Accidental needlesticks: do anesthesiologists practice proper infection control precautions?

Anesthesiologists as well as patients are at risk for acquiring blood-borne infections such as hepatitis and AIDS. We surveyed 2,530 anesthesiologists, a 10% random sample of the members of the American Society of Anesthesiologists, with a response rate of 57.1%, to determine the incidence of accidental needlestick exposure among anesthesia personnel and whether anesthesiologists are adhering to infection control guidelines to protect themselves and their patients from exposure to infectious diseases. Eighty-eight percent of respondents reported at least 1 accidental needlestick in the past 10 years; 21% received a needlestick from a high-risk patient and 4.5% a needlestick from a known HIV-positive patients. Residents reported significantly more accidental needlesticks from known HIV-positive patients (8.5%). Mucous membrane, open cut, eye, or other significant exposure to HIV-contaminated blood or body fluids was sustained by 8.34% of respondents in the past 10 years. Sixty percent of respondents reported they almost never reuse common syringes now compared with a 40.8% non-reuse rate (P < 0.001) in a similar survey on infection control practices conducted in 1990. Sixty-three percent reported they almost never reuse a vasopressor syringe compared with the 1990 non-reuse rate of 52.5% (P < 0.001). In the current survey, 39% of anesthesiologists reported reusing syringes from one patient to another and 36% reported reusing the same vasopressor syringes for different patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of HBV, HCV and HIV injection in a population of Polish orthopedic surgeons]

Orthopedic surgeons are at risk for occupationally acquired infections with blood borne pathogens. OBJECTIVE: To estimate the prevalence of infection with HBV, HCV, CMV and HIV among orthopedic surgeons. DESIGN: Voluntary, anonymous serosurvey at an annual meeting of Polish Association of Orthopedic Surgeons held in Szczecin, Poland in 2004. Serum samples were tested for anti-HIV, anti-CMV IgG, anti-HCV and markers of HBV infection: anti-HBc total and HBs. RESULTS: Of 1000 eligible orthopedic surgeons at the meeting, 101 (10.4%) participated; 75% participants reported a percutaneous blood contact in the previous month. None of the doctors was positive for HIV (0%, 95% CI:0-3.7%). One participant (1%, 95% CI: 0.2-5.4%), 26 years in profession, had anti-HCV. There was evi-dence of infection with HBV in 10 of 96 participants (10.4%) who had reported having no nonoccupational risk factors and in 5 participants with such factors. None of them developed a chronic infection. Only 5 out of 15 doctors infected with HBV knew their serological status, 13 out of those 15 had been immunized with hepatitis B vaccine, 4 revaccinated. The immunization rate was 91%. The seroprevalence for CMV was 63/101 (62%); it increased with age (p < 0.0003). CONCLUSIONS: Despite infection control precautions and availability of hepatitis B vaccine, orthopedic surgeons remain at risk for acquiring bloodborne viral infection. CMV poses the highest risk, followed by HBV and HCV. As the majority of HBV infected doctors did not know their serological status and underwent immunization with hepatitis B vaccine, testing for anti-HBc before vaccination remains crucial.     

Occupational blood-borne diseases in surgery

BACKGROUND: Human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) infections are transmitted by blood exposure. Surgeons have been concerned about the risks of blood exposure in the operating room as a potential source of occupational infections from these viruses. The actual risk and frequency of operating room transmission remains poorly understood by many surgeons. METHODS: The pertinent recent literature on the pathophysiology, diagnosis, prevention, and treatment of HIV, HBV and HCV were reviewed to address the current understanding of these viruses as occupational risks to surgeons. RESULTS: HIV transmission to surgeons has not been documented in the United States by the Centers for Disease Control. HIV transmission from a surgeon to a patient in the environment of the operating room, as well as transmission from an HIV-infected surgeon to a patient, has not been documented. HBV infection of surgeons has declined with the general acceptance of the HBV vaccine. HCV infection remains a real risk for transmission in the operating room, given that no vaccine is currently available and that the overall number of chronically infected patients remains quite high. CONCLUSION: The risk of occupational infection from known viral pathogens for surgeons is low, but it is not zero. Effective barriers, modified patterns of behavior, and prompt responses to blood exposure events are the best methods for prevention.     

Occupational risks of blood exposure in the operating room

Bloodborne pathogens continue to be a source of occupational infection for healthcare workers, but particularly for surgeons. Over 1 per cent of the U.S. population has one or more chronic viral infections. Hepatitis B is the infection that has the longest known role as an occupational pathogen, but infection with this virus is largely preventable with the use of the effective hepatitis B vaccine. Hepatitis C affects the largest number of people in the United States, and there is no vaccine available for the prevention of this infection. HIV infection still has not been associated with a documented transmission in the operating room environment, but six cases of probable occupational transmission have been reported. A total of 57 healthcare workers have had documented occupational infection since the epidemic of HIV infection began. Infection of blood-borne pathogens to patients from infected surgeons remains a concern. Surgeons who are e-antigen-positive for hepatitis B have been well documented to be an infection risk to patients in the operating room. Only four surgeons have been documented to transmit hepatitis C, although other transmissions have occurred in the care of patients when practices of infection control have been violated. No surgical transmission of HIV to a patient has been identified at this time. Prevention of occupational infection requires use of protective barriers, avoidance of exposure risk by modification of techniques, and a constant awareness of sharp instruments in the operating room. Blood exposure in the operating room carries risk of infection and should be avoided. It is likely that other infectious agents will emerge as operating room threats. Surgeons must maintain vigilance in avoiding blood exposure and percutaneous injury.     

Frequency of puncture injuries in surgeons and estimated risk of HIV infection

To evaluate the occupational risk of human immunodeficiency virus (HIV) infection, we surveyed 202 surgeons working in the New York City metropolitan area. One hundred seventy-three (86%) surgeons reported at least one puncture injury in the preceding year (median number, 2 per year; interquartile range, 1 to 4 per year). Seventy-six percent of the injuries occurred during surgery, and the median injury rate was 4.2 per 1000 operating room hours. Twenty-five percent of the surgeons sustained yearly injury rates of 9 or more per 1000 operating room hours, and these high rates were independent of sex, age, type of practice, operative work load, or hospital location. Fifty-three percent of all injuries involved the index finger of the nondominant hand. If the prevalence of HIV infection in surgical patients is 5%, then the estimated 30-year risk of HIV seroconversion is less than 1% for 50% of the group, 1% to 2% for 25% of the group, 2% to 6% for 15% of the surgeons, and greater than 6% for 10% of the surgeons.     

The occupational risk to dental anesthesiologists of acquiring 3 bloodborne pathogens

OBJECTIVE: To estimate the occupational risk to dental anesthesiologists of contracting 3 bloodborne pathogens: hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). METHODS: Through an anonymously returned, mailed questionnaire, dental anesthesiologists in Canada and the United States provided information regarding percutaneous and mucocutaneous contacts with contaminated fluid during the treatment of patients under deep sedation and general anesthesia as well as other general practice information. A mathematical model was applied to determine the occupational risk. RESULTS: Of the 101 (65%) returned questionnaires, 98 reported having treated patients within the previous 6 months. Of these, 41 (42%) had at least one percutaneous accident (89 accidents in total), and the projected mean annual injury rate for dental anesthesiologists overall was 1.82. The most common causes of injury were burs, intraoral needles, and dental instruments. Operator error during use was associated with 31% of reported accidents. Significantly more injuries were reported by those who also reported a mucocutaneous contact and by those working more than 25 hours per week. The projected mean annual number of mucocutaneous exposures was 0.88 for dental anesthesiologists overall. CONCLUSIONS: The calculated annual risk to the average dental anesthesiologist of acquiring HBV (if not immune), HCV, and HIV following percutaneous injury was very low for all infections (HBV the most; HIV the least). The risk of contracting HIV following mucocutaneous contact was extremely low.     

Concerns,attitudes, and practices of orthopaedic surgeons towards management of patients with HIV/AIDS in Nigeria

The increasing number of people living with HIV/AIDS is causing concern among surgeons over risk of occupationally acquired HIV infection. This may influence their attitude to such patients. The purpose of this study was to develop a cross-sectional survey of orthopaedic surgeons to assess their concerns, attitudes, and practices towards management of HIV-positive patients in Nigeria. All respondents were males, 55 (73.3%) of them indicated concern over the risk of occupational acquisition of HIV infection and 37 (49.3%) had examined or operated on at least one HIV/AIDS patient. Sixty (79.9%) were willing to be tested for HIV and 51 (67.9%) were previously tested. Fifty-seven (75.9%) would order preoperative HIV screening of high risk patients, and 67 (89.3%) would operate on HIV-positive patients. Most orthopaedic surgeons in Nigeria would operate on HIV-positive patients.     

传染病医院与综合医院护理人员职业暴露及管理现况调查

目的了解医院护理人员职业暴露现况,比较传染病医院与综合医院的差异性,为针对性干预提供参考。方法采用自行设计的职业暴露与防护管理调查问卷对全国31个省市自治区306所医院的19588名护士进行调查。结果标准预防知晓率为93.29%;乙型肝炎暴露后处理掌握率为95.79%,两类医院差异无统计学意义(P>0.05);艾滋病和丙型肝炎职业暴露后正确处理掌握率传染病医院显著高于综合医院(均P<0.01);护士职业暴露发生率为51.86%,暴露部位主要为手(97.75%),暴露原因主要为锐器处理不当(62.61%),上报率为66.00%,综合医院均显著差于传染病医院(均P<0.01);职业暴露后24 h内检测率为84.04%,获得随访与补偿者为87.72%及70.81%,两类医院差异无统计学意义(P>0.05);支付方式多为医保+自费方式;医院有明确职业暴露补偿制度者为33.02%,传染病医院显著优于综合医院(均P<0.01)。结论护理人员职业暴露发生率高,以锐器伤为主,上报率低;在职业暴露知识掌握、风险评估、支持及保障3个方面尚需提高,综合医院更甚。各级医院管理人员应引起高度重视,应采取针对性措施加以改进,确保护理人员职业安全。     

Needlestick injury in surgeons: what is the incidence?

A prospective study by questionnaire was carried out to investigate the incidence of needlestick injury in the operating theatre staff of a teaching hospital and to calculate the individual risk of acquiring blood-borne virus infection in the UK from this source. The individual rate of needlestick injury in operating theatre staff was 1.55% per surgeon per operation (confidence interval (Cl) 0.6-2.5%). The calculated rate of clinical hepatitis B in surgeons compared with the observed rate suggests that needlestick in theatre is the main mode of transmission.     

A multicenter study of the epidemiology of hepatitis B in anesthesia residents

Practicing anesthesiologists are at high risk of hepatitis B infection, but the risk for anesthesia residents has not been assessed. Anesthesia residents at seven universities were surveyed to study the epidemiology of hepatitis B in these trainees. Hepatitis B virus markers in serum were measured and data from questionnaires were used to determine characteristics of anesthetic practice, effectiveness of strategies for hepatitis B virus infection control, and nonvocational hepatitis B risk factors. Of 267 participants, 12.7% (range of the seven centers, 8.7%-22.7%) had serum markers for hepatitis B virus. The seropositivity (17.8%) in anesthesia residents who had completed more than 12 months of nonanesthesia postgraduate clinical training, or who had practiced medicine in another specialty prior to anesthesia, was greater than in the other trainees (9.4%). Based on their risk and the ineffectiveness of current control measures, anesthesia residents who lack hepatitis B virus immunity should be vaccinated prior to or as early as possible in their training.     

Nadelstichverletzungen im klinischen Alltag

Healthcare workers (HCW) are exposed to bloodborne pathogens, especially hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV), through such job-related risk factors as needlestick, stab, scratch, and cut injuries or others that draw blood. The purpose of this study was to ascertain the frequency and the causes of needlestick injuries in a German university hospital. We calculated what proportion of the reported needlestick injuries could have been prevented by using safety devices. Within the previous 12 months 31.4% (n=226) of the HCWs taking part in the study had sustained at least one needlestick injury. HCWs in the department of surgery were most at risk, 46.9% of these having sustained needlestick injuries. On average 36.4% (n=204/561) of all needlestick injuries could have been avoided by the use of safety devices. However, the various medical disciplines differ significantly in the proportion of needlestick injuries that could definitely have been avoided, this being highest in pediatrics (82.6%), declining through gynecology (81.4%), anesthesia (53.7%), and dermatology (41.7%) to surgery (14.6%). Numerous independent studies have documented the benefit of using safety devices. The introduction of such instruments will lead to improved protection of the medical staff and through this in turn to better protection of the patients.     

Estimated Risk of Human Immunodeficiency Virus and Hepatitis C Virus Infection among Potential Organ Donors from 17 Organ Procurement Organizations in the United States

To prevent unintentional transmission of bloodborne pathogens through organ transplantation, organ procurement organizations (OPOs) screen potential donors by serologic testing to identify human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. Newly acquired infection, however, may be undetectable by serologic testing. Our objective was to estimate the incidence of undetected infection among potential organ donors and to assess the significance of risk reductions conferred by nucleic acid testing (NAT) versus serology alone. We calculated prevalence of HIV and HCV—stratified by OPO risk designation—in 13 667 potential organ donors managed by 17 OPOs from 1/1/2004 to 7/1/2008. We calculated incidence of undetected infection using the incidence‐window period approach. The prevalence of HIV was 0.10% for normal risk potential donors and 0.50% for high risk potential donors; HCV prevalence was 3.45% and 18.20%, respectively. For HIV, the estimated incidence of undetected infection by serologic screening was 1 in 50 000 for normal risk potential donors and 1 in 11 000 for high risk potential donors; for HCV, undetected incidence by serologic screening was 1 in 5000 and 1 in 1000, respectively. Projected estimates of undetected infection with NAT screening versus serology alone suggest that NAT screening could significantly reduce the rate of undetected HCV for all donor risk strata.     

Prevalence of hepatitis C, hepatitis B and HIV infection among haemodialysis patients in Ibn-Rochd university hospital, Casablanca

The viral infections are frequent in haemodialysis patients, notably those due to the hepatitis C virus (HCV), the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV). The objective of this study is to determine the prevalence of the hepatitis C, the hepatitis B, the HIV infection in haemodialysis patients and the main risk factors for hepatitis C in the chronic haemodialysis patients treated in haemodialysis unit of Ibn Rochd University Hospital in Casablanca. This retrospective study was performed in 186 chronic haemodialysis patients and showed a high prevalence of HVC infection (76%), the prevalence of HBV infection was at 2%, none of the patients had detectable antibodies of HIV. Among the patients infected by the HCV, the mean duration of dialysis was 8,7 years. The mean number of blood units transfused was 16,5. Seventeen patients (11%) had no history of blood transfusion. In conclusion, the blood transfusion is not considered to be a like a major risk factor of the HCV infection in haemodialysis patients and this since the systematic detection of the anti-HCV antibodies in the blood donors. The nosocomial transmission of HCV seems to be the main risk factor HCV infection in the haemodialysis units requiring a strict adherence to infection control procedures for prevention of HVC infection in haemodialysis patients.     

Prevalence and behavioural risks for HIV and HCV infections in a population of drug users of Dakar,Senegal: the ANRS 12243 UDSEN study

Objectives

Data on the extent of drug use and associated HIV, hepatitis C and hepatitis B infection in West Africa are lacking. The objectives of ANRS12244 UDSEN study were to estimate the size of the heroin and/or cocaine drug user (DU) population living in the Dakar area (Senegal), and assess the prevalence and risk factors of HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV), including behavioural determinants in this population, in order to set up an integrated prevention and treatment programme for DUs.

Design and methods

A capture-recapture method was applied for population size estimation, whereas the respondent-driven sampling (RDS) method was used to recruit a sample of DUs living in the Dakar area and determine HIV, HBV and HCV prevalence. Behavioural data were gathered during face-to-face interviews, and blood samples were collected on dried blood spots for analysis in a central laboratory. Data analysis was performed using the RDS analysis tool, and risk factors were determined by logistic regression. Access to laboratory results was organized for the participants.

Results

The size of the DU population in the Dakar area was estimated to reach 1324 (95% confidence interval (95% CI: 1281–1367)). Based on the 506 DUs included in the study, the HIV, HCV and HBV prevalence were 5.2% (95% CI: 3.8–6.3), 23.3% (95% CI: 21.2–25.2) and 7.9% (95% CI: 5.2–11.1), respectively. In people who inject drugs (PWID), prevalence levels increased to 9.4% for HIV and 38.9% for HCV (p=0.001 when compared to those who never injected). Women were more at risk of being HIV infected (prevalence: 13.04% versus 2.97% in males, p=0.001). Being PWID was a risk factor for HCV and HIV infection (odds ratio, OR: 2.7, 95% CI: 1.7–4.3, and OR: 4.3, 95% CI: 1.7–10.7, respectively), whereas older age and female sex were additional risk factors for HIV infection (10% increase per year of age, p=0.03 and OR: 4.9, 95% CI: 1.6–156, respectively). No specific determinant was associated with the risk of HBV infection.

Conclusions

High HIV and HCV prevalence were estimated in this population of DUs (including non-injectors) living in the Dakar area, Senegal, whereas HBV prevalence was close to that of the global Senegalese population, reflecting a risk of infection independent of drug use. Women seem to be highly vulnerable and deserve targeted interventions for decreasing exposure to HIV, while behavioural risk factors for HIV and HCV include the use of unsafe injections, reflecting the urgent need for developing harm reduction interventions and access to opioid substitution therapy services.     

Cause-specific mortality risks of anesthesiologists

BACKGROUND: The health-related effects of the operating room environment are unclear. The authors compared mortality risks of anesthesiologists to those of internal medicine physicians between 1979 and 1995. METHODS: The Physician Master File database, a listing of all US physicians, was used to identify anesthesiologists and general internists. The cohort of internists (n = 40,211) was a stratified random sample of all internists, frequency-matched to the cohort of anesthesiologists (n = 40,242) by gender, decade of birth, and US citizenship. The National Death Index was used to confirm death status and to determine specific causes of death. Mortality risks, adjusted for age, gender, and race, were compared using the Cox proportional hazards regression model. RESULTS: The standardized mortality ratios for all physicians were well below 1.0, except for suicide. The all-cause mortality ratios, and the risks of death caused by cancer and heart disease, did not differ between anesthesiologists and internists. Anesthesiologists had an increased risk of death from suicide (rate ratio [RR] = 1.45, 95% confidence interval [CI] = 1.07 - 1.97), drug-related death (RR = 2.79, 95% CI = 1.87 - 4.15), death from other external causes (RR = 1.53, 95% CI = 1.05 - 2.22), and death from cerebrovascular disease (RR = 1.39, 95% CI = 1.08 - 1.79). Male anesthesiologists had an increased risk of death from HIV (RR = 1.82, 95% CI = 1.09 - 3.02) and viral hepatitis (RR = 7.98, 95% CI = 1.0 - 63.84). Although the risk to anesthesiologists of drug-related deaths was highest in the first 5 years after medical school graduation, it remained increased over that of internists throughout the career. CONCLUSIONS: Substance abuse and suicide represent significant occupational hazards for anesthesiologists. New methods to combat substance abuse among anesthesiologists should be developed.     

Documented prevalence of HIV and hepatitis C infection in patients with penetrating trauma

Background : Trauma patients infected with human immunodeficiency virus (HIV) or hepatitis C (HCV) pose specific problems to health‐care workers due to the risk of exposure to these agents in blood and other body fluids. Studies of patients with penetrating trauma in the USA have shown a higher prevalence of HIV and HCV infection than the general population. No studies have examined the prevalence of these infections in Australian trauma patients. Methods : The medical records of all patients presenting to St Vincent’s Hospital, Sydney, from January 1994 to December 1998, with a stab wound to the neck, chest or abdomen, or with a gunshot wound to any anatomical site, were retrospectively reviewed. The number of patients with a history of HIV or HCV infection, or with risk factors for these such as male‐to‐male sexual intercourse and intravenous drug use, were recorded. Results : The medical records of 148 patients with stab wounds to the neck, chest or abdomen, or with gunshot wounds were examined. Risk factors for HIV or HCV infection were recorded in 31 patients (21%). Two patients (1.3%) had a history of HIV infection and a further eight patients (5.4%) were known to have HCV. Conclusions : There was a high prevalence of risk factors for HIV and HCV in patients with major penetrating wounds at St Vincent’s Hospital. The prevalence of documented HIV and HCV infection was subsequently greater than that expected in the general population, highlighting the risks to health‐care workers managing these patients.     

The prevalence of hepatitis B co-infection in a South African urban government HIV clinic

OBJECTIVE: There are an estimated 350 million hepatitis B carriers worldwide. In South Africa the prevalence of mono-infection with hepatitis B has been estimated to range from 1% in urban areas to approximately 10% in rural areas. The exact prevalence of hepatitis B in the HIV-infected population has not been well established. Hepatitis B screening is not standard practice in government HIV clinics. Co-infection with hepatitis B and HIV can influence antiretroviral treatment and prognosis of both diseases. The purpose of this study was to evaluate the prevalence of hepatitis B/HIV coinfection. DESIGN: This is believed to be the first prospective observational report on the prevalence of hepatitis B/HIV co-infection in South Africa. Patients on whom hepatitis B serological tests could not have been done previously were recruited from an HIV clinic in a regional hospital in Johannesburg. Standard hepatitis B serological tests were performed. RESULTS: Five hundred and two participants were screened. The cohort's average age was 37 +/- 9 years and the average CD4 count was 128 cells/pi. Twenty-four (4.80%) were hepatitis B surface antigen positive. Nearly half (47%) of the participants showed some evidence of hepatitis B exposure. The risk of hepatitis B co-infection was not significantly different when analysed in terms of sex, race, CD4 count or age. Liver function tests were not a good predictor of hepatitis B infection. CONCLUSION: The rate of hepatitis B infection, as defined by hepatitis B surface antigen positiviw in HJV-infected individuals in urban South Africa was 5 times the rate in people who were not HIV-infected. A 5% rate of hepatitis B/HIV co-infection is a reason to increase the accessibility of tenofovir/emtricitabine (Truvada) for first-line treatment for this population.     

Attitudes of operating theatre staff to inoculation-risk cases

In a 12-month period, 177 patients at risk of infection with human immunodeficiency virus (HIV) or hepatitis B were operated on. Sixty-nine had HIV antibodies. The procedures used to identify these patients and minimize the risk of infection of hospital staff in the operating department are described. All staff working in the operating department were surveyed to determine their caseload, feelings of anxiety, and the incidence of high-risk exposure to infection. Anxiety was not related to workload, but was more common in those who had high-risk exposure. All members of staff who sustained a needlestick injury were tested for HIV antibodies at intervals after injury; 33 also volunteered to be tested in a screening session 3 months after the study period. None had HIV antibodies, suggesting that the risk of acquiring HIV infection in the operating department is low.     

Needlestick injuries in ophthalmology

Because serious nosocomial diseases can be transmitted by needlestick injuries, a retrospective review of needlestick injuries was conducted for a period of 2.5 years at a major university teaching hospital. The objective was to determine the needlestick injury rate among employees of the Department of Ophthalmology versus the other departments. Ophthalmologists had the highest incidence per person of needle injuries among physicians. Retina and strabismus surgeons were at higher risk than anterior segment surgeons.