestick injuries were 29.5% for students and 22.5% for employees. Incidence rates per 1000 employee days were 0.61 for needlestick injuries or sharp object injuries and 0.27 for mucocutaneous exposure to body fluids. The mean rate of underreporting was approximately 45%. Contrary to expectations, only 4.3% of nurses and 3.9% of doctors officially reported an OEB in 2003. The number of persons who did not attend for a serological test increased during the follow-up period. Considering all documented test results, 35 out of 100 affected persons were lost to follow-up due to default of appearance. As a consequence, the employer should provide safety devices and enforce didactical interventions with practical training and incident reporting. Periodical occupational health medicals, including serological testing, should be mandatory for all employees, including medical students and student nurses. To increase compliance after OEB, a short follow-up period using improved laboratory tests requires further discussion.     

实习护士发生医疗锐器伤的调查

目的 了解实习护士在实习期间发生医疗锐器伤的情况，并探讨相关对策。方法 2001年8月作者对北京13所医院的新护士采用回顾性问卷调查。结果 432名实习护士发生锐器损伤的占93．3％，共发生2756次损伤，平均每人6．4次，其中针刺伤2．6次；被调查者所在26所学校均无开设职业防护课程，也无相应教材；发生损伤后能主动汇报的比率很低，占5．71％；发生锐器损伤的地点分布以病房为主，占71．41％；锐器伤发生的种类中以针头和玻璃伤为主，占80．33％；被污染物刺伤的占37．72％；在有潜在血液接触的操作中戴手套率很低。结论 实习护士缺乏防护知识，发生锐器损伤率高，因此，学校应增设职业防护课程，医院应加强岗前安全教育及管理。     

手术中血源性职业暴露特点分析

目的分析手术中血源性职业暴露的特点,为制定预防和控制对策提供依据。方法调查某三甲医院2016年6月—2017年1月发生的手术中血源性职业暴露病例,调查内容包括医务人员一般资料、职业暴露方式、暴露源及锐器伤器械种类及操作环节等。结果手术中发生血源性职业暴露的医务人员共100名。主要为护士64名(64.00%),其次为医生30名(30.00%)。暴露方式主要为锐器伤88例(88.00%)、眼黏膜暴露10例(10.00%)。暴露源病种主要为乙型肝炎36例(36.00%)、梅毒11例(11.00%)。导致锐器伤的锐器主要为输液器针头(31例,35.23%),其次为注射器针头(24例,27.27%)、缝合针(14例,15.91%)等。锐器伤发生的操作环节主要为术中操作(31例,35.23%)。结论应加强医务人员的职业暴露培训,完善职业暴露的登记和报告流程;严格要求医务人员,尤其是护士在手术过程中应严格按照操作流程规范操作,从而减少手术中血源性职业暴露的发生。     

医学实习生血源性物质职业暴露及影响因素分析

目的 了解医学实习生血源性物质职业暴露情况,并分析其影响因素.方法 采用分层整群抽样的方法,对某医学院护理、临床、检验医学专业的510名实习生进行问卷调查,数据统计分析用SAS 9.1软件.结果 实习1年期间,27.70％ (141/509)发生过血源性物质暴露,溅入黏膜占31.19％,针头等锐器伤占66.06％,沾染伤口等其他暴露占2.75％,暴露后68.93％进行了登记,84.47％进行了立即处理;单因素分析结果表明:文化程度、专业、防护知识、培训情况与血源性物质暴露有统计学联系(P＜0.05);多元logistic回归分析显示,护理和检验专业以及不知道如何处理锐利废弃物是发生血源性物质暴露的独立危险因素,与临床专业相比,护理和检验专业的学生血源性物质暴露的风险分别增高64％和287％,不知道如何处理用过的锐利废弃物者发生血源性物质暴露的风险是知道者的1.64倍.结论 医学实习生存在较高的血源性物质暴露率,主要与专业和锐利废弃物处理不当有关.     

护生进入临床实习前针刺伤相关知识和态度的现状调查

目的调查护生进入临床实习前针刺伤的相关知识和态度现状。方法于2015年6月20—23日调查某院2015年6月准备进入临床实习的护生,采用问卷调查法调查实习护生针刺伤知识和态度。结果共发放问卷350份,回收有效问卷324份,有效率92.57%。男生40名（12.35%）,女生284名（87.65%）;本科学历34名（10.49%）;平均年龄（20.83±1.24）岁。实习护生针刺伤相关知识各条目中回套针帽、戴手套相关问题的回答正确率最低,均为60%左右;接种乙肝疫苗后发生针刺伤感染乙型肝炎病毒的问题及针刺伤后的用药问题回答正确率均在70%左右。实习护生针刺伤态度部分部分条目得分≤3分,主要为针刺伤所致血液、体液传播性疾病易感性以及回套针帽的问题。结论实习护生的针刺伤相关知识和态度存在薄弱的方面,如回套针帽、及时报告、传染病易感性等问题。学校和医院应加强对护生职业安全防护知识教育,提高职业防护的态度和能力。     

北京地区医护人员锐器伤现况及对策

目的 分析北京地区医护人员锐器伤现况,并提出控制医护人员锐器伤相应的对策.方法 利用北京地区医院感染监控系统,根据该地区124所二、三级医院上报的医护人员锐器伤害情况,对其进行描述性统计学分析,通过发现的影响因素制定相应对策.结果 护士在全部报告的伤害记录比例最高,约占65.4％,医师占26.9％;锐器伤害的发生地点主要在病房内、手术室、病房外、门诊、急诊、ICU等;工龄＜5年的医护人员最易发生锐器伤害;导致锐器伤害的器械种类主要为注射针头等;最为常见发生伤害的医疗操作环节是手术中(缝合或切开时等),占14.8％,丢弃前针头等锐器物处理时占10.3％.结论 手术室护理人员锐器伤发生率最高,发生率与工龄、职业分布、工作地点、锐器物种类、操作环节、自我防护意识薄弱,缺乏职业安全教育、操作不规范等因素有关.