Occupational risk factors for blood and body fluid exposure among home care aides

This cross-sectional study of home care aides examines self-reported occupational exposure to blood and body fluids to determine if factors that place these workers at risk can be identified. Home care aides working for two agencies in the Chicagoland area were surveyed. A total of 62 (6.3%) of the home care aides reported instances of blood and body fluid exposure either via sharps or mucous membrane contact. Although few aides reported performing health care-related tasks such as colostomy care, caring for a urinary catheter, or bowel stimulation (which were outside their scope of duties), those who did were significantly more likely to experience blood and body fluid exposure (p≤.01). Level of assistance needed by clients in tasks such as feeding, laundry, and transportation was also found to be significantly associated with blood and body fluid exposure (p≤.01). These data highlight the importance of, and need for, home care aid training in the use of universal precautions.     

Accidental blood and body fluid exposure among doctors

Aim To study the epidemiology and time trends of blood and bodyfluids (BBF) exposures among hospital doctors. Methods A 3-year study was carried out using data from the ExposurePrevention Information Network of four teaching hospitals inthe UK. Results One hundred and seventy-five cases of BBF exposuresin doctors were reported over the 3-year study period. Eighty-one(46%) occurred in senior doctors and 94 (54%) in junior doctors.Junior doctors had a higher rate of BBF exposures compared tosenior doctors: 13 versus 4 incidents per 100 person-years,respectively (relative risk 3, 95% confidence interval 2–4).The most frequent setting for BBF exposures among senior doctorswas the operating theatre/recovery (59%). Among junior doctors,it was the patient room (48%). The commonest original reasonfor use of sharps by junior doctors was the taking of bloodsamples (42%). Among senior doctors, it was suturing (41%). Conclusion While ongoing training efforts need to be directedtowards both junior and senior doctors, our data suggest thatjunior doctors are at higher risk of BBF exposures and may needparticular attention in prevention strategies. An improvementin the safety culture in teaching hospitals can be expectedto reduce the number of BBF exposures.     

临床医生发生血源性病原体职业暴露的调查分析

目的了解临床医生发生血源性病原体暴露的情况，为制定预防对策提供依据。方法建立血源性病原体职业暴露监测报告系统，调查医生在工作中发生暴露的相关情况。结果共收到106名医生发生血源性病原体职业暴露的报告。其中，血液或体液溅污20人，锐器伤86人。最常见的暴露物为血液。外科医生发生锐器伤的比率最高，达67．44％，暴露多发生在医生使用缝合针、穿刺针或刀片进行手术时。暴露源以乙型肝炎表面抗原（HBsAg）阳性患者最多见（51．89％），其次是梅毒抗体阳性患者（16．98％），抗HIV阳性患者2例。对发生职业暴露的医生及时进行相关干预，经追踪随访，无人因暴露而发生感染。结论外科医生在进行手术相关操作时易发生血源性病原体暴露，应加强职业安全防护意识，规范操作规程，暴露后及时进行干预以降低暴露后感染的危险。     

Methicillin-resistant Staphylococcus aureus in an Australian teaching hospital

A survey was undertaken of all isolations of methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MRSA) at a large Australian teaching hospital over a 12 month period. All methicillin-resistant isolations obtained from the Casualty and Outpatient clinics were from staff members or patients with recent hospital contact. Twenty per cent of all methicillin-resistant isolations from in-patients were from specimens taken within 2 days of the patient's admission. Each of these patients had had hospital contact within the previous 4 months and it is assumed that the majority of them reintroduced the organism into the hospital. Such patients may provide an important means by which infection control procedures are bypassed. Patients who were relatively more likely to become infected or colonized with methicillin-resistant than with methicillin-sensitive strains included the elderly and those with postoperative wound infections (especially after orthopaedic or vascular surgery), spinal injuries, peripheral vascular disease, chronic skin ulcers or chronic diseases of the respiratory or urinary tracts. Eleven per cent of MRSA wound isolates and 15 per cent of sputum isolates were associated with serious infections requiring specific treatment, emphasizing the ability of these strains to produce serious illness. A small proportion of staff and asymptomatic patients were found to harbour MRSA and the importance of these individuals in facilitating cross-infection requires further investigation.     

Occupational lead exposure and blood pressure

Recent community studies have suggested that low level lead exposure is significantly associated with blood pressure in the general population. This finding is inconsistent with the results of recent occupational studies of lead exposed workers, although the occupational studies contained serious methodological weaknesses. The present study examined the relation between occupational lead exposure and diastolic and systolic blood pressure in randomly selected samples of 270 exposed and 158 non-exposed workers. Four exposure indicators were examined: employment at a lead battery plant nu a control plant, current blood lead value, current zinc protoporphyrin value, and time weighted average blood lead value. After controlling for other known risk factors such as age, education, income, cigarette usage, alcohol consumption, and exercise, the associations between exposure and blood pressure were small and non-significant. In the absence of a biologically feasible hypothesis regarding the mechanism by which low level lead exposure would influence blood pressure the present findings challenge the validity of the general population association.     

Occupational exposure to influenza--introduction of an index case to a hospital

The epidemiology of influenza in the hospital is frequently confounded by failure to separate community-acquired from nosocomial transmission. An 83-year-old woman was hospitalized one day after returning from Asia with complications resulting from acute influenza A (H3N2) infection; she was the first culture-confirmed case in the region during the 1987-1988 influenza season, and her illness antedated other influenza cases in the area by at least four weeks. The patient shed virus at least four days after admission and transmitted influenza to her primary physician; both had received trivalent influenza vaccine four weeks earlier. Surveillance data from the 28 health care providers (HCPs) in contact with the index case (mean age: 34.5 years; median time of contact: four hours, none receiving vaccine) revealed no evidence of transmission as detected by paired type-specific complement-fixation antibodies and throat culture (20 subjects) or acute serologies and culture (7 subjects). No febrile respiratory illnesses were detected among other patients on the same ward, although three were reported among HCPs. Thus, neither secondary spread of influenza from infected patient to hospital HCPs nor nosocomial transmission apparently took place, although transmission did occur to the primary physician.     

Occupational exposure to metalworking fluid mist and sump fluid contaminants

This paper summarizes the analytical and occupational hygiene findings from a recent survey of occupational exposure to metalworking fluids (MWFs) in the engineering industry. The aim of the survey was to link MWF mist exposure measurements with particular engineering processes and controls, and utilize the data obtained to develop exposure standards. At the same time the opportunity was taken to assess fluid management and control, including bacterial and fines contamination in the machine sumps. In general, occupational exposure to mineral oil MWF mist was controlled to <3 mg/m(3) (8 h time-weighted average) and to <1 mg/m(3) for water-mix MWF mist (in terms of the concentrate). These exposure values do not necessarily represent best practice, but are believed to be achievable and representative of industry as a whole. Gravimetric analysis of the total inhalable particulate was found to be a good predictor of mineral oil MWF mist but not for water-mix MWF mist. Grinding and drilling operations produced higher exposures than turning and milling for water-mix fluids. There were insufficient data to compare machining operations for mineral oil MWFs. On the whole, fluid management was found to be poor, with most sites failing to meet industry good practice or Health & Safety Executive (HSE) standards. Some of the operating procedures utilized were deficient or unsatisfactory. Poor standards of fluid management were found at all sizes of company. High levels of bacteria, endotoxin and fines were found in sumps, and control of other factors, such as water-mix fluid concentration, was often poor. Mineral oils had higher levels of fines than water-mix fluids (medians of 395 and 18 mg/l, respectively), and grinding produced high levels of fines in both types of MWF. Many water-mix sumps contained bacterial levels of >1 x 10(6) CFU/ml, and endotoxin levels of >100 000 EU/ml were not uncommon. The median values were 109 000 CFU/ml and 8039 EU/ml, respectively. Mists could potentially contain extensive contamination from bacteria and endotoxin. Analysis of the data suggests that sumps operating under typical conditions for machining (a temperature of 20 degrees C, a pH of 9 and a fluid strength below 10%), also appear to provide optimum conditions for the proliferation of bacteria. Low levels of benzo[a]pyrene (median 0.03 micro g/g) were found in the mineral oils, and low levels of N-nitrosodiethanolamine (median 0.4 micro g/ml) were found in the water-mix MWFs. The results of this work will contribute to guidance from the HSE, setting out accepted industry good practice, including guide values for MWF mist and sump fluid contaminants, with significant emphasis on sump fluid management (maintenance and monitoring), as well as control issues.     

医院清洁工职业暴露的调查及防护措施

目的 了解医院清洁工锐器损伤情况及对职业防护相关知识掌握程度,采取有效措施,避免防护不当危害健康.方法 通过问卷调查,到科室询问、实地检查了解清洁工职业防护掌握情况;加强清洁工自身防护教育,加强医务人员对医疗废弃物知识培训,正确采取防锐器伤措施;规范洗手,配备劳动防护用品,保护清洁工合法权益,建立健康档案.结果 通过上述各项预防措施,最大限度控制了清洁工的职业伤害,保障了清洁工的安全和身体健康.结论 加强清洁工职业防护意识,强化医疗废弃物源头管理,正确执行手卫生,加强检查监督,可以有效避免清洁工的职业伤害.     

Occupational lead exposure and blood pressure.

Recent community studies have suggested that low level lead exposure is significantly associated with blood pressure in the general population. This finding is inconsistent with the results of recent occupational studies of lead exposed workers, although the occupational studies contained serious methodological weaknesses. The present study examined the relation between occupational lead exposure and diastolic and systolic blood pressure in randomly selected samples of 270 exposed and 158 non-exposed workers. Four exposure indicators were examined: employment at a lead battery plant nu a control plant, current blood lead value, current zinc protoporphyrin value, and time weighted average blood lead value. After controlling for other known risk factors such as age, education, income, cigarette usage, alcohol consumption, and exercise, the associations between exposure and blood pressure were small and non-significant. In the absence of a biologically feasible hypothesis regarding the mechanism by which low level lead exposure would influence blood pressure the present findings challenge the validity of the general population association.     

某院医务人员职业暴露监测

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

医院检验人员的职业暴露及防护

目的分析医院检验专业人员职业暴露的致伤原因及风险因素,提出安全防护对策和职业暴露发生后的处理措施,以减少检验人员的职业暴露和暴露后感染的发生。方法提高检验专业各种风险因素的思想认识,从加强培训,提高职业防护意识;加强管理,规范操作程序,使用必备的防护用具,实施标准预防;强化生物安全理念,落实必要防护措施做起。结果根据检验人员的工作性质和特点制定切实可行的职业暴露的防护干预措施。结论正确的安全防护对策和职业暴露发生后的处理措施,可最大限度地预防和降低医院检验人员的职业暴露和暴露后感染的发生。     

血站采血护士职业暴露与防护

目的分析血站采血护士职业暴露的危险因素,并探讨有效的防护措施。方法对血站采血护士职业暴露的原因、方式、危险程度及防护方法进行分析。结果采血时环境拥挤,互相碰撞;长时间工作或一人同时为2名献血者采血;操作中双手回套针头,护针帽脱落,传递过程中被带血针头刺伤及采集小样针头放置不当,易导致采血护士针刺伤。2006年未设置防刺破试管座前,采血护士针刺伤发生率为80%;采用不锈钢试管座后未再发生针刺伤。结论采血护士易受职业暴露危险因素的影响,针刺伤是其职业暴露的主要方式。应加强采血护士的职业防护。     

Hospital bloodborne pathogens programs: program characteristics and blood and body fluid exposure rates.

OBJECTIVE: To describe hospital practices and policies relating to bloodborne pathogens and current rates of occupational exposure among healthcare workers. PARTICIPANTS AND METHODS: Hospitals in Iowa and Virginia were surveyed in 1996 and 1997 about Standard Precautions training programs and compliance. The primary outcome measures were rates of percutaneous injuries and mucocutaneous exposures. RESULTS: 153 (64%) of 240 hospitals responded. New employee training was offered no more than twice per year by nearly one third. Most (79%-80%) facilities monitored compliance of nurses, housekeepers, and laboratory technicians; physicians rarely were trained or monitored. Implementation of needlestick prevention devices was the most common action taken to decrease sharps injuries. Over one half of hospitals used needleless intravenous systems; larger hospitals used these significantly more often. Protected devices for phlebotomy or intravenous placement were purchased by only one third. Most (89% of large and 80% of small) hospitals met the recommended infection control personnel-to-bed ratio of 1:250. Eleven percent did not have access to postexposure care during all working hours. Percutaneous injury surveillance relied on incident reports (99% of facilities) and employee health records (61%). The annual reported percutaneous injury incidence rate from 106 hospitals was 5.3 injuries per 100 personnel. Compared to single tertiary-referral institution rates determined more than 5 years previously, current injury rates remain elevated in community hospitals. CONCLUSIONS: Healthcare institutions need to commit sufficient resources to Standard Precautions training and monitoring and to infection control programs to meet the needs of all workers, including physicians. Healthcare workers clearly remain at risk for injury. Further effective interventions are needed for employee training, improving adherence, and providing needlestick prevention devices.     

某妇幼保健机构工作人员职业暴露监测

目的了解某妇幼保健院工作人员职业暴露情况,探讨职业暴露相关危险因素及预防对策。方法对该院2012年1-12月间55名工作人员发生职业暴露的监测数据进行统计分析。结果共发生工作职业暴露55例、57例次。其中暴露源不明确31例次（54.39％）,暴露源情况明确26例次（45.61％）。 57例次职业暴露人员中,保洁员和护士占82.46%（47例次）,其职业暴露发生率分别为9.76%和5.32%。职业暴露发生率居前3位的科室是门急诊、产科和保洁部,分别为29.51%、9.80%和9.76%;暴露人员的工龄≤3年者占87.72%（50例次）。暴露种类以锐器伤为主,占94.74%（54例次）,暴露物以头皮钢针为主（42.11％）,其次为注射器针头（19.30％）。 职业暴露主要环节为拔针（29.83％）,其次为医疗废物处置（28.07％）。结论保洁员、护士和低年资工作人员是职业暴露高危群体,应采取相关的防范措施,加强对其职业防护教育培训;加强对重点部门、环节的管理,降低医院工作人员职业暴露危害。     

Occupational exposure to antineoplastic agents at several departments in a hospital

Summary The occupational exposure to cyclophosphamide (CP), ifosfamide (IF), 5-fluorouracil (5FU), and methotrexate (MTX) of 25 pharmacy technicians and nurses from four departments of a hospital was investigated. Previously developed methods for the detection of exposure to some antineoplastic agents were validated. Exposure to CP, IF, 5FU, and MTX was measured by the analysis of these compounds in the environment (air samples and wipe samples from possible contaminated surfaces and objects). Contamination of the work environment was found not only on the working trays of the hoods and on the floors of the different rooms but also on other objects like tables, the sink unit, cleaned urinals and chamber pots, and drug vials and ampules used for preparation and packing of drugs. The gloves used during preparation of the drugs and during cleaning of the hoods were always contaminated. The uptake of CP or IF was determined by the analysis of both compounds in urine. CP or IF was detected in the urine of eight pharmacy technicians and nurses. The amounts ranged from < 0.01 to 0.5 g (median: 0.1 g). CP and IF were found not only in the urine of pharmacy technicians and nurses actively handling these compounds (n = 2) but also in the urine of pharmacy technicians and nurses not directly involved in the preparation and administration of these two drugs (n = 6). CP and IF were excreted during different periods ranging from 1.40 to 24.15 h after the beginning of the working day, suggesting different times of exposure, different exposure routes, and/or interindividual differences in biotransformation and excretion rate for these compounds. The urinary CP and IF determination method seems to be sensitive and suitable for monitoring the exposure to and measuring the uptake of these toxic compounds by pharmacy technicians and nurses during occupational activities.     

Trends in bloodborne pathogen exposure and follow-up at an urban teaching hospital: 1987 to 1997

Health care workers (HCWs) risk occupational exposure to bloodborne pathogens. Effective postexposure treatment and testing depend on compliance with follow-up, but compliance rates are poorly understood. We examined trends in exposure and follow-up at a large teaching hospital after interventions to improve compliance. We reviewed exposures from October 1987 to September 1988 (group 1) and July 1996 to June 1997 (group 2). Data were analyzed for HCW demographics, source patient characteristics, and follow-up outcomes. We found that group 2 source patient serologic data were obtained more often. Group 1 source patients were more likely to be positive for the human immunodeficiency virus (HIV). Group 2 HCWs were more likely to be immune to hepatitis B virus, to agree to HIV testing, and to comply with follow-up. Follow-up rates remained suboptimal, even after high-risk exposures. Non-licensed HCWs were less likely to accept postexposure testing than physicians or nurses in group 2. General and targeted interventions to improve compliance and follow-up are still needed.