Medical students' knowledge of sharps injuries

Healthcare workers (HCWs) including medical students are at risk of occupational exposure to blood-borne viruses following sharps incidents including needlestick injuries. The recent Department of Health guidelines recommend that all HCWs entering a career involving exposure-prone procedures should be tested for hepatitis C, making preventative strategies even more relevant. A survey of current medical students' knowledge regarding prevention of sharps injuries in Birmingham, UK was carried out to determine their awareness of these risks and to compare the findings with an earlier cohort of students. Two hundred and fifty-six medical students were enrolled into the study. Their knowledge of needlestick injury, prevention and management had significantly improved compared with the previous study. This demonstrates that intensive teaching and self-learning programmes can improve the knowledge of HCWs and reduce the number of needlestick injuries.     

医务人员职业损伤的研究分析

目的：研究分析医务人员因针头或其他尖锐器具造成损伤的发生率及其原因。方法：对610名医务人员进行问卷调查，被调查人员包括医生，护士，技师和实验工作人员。被调查者通过回顾的方式，如实填写过去一年内皮肤损伤的原因，次数及所采取的预防措施，回收有效问卷581份（95％），结果：在581名被调查者中，共发生1811例次皮肤务污染事件，其中54％是被污染血液后的内孔针头引起的，医务人员清楚地了解，有13％的病人患有乙肝，丙肝，梅毒，艾滋病等可以通过血液传播的疾病，每名医师（技师）每年有2．85次皮肤损伤几率，每名护士每年有3．4次皮肤损伤几率,所有的损伤事故发生后，均采用强力碘等消毒伤口，并有针对性地采取大量盐水冲洗，注射乙肝疫苗，高效免疫球蛋白等措施，结论：医务人员的这种损伤与他们的特殊职业有密切的关联，54％的损伤是在内孔针头充满血液的情况下造成的，具有很高的传播疾病的危险性，因此，应采取针对性的防护安全教育，预防事故发生。     

Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers.

OBJECTIVE: To evaluate the effect of introducing an engineered device for preventing injuries from sharp instruments (engineered sharps injury prevention device [ESIPD]) on the percutaneous injury rate in healthcare workers (HCWs). METHODS: We undertook a controlled, interventional, before-after study during a period of 3 years (from January 1998 through December 2000) at a major medical center. The study population was HCWs with potential exposure to bloodborne pathogens. HCWs who sustain a needlestick injury are required by hospital policy to report the exposure. A confidential log of these injuries is maintained that includes information on the date and time of the incident, the type and brand of sharp device involved, and whether an ESIPD was used. INTERVENTION: Introduction of an intravenous (IV) catheter stylet with a safety-engineered feature (a retractable protection shield), which was placed in clinics and hospital wards in lieu of other IV catheter devices that did not have safety features. No protective devices were present on suture needles during any of the periods. The incidence of percutaneous needlestick injury by IV catheter and suture needles was evaluated for 18 months before and 18 months after the intervention. RESULTS: After the intervention, the incidence of percutaneous injuries resulting from IV catheters decreased significantly (P<.01), whereas the incidence of injuries resulting from suture needle injuries increased significantly (P<.008). CONCLUSION: ESIPDs lead to a reduction in percutaneous injuries in HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens.     

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.     

Needlestick injuries in a tertiary care centre in Mumbai, India

Accidental exposure from blood/body fluid of patients is a risk to healthcare workers (HCWs). Percutaneous injury is the most common method of exposure to blood-borne pathogens. A policy was formulated at our institute, a tertiary care centre in central Mumbai, and we report a six-year (1998--2003) ongoing surveillance of needlestick injuries. Of the 380 HCWs who reported needlestick injuries, 45% were nurses, 33% were attendants, 11% were doctors and 11% were technicians. On source analysis, 23, 15 and 12 were positive for Hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV) and hepatitis C virus (HCV), respectively. Immediate action following potential exposure included washing the wound with soap and water, encouraging bleeding and reporting the incident to the emergency room. Analysis of the source of injuries revealed that known sources accounted for 254 injuries, and unknown sources from garbage bags and Operating Theatre instruments accounted for 126 injuries. Most needlestick injuries occurred during intravenous line insertion (N=112), followed by blood collection (N=69), surgical blade injury (N=36) and recapping needles (N=36). Immediate postexposure prophylaxis (PEP) for HCWs who sustained injuries with hepatitis-B-virus-positive patients included booster hepatitis B immunization for those positive for antiHBs. A full course of immunization with hepatitis B immunoglobulin was given to those who were antiHBs negative. All staff who sustained injury with HIV were given immediate antiretroviral therapy (AZT 600 mg/day) for six weeks. Subsequent six-month follow-up showed zero seroconversion.     

广东省39所医院医务人员锐器伤调查

目的了解广东省医务人员血源性职业暴露的发生情况,为制定预防措施提供科学的依据。方法采用问卷调查方法,对广东省39所医院医务人员2011年6月锐器伤的发生情况进行横断面调查。结果发放调查表32 617份,回收32 297份,回收率为99.02%;实际有效问卷32 007份,有效率为99.10%。发生锐器伤1 460例,1 909例次,锐器伤发生率为4.56%,例次率为5.96%,平均月发生密度为0.06次/（人月）。发生污染锐器伤1 495例次,污染锐器伤例次发生率为4.67%（1 495/32 007）;污染锐器伤占锐器伤总例次的78.31%（1 495/1 909）,其中61.67%(922/1 495)能追踪到暴露源,38.33%（573/1 495）不能确定其是否具有传染性。血源性污染器械中,81.71%（67/82）为乙型肝炎暴露源,14.63%（12/82）为梅毒暴露源,3.66%（3/82）为丙型肝炎暴露源,无艾滋病暴露源。锐器伤发生的地点主要为普通病房（47.72%）与手术室(20.27%);频率最高的操作是加药(15.92%),其次为医疗废物处置(12.78%)和拔除动（静）脉针（12.21%）;主要医疗器具为一次性注射器 (35.99%)、头皮钢针 (19.43%)和手术缝针(13.41%)。医务人员职业暴露相关知识培训率为93.25%。结论锐器伤是导致血源性传播疾病感染的主要职业因素, 医疗机构应建立健全职业病防治组织机构和规章制度,规范医务人员的血源性职业暴露预防与控制行为,降低血源性职业暴露伤害风险。     

某大型综合医院医护人员针刺及其他锐器损伤情况

目的 了解医院医护人员针刺及其他锐器损伤情况,为进一步开展干预研究提供线索,并为干预措施效果评价提供基线数据.方法 采用白填式调查问卷对某大型综合医院1201名临床一线医护人员在2009年1月1日至2009年12月31日期间所发生的针刺及其他锐器损伤状况进行回顾性调查.结果 医护人员在过去1年中发生针刺及其他锐器损伤共4302人次,针刺及其他锐器损伤年人均发生次数为3.58人次,损伤发生率为78.85％.发生针刺及其他锐器损伤的高风险人群为妇产科、外科、重症监护室和急诊科医护人员,其接触发生率和年人均发生次数分别为94.67％和4.51人次、93.09％和4.46人次、85.44％和3.08人次、76.62％和4.55人次,引起医护人员针刺及其他锐器损伤的主要医疗操作是掰安瓿、输液结束拔针、整理用毕的锐器和手术中(缝合或切开),其接触发生率分别为46.96％ 、30.97％ 、25.73％和14.49％.医护人员针刺及其他锐器损伤主要是由安瓿瓶、头皮针、皮下注射针、缝合针和手术刀片引起,其损伤发生率分别为47.04％、37.22％、31.31％ 、17.65％和7.08％.结论 医护人员仍然面临较大的针刺及其他锐器损伤风险,不同工种、不同科室医护人员在不同医疗操作及医疗操作的不同阶段、使用不同医疗锐器、使用锐器的用途不同发生职业接触的风险不同,应积极采取有针对性的综合性预防控制措施,全面贯彻落实GBZ/T 213-2008《血源性病原体职业接触防护导则》.     

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.     

Occupational blood and body fluid exposure in an Australian teaching hospital

To examine work-related blood and body fluid exposure (BBFE) among health-care workers (HCWs), to explore potential risk factors and to provide policy suggestions, a 6-year retrospective study of all reported BBFE among HCWs (1998-2003) was conducted in a 430-bed teaching hospital in Australia. Results showed that BBFE reporting was consistent throughout the study period, with medical staff experiencing the highest rate of sharps injury (10.4%). Hollow-bore needles were implicated in 51.7% of all percutaneous injuries. Most incidents occurred during sharps use (40.4%) or after use but before disposal (27.1%). Nursing staff experienced 68.5% of reported mucocutaneous exposure. Many such exposures occurred in the absence of any protective attire (61.1%). This study indicated that emphasis on work practice, attire, disposal systems and education strategies, as well as the use of safety sharps should be employed to reduce work-related injuries among HCWs in Australia.     

Needlestick injuries to the feet of Japanese healthcare workers: a culture-specific exposure risk.

A comparison of needlestick injury surveillance data from Japan and the United States revealed a higher proportion of foot injuries to Japanese healthcare workers (HCWs), compared with US HCWs. This study investigates the underlying factors that contribute to this difference and proposes evidence-based prevention strategies to address the risk, including the use of safety-engineered needle devices, point-of-use disposal containers for sharp instruments and devices, and closed-toe footwear.     

Needlestick and sharps injuries among health-care workers in Taiwan.

Sharps injuries are a major cause of transmission of hepatitis B and C viruses and human immunodeficiency virus in health-care workers. To determine the yearly incidence and causes of sharps injuries in health-care workers in Taiwan, we conducted a questionnaire survey in a total of 8645 health care workers, including physicians, nurses, laboratory technicians, and cleaners, from teaching hospitals of various sizes. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 per person in the past 12 months, respectively. Of most recent episodes of needlestick/sharps injury, 52.0% were caused by ordinary syringe needles, usually in the patient units. The most frequently reported circumstances of needlestick were recapping of needles, and those of sharps injuries were opening of ampoules/vials. Of needles which stuck the health-care workers, 54.8% had been used in patients, 8.2% of whom were known to have hepatitis B or C, syphilis, or human immunodeficiency virus infection. Sharps injuries in health-care workers in Taiwan occur more frequently than generally thought and risks of contracting blood-borne infectious diseases as a result are very high.     

某三级综合医院医务人员职业暴露调查

目的了解某三级综合医院医务人员职业暴露情况,分析职业暴露发生原因及预防对策。方法对某院2010年1月—2013年12月134例发生职业暴露的医务人员进行调查。结果暴露人群中,护士所占比率最高(59.70%),其次是医生(19.40%)、医技人员(9.70%)。职业暴露主要原因为锐器管理不规范(占46.27%,62例),其次为操作意外(占42.54%,57例)、防护措施不足所致(占11.19%,15例);暴露方式以锐器伤为主(占94.78%,127例),黏膜接触暴露占5.22%(7例),暴露源不明确者占42.54%,暴露源明确者占57.46%,其中乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、梅毒螺旋体(TP)、人类免疫缺陷病毒(HIV)分别占35.82%、12.69%、3.73%、2.24%;HBV、HCV合并感染占2.24%(3例);HIV、HBV、HCV、TP合并感染占0.74%(1例)。职业暴露后正确处理率为95.52%。结论护士是职业暴露高危群体,做好职业防护,并规范锐器管理,可以减少医务人员职业暴露发生。     

Hospital housekeepers: Victims of ineffective hospital waste management

Improper waste management exposes hospital housekeepers to biological risk. The objectives of this study were to identify the frequency and profile of exposure incidents, classify the role of sharps waste, and compare the first and last occurrences for hospital housekeepers with multiple exposure incidents. A retrospective epidemiological study using Brazilian records from 1989 to 2012 was conducted. Data analyzed included hospital treatment records and the state notification database. Probabilistic linkage was performed using LinkPlus and data analysis using SPSS. There were 996 (11.6%) injuries, with 57 (6.1%) workers reporting multiple occurrences, for a total of 938 workers. These were primarily needlestick injuries (98.5%), involving blood (85.6%), caused by hypodermic needles (75.1%), and improper sharps disposal (70.8%). The number of workers completing vaccination after their first injury and before their last injury was statistically significant. Additional efforts to prevent and manage exposure incidents are needed.     

Needlestick and sharps injuries among nurses in the healthcare sector in a city of western Turkey

The aims of this study were to determine the rate of bloodborne infections after needlestick and sharps injuries in nurses at work, to estimate the number of vaccinations administered, and to assess whether universal precautions were being followed. The study involved 289 nurses working in five hospitals and six primary healthcare centres. Between 1 April 2002 and 31 June 2002, a total of 139 practising nurses were included in the study following a needlestick or sharps injury. The results of completed questionnaires were collated, and Chi-squared test was used for analysis. The rate of hollow-bored needle-related injuries was 76.2% (106/139). Most nurses (69.1%) did not report any details of their injuries and 32.4% (45/139) of nurses had not been vaccinated against hepatitis B virus (HBV). Only 5.3% of the nurses who responded to the compliance question indicated that they always complied with universal precautions. Of 139 nurses, 1.4% and 7.9% showed evidence of HBV infection and hepatitis C virus (HCV) infection, respectively. All those who had hepatitis B were aged 30 years or under, whereas most of those who were anti-HCV positive (81.8%) were over 30 years old (P < 0.05). Nurses working in the Turkish healthcare sector are frequently exposed to bloodborne infections. Precautions and protection from needlestick and sharps injuries are important in preventing infection of nurses. Education about the transmission of bloodborne infections, vaccination and post-exposure prophylaxis must be implemented. Further investigations are warranted to elucidate the risk to nurses of contracting these potentially serious infections.     

Effect of educational programs, rigid sharps containers, and universal precautions on reported needlestick injuries in healthcare workers

OBJECTIVE: To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital. DESIGN: Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially. SETTING: A 700-bed general hospital that serves as the main teaching hospital of the University of Cincinnati. PARTICIPANTS: All employees of University Hospital who reported to personnel health for management of needlestick injuries. INTERVENTIONS: In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice. RESULTS: Surveillance identified 1,602 needlestick injuries (320/year) or 104/1,000/year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers. CONCLUSIONS: The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.     

某军校男大学生心理健康状况及相关因素分析

目的了解军校大学生的心理健康状况及其相关因素,为军校大学生的心理健康教育提供科学依据。方法分层整群抽取某军校998名大学生,采用自测健康评定量表(SRHMS)、UCLA孤独量表、Beck抑郁问卷(BDI)和焦虑自评量表(SAS)进行心理健康状况调查。结果该军校大学生中存在抑郁情绪的占71.9%,存在焦虑情绪的占65.8%;各年级在自测健康、孤独、抑郁和焦虑方面得分的差异有统计学意义(P<0.001);存在抑郁和焦虑情绪的学生,其自测健康状况显著低于无抑郁和无焦虑情绪的学生(P<0.01)。多元线性回归分析表明,孤独与出生地、社会支持、社会资源和社会接触以及健康总体自测等因素呈负相关(P<0.05),而与抑郁、焦虑和心理症状及负向情绪明显呈正相关(P<0.05)。结论军校大学生在适应军校环境的过程中容易产生一些心理问题。应加强军校大学生的心理健康教育,避免各种不良情绪的发生。     

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.     

The use of a quality-improvement approach to reduce needlestick injuries in a Saudi Arabian hospital

OBJECTIVE/DESIGN: An increase was noted in the incidence of needlestick injuries in our institution. A retrospective study was carried out analyzing the accident reports and medical records of needle-stick injuries from January 1995 to July 1996. Study variables included monthly incidence; location; injury site; mechanism; staff vocational status; source virological status; staff immunity; and serological conversion to hepatitis B and C viruses and the human immunodeficiency virus (HIV). SETTING: 350-bed general hospital in Western Saudi Arabia employing 2,083 employees of many different nationalities. RESULTS: 126 injuries were identified. Thirty percent of injuries occurred in the operating room and 28% on general wards. Twenty-five injuries occurred during a surgical procedure in the operating room, 22 injuries were caused by undisposed sharps, 11 occurred during suturing, 11 occurred during injection, and 10 occurred while disposing of refuse. At least 38% of the injuries were avoidable. Sixty percent of those injured were nurses, 30% were medical staff, and 6% were housekeeping staff. Nine of the identifiable sources were hepatitis B surface antigen-positive, nine were hepatitis C antibody-positive, and none were anti-HIV positive. Eighty-nine percent of injuries involved the hands. None of our injured employees had seroconverted at 3, 6, or 9 months follow-up to HIV, hepatitis C, or hepatitis B. Eighty-four percent of injured staff were hepatitis B immune. CONCLUSION: Steps taken to reduce the future incidence of injuries included the provision of readily accessible sharps boxes, a hospitalwide education program focusing on safe handling and disposal of sharps, and the development of clear policies and procedures for dealing with sharps injuries. A further study will be conducted 12 months after the introduction of these measures.     

Sharps-related injuries in California healthcare facilities: pilot study results from the Sharps Injury Surveillance Registry.

BACKGROUND AND OBJECTIVES: In 1998, the California Department of Health Services invited all healthcare facilities in California (n = 2,532) to participate in a statewide, voluntary sharps injury surveillance project. The objectives were to determine whether a low-cost sharps registry could be established and maintained, and to evaluate the circumstances surrounding sharps injuries in California. RESULTS: Approximately 450 facilities responded and reported a total of 1,940 sharps-related injuries from January 1998 through January 2000. Injuries occurred in a variety of healthcare workers (80 different job titles). Nurses sustained the highest number of injuries (n = 658). In hospital settings (n = 1,780), approximately 20% of the injuries were associated with drawing venous blood, injections, or assisting with a procedure such as suturing. As expected, injuries were caused by tasks conventionally related to specific job classifications. The overall results approximate those reported by the Centers for Disease Control and Prevention's National Surveillance System for Health Care Workers and the University of Virginia's Exposure Prevention Information Network. CONCLUSION: These data further support findings from previous studies documenting the complex and persistent nature of sharps-related injuries in healthcare workers. In the future, mandated reporting using standardized forms and consistent application of decision rules would facilitate a more thorough analysis of injury events.