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.     

Potential work-related exposures to bloodborne pathogens by industry and occupation in the United States Part II: A telephone interview study

BACKGROUND: The companion surveillance portion of this study [Chen and Jenkins, 2007] reported the frequency and rate of potential work-related exposures to bloodborne pathogens (BBP) treated in emergency departments (EDs) by industry and occupation, but it lacks details on the circumstances of the exposure and other relevant issues such as BBP safety training, use of personal protective equipment (PPE) or safety needles, or reasons for seeking treatment in a hospital ED. METHODS: Telephone interviews were conducted with workers who had been treated in EDs for potential work-related exposures to BBP in 2000-2002. Respondents were drawn from the National Electronic Injury Surveillance System. RESULTS: Of the 593 interviews, 382 were from hospitals, 51 were from emergency medical service/firefighting (EMS/FF), 86 were from non-hospital healthcare settings (e.g., nursing homes, doctors' offices, home healthcare providers, etc.), 22 were from law enforcement (including police and correctional facilities), and 52 were from other non-healthcare settings (i.e., schools, hotels, and restaurants). Needlestick/sharps injuries were the primary source of exposure in hospitals and non-hospital healthcare settings. Skin and mucous membrane was the primary route of exposure in EMS/FF. Human bites accounted for a significant portion of the exposures in law enforcement and other non-healthcare settings. In general, workers from non-hospital settings were less likely to use PPE, to have BBP safety training, to be aware of the BBP standards and exposure treatment procedures, and to report or seek treatment for a work-related exposure compared to hospital workers. CONCLUSIONS: This study suggests that each industry group has unique needs that should be addressed.     

基层医院血源性职业暴露防护工作存在的问题与对策

目的 探索基层医院医务人员血源性职业暴露防护工作存在的问题,制定相关对策.方法 通过临床实践,总结出基层医院医务人员血源性职业暴露防护工作中存在的问题.结果 组织制度不健全、认知不足、医疗操作不规范、医疗环境不佳及报告处理不及时等是影响医务人员职业防护工作的原因.结论 应提高医院领导意识,采取健全组织制度、加强培训、规范操作、改善环境、完善流程及规范预防用药等综合措施,才能有效预防和控制血源性病原体疾病感染的发生.     

Injuries among domestic waste collectors

Detailed information on occupational injuries and the precise number of injuries among waste collectors is missing. In this study, risk circumstances associated with injuries among waste collectors were analyzed and described. The study was carried out in a single company with 667 employees in 1993. For each injury, information was collected on date, time, type, and severity of the injury, injury circumstances, department of employment, external or internal registration, sex, year of birth and employment, type of employment, and a registration of where the injury happened. A total of 17% of the employees experienced injury. The number of injuries decreased with increasing seniority and age. Most injuries occurred outside the company area. More injuries occurred on Mondays and Thursdays, and there were peaks in the injury rate in May and September. Most often injured was the back, followed by the knees, hands, and feet. The job as a waste collector was associated with a high risk of experiencing an occupational injury and the number of injuries decreased with increasing seniority and nonsignificantly with increasing age. Moreover, a seasonal and weekly variation was observed. Am. J. Ind. Med. 33:182–189, 1998. © 1998 Wiley-Liss, Inc.     

Sharps injuries among hospital support personnel

Sharps injuries (SIs) among support personnel in hospitals have received little attention in the scientific literature. A cross-sectional study was undertaken to measure the incidence of SIs in Taiwanese support personnel. All support personnel, including laundry workers, cleaners, porters and central supply workers, from 16 hospitals were surveyed for SIs, sustained between June 1996 and July 1997. Either a questionnaire or face-to-face interviews, for those staff with a literacy problem, were used. Of the 862 persons eligible for study, 79.4% (684) were evaluable. Few staff (30.4%) had attended a prevention programme and 61% had suffered an SI in the past year. Few (25.4%) reported their injury. Hollow-bore needles, of which 72.2% had been used, were associated with 42.2% of injuries. Cleaners sustained the majority (65.7%) of injuries, and inappropriate disposal was associated with 54.7% of all injuries. For those staff employed for more than four years, the risk of sustaining an injury increased significantly with length of employment (P<0.001). Most of the injuries were sustained by cleaners handling sharps inappropriately disposed of by clinical staff. A safer environment for support staff could be achieved with the co-operation of clinical staff to correctly dispose of sharps to ensure single handling of sharps. A formal orientation of support staff in the reporting of SIs would enable clinical assessment and management of injuries, as well as an evaluation of needle and sharps safety in the healthcare setting.     

Nigerian medical students are at risk for hepatitis B infection

Medical students are exposed to blood and body fluids. This study was conducted to estimate the prevalence of hepatitis B virus (HBV) infection amongst medical students of the Lagos State University College of Medicine, Ikeja, Nigeria. Data were collected through a self-administered questionnaire and through blood analysis for hepatitis B surface antigen (HBsAg), hepatitis B 'e' antigen (HBeAg) as well as antibodies to the core (anti-HBc), surface (anti-HBs) and 'e' (anti-HBe) antigens. Three hundred and thirteen of 325 students (96%) participated. The mean age was 24.3+/-3.98 years; 231 (74%) were pre-clinical students and 82 (26%) were in the clinical years of study. Only 8 (2.6%) had received three doses of vaccination against HBV. Eighty-one (26%) tested positive for anti-HBc, 10 (3.2%) were positive for HBsAg and 56 (17.9%) had anti-HBs antibodies. A significant relationship was found between students who had a positive history of hepatitis B in the family and anti-HBc (P=0.03). Age was also significantly associated with HBsAg (P=0.012). Two hundred and twenty-five (72%) students were susceptible to the infection and required vaccination. Most students at this medical school are susceptible to HBV infection and should be vaccinated.     

Work-related eye injuries treated in hospital emergency departments in the US

BACKGROUND: Eye injuries account for 3.3% of all occupational injuries resulting in lost workdays in private industry in the United States. Work-related eye injuries among individuals 15 years of age and older treated in hospital emergency departments (EDs) in the United States in 1999 were investigated in this study. METHODS: Work-related eye injuries treated in hospital EDs in the US were identified from the Work-Related Injury Statistics Query System (Work-RISQS). National estimates of the numbers and rates per 10,000 full-time worker equivalents (FTE) of work-related eye injuries were determined by gender and age. The characteristics of these injuries were described, including the injury event, the main source of injury, injury diagnosis, and the disposition of the injured patient. RESULTS: In 1999, there were approximately 280,000 (95% confidence interval (CIs) +/- 66,400) work-related eye injuries treated in hospital EDs, with individuals 20-34 years of age at highest risk for work-related eye injury. Foreign-bodies in the eye and chemical burns were among the most common types of work-related eye injuries. CONCLUSIONS: The findings of this study underscore the need for use of appropriate eye protection and implementation, and enforcement of eye protection policies in the workplace to prevent work-related eye injuries.     

高职护理专业学生血源性职业危害及防护知识的调查

目的了解高职护理专业的学生对血源性的职业危害及防护知识状况。方法采用自我设计的调查问卷,采用整群抽样的方法对河北大学卫生职业技术学院245名即将实习的学生进行调查。血源性知识危害满分为4分,防护知识掌握满分为9分。结果高职护理专业的学生对血源性职业危害的认知水平较低,为（2．0±0．75）分,自我防护行为较差,为（6．0±O．75）分。92．3％的学生认为实习前进行职业防护教育非常必要。结论医学院校应在实习前对在校学生进行系统的职业防护教育,并制定严格的考核制度,以减少学生在实习期间乃至以后的职业生涯中感染血源性疾病的机会。     

临床医师血源性病原体职业暴露风险及干预

目的 了解临床医师血源性感染职业暴露风险的现状,进一步明确职业防护的重点,完善职业防护措施.方法 采用自行设计问卷,调查160名临床医师在2009年7月-2011年6月血源性病原体职业暴露情况.结果 51名医师发生63人次血源性病原体职业暴露,其中,血液/体液喷溅12人,锐器伤51人;血液为最常见的暴露物;普外科与胸外科医师发生锐器伤的比率最高,其次为肿瘤内科医师;锐器伤的种类主要是缝合针占21.6％、注射器针头占19.6％、手术刀剪占17.7％;主要在医护间配合传递器械占31.4％、注射或穿刺占21.6％、处理使用后锐器占19.6％等环节容易发生锐器伤;暴露源主要为乙型肝炎表面抗原(HBsAg)阳性患者,占46.0％,其次为梅毒抗体阳性患者,占14.3％,暴露后均进行了相关干预,经追踪随访,未发现有血源性传播性疾病感染者.结论 医师是血源性病原体职业暴露的高危人群,管理者应帮助消除风险,并进行操作规程控制,最大限度地减少职业暴露及暴露后感染的发生.     

Solvent exposure and the risk of slips, trips, and falls among painters

This study evaluated risk factors for injurious and noninjurious slips, trips, and falls among painters and investigated the hypothesis that exposure to solvents influenced the risk of such accidents. The data were collected longitudinally over an 11 month period. Weekly self-administered questionnaires detailed paint solvent exposure; work-related slips, trips, and falls (STFs); and potentially hazardous job tasks and environmental conditions. An initial questionnaire ascertained personal data, such as age, solvent exposure history, and alcohol consumption. During the study, 2,088 person-weeks of data were collected. Some participants provided many weeks of data, while others responded sporadically. Exposure to potentially hazardous environmental conditions was significantly related to the occurrence of STFs during a week. Several measures of solvent exposure were evaluated for their effect on STFs. Low solvent exposure during a week significantly increased the occurrence of slips, trips, and falls compared to no exposure. Moderate and high weekly exposure were not associated with increased risk, however. Week-to-week variability in the amount of solvent exposure was a strong positive predictor of STFs. Further analysis showed that both increases and decreases in solvent exposure between the preceding 2 weeks and the week of the STF were positively related to the risk of such events. The strongest effect was observed for exposure increases over the preceding 2 weeks. Overall, the results suggest that solvent exposure variability may increase accident risk, and possible explanations are explored.     

临床医师血源性职业暴露后心理调查及对策

目的 了解临床医师血源性职业暴露的认知、心理状态,为实施有效的预防模式及心理干预提供科学依据.方法 采取自行设计的开放式问卷调查表,调查2009年7月-2011年6月医院临床医师发生血源性职业暴露情况,以及暴露后的认知、心理状态.结果 有51名医师发生63次血源性职业暴露,其中血液/体液喷溅12次,锐器伤51次;46.0％的暴露源为乙型肝炎表面抗原(HBsAg)阳性;63.8％的医师认为职业暴露后最可怕的结果是感染艾滋病;60.3％的医师认为职业暴露后感染的概率很大;29.3％的医师认为职业暴露尤其是针刺伤不可避免;49.0％的医师职业暴露后表现为惧怕心理.结论 临床医师血源性职业暴露后表现为一定的心理反应,应进一步加强职业防护及心理干预,完善医院支持系统,以减轻暴露者暴露后的负性心理.     

Occupational injuries among adolescents in Washington State, 1988–1991

Background To characterize work-related injuries and illnesses in minors. Methods We analyzed Washington State workers' compensation claims from 1988 through 1991. Results There were 17,800 claims among adolescents from age 11 through 17 years accepted in the 4-year period, including three occupational fatalities, 22 amputations, and 464 fractures; 89% of all injuries occurred among the 16- and 17-year-olds. Claims were most frequent in restaurants, food stores, service industry, other retail and wholesale trade, and agriculture. Washington State census data were used for the denominator in calculating injury rates for adolescents and adults. The crude injury rate for 16- and 17-year-olds employed at the time of the census was similar to that seen among adults (9.0 vs.10.4 per 100 workers), despite that minors work fewer hours per year. The rate among boys was almost twice that seen among girls (11.7 vs. 6.4 per 100 workers). Highest rates, per 100 workers, were in public administration (27.0), construction (21.1), agriculture (11.4), and restaurants (11.0). Using census data for those working anytime over the course of the year and adjusted for the number of hours worked, the injury rate for 16- and 17-year-olds was 19.4/100 full-time equivalents compared with 10.6 of 100 full-time equivalents for adults. Most injuries were lacerations, sprains and strains, contusions, and burns. Conclusions Public health policy and injury prevention strategies for working adolescents should be developed and implemented. Am. J. Ind. Med. 34:121–132, 1998. © 1998 Wiley-Liss, Inc.     

Needlestick Injuries in Agriculture Workers and Prevention Programs

There are a variety of biologics, vaccines, antibiotics, and hormones used in animal agriculture. Depending upon the procedure or pharmaceutical used, accidental injections or product exposures can result in mild to severe injuries. Needlestick injury (NSI) prevention, research, and education for veterinarians and agriculture workers is limited. The objective of this study was to collect and review published case reports and case series/surveys on human needlestick exposure to veterinary biologics and to summarize needlestick prevention strategies for agricultural workers/veterinarians. A search was conducted of PubMed and Centre for Agriculture Bioscience International (CABI) databases. References were reviewed to identify additional articles. NSI among agricultural workers were primarily included in this review. Thirty articles were applicable to exposures in agricultural settings. Relevant literature consisted of case reports, survey/case series articles, prevention documents, and background articles. Fifty-nine case patients were identified. Most of these cases were associated with exposures to specific vaccines or veterinary products. Injury location was identified from 36 individuals: 24 (67%) NSI to the hands, 10 (28%) injuries to the legs, and 2 to other body locations. Of the 59 cases, 20 (34%) involved oil-adjuvant vaccines. Evidence of hospitalization was recorded for 30 case patients. The length of hospitalization was available from 11 case patients. Median length of hospitalization was 3 days (range: 1–4). Surgical intervention was reported in 25 case patients. Outcome information was available on 30 case patients. Fifteen made a complete recovery within 2 weeks of treatment, 14 had residual sequelae attributed to the injury, and there was 1 reported death. Of the 13 survey/case series articles: 2 focused on oil-adjuvant products, 1 on Brucellosis RB-51 vaccine, 3 on tilmicosin, 1 on Salmonella enteritidis vaccine, 1 on high-pressure injection, and 5 were nonspecific. NSI in agriculture workers and veterinarians can result in significant bodily injury and loss of work. There is a need for varied and comprehensive educational programs for agricultural workers and veterinarians to prevent NSI on livestock operations.     

中国护士静脉采血针刺伤现状调查

目的了解护理人员静脉采血过程中针刺伤现状,探讨有效防护策略。方法采用分层整群抽样的方法对中国临床一线护士进行问卷调查。问卷内容包括护士的一般资料及护理人员静脉采血培训与管理状况、采血前戴手套依从性、近一年因静脉采血发生针刺伤的情况等。结果共发放问卷2 861份,回收有效问卷2 575份。护士定期参加静脉采血培训的占93.17%;定期进行静脉采血考核的占87.15%;仅72.74%护士在采血前了解患者是否患有血源性传染病;采血时坚持佩戴手套的仅61.01%;近一年,因采血发生针刺伤的占20.78%。使用三种不同针具静脉采血时针刺伤的发生率比较,差异无统计学意义(Pearsonχ2=1.649,P=0.438)。48.21%的静脉采血针刺伤发生在整理医疗废物时。结论中国护士静脉采血培训与管理较好,但针刺伤发生率仍较高。预防针刺伤应制定静脉采血安全操作规程,规范操作流程,明确培训内容,以改变护理人员不安全的行为。     

Underreporting of work accidents associated with blood-borne risk factors

Background: Work accidents (WA) due to percutaneous or mucocutaneous injury are frequent among health professionals. Accident notification ensures compliance with legal requirements, enabling health institutions to develop, implement and evaluate prevention strategies. This study aimed to estimate the proportion of underreporting of work accidents caused by percutaneous and mucocutaneous lesions in a hospital setting and its determinants. Methods: A self-administered questionnaire was made available to all hospital employees. The multivariate logistic regression models computed age, gender, professional category, and type of service adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results: Underreporting of WA associated with biological risk factors was high, particularly in accidents by mucocutaneous injury (80.9%). Physicians were the professional category that least reported this type of work accident (OR=4.64; 95% CI2.20-9.78). The main determinants of underreporting were underestimating the risk of transmission and the excessive bureaucracy. Conclusion: The underreporting of work accidents associated with biological risk factors was considerable, and it contributes to a high degree of uncertainty on accidents'' characterization.     

Occupational risk of Mycobacterium tuberculosis infection in hospital workers

We conducted a 4-year (1/89–12/92) retrospective cohort study among employees at a large metropolitan hospital where a nosocomial outbreak of multidrug-resistant tuberculosis (TB) had occurred. We compared the risk of tuberculin skin test (TST) conversion among employees who worked on wards where patients with culture-confirmed TB were cared for (“exposed”) with the risk among employees who worked on wards with no such patients (“unexposed”). Exposed employees had a higher 4-year risk of TST conversion (14.5%) than unexposed employees (1.4%) (adjusted relative risk 13.4; 95 percent confidence interval 5.1–35.2). Exposed employees had significantly higher risks of conversion than unexposed employees during 1989–91, but not for 1992. Among the exposed, ward clerks had a risk of conversion (15.6%) only slightly lower than nurses (18.2%). We conclude that employees who worked in areas where patients with active M. tuberculosis infection were cared for, including workers who did not provide direct patient care, had a higher risk of TST conversion than employees who did not work in these areas. Reasons for the decline in risk over time include outbreak termination, fewer admissions of patients with TB, implementation of effective infection control measures, and possible resistance to infection in some members of the study population. Am. J. Ind. Med. 32:528–534, 1997. © 1997 Wiley-Liss, Inc.