Risk of infections by the human immunodeficiency virus (HIV) among health professionals]

To investigate the occupational risk of infection by HIV among health professionals, 36 cases of occupational accidents involving exposure to material potentially infected with HIV, reported at a Brazilian General Hospital (HCFMRP), were studied. Of the injured workers 75% were female and 25% male (ranging from 23 to 49 years old) and just one of them had high-risk behavior of HIV infection. Of these health professionals, 52.8% were nursing auxiliaries, 19.4%, nurses, 13.9%, nursing attendants, 5.5%, laboratory technicians, 2.8% surgery instrumentalist, 2.8% accountants and 2.8% nursing technicians. In 47.2% of cases the workers had a parenteral exposure to blood (needlestick injuries). The right hand and fingers were the body areas most effected. The serologic test to detect HIV antibodies by the ELISA method was required of all the workers. The results were negative and no seroconversion was registered during the one year follow-up period. The professionals were retested one month, 2 months, 6 months and one year after the exposure. In conclusion, the risk of infection by HIV among health professionals of HCFMRP seems to be very low. Continuing education should be provided for health care workers with a view to reinforcing the use of universal precaution, especially those to prevent injuries caused by needles or other sharp instruments.     

应用信息化技术调查护生针刺伤现状

目的 了解护生针刺伤发生现状，探讨有效的职业暴露应对策略。方法 回顾性调查某院2016—2018年临床实习护生针刺伤发生情况。护生在进入临床实习前，统一登记基本资料，并对其进行感染预防及控制相关知识培训，告知护生发生针刺伤后应经蓝蜻蜓医院感染实时监控管理系统上报。通过蓝蜻蜓系统导出护生针刺伤相关数据进行统计、分析。结果 共调查2 099名护生，其中男生256名，女生1 843名；大专生1 117名，本科生921名，国内硕士研究生34名，外籍硕士研究生27名。发生针刺伤232例次，针刺伤发生率为11.05%。不同性别、学历、实习阶段、科室护生针刺伤发生率比较差异有统计学意义（均P<0.05）。在操作环节分布上，分离针头、拔针和回套针帽时针刺伤所占比率分别为28.88%、21.55%和18.10%。在暴露源的分布上，HBV和梅毒分别占21.12%、6.90%。在暴露场所分布上，发生在病房的针刺伤占32.33%。结论 该院护生针刺伤发生率较低，但女性实习生、学历较低者、实习第一阶段、分离针头时、回套针帽时针刺伤发生率较高。应加强安全注射规范化培训，制定个性化培训方案等。     

Implication of the prevalence of needlestick injuries in a general hospital in Malaysia and its risk in clinical practice

Objectives  To determine the prevalence of cases and episodes of needlestick injury among three groups of health care workers in the past one-year, the level of knowledge on blood-borne diseases and universal precautions and the practice of universal precautions. Other factors associated with the occurrence of needlestick injuries and the reporting of needlestick injuries were also analysed. Methods  A cross-sectional study was conducted in May 2003 to study the needlestick injuries among 285 health care workers (doctors, nurses, medical students) in a public teaching hospital in Negeri Sembilan, Malaysia. Results  The prevalence of needlestick injuries among the respondents was 24.6% involving 71 cases i.e. 48.0% among doctors, 22.4% among medical students, and 18.7% among nurses and the difference was statistically significant (p<0.001). There were a total of 174 episodes of needlestick injury. Prevalence of episode of needlestick injuries was highest among doctors (146%), followed by nurses (50.7%) and medical students (29.4%). Cases of needlestick injuries attained lower scores on practice of universal precautions compared to non-cases (p<0.001). About 59% of cases of needlestick injury did not report their injuries. Conclusions  The study showed that needlestick injuries pose a high risk to health care workers and it is underreported most of the time. Many needlestick injuries can be prevented by strictly following the practice of universal precautions.     

应用信息化技术调查护生针刺伤现状

目的了解护生针刺伤发生现状,探讨有效的职业暴露应对策略。方法回顾性调查某院2016—2018年临床实习护生针刺伤发生情况。护生在进入临床实习前,统一登记基本资料,并对其进行感染预防及控制相关知识培训,告知护生发生针刺伤后应经蓝蜻蜓医院感染实时监控管理系统上报。通过蓝蜻蜓系统导出护生针刺伤相关数据进行统计、分析。结果共调查2 099名护生,其中男生256名,女生1 843名;大专生1 117名,本科生921名,国内硕士研究生34名,外籍硕士研究生27名。发生针刺伤232例次,针刺伤发生率为11.05%。不同性别、学历、实习阶段、科室护生针刺伤发生率比较差异有统计学意义(均P0.05)。在操作环节分布上,分离针头、拔针和回套针帽时针刺伤所占比率分别为28.88%、21.55%和18.10%。在暴露源的分布上,HBV和梅毒分别占21.12%、6.90%。在暴露场所分布上,发生在病房的针刺伤占32.33%。结论该院护生针刺伤发生率较低,但女性实习生、学历较低者、实习第一阶段、分离针头时、回套针帽时针刺伤发生率较高。应加强安全注射规范化培训,制定个性化培训方案等。     

Minor and major work accidents in a Puglia business in the food sector: a 10-year study

At present no official data are available for those occupational accidents which, according to current law, are not subject to notification to the Italian National Institute for Insurance of Occupational Accidents (INAIL) and which are conventionally called "minor" accidents. They can be divided into accidents with prognosis from 1 to 3 days (franchises) and accidents which do not cause absence from work (medications). The already mentioned lack of data, which is not confined to Italy, is reflected in the small number of articles published in Italian and international journals. Also information regarding the possible relationships between "minor" accidents and the life habits of injured workers, are rare. The aim of this study was to provide detailed data on the characteristics of the different kinds of occupational accidents occurring in a food factory in Apulia, southern Italy, from 1985 to 1994, as well as to verify whether any relationship existed between the different types of occupational accidents and the consumption of cigarettes and alcohol by injured workers. The company's accident register yielded data on injuries which caused absence from work; the nursing service register provided information about accidents which did not determine absence from work; personal health documents gave details of worker life habits; and the company pay roll showed the amount of "worked hours". "Minor" accidents represented 70% of all accidents occurring during the ten year period studied. "Blue collars" had more frequent and serious occupational injuries, in comparison with "technical employees". "Minor" accidents, and especially "medications", occurred more frequently during one-shift work than during three-shift work. As work seniority increased, the number of "major" accidents decreased and number of accidents without absence from work rose. Contusions were the most frequent lesions and were responsible for the majority of the 3 kinds of accidents. "Medications" together with injuries notified to INAIL ("major" accidents), mostly involved upper limbs; "franchises" were mostly head interested. About 50% of all causes of occupational accidents were mainly associated with unsafe environmental and working situations, whereas the remaining 50% were mainly associated with unsafe behaviour by workers. Heavy smokers showed a higher frequency of "major" accidents. As alcohol consumption rose, she did number of accidents with absence from work. "Minor" accidents, particularly the "medicated" ones, represented the greatest part of occupational injuries. All the considered causes and circumstances contributed to determine the different kinds of accidents. Thereby, it appears necessary for prevention purposes to obtain information about any kind of injury in the different manufacturing sectors. Finally, it seems dutiful to inform workers about the relationships between life habits and occupational accidents.     

Risk of needlestick injuries by injection pens

Injection pens are used by patients when auto-administering medication (insulin, interferon, apokinon etc.) by the subcutaneous route. The objective of this study was to evaluate the rate of injection pen use by healthcare workers (HCWs) and the associated risk of needlestick injuries to document and compare injury rates between injection pens and subcutaneous syringes. A one-year retrospective study was conducted in 24 sentinel French public hospitals. All needlestick injuries linked to subcutaneous injection procedures, which were voluntarily reported to occupational medicine departments by HCWs between October 1999 and September 2000, were documented using a standardized questionnaire. Additional data (total number of needlestick injuries reported, number of subcutaneous injection devices purchased) were collected over the same period. A total of 144 needlestick injuries associated with subcutaneous injection were reported. The needlestick injury rate for injection pens was six times the rate for disposable syringes. Needlestick injuries with injection pens accounted for 39% of needlestick injuries linked with subcutaneous injection. In all, 60% of needlestick injuries with injection pens were related to disassembly. Injection pens are associated with needlestick injuries six times more often than syringes. Nevertheless, injection pens have been shown to improve the quality of treatment for patients and may improve treatment observance. This study points to the need for safety-engineered injection pens.     

Non-fatal occupational accidents in Brunei Darussalam

Globally, ILO estimates 374 million non-fatal and 380,500 fatal occupational accidents annually. Slips, trips, falls and contact with objects are the leading modes of injury, with extremities being the most common body part involved. Occupational accidents are of major concern for high risk occupational groups such as migrant workers, or work areas e.g. construction, manu-facturing, wholesale, and retail industries. This study was aimed to determine the prevalence of non-fatal occupational injuries and its trends among industry workers in Brunei Darussalam. A retrospective cross-sectional review of occupational accidents notified to the Occupational Health Division, Ministry of Health, over a five-year period from January 2014 until December 2018 was conducted. A total of 424 non-fatal occupational accidents were notified, with increasing trend from 44 in 2014 to 132 in 2018. Accidents were more common in males (98%), migrant workers (86%), in the 30–39 age group (42.5%), and in the construction industry (56.4%). Struck by object (37.7%) was the commonest cause and upper limb (43.9%) was the commonest body part involved. There is a need for workplaces to develop capabilities and support mechanisms for risk assessments, as well as auditing and reviewing performances to minimize occurrence of preventable occupational injuries.     

Needlestick injuries during medical training

Medical students are at risk of acquiring infections caused by needlestick injuries, although it is unknown when needlestick injuries are most likely to occur during medical training. The aim of this study was to define high-risk periods over the course of medical training. A cross-sectional study was conducted among medical students in the first, third, fourth and fifth years of training at two medical schools in Munich. Overall, 1317 (85%) students returned a questionnaire on demographic data, vaccination status against hepatitis B, lifetime prevalence of needlestick injuries, level of knowledge about measures after such accidents, and transmission risks. Lifetime prevalence of needlestick injuries was 23%, ranging from 12% in first year students to 41% in fourth year students. These accidents happened most commonly during medical internships, especially during blood-taking practices; an activity that usually starts during the third year of training. The frequency of respondents not vaccinated against hepatitis B also varied between first (21%) and fourth (6.6%) year students. Needlestick injuries occur frequently and early on in medical training. In order to decrease the risk of preventable infections, complete coverage of vaccination against hepatitis B should be achieved early in medical training.     

Preventability of percutaneous injuries in healthcare workers: a year-long survey in Italy

The aim of the study was to examine the preventability of percutaneous injuries either through the adoption of correct behaviour or by the use of needles with safety features. We analysed the report forms of occupational needlestick or sharps injuries in a sample of healthcare workers exposed to the risk of percutaneous injuries in the period between 1 June 2000 and 31 May 2001; the forms were returned to the regional SIROH (Italian Study on Occupational Exposure to HIV) centre in which all hospitals of the Piemonte region (Italy) participate. Percutaneous injuries caused by needles (injection, phlebotomy, infusion), suture needles and scalpels were analysed; three samples were extracted according to the type of device that caused the injury. In the sample of 439 needlestick-related percutaneous injuries, 74% were caused by incorrect health worker behaviour and 26% were unpreventable, seventy-nine percent of accidents caused by incorrect behaviour and 24% of accidents could have been prevented by using needles with safety features. In the sample of 221 suture needle and 114 scalpel injuries, incorrect health worker behaviour was identified in 26.2% and 14%, respectively, and unpreventable causes in 73.8% and 50.9%, respectively. A high rate of percutaneous injuries, especially those involving needles for injection, phlebotomy, infusion, and scalpels, could be prevented by adopting safe work behaviour practices and using personal protection equipment. The introduction of devices with safety features could lead to a significant reduction in the number of injuries from needles.     

Police training to align law enforcement and HIV prevention: preliminary evidence from the field

Having identified gaps in implementation of Rhode Island's syringe access law and police occupational safety education, public health and police professionals developed police training to boost legal knowledge, improve syringe access attitudes, and address needlestick injuries. Baseline data (94 officers) confirmed anxiety about needlestick injuries, poor legal knowledge, and occupational risk overestimation. Before training, respondents believed that syringe access promotes drug use (51%), increases likelihood of police needlestick injuries (58%), and fails to reduce epidemics (38%). Pretraining to posttraining evaluation suggested significant shifts in legal and occupational safety knowledge; changes in attitudes toward syringe access were promising. Training that combines occupational safety with syringe access content can help align law enforcement with public health goals. Additional research is needed to assess street-level effect and to inform intervention tailoring.     

HIV infection risk to health-care workers

The risk of occupationally acquired human immunodeficiency virus (HIV) infection in exposed health-care workers has been estimated to be 0.5% after accidental needlestick with an HIV-contaminated needle. Needlestick injuries resulting in parenteral exposure to HIV-infected material are the most common reported cause of occupational HIV infection in health-care workers. With 60% of these exposures unpreventable even with strict adherence to current infection control procedures, it is necessary to develop technical changes in work protection in order to further reduce the risk.     

汽车制造业不同工种工伤事故分布特征的研究

目的 探索汽车制造不同工种工人工伤事故发生的种类,特征及影响因素,为劳动安全部门制定防治对策。方法 对３６５１例工伤档案资料按种类和分布特征进行描述和分析。结果 受伤者中机加工、冲压工、特种工、辅助工、铸造工分别占２０．３％、１６．１％、１６．９％、２０．２％、８．６％。男女工伤人数分别为３０６１人和５９０人,工伤率分别为４．０‰和１．５‰。冲压工工伤率和致残率最高,达２２．４％和３６．５％。结论     

Work schedule, needle use, and needlestick injuries among registered nurses.

OBJECTIVE: To examine the association between working conditions and needlestick injury among registered nurses. We also describe needle use and needlestick injuries according to nursing position, workplace, and specialty. DESIGN: Three-wave longitudinal survey conducted between November 2002 and April 2004. SETTING AND PARTICIPANTS: A probability sample of 2,624 actively licensed registered nurses from 2 states in the United States. Follow-up rates for waves 2 and 3 were 85% and 86%, respectively. Respondents who had worked as a nurse during the past year (n=2,273) prior to wave 1 were included in this analysis. RESULTS: Of the nurses, 15.6% reported a history of needlestick injury in the year before wave 1, and the cumulative incidence by wave 3 was 16.3%. The estimated number of needles used per day was significantly related to the odds of sustaining a needlestick injury. Hours worked per day, weekends worked per month, working other than day shifts, and working 13 or more hours per day at least once a week were each significantly associated with needlestick injuries. A factor combining these variables was significantly associated with needlestick injuries even after adjustment for job demands, although this association was somewhat explained by physical job demands. CONCLUSIONS: Despite advances in protecting workers from needlestick injuries, extended work schedules and their concomitant physical demands are still contributing to the occurrence of injuries and illnesses to nurses. Such working conditions, if modified, could lead to further reductions in needlestick injuries.     

Prevalence and prevention of needlestick injuries among health care workers in a German university hospital

Objective Health care workers (HCWs) are exposed to bloodborne pathogens, especially hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) through job-related risk factors like needlestick, stab, scratch, cut, or other bloody injuries. Needlestick injuries can be prevented by safer devices. Methods The purpose of this study was to investigate the frequency and causes of needlestick injuries in a German university hospital. Data were obtained by an anonymous, self-reporting questionnaire. We calculated the share of reported needlestick injuries, which could have been prevented by using safety devices. Results 31.4% (n = 226) of participant HCWs had sustained at least one needlestick injury in the last 12 months. A wide variation in the number of reported needlestick injuries was evident across disciplines, ranging from 46.9% (n = 91/194) among medical staff in surgery and 18.7% (n = 53/283) among HCWs in pediatrics. Of all occupational groups, physicians have the highest risk to experience needlestick injuries (55.1%—n = 129/234). Evaluating the kind of activity under which the needlestick injury occurred, on average 34% (n = 191/561) of all needlestick injuries could have been avoided by the use of safety devices. Taking all medical disciplines and procedures into consideration, safety devices are available for 35.1% (n = 197/561) of needlestick injuries sustained. However, there was a significant difference across various medical disciplines in the share of needlestick injuries which might have been avoidable: Pediatrics (83.7%), gynecology (83.7%), anesthesia (59.3%), dermatology (33.3%), and surgery (11.9%). In our study, only 13.2% (n = 74/561) of needlestick injuries could have been prevented by organizational measures. Conclusion There is a high rate of needlestick injuries in the daily routine of a hospital. The rate of such injuries depends on the medical discipline. Implementation of safety devices will lead to an improvement in medical staff’s health and safety.     

A five-year study of needlestick injuries: significant reduction associated with communication, education, and convenient placement of sharps containers.

OBJECTIVE: To decrease the numbers of needlesticks among healthcare workers. DESIGN: All reported needlestick injuries at Santa Clara Valley Medical Center, San Jose, California, were reviewed, analyzed, and tabulated by the infection control department yearly from 1986 to 1990. SETTING: A 588-bed county teaching hospital in San Jose, California, affiliated with Stanford University. PARTICIPANTS: All employees of Santa Clara Valley Medical Center who reported needlestick injuries on injury report forms. INTERVENTIONS: From April to December 1987, more needle disposal containers were added to as many patient care areas and as close to the area of use as possible. Results of 1986, 1988, 1989, and 1990 analyses were communicated yearly to all personnel, extensive educational programs were conducted in 1987 and 1988, and educational efforts continued in 1989 and 1990. RESULTS: In 1986, there were 259 needlestick injuries at our institution, 22% (32) from recapping. After needle disposal containers were added to all patient care areas, needlestick injuries for 1988 totalled 143, a 45% decrease in the total needlestick injuries and a 53% decrease in recapping injuries. Communication of results to all areas of the hospital and educational activities were started in 1987 and continued through the next 3 years. In 1989, there were 135 needlestick injuries, a decrease of 6% from 1988; recapping injuries decreased 40% from 1988. In 1990, there were 104 needlestick injuries, a 23% decrease since 1989, and a 33% decrease in recapping injuries. The total number of needlestick injuries from 1986 to 1990 decreased by 60%, and those injuries from recapping decreased by 81% to 89%. CONCLUSIONS: We have continued to monitor needlestick injuries, communicate findings to all personnel, and include needlestick prevention in educational programs. We contend that more convenient placement of needle disposal containers, communication of findings, and education do decrease needlestick injuries in healthcare workers.     

Occupational health and safety in agriculture: situation and priorities at the beginning of the third millennium

Agriculture is a human activity, which includes a number of different tasks and occupies a huge number of people worldwide. Estimates of World Bank for 2003 suggest that 51% of globalpopulation lives in rural areas. ILO estimates that 1.3 billion of workers are engaged in agriculture, and they represent almost a half of the total number of economically active subjects (2,838,897,404). In developed countries, agriculture workers are only a small fraction of the whole work force (up to 9% according to ILO data), while in developing countries, especially in Asia, agriculture workers represent up to the 60% of the total work force. Most agriculture workers reside in Asia, in the Pacific (74%) and in Africa (16%). ILO estimates suggest that half of fatal occupational injuries in the world are attributable to agriculture. This means that around 170,000 agriculture workers die every year as a consequence of occupational injuries. Using the same estimate, half of the fatal accidents could be linked to agricultural activities (more than 130 million). Comparing this estimate with the 6.328.217 people injured in war in 2002 or with the 20-50 million injured victims of road accidents, one has a much clearer picture about the importance of preventing agricultural injuries. In a complicated situation such as occupational health and safety problems in agriculture, it is not so easy to select priorities clearly. But "legalization" of agriculture workers could be a key to solving all the other problems. Actual data on fatal and non-fatal occupational injuries in agriculture show that occupational health and safety issues are among the top priorities for that discipline.     

Epidemiologic study of occupational injuries among foreign and native workers in Taiwan

This study was designed to compare the risk of occupational injuries in foreign workers compared to native workers in Taiwan. The cohort of foreign workers under study was constructed by records of legally registered workers migrated from foreign countries to Taiwan from July 1, 1991 to December 31, 1993. The native Taiwanese workers for comparison were labor-insured workers working in the same industries as foreign workers in 1992. The number of occupational injuries in the first year of employment were obtained by matching the cohort of foreign workers with the labor insurance payment records by name, birth date and passport number. The 1-year incidence rate of occupational injuries in the first year of employment was calculated and a standardized morbidity ratio (SMR) was used for comparison with adjustment for age distribution and to accommodate the small sample size of foreign workers. The risk to occupational injuries among total (SMR = 0.86) and male (SMR = 0.58) foreign workers was not higher: indeed, it was even lower, than that among native workers in Taiwan. However, the risk to female migrant workers, especially in the construction industry, was significantly higher than that of female Taiwanese workers (SMR = 1.60). Stratified by industry, the incidence was high in the fabricated metal products manufacturing industry and in machinery and equipment manufacturing industry for male foreign workers, while a high incidence for the female foreign workers occurred in construction industry and rubber products manufacturing industry. The risk of occupational injuries was greater for foreign workers who had been in Taiwan for only a short time. Most fo the injuries occurred within the first 6 months of employment. Eighty-four out of the 394 occupational injuries among foreign workers resulted in disabilities. None of the accidents was fatal, but most of the disabilities were severe. The most common disabling injuries were cut or crushed fingers. The finding of a similar distribution of occupational injuries among foreign and native workers indicates that control measures are needed to reduce occupational injuries for all foreign and native workers in Taiwan. Am. J. Ind. Med. 31:623–630, 1997. © 1997 Wiley-Liss, Inc.