A long-term study of sharps injuries among health care workers in Japan

BACKGROUND: The risk of transmission of occupational blood-borne infection is a serious problem for health care workers (HCWs) in Japan. Although the Japanese version of Exposure Prevention Information Network (EPINet) was introduced in 1997, no published data in the clinical setting have been available yet. OBJECTIVE: To examine the epidemiology of occupational sharps injuries of HCWs in a university hospital using EPINet and to analyze the trends and changes in epidemiologic characteristics of needlestick injuries in a detailed situation. METHODS: The HCWs were requested to report sharps injury incidents to the Infection Control Nurse when the incidents occurred. Those who were involved in the incidents were required to personally complete an EPINET form. RESULTS: A total of 259 cases of sharps injuries occurred during the 7-year period. Registered nurses accounted for 72.2% of the cases, constituting the largest group of the HCWs. The incidents occurred most frequently in the hospital wards. Thirty-three cases (55.9%) of the injuries with syringe-needle units occurred "after use before disposal," whereas 34 cases (73.9%) of the injuries with suture needles occurred "during use of device." More than half of the injuries with a winged steel needle occurred despite the protective mechanism. DISCUSSION: There was no apparent difference in the characteristics of the subjects compared with other reports. The circumstances of the injuries varied with the kinds of instruments. This fact may provide useful information for planning measures to sharps injuries. CONCLUSIONS: With the problem of underreporting aside, a detailed study, such as ours, comprising by job category and by kind of instrument or the like would provide more useful and effective information in terms of sharps injury prevention.     

Assessment of preventive measures for accidental blood exposure in operating theaters: a survey of 20 hospitals in Northern France

BACKGROUND: Accidental exposures to blood of body fluids (ABE) expose health care workers (HCW) to the risk of occupational infection. OBJECTIVES: Our aim was to assess the prevention equipment available in the operating theater (OT) with reference to guidelines or recommendations and its use by the staff in that OT on that day and past history of ABE. METHODS: Correspondents of the Centre de Coordination de la Lutte contre les Infections Nosocomiales (CCLIN) Paris-Nord ABE Surveillance Taskforce carried out an observational multicenter survey in 20 volunteer French hospitals. RESULTS: In total, 260 operating staff (including 151 surgeons) were investigated. Forty-nine of the 260 (18.8%) staff said they double-gloved for all patients and procedures, changing gloves hourly. Blunt-tipped suture needles were available in 49.1% of OT; 42 of 76 (55.3%) of the surgeons in these OT said they never used them. Overall, 60% and 64% of surgeons had never self-tested for HIV and hepatitis C virus (HCV), respectively. Fifty-five surgeons said they had sustained a total of 96 needlestick injuries during the month preceding the survey. Ten of these surgeons had notified of 1 needlestick injury each to the occupational health department of their hospital (notification rate, 10.4%). CONCLUSION: The occurrence of needlestick injury remained high in operating personnel in France in 2000. Although hospitals may improve access to protective devices, operating staff mindful of safety in the OT should increase their use of available devices, their knowledge of their own serostatus, and their ABE notification rate to guide well-targeted prevention efforts.     

非职业针刺伤及意外伤害HIV暴露后预防现状及干预研究

目的为了解艾滋病病毒（HIV）非职业针刺及意外伤害暴露及暴露后预防的现状,以及暴露后预防的影响因素,探讨HIV非职业针刺伤及意外伤害暴露后预防的必要性和可行性.方法对北京地坛医院2001年1月至2002年12月收治的2 637例HIV非职业暴露者,实施或未实施暴露后预防（PEP）的结果进行了统计分析.结果全部非职业暴露者均提出了实施PEP的要求,但根据危险性评估,两年里共对52人实施了PEP.其中仅19人（36.54%）完成了28天的疗程,33例（63.46%）因副作用等而中止治疗.心理干预可以降低PEP的实施率.对实施或未实施PEP的1 486非职业暴露者于暴露后1个月,948例于暴露后3个月,689例于暴露后6个月,检测HIV抗体,均未发现阳性者.影响非职业暴露PEP完成的因素是：暴露源情况不明,HIV感染的危险性低及抗逆转录病毒治疗的副作用.结论HIV非职业意外伤害暴露感染的危险性极低.提示PEP对于那些暴露源HIV情况不明,HIV感染的危险性小,而又有明显的副作用时应该受到限制.     

Impact of safety devices for preventing percutaneous injuries related to phlebotomy procedures in health care workers

BACKGROUND: Use of protective devices has become a common intervention to decrease sharps injuries in the hospitals; however few studies have examined the results of implementation of the different protective devices available. OBJECTIVE: To determine the effectiveness of 2 protective devices in preventing needlestick injuries to health care workers. METHODS: Sharps injury data were collected over a 7-year period (1993-1999) in a 3600-bed tertiary care university hospital in France. Pre- and postinterventional rates were compared after the implementation of 2 safety devices for preventing percutaneous injuries (PIs) related to phlebotomy procedures. RESULTS: From 1993 to 1999, an overall decrease in the needlestick-related injuries was noted. Since 1996, the incidence of phlebotomy-related PIs has significantly decreased. Phlebotomy procedures accounted for 19.4% of all percutaneous injuries in the preintervention period and 12% in the postintervention period (RR, O.62; 95% CI, 0.51-0.72; P < .001). Needlestick-related injuries incidence rate decreased significantly after the implementation of the 2 safety devices, representing a 48% decline in incidence rate overall. CONCLUSIONS: The implementation of these safety devices apparently contributed to a significant decrease in the percutaneous injuries related to phlebotomy procedures, but they constitute only part of a strategy that includes education of health care workers and collection of appropriate data that allow analysis of residuals percutaneous injuries.     

Needlestick injuries and needle disposal in Minnesota physicians' offices

Because little is known about needlestick injury and needle disposal in non-hospital settings, we surveyed physicians' offices in Minnesota. Recapping of needles was frequent (51.1%, 72 of 141) and injuries had occurred during the past year in 44.0% of offices. When of known cause, needlesticks were most common during blood drawing and recapping (52.0%, 13 of 25). Small offices more often recapped needles, but only metropolitan small offices reported more frequent injuries. Only 37.6% of offices used a protocol for management of injuries, and in less than half (45.4%) was physician evaluation routine. Although most offices used plastic containers and a majority (73.0%) incinerated or autoclaved needles prior to disposal, small offices more often disposed of sharps in their routine solid waste. Larger metropolitan offices more consistently followed current recommendations for handling and disposing of needles. There is a need for education efforts to address these issues for physicians and their office staff.     

Reducing percutaneous injuries at an academic health center: a 5-year review

BACKGROUND: The University of Connecticut Health Center Employee Health Service collected and used National Surveillance System for Hospital Health Care Workers (NaSH) data to (1) improve surveillance of health care worker blood and body fluid exposures (BBFEs) and (2) target specific interventions for higher-risk groups (nursing staff, medical and dental students, and residents). METHODS: All 870 BBFE incidents were abstracted from the NaSH database from the 1997 through 2002 academic years. Incidence rates per 100 full-time-equivalent workers were determined for each targeted occupation group with 95% confidence intervals. RESULTS: The number of percutaneous injuries declined among medical/dental students and nursing staff, and to a lesser degree for residents. The incidence rates decreased from 7.9% in 2000 to 2001 to 2.6% in 2001 to 2002 for students and from 9.2% in 1997 to 1998 to 2.7% in 2001 to 2002 for nursing staff. CONCLUSIONS: Data from a surveillance database provided guidance for administrative, educational, and engineering control interventions. Active surveillance and periodic review of interventions are important aspects to reduce BBFEs in targeted high-risk occupational groups, especially when the workforce has a high turnover, as is typical in academic health centers.     

Cardiovascular diseases and the subspecialties cardiology and angiology in "Schlichtungs"- Proceedings

A: The Schlichtungsstelle (expert panel for alternative dispute resolution) of Northern Germany, in 2001, decided on 2620 malpractice claims; 233 of these were related to the treatment of cardiovascular disorders, coronary and venous diseases being the most common. The physicians involved in these disputes represented 18 (sub-)specialities. Complaints related to procedures were the ones most frequently submitted by the patients, followed by those concerning diagnostics. Negligence was found to be present in 37% of the cases, the highest proportion being due to mistakes of diagnosis, followed by organisational and system-related mistakes. Medical negligence as the cause of injury was assumed in 46/233 (20%) of the cases, the injuries being serious in 18 and fatal in 6 of the 46 patients. Negligent and non-negligent iatrogenic injuries combined, amounted to 132/233 (57%) of the "cardiovascular" panel cases. B: From 1992 to 2001, we collected 165 panel cases involving cardiologists and 3 involving angiologists. In most of these the underlying disease was coronary, but in 14 cases the underlying disorder was psychosomatic. 35% of the complaints submittted by the patients were about invasive procedures. 12% of the instances of negligence determined in the panel proceedings were due to procedural mistakes, whereas 47% were due to mistakes related to indication and to the monitoring of the patients after procedures. Negligent iatrogenic injury was assumed in 27%, non-negligent iatrogenic injury in another 53% of the cases, so that the total of iatrogenic injuries amounted to 80% of the "cardio-angiologists" panel cases. 19/168 (11%) patients died from iatrogenic injuries. Organization and coordination among medical persons and institutions treating patients need improvement. A considerable number of disputes and claims seems to be initiated and caused by deficits in doctor-patient-communication. Attempts at reducing negligence and adverse events should center around those professionals actually involved in patient care, where the decisions on diagnostics, indication and therapy are made. Processes promoting patient safety should be based and depend on the groups cooperating in their daily work (department, practice). External influences and directives tend to be less effective.     

Improved injection safety after targeted interventions in the Syrian Arab Republic

OBJECTIVES: Concerns about unsafe injection practices and possible infections with blood-borne pathogens in the Syrian Arab Republic motivated an assessment of the injection safety situation in the country in July 2001. In light of the recommendations from this assessment, the Ministry of Health of Syria, with the assistance of WHO, implemented a set of activities under the 'Focus Project', which aims to ensure immunization safety. The first phase of the project ran from May 2002 to February 2004, and consisted of the improved provision of injection safety equipment and supplies, the elaboration and wide distribution of national guidelines on injection safety and safe waste management, a behaviour change and communication campaign targeting the general public, and comprehensive training of healthcare workers. A follow-up survey was carried out in February 2004, 2 years after initiation of the project. METHODS: Two representative surveys were conducted using a standardized assessment tool. A cluster sampling strategy, with probability proportionate to the population size, led to the inclusion of 80 health facilities in eight districts in 2001 and of 120 health facilities in 12 districts in 2004. RESULTS: Injection practices had significantly improved 2 years after the start of the project. The 2001 study had pointed to a low, but non-negligible risk to patients (2% unsafe injections), coupled with a high risk to healthcare workers (61% reported needle-stick injuries in the last 12 months) and to the communities owing to unsafe waste disposal (sharps waste found outside 37% of health facilities, waste disposal considered unsafe in 48% of them). The 2004 survey showed that 90% of Syrian healthcare workers had received training in injection safety. All injections observed were given safely (difference to 2001 not significant), although some problems in preparation and reconstitution prevailed. The risk to healthcare workers was significantly reduced as only 14% of the staff reported needle-stick injuries (p < 0.001). The risk to the communities was notably decreased following improvements in sharps waste management (sharps were found in the surroundings of only 13% of health facilities, p < 0.001). CONCLUSIONS: The example of Syria shows that rapid improvement in injection safety is possible and that the necessary tools and methods to monitor and evaluate progress are at our disposal. Challenges remain in transferring this successful programme from the well-structured immunization programme to the more diverse curative health services.     

Epidemiology of needlestick injuries in house officers

Eighty-eight medical students, interns, and residents were surveyed to study the epidemiology of their percutaneous exposures to blood. Respondents described 159 injuries in 221 person-years (py) of exposure in hospital wards and 213 injuries in 166 py of exposure in operating rooms. Nearly all injuries (greater than 98%) were needlesticks; less than 5% were reported to occupational health services. Rates of ward-related injury were highest for students (0.97/py) and decreased during training. Most injuries were due to recapping of used needles. In contrast to ward-related injury, rates of operating room-related injury were relatively low for nonsurgical students and interns (0.3/py), higher for surgical students (1.36/py), and stable over surgical residency training (mean, 5.4/py). Virtually all surgical injuries occurred during suturing. Further research into mechanisms of needlestick injuries and product design for their prevention are needed.     

Hospital work environments, nurse characteristics, and sharps injuries

BACKGROUND: A growing body of research links working conditions, such as staffing levels and work environment characteristics, with safety for both patients and workers in health care settings, including sharps injuries in hospital staff nurses. METHODS: Surveys of 11,516 staff nurses from 188 Pennsylvania general acute care hospitals in 1999 were analyzed. Hospital work environments, measured using the Practice Environment Scales of the Nursing Work Index--Revised, and staffing were tested as predictors of experiencing at least one sharps injury in the preceding year, both before and after controlling for nurse risk factors, use of safety-engineered devices, and hospital structural characteristics. RESULTS: Nurses with less than 5 years of experience, perioperative nurses, and those performing routine venipuncture for blood draws were more likely to be injured. Nurses working in hospitals with the most favorable working environments were one-third less likely to be injured. Staffing levels were not associated with sharps injuries. CONCLUSIONS: Across a large state, nurses working in acute care hospitals with better practice environments had fewer sharps injuries. Work environment conditions and specialty- and setting-specific risk factors deserve continued attention in sharps injury research.     

Perceptions and beliefs of nursing and medical personnel about needle-handling practices and needlestick injuries

A survey of 1473 nursing and medical personnel employed in two hospitals in a large metropolitan area was conducted to determine perceptions and beliefs about needle-handling practices and needlestick injuries. Additional questions in the survey focused on responsibility for discarding needles and syringes and the correct practice for disposal of needles and syringes in various situations presented. Analyses were based on 488 responses (33%). Nurses at the 437-bed University Hospital handled more needles and experienced more needlestick injuries than did nurses at the 300-bed Community Hospital. Needle-handling and needlestick injuries among medical personnel at the two hospitals were similar, although University Hospital interns and residents and University Hospital fourth-year medical students handled more needles than did the medical staff at either hospital. A total of 164 (33.6%) respondents reported receiving one or more needlestick injuries during 1983. A large proportion of respondents in each group reported that they did nothing about the needlestick injuries they experienced. Carelessness was perceived by all groups to be the most common reason for needlestick injuries. Most respondents reported some knowledge of proper needle disposal techniques and perceived lack of knowledge as the least important reason for needlestick injuries.     

Reducing the legal blood alcohol concentration limit for driving in developing countries: a time for change? Results and implications derived from a time–series analysis (2001–10) conducted in Brazil

Aims In Brazil, a new law introduced in 2008 has lowered the blood alcohol concentration limit for drivers from 0.06 to 0.02, but the effectiveness in reducing traffic accidents remains uncertain. This study evaluated the effects of this enactment on road traffic injuries and fatalities. Design Time–series analysis using autoregressive integrated moving average (ARIMA) modelling. Setting State and capital of São Paulo, Brazil. Participants A total of 1 471 087 non‐fatal and 51 561 fatal road traffic accident cases in both regions. Measurements Monthly rates of traffic injuries and fatalities per 100 000 inhabitants from January 2001 to June 2010. Findings The new traffic law was responsible for significant reductions in traffic injury and fatality rates in both localities (P < 0.05). A stronger effect was observed for traffic fatality (?7.2 and ?16.0% in the average monthly rate in the State and capital, respectively) compared to traffic injury rates (?1.8 and ?2.3% in the State and capital, respectively). Conclusions Lowering the blood alcohol concentration limit in Brazil had a greater impact on traffic fatalities than injuries, with a higher effect in the capital, where presumably the police enforcement was enhanced.     

Molecular epidemiology of tuberculosis by the use of IS6110 restriction fragment length polymorphism: a study from 2001 to 2003

OBJECTIVE: To analyze the situation of tuberculosis infection by DNA fingerprinting in the middle and eastern part of Osaka, Japan. DESIGN: We performed IS6110 restriction fragment length polymorphism (RFLP) on 1200 isolates from tuberculosis patients who visited our hospital from January 2001 to December 2003. A cluster was defined as a series of isolates with more than 90% similarity by IS6110 RFLP and those with the same drug-susceptibility pattern. The isolates with fewer than six copies of IS6110 were considered to be clustered if the IS6110 RFLP patterns and the variable numbers of tandem repeats with 16 regions of ETR and MIRU "allele profile" were identical. RESULTS: The number of samples in incremental study periods was 422 in 2001, 817 between 2001 and 2002 and 1200 between 2001 and 2003. The percentage of clustered cases was 27.8% in 2001, 19.1% in 2002 and 19.5% in 2003. The cumulative percentage of clustered cases was 27.8% in the first year, 29.7% over two years and 32.6% over three years. The percentage of clustered cases of isolates with a drug resistance was significantly lower (25.0%) than that of drug susceptible isolates (33.7%). Next, we investigated the clustered cases by gender and age. The percentage of clustered cases with isolates from young males and females (0-19 years old) was 23.8%. In contrast, the percentage of clustered cases with isolates from 20-59 year-old females gradually decreased from 14.7% to 4.4%. Conversely, the percentage of clustered cases from young and middle aged male (20-59 years old) was higher (20.2%-32.4%) than that of females. CONCLUSION: The sharp increase in the cumulative cluster formation rate was curbed by the decline in the tuberculosis incidence rate in Osaka, Japan, after the first year of examination. We thought that this phenomenon suggests the success of the anti-tuberculosis measure in Japan.     

Occupational exposure to needlestick injuries and hepatitis B vaccination coverage among health care workers in Egypt

BACKGROUND: The health care worker (HCW) is at substantial risk of acquiring bloodborne pathogen infections through exposure to blood or infectious body fluids. Hepatitis B vaccination of HCWs and optimal HCW practices regarding management of sharps can minimize these risks. This study explores the frequency of exposure to needlestick injuries and the hepatitis B vaccination coverage among HCWs in Egypt. METHODS: All HCWs available in a 25% random sample of different types of health care facilities from 2 governorates in Egypt (Nile Delta and Upper Egypt) were included in the study. A total of 1485 HCWs were interviewed. History of exposure to needlestick injuries, vaccination status, and socioeconomic data were collected. RESULTS: Of the 1485 HCWs interviewed, 529 (35.6%) were exposed to at least 1 needlestick injury during the past 3 months with an estimated annual number of 4.9 needlesticks per worker. The most common behavior associated with needlestick injuries was 2-handed recapping. Overall, 64% of HCWs disposed of needles unsafely in nonpuncture-proof containers. Overall 15.8% of HCWs reported receiving 3 doses of hepatitis B vaccine. Vaccination coverage was highest among professional staff (38%) and lowest among housekeeping staff (3.5%). Using Kane's model to predict infections after needlestick exposures, we estimate 24,004 hepatitis C virus and 8617 hepatitis B virus infections occur each year in Egypt as a result of occupational exposure in the health care environment. CONCLUSION: High rates of needlestick injuries and low vaccination coverage contribute highly to the rates of viral hepatitis infections among HCWs. Prevention of occupational infection with bloodborne pathogens should be a priority to the national program for promotion of infection control. Training of HCWs on safe handling and collection of needles and sharps, and hepatitis B vaccination of all HCWs is required to reduce transmission.     

Progress toward interruption of endemic measles transmission in Tunisia

Measles was the second leading cause of infant mortality in Tunisia prior to introduction of measles vaccination in 1979. The number of reported measles cases has decreased from 3007 in 1981 to 47 cases in 2000 due in part to the high coverage rates achieved after 1992. During 1998, a measles catch-up campaign vaccinated 1,846,657 children (95%) aged 6-16 years, and a follow-up campaign for children aged 9 months to 5 years in 2001 reached 547,766 (94%). During 1999-2001, 1717 cases of rash and fever illness were tested for measles; only 3 (0.2%) were positive for measles. From February to July 2002, an outbreak of measles involving 87 cases occurred in Tunisia in a health care setting and 56 (64%) patients were aged 15-30 years. The low number of laboratory-confirmed measles cases during 1999-2001 suggests endemic measles transmission may have been interrupted.     

Bile Duct Injuries Following Laparoscopic Cholecystectomy: A Clinical Study

Background/Aim:

This study aimed at assessing the outcome of laparoscopic cholecystectomy (LC) by determining the frequency of complications, especially of bile duct injuries.

Materials and Methods:

The case files of all patients undergoing laparoscopic cholecystectomy between 2002 and 2006 (inclusive) at King Hussein Medical Center (KHMC) were retrospectively analyzed. We evaluated the data according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose resections had to be converted from laparoscopic to open.

Results:

During the four years (January 2002 and December 2006), 336 patients underwent LC for chronic cholecystitis (CC), of whom 22 (6.5%) developed complications. Among those who developed complications, two patients had major bile duct injuries (0.4%); 43 other patients (12.8%) had planned laparoscopic operations converted to open cholecystectomy intra-operatively. None of the patients in this study died as a result of LC.

Conclusion:

Bile duct injury is a major complication of LC. Anatomical anomalies, local pathology, and poor surgical techniques are the main factors responsible. The two patients who had severe common bile duct injury in this study had major anatomical anomalies that were only recognized during surgery.     

Prospective Countywide Evaluation of the Effects of Motor Vehicle Safety Device Use on Hospital Resource Use and Injury Severity

Study objective: We evaluated the efficacy of safety devices (seat belts and air bags) on hospital resource use and injury severity while controlling for variables known to affect outcome of motor vehicle crashes. Methods: We conducted a prospective observational study of motor vehicle crash victims who were transported to the hospital in a suburban-rural county with a population of 1.4 million. Out-of-hospital providers recorded patient demographic characteristics, mechanism of injury (based on American College of Surgeons criteria), and use of seat belts or air bags. Hospital charts were reviewed for hospital admission, length of hospital stay, ICU stay, surgery, major nonorthopedic surgery or death, and severe injury (Injury Severity Score > 15). Results: The study group comprised 1,446 motor vehicle crash victims. Median age was 30 years, 47% were male, and 69% used safety devices. The use of safety devices reduced the likelihood of hospital admission (adjusted odds ratio [OR], .67; 95% confidence interval [CI], .46 to .98), surgery (adjusted OR, .52; 95% CI, .27 to 1.01), major surgery or death (adjusted OR, .14; 95% CI, .04 to .52), and severe injuries (adjusted OR of Injury Severity Score > 15, .39; 95% CI, .19 to .83). Conclusion: The use of safety devices is associated with decreased hospital resource use and less severe injuries for victims of motor vehicle crashes who are transported to the hospital by emergency medical services providers, even after adjustment for many other variables known to affect the outcome of motor vehicle crashes. Continued efforts to promote safety device use are warranted. [Henry MC, Hollander JE, Alicandro JM, Cassara G, O'Malley S, Thode HC Jr: Prospective countywide evaluation of the effects of motor vehicle safety device use on hospital resource use and injury severity. Ann Emerg Med December 1996;28:627-634.]     

Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center

BACKGROUND: Laparoscopic cholecystectomy has a higher incidence of bile-duct injuries than open cholecystectomy. Although a learning curve phenomenon was attributed to biliary injuries early after its introduction, we were interested in trends in biliary injury rates over time as laparoscopic cholecystectomy has become a mature technology. OBJECTIVE: To analyze the frequency and anatomic distribution of bile-duct injuries referred after laparoscopic cholecystectomy over a 10-year period. DESIGN: Retrospective, case-series. SETTING: Tertiary, referral hepatobiliary unit. PATIENTS: Referrals to ERCP unit for diagnosis and treatment of biliary injuries after laparoscopic cholecystectomy. INTERVENTION: ERCP to diagnose level and severity of bile duct injury. MAIN OUTCOME MEASUREMENTS: Type and anatomy of bile-duct injury, reason for cholecystectomy, mean time between injury and diagnosis, presenting symptoms, ratio of bile-duct injuries diagnosed over total ERCPs done per year. RESULTS: There were 87 bile-duct leaks, 28 leaks with stones, 51 strictures, and 17 complete duct transactions. The bile-duct injury rate calculated per 100 ERCPs per year was 0.84 (1994), 0.99 (1995), 1.36 (1996), 1.41 (1997), 1.03 (1998), 1.31 (1999), 0.84 (2000), 0.75 (2001), 1.15 (2002), and 0.94 (2003). LIMITATIONS: Single institution, retrospective analysis, unknown denominator of cholecystectomies done in referral area per year to calculate true bile-duct injury rate. CONCLUSIONS: Static incidence in frequency, anatomic distribution, and rate per 100 ERCPs per year of postcholecystectomy bile-duct injuries at a tertiary referral hepatobiliary unit over a 10-year period of observation.     

Slow improvement of clinically-diagnosed dengue haemorrhagic fever case fatality rates

Dengue haemorrhagic fever (DHF) is recognized as a leading cause of hospitalization and death among children in many Southeast Asian countries. This study reviews the case fatality rates of DHF cases admitted to a referral hospital in Cebu (Philippines) over the past 5 years. Information on patients 14 years old or younger admitted from 1 January 1997 to 31 December 2001 with the final clinical diagnosis of DHF was collated and analysed. Case fatality rates were compared before and after a standardized management protocol was implemented by the healthcare staff and after introduction of revisions to that protocol. The case fatality rate during the 2-year periods prior and after introduction of the management protocol decreased significantly from 197/2644 (7.45%) to 39/1182 (3.30%) (P < 0.01). Following the introduction of revisions to the protocol, the case fatality was reduced even further to 52/1697 (3.06%) (P = 0.7). In this government hospital the introduction of a standardized management protocol for DHF was associated with a significant improvement in the case fatality rate of hospitalized children with clinically diagnosed DHF. However, compared with reports from hospitals in other dengue-endemic countries, the improvement has been slow. Possible ways to decrease fatality rates further have been identified.