Reported needlestick and sharp injuries among health care workers in a Greek general hospital

Between July 1990 and June 1996, 284 exposures to infectious material were reported by 247 health care workers (HCWs) at AHEPA University Hospital, Thessaloniki, Greece, representing an overall rate of 2.4% reported injuries per 100 HCWs/year. Nurses reported the highest rates of incidents (3.0%) and in all but one working group women exhibited higher injury rates per year than male HCWs. Young workers (21-30 years old) were primarily affected in incidents (P < 0.001). Needles were the most common implement causing injury (60.6%) and resheathing of used needles as well as garbage collection were common causes of injury. None of the HCWs seroconverted in exposures where immune status to blood-borne pathogens was estimated. Efforts by the infection control committee need to be more intense, in order to increase the rate of reported staff injuries. This will facilitate identification of unsafe practices and provide more adequate preventive measures.     

Potential for reported needlestick injury prevention among healthcare workers through safety device usage and improvement of guideline adherence: expert panel assessment

A prospective survey was conducted over six months in order to estimate the proportion of reported occupational needlestick injuries sustained by National Health Service (NHS) Scotland staff that could have been prevented through either safety device introduction, improved guideline adherence, guideline revision or a combination of these. This survey involved the administration of a standard proforma to healthcare workers followed by an expert panel assessment. All acute and primary care NHS Scotland trusts, the Scottish Ambulance Service and the Scottish National Blood Transfusion Service were included. Proforma and expert panel assessment data were available for 64% of injuries (952/1497) reported by healthcare staff. These injuries were all percutaneous. The expert panel concluded that: 56% of all injuries and 80% of venepuncture/injection administration injuries would probably/definitely have been prevented through safety device usage, 52% of all injuries and 56% of venepuncture/injection administration injuries would probably/definitely have been prevented through guideline adherence and 72% of all injuries and 88% of venepuncture/injection administration injuries would probably/definitely have been prevented through either intervention. Multi-factorial analysis indicated that injuries sustained through venepuncture/injection administration were significantly more likely to be prevented through safety device usage [adjusted odds ratio (OR) 5.09, 95% confidence intervals (CI) 3.11-8.31 and adjusted OR 2.70, 95% CI 1.64-4.45, respectively], and significantly less likely to be prevented through guideline adherence (adjusted OR 0.26, 95% CI 0.11-0.60 and adjusted OR 0.31, 95% CI 0.12-0.78, respectively). Injuries sustained after completing procedures were significantly more likely to be prevented through safety device usage and guideline adherence. The study's findings support the need for improvements to staff's adherence to needlestick injury guidelines and appropriate implementation of safety devices for venepuncture and injection administration.     

口腔医院护工锐器伤现况调查

摘要:目的　了解口腔医院护工锐器伤的发生情况,为制定口腔医院护工锐器伤规范化防护措施提供理论依据。方法　采用卫生部设计的《医务人员锐器伤筛查表》,对某院55名护工人员对过去1个月中锐器损伤的发生情况进行问卷调查。结果　护工锐器伤发生率为21.8%（12/55）,发生密度为 0.47次/（人.月）;年限≤1年的护工锐器伤发生率最高,为61.1%;接受过培训的护工锐器损伤发生率（18.5%）明显低于未培训的护士（39.3%）。结论　口腔医院护工是锐器伤发生的高危人群,通过针对性预防和干预,可有效地降低锐器伤发生率。     

Prevalence of HCV infection among health care workers in a hospital in central Italy

Health care workers are at risk of acquiring transmissible diseases. Controversial results have been reported about HCV. The aims of the present study are to assess the prevalence of HCV in health care workers in Pistoia General Hospital (central Italy) and to compare prevalence with other groups, particularly with a sample of the general population. Serum samples collected from 511 health care employees engaged in direct clinical task and 222 clerical and nurse school attendees have been tested by ELISA and confirmed by RIBA. Total seroprevalence was 3.8%:4.7% in the first group; 1.8% in the second group. The data showed a slight increase in prevalence by age and not by length of stay in the health care workers' group. Comparison of HCV prevalence with blood donors from the province of Pistoia and the general population from Sersale (Catanzaro, southern Italy), restricted to under-40 subjects, indicates an increasing trend in this order: Blood donors, general population, clerical and nursing school attendees, health care workers' group with the highest value (3.4%). A cohort study is needed to evaluate pattern of HCV seroconversion.     

全球医护人员针刺伤的疾病经济负担文献研究

目的了解全球针刺伤疾病经济负担,以获得相关证据,引起有关部门对针刺伤防护的重视。方法在PubMed、ScienceDirect、EBSCOhost、Cochrane中国知网和万方数据库中检索1990年—2016年5月有关针刺伤疾病经济负担的相关研究,应用世界银行通货膨胀率和2015年货币汇率将各研究针刺伤成本转换成2015年12月美元表示,并进行合并比较分析。结果共纳入7篇文献,3篇美国研究,瑞典、韩国、比利时、中国台湾地区研究各1篇。中国大陆的研究均只集中在针刺伤发生率的报道,未见有成本研究。2篇未明确研究人群,其余5篇的研究人群均为在医疗机构中所有工作人员。成本分析方法:7篇文献中3篇为一手数据分析,4篇为模型推算得出。成本研究范围:4篇研究测算了直接成本,2篇研究分别测算直接成本和间接成本,1篇只测算了直接成本和间接成本总和。每次针刺伤总成本(直接成本+间接成本)为747~2 173美元,直接成本为167~617美元,间接成本为322~455美元。结论全球范围内针刺伤经济负担沉重,但仍被低估;中国针刺伤发生频繁,但关注不足,经济负担研究缺乏,有关部门应重视针刺伤防护及追踪处理流程。     

某院医务人员锐器伤目标性监测

目的了解某院医务人员发生锐器伤的人群分布特征和风险环节,为制定有效防护措施提供依据。方法回顾性调查2014年1-12月该三级甲等医院医务人员上报医院感染管理科的职业暴露情况,分析发生锐器伤者的职业类别、暴露地点及环节、暴露源等情况。结果2014年1-12月共监测医务人员2 643名,发生锐器伤61名,其中护士43名（占70.49%）,医生13名（占21.31%）。医务人员锐器伤职业暴露科室主要为骨科（9名,占14.75%）,致伤锐器主要为输液针（33名,占54.10%）,发生的主要操作环节为拔针（21名,占34.43%）;暴露源主要为乙型肝炎病毒（HBV）,共36例（占59.01%）;34名（占55.74%）锐器伤职业暴露医务人员在操作中均未戴手套。锐器伤职业暴露后进行局部处理者54名（占88.52%）,进行药物治疗（含预防用药）者仅18名（占29.51%）;追踪随访43名（占70.49%）,均未因暴露而发生感染。结论医院应建立完善的锐器伤职业暴露监控体系,加强对发生锐器伤高危人群的培训,强化标准预防,对风险环节进行监控和干预,有效减少医务人员锐器伤的发生。     

某院医务人员针刺伤调查及防护对策

目的了解医务工作者针刺伤现况并分析原因,以探讨有效的针刺伤防护策略。方法回顾性调查某院2013年1月—2015年12月医院感染管理科登记的针刺伤案例并进行分析。结果共发生164例针刺伤,其中医生71名(43.29%),护士81名(49.39%),其他医务人员12名(7.32%)。2013年发生针刺伤事件47例(28.66%),2014年54例(32.93%),2015年63例(38.41%)。医疗器械为受污染器械的有152例(92.68%),医疗器械污染情况未知的有9例(5.49%),而未受污染的器械仅为3例(1.83%)。164例针刺伤发生地点以手术室最多(67例,占40.85%);针刺伤发生部位以手指的发生率最高(141例,占85.98%);发生针刺伤的原因以粗心、工作繁忙或者未按规范操作为主(115例,占70.12%),医生发生针刺伤的原因以工作经验不足者最多,占52.11%,护士发生针刺伤原因以粗心、工作繁忙或者未按规范操作者最多,占93.83%。结论医务人员针刺伤案例逐年增多,应加强医务人员职业防护意识,加强医院感染管理制度建设,改善医疗环境等措施减少针刺伤的发生。     

Risk for occupational transmission of HIV infection among health care workers

The aim of this study was to evaluate the HIV seroconversion rate associated with different types of occupational exposures in health care workers. A longitudinal study was conducted from January 1986 to October 1992 in a teaching hospital in Spain, where HIV infection is prevalent among patients. Each health care worker was asked to complete a questionnaire regarding age, sex, staff category, lace of exposure, other exposures, type of exposure, body fluid, infected material and HIV status of source patient. These health care workers were then followed up at 6 weeks, 3 months, 6 months and 12 months with repeated test for HIV antibody. Four hundred twenty three reports of occupational exposure were analysed. Nursing was the profession with more exposures (42.8%). Ninety five percent of total exposures were percutaneous, 4% mucous membrane contacts and 1% skin contacts, 88.3% were described as blood contact and 71.8% had resulted from needlestick and suture needles. Exposures from HIV-positive patients comprised 23.2% of occupational exposures. There was a significant difference in the length of follow-up in physicians (p=0.00009) and nurses (p=0.00001), when we compared HIV-positive patients with patients in whom the HIV status was unknown or negative. The HIV seroconversion rate was 0.00%. We consider that the risk of acquiring HIV infection via contact with a patient is low, but not zero. Well documented cases of seroconversion have been published. Because it is often impossible to know a patient's infection status, health care workers should follow for rotine the universal precautions for all patients when there is a possibility of exposure to blood or other body fluid. Equally important is the development of new techniques to minimize the risk of exposures to blood.     

当涂县医务人员艾滋病职业暴露知识与针刺伤状况调查

目的了解当涂县医务人员对艾滋病职业暴露知识的知晓情况和医护过程中锐器刺伤暴露情况。方法采用整群抽样方法选择当涂县1家县级医院和13家乡镇卫生院及25家村卫生室,于2010年11月~2011年1月对其中的307名医务人员进行问卷调查。结果 307名医务人员艾滋病职业暴露相关知识总体知晓率为52.4%,其中对发生HIV职业暴露后的报告单位知晓率为90.9%;不同医院级别、职业和科室以及是否曾参加过相关培训的医务人员之间掌握艾滋病职业暴露相关知识的程度不同(均有P<0.05);57.3%的调查对象承认在最近1年医疗护理过程中有曾经被针具利器刺破皮肤的经历,不同职业、职称和科室医务人员之间针刺伤发生率不同(均有P<0.05)。结论当涂县医务人员对艾滋病职业暴露相关知识知晓程度较低,发生锐器刺伤等职业暴露率较高,有必要加强培训,提高医务人员艾滋病职业暴露相关知识和自我防护能力。     

Perception and prevalence of work-related health hazards among health care workers in public health facilities in southern India

Background:

Health care workers (HCWs) are exposed to occupational related health hazards. Measuring worker perception and the prevalence of these hazards can help facilitate better risk management for HCWs, as these workers are envisaged to be the first point of contact, especially in resource poor settings.

Objective:

To describe the perception of occupational health hazards and self-reported exposure prevalence among HCWs in Southern India.

Methods:

We used cross sectional design with stratified random sampling of HCWs from different levels of health facilities and categories in a randomly selected district in Southern India. Data on perception and exposure prevalence were collected using a structured interview schedule developed by occupational health experts and administered by trained investigators.

Results:

A total of 482 HCWs participated. Thirty nine percent did not recognize work-related health hazards, but reported exposure to at least one hazard upon further probing. Among the 81·5% who reported exposure to biological hazard, 93·9% had direct skin contact with infectious materials. Among HCWs reporting needle stick injury, 70·5% had at least one in the previous three months. Ergonomic hazards included lifting heavy objects (42%) and standing for long hours (37%). Psychological hazards included negative feelings (20·3%) and verbal or physical abuse during work (20·5%).

Conclusion:

More than a third of HCWs failed to recognize work-related health hazards. Despite training in handling infectious materials, HCWs reported direct skin contact with infectious materials and needle stick injuries. Results indicate the need for training oriented toward behavioral change and provision of occupational health services.     

Some epidemiological aspects of needle stick injuries among the hospital health care workers: Eastern Province, Saudi Arabia

This study was conducted to provide some epidemiological aspects of needle stick injuries among health care workers in the eastern province in Saudi Arabia. Data about 282 injuries reported from the hospitals of the Eastern Province of Saudi Arabia were collected through specially designed questionnaire retrospectively from 1995 to 1997. Results showed that 50% of injuries occurred in the first 3 years of employment. Workers in medical and surgical specialties suffered an equal degree of reported exposure. The highest percentage (46.8%) of injuries occurred during syringe related actions. Patients' wards were the major location of incidents (48.5%) followed by ICUs and dialysis units (17.7%), theatres (15.6%) and accidents and emergency departments (13.8%). There was no significant association between injuries and type of shifts. The middle hours of the shifts showed a significant association with injuries. The pattern of injuries was significantly associated with over loaded periods of medical practices. Deficiencies in implementing the standard recommendations for prevention and control of needle stick injuries were noted in the studied hospitals.     

广州市医务人员传染性非典型肺炎流行情况及预防控制效果分析

目的 分析广州市医务人员传染性生非典型肺炎(SARS)流行的基本特征，探讨流行因素，评价防制措施，为医疗卫生单位开展SARS收治及预防控制工作提供指导。方法 采用统一调查表对医务人员SARS患进行流行病学调查，采用定性生研究方法对医院SARS流行影响因素、预防控制措施及其效果进行调查，资料采用描述性流行病学方法分析。结果 广州市医务人员首例SARS患发病时间为2003年1月13日，截止5月5日共有29家医疗卫生单位报告医护人员发病280例，占全市总病例数的26．07％。医务人员发病高峰在2月上、中旬，共有167例，占医务人员发病总数的59．64％，呈明显聚集性。4月后病例为零星散发。病例主要集中在1月下旬前开始收治SARS患(对SARS尚缺乏认识的时期)的6家医院，占总病例数的73．2％(2c15／280)。调查180例医务人员SARS患中92．22％直接参与过SARS患的救治工作。采取定点收治患、加强医院病区通风、加强医护人员自身的个人防护等综合措施后，2月下旬开始，医务人员的新发SARS病例明显减少。结论 控制SARS在医务人员中流行的关键措施是：(1)要对出现SARS症状的患高度警惕，及时诊断并隔离患；(2)严格按照操作规范做好个人防护措施；(3)收治区要合理布局，严格区分污染区、半污染区和清洁区；(4)加强病区通风换气；(5)严格按照有关指引做好污染物、空气及环境的消毒工作。     

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。     

某院医务人员职业暴露监测

目的了解医务人员发生职业暴露人群的分布特征、危险因素与风险环节。方法对某院所有医务人员2011年1月—2014年6月发生的职业暴露进行风险监控,分别从发生职业暴露者的职业类别,暴露的地点、环节以及方式进行数据统计。结果 286例次职业暴露者中,男性63例(22.03%),女性223例(77.97%);2011年111例次(38.81%),2012年75例次(26.22%),2013年67例次(23.43%),2014年1—6月份33例次(11.54%);对不同人群发生职业暴露者统计数据显示,各年度不同人群发生职业暴露所占百分比相似,由高到低依次为护士(31.97)%、医师(19.90%)、护工(15.79%)、技师(7.64%)、护师(4.17%)和保洁员(2.84%);整理废物、拔针或更换针头、丢弃锐器入利器盒、手术缝合或器械传递、各种穿刺(含抽血)操作时的锐器伤是医务人员发生职业暴露损伤的主要风险环节,其构成比分别为22.38%、19.58%、14.34%、12.94%和11.19%;各年度职业暴露发生地点相似,主要是病房、手术室和注射(治疗)室,其构成比分别为51.40%、19.58%和11.54%。结论医院应建立完善的职业暴露监控与风险管理体系,强化标准预防,加强对职业暴露高危人群的培训,对风险环节及危险因素进行监控和干预,以有效降低医务人员职业暴露发生率。     

211例医务人员锐器伤监测结果分析

目的分析医务人员锐器伤发生情况,为持续改进锐器伤安全管理工作提出建议。方法回顾性分析某院2006年8月—2015年7月上报的《锐器伤登记表》,分析统计相关资料。结果共上报211例锐器伤,主要人群为护士(118例,55.92%)和医生(83例,39.34%);工龄主要为5年及以下者(117例,55.45%);发生地点主要为外科病房(67例,31.75%)、内科病房(65例,30.81%)及门急诊(33例,15.64%);致伤物主要为注射器针头(91例,43.13%)、缝合针(34例,16.11%)和头皮针/输液器针头(27例,12.80%);主要致伤操作为各种注射(40例,18.95%)、静脉输液(38例,18.00%)、手术缝合/剪断(36例,17.06%)。主要致伤环节为操作中(治疗、检查、手术),共109例(51.66%)。血源性病原体污染的器械中,HBV污染95例(76.61%),HCV污染25例(20.16%),HIV污染4例(3.23%)。无血源性病原体感染病例发生。211例医务人员接种乙肝疫苗者155例(73.46%)。结论应重点针对工作时间≤5年的护士和医生,外科病房、内科病房及门急诊的医务人员,注射、静脉输液、缝合/剪断等操作时做好锐器伤防护工作。医院相关部门完善上报流程,加强追踪。     

Occupational health in health care workers

Since the second half of the 20th century occupational health in health care workers is a well-established part of occupational medicine. Identification of environmental, biological, chemical, physical, and psychosocial hazards has lead to a number of preventive measures: Technical (e.g. use of safe instruments and double gloving as protection) and immunological (vaccinations) measures against biological hazards), and technical (lifting aides) and personal (back-schools) intervention to prevent musculoskeletal disorders are well-designed examples.     

Cross-sectional study of hepatitis B antibody status in health care workers immunized as children at an academic medical center in Wisconsin

Individuals who received the hepatitis B vaccine series as young children are entering the healthcare workforce. Our study measured the persistence of antibody to the hepatitis B surface antigen (anti-HBs) at time of employment. Among 986 individuals born in 1991 or more recently with documentation of completion of the hepatitis B vaccine series, 51% had anti-HBs < 10mIU/ml. Of these 507 healthcare workers, 446 (88%) received documented fourth dose of hepatitis B vaccine followed by another anti-HBs ≥ 28 days post vaccination; 11% (50/446 or 5% of the total population) did not mount an anamnestic response. The non-responders were more likely to be male or complete the vaccine series prior to age 7 months. Measuring anti-HBs at the time of hire in this population of healthcare workers who had documentation of hepatitis B series completion as young children may be unnecessary because of the high rate of hepatitis B vaccine protection.     

Hepatitis B virus infection among health care workers at an urban teaching hospital in southern Italy: A low occupational hazard?

A prevalence study of HBV serologic markers was carried out among hospital employees of ten departments of the Second School of Medicine in Naples, an urban area with a high prevalence of HBV infection.Departments and occupational categories were selected to represent a spectrum of different exposure to B virus infection. Workers in a large electronic plant in the same geographical area were screened as controls. HBsAg prevalence was 4.8% in the hospital community and 4.0% in control group. It rises to 4.3% in the Campania Region, where all screened workers live, and in some specific areas of the same region it rises to 12%. But no significant difference among seropositivities for at least 1 marker of HBV, considered to be a better indicator of occupational hazard, was found among personnel of different departments or belonging to different occupational categories. None of the occupational and non-occupational risk factors studied was found to be significantly associated with HBV infection.Two years later, an incidence study was carried out among susceptible subjects. Seropositivity for 1 marker was 2.2% among hospital workers and 2.8% in the control group. These figures are lower than the annual attack rate (5%) required for an acceptable cost-benefit ratio of vaccination against hepatitis B.Our results indicate that in a geographical area with HBV endemicity the occupational hazard for B virus infection is low in hospital workers because of the high number of immunized subjects and the contacts with infected people out of the hospital.