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.     

4th Global CRO Council for Bioanalysis: coadministered drugs stability, EMA/US FDA guidelines, 483s and carryover

The Global CRO Council for Bioanalysis (GCC) was formed in September 2010. Since then, the representatives of the member companies come together periodically to openly discuss bioanalysis and the regulatory challenges unique to the outsourcing industry. The 4th GCC Closed Forum brought together experts from bioanalytical CROs to share and discuss recent issues in regulated bioanalysis, such as the impact of coadministered drugs on stability, some differences between European Medicines Agency and US FDA bioanalytical guidance documents and lessons learned following recent Untitled Letters. Recent 483s and agency findings, as well as issues on method carryover, were also part of the topics discussed.     

Clinical course and long-term prognosis of spontaneous coronary artery dissection

Spontaneous coronary artery dissection is rare. In comparison with the usual myocardial infarction population, it occurs in relatively young people with a striking predilection for women. Of 83 cases that have been described, 62 were diagnosed at autopsy and 21 were found antemortem. A series of 11 patients with the antemortem diagnosis of spontaneous coronary artery dissection is reported and follow-up is provided for 16 of the 21 previously reported cases. Of the 62 autopsy cases, 10 (16%) were men (mean age 47) and 52 (84%) were women (mean age 40). Dissection of the left anterior descending coronary artery predominated in this group of patients, occurring in 80% of men and 65% of women. Of the 32 cases diagnosed antemortem, 15 (47%) were men (mean age 46) and 17 (53%) were women (mean age 38). Men were found to have dissection predominantly of the right coronary artery (73%). Women were found to have dissection predominantly of the left coronary artery system (88%). The etiology of spontaneous coronary artery dissection remains unclear. The 3 groups that can be identified are those associated with atherosclerotic coronary artery disease, those in the postpartum period and those found to be idiopathic. Of the 94 known cases, 69 (73%) occurred in women; 21 (31%) of these were associated with the postpartum state. The prognosis of patients surviving the initial event is good, with an 82% survival rate (follow-up: range 1.5 to 144 months, mean 38). The indications for medical or surgical treatment are presented. Spontaneous coronary artery dissection should be considered in the differential diagnosis of any young person sustaining an acute myocardial infarction, especially women in the postpartum state.     

Promoting the community health clinical nurse specialist.

The role of the community health nurse clinical specialist (CHNCS) has been clearly delineated by the profession as having a responsibility to the community as client. The need for this specialist has escalated as communities try to address health problems that are preventable and overwhelming their resources. Yet, a survey conducted in New Jersey and counsel from the Rutgers College of Nursing Community Health Nursing Advisory Committee suggest that nurses and agencies may not be aware of the role of the CHNCS and how to use this advanced practitioner most effectively. This article discusses the role of the CHNCS as described by the American Nurses' Association, the need for the CHNCS, a survey of the perceived need for Master's-prepared community health nurses, the role of a CHNCS in a New Jersey community health nursing agency (MCOSS, Inc.), and recommendations for promoting the role of the CHNCS.     

Assessment of a pilot child playground injury prevention project in New York State.

Following a child playground equipment injury prevention project conducted in New York State in 1977, there was a 42 per cent reduction in playground equipment hazards, and a 22.4 per cent reduction in playground related injuries treated in the two largest hospitals of one of the program sites. Knowledge about unsafe playground practices and equipment hazards improved after the workshops for playground personnel. This approach to injury prevention deserves further study.