Non-Hospital Based Registered Nurses and the Risk of Bloodborne Pathogen Exposure

Variation in blood and body fluids exposure when small-gauge needles or peripheral venous catheters were implicated: Results of a 4-year surveillance in France

Healthcare workers are habitually in direct contact with patients, possible carriers of infectious diseases and with potentially infectious biological materials; therefore, the implementation of standard precautions and good working practices represent an intervention strongly recommended by the Centers for Disease Control and Prevention, and required by Italian law, for the prevention of professional cut wounds. The study focused on assessing the exposure frequency and factors related to biological injuries among healthcare workers in a teaching hospital in Palermo, Italy. We performed a 14-years retrospective descriptive analysis on blood and body fluids exposures in healthcare workers, documented by questionnaires administered at the time of injury and by data collected during the follow-up period. The questionnaire included questions concerning personal data (age, sex), job position (role, employment contract, ward), biological exposure (type of exposure, devices used and circumstance of blood and body fluids exposure), precautions adopted (personal protecting equipment, safety devices) and vaccination status. A total amount of 899 healthcare workers was investigated. The incidence rate per 100 beds was 10.7. Frequency of exposure to blood and body fluids among healthcare workers was 35.3% in nurses, 31.7% in physicians, 17.6% in students. The mean age of injured healthcare workers was 36 years. The most common blood and body fluids exposures were represented by needlestick injury (76.2%), splash and spill (15.0%) and sharp (8.3%). 585 out of 685 percutaneous exposures were caused by needles (syringe, peripheral venous catheter, butterfly needles, etc.) and occurred mainly to nurses (N=224, 38.3%), physicians (N=184, 31.4% of whom resident physicians=122, 20.1% and hospital doctors=62, 10.6%), students (N=96, 16.4%) and auxiliary personnel (N=77, 13.1%). No seroconversion among exposed healthcare workers was recorded in the whole survey period. Twenty-four healthcare workers (2.6%) received post-exposure prophylaxis against Hepatitis B Virus. To our knowledge, this is the first long-term survey on blood and body fluids exposure in Southern Italy. Nurses are the most commonly affected group by biological injuries. Resident physicians and students follow the nurses probably due to a lack of training and experience about biological risk. These last two groups, however, seem to have more awareness of blood and body fluids exposures to which they are susceptible during their training cycle; in fact, they mostly use personal protective equipment compared to other healthcare workers. The blood and body fluids exposures are a preventable and a major occupational hazard in healthcare. This focus highlights the need for interventions to enhance the occupational safety of workers and students.

Legislative actions and advanced technologies, particularly dissemination of safety-engineered devices, have aided in protecting healthcare personnel from occupational blood and body fluid exposures (BBFE). To investigate the trends in BBFE among healthcare personnel over 15 years and the impact of safety-engineered devices on the incidence of percutaneous injuries as well as features of injuries associated with these devices. Retrospective cohort study at University of North Carolina Hospitals, a tertiary care academic facility. Data on BBFE in healthcare personnel were extracted from Occupational Health Service records (2000-2014). Exposures associated with safety-engineered and conventional devices were compared. Generalized linear models were applied to measure the annual incidence rate difference by exposure type over time. A total of 4,300 BBFE, including 3,318 percutaneous injuries (77%), were reported. The incidence rate for overall BBFE was significantly reduced during 2000-2014 (incidence rate difference, 1.72; P=.0003). The incidence rate for percutaneous injuries was also dramatically reduced during 2001-2006 (incidence rate difference, 1.37; P=.0079) but was less changed during 2006-2014. Percutaneous injuries associated with safety-engineered devices accounted for 27% of all BBFE. BBFE was most commonly due to injecting through skin, placing intravenous catheters, and blood drawing. Our study revealed significant overall reduction in BBFE and percutaneous injuries likely due in part to the impact of safety-engineered devices but also identified that a considerable proportion of percutaneous injuries is now associated with these devices. Additional prevention strategies are needed to further reduce percutaneous injuries and improve design of safety-engineered devices.

Prevalence and risk factors of needlestick injuries, sharps injuries, and blood and body fluid exposures among operating room nurses in Thailand

To investigate occupational exposures to biological material potentially infected by blood-borne viruses in nursing student population during the course years. An observational retrospective study was designed. Data were collected in May 2007. Two-thousand-two-hundred-fifteen nursing students from the 3 years of degree course were enrolled in the four Italian universities. A structured questionnaire was constructed and was given out unannounced to nursing students in four universities on a randomly chosen day. The likelihood of association between nursing student exposure and certain assumed risk factors was measured. The exposure risk is associated with each study year of nursing students. Specifically, the probability of accidental exposure is reduced significantly with the increase of clinical skills during the training period. The risk for exposure in the 1st year students appears significantly higher than in those of the next years (odds ratio [OR] 1.465; 95% confidence interval [CI] 1.105-1.943). Data highlighted a gradual increase of bio-safety knowledge in nursing students from the 1st to the 3rd years of study. However, a statistically significant association exists only between awareness of a correct use of gloves and exposure risk (OR 0.435; 95%CI 0.227-0.834). Mucocutaneous exposures are more frequent than percutaneous exposures (62.2%), and the hollow-bore needle is the device most often involved. In 42.5% of cases, accidental exposures occurred when nursing students are working alone in a medical ward or surgery area. During their clinical training, nursing students can encounter a real risk for percutaneous and mucocutaneous exposures to blood potentially infected with blood-borne viruses. However, this risk is reduced with an increase in clinical skills. Results show that some new strategies are necessary for exposure risk reduction such as development of simulation laboratories for nursing practice and the adequate presence of tutors in clinical training education.

Risk of exposure to blood‑borne pathogens has always been a problem for healthcare professionals including dental professionals. The emergence of acquired immunodeficiency syndrome (AIDS) in 1981 brought the issue to the forefront of public health policy. Percutaneous injuries, which include needle stick injuries (NSI), expose dental healthcare workers to deadly blood‑borne pathogens such as Hepatitis C virus (HCV), Hepatitis B virus (HBV), and Human Immunodeficiency Virus (HIV). The risk of transmission of HCV, HBV, and HIV from patient to the healthcare personnel is 3%, 30%, and 0.3%, respectively. [1,2] Although the likelihood of being infected by a blood‑borne virus (BBV) may be low after a single exposure, the consequences for the dental professional who becomes infected are potentially serious and include the potential of transmission of blood‑borne pathogens and associated detrimental effects on their personal and professional lives. [3] Needles used for injecting local anesthesia during restorative procedures and the use of sharps during endodontic and prosthodontic procedures pose a high risk of transmission of BBVs. Procedures in restorative dentistry that may make the patient to cause a sudden jerky movement can lead to increase probability of NSI. Thus, education and training regarding the use of universal precautions when handling body fluids should be conducted. New employees should go through the training program stressing the need to report all injuries and the availability of chemoprophylaxis. Improving sharps disposal by introducing improved sharps containers in the dental clinics. Sharps should be disposed immediately. Recapping and re‑sheathing should be discouraged and new arrangements for sharps disposal should be done to avoid overfilling boxes. NSI prevention strategies for dental professionals should be implemented in the dental curriculum and during the pre‑occupational/occupational training programs. Since a relatively high percentage of patients are positive for major blood‑borne infections, the risk of exposure to blood‑borne pathogens for healthcare workers through NSI should not be ignored. Regular health checkups, tests for serum antibodies and antigens of HBV, and appropriate hepatitis B vaccination are mandatory for occupational safety of healthcare workers. Report of NSI cases should be encouraged since it is needed for root cause analysis of the adverse events and future prevention. The report of NSI events is also highly important for the injured parties in view of risk assessment and implementation of appropriate prophylactic measures for blood‑borne infections.

To describe the effectiveness of 2-octyl cyanoacrylates (2-OCA) for repair of lacerations, reduction of needle-stick injuries to health care providers, patient satisfaction, and overall cost reduction. A descriptive study of typical lacerations (N = 38) presenting to a suburban urgent care center. Wound approximation was complete (92.1%); with no erythema, drainage, or warmth (100%) and patients were satisfied (87%) and preferred 2-OCA (91%). No needle stick injuries occurred (100%) to providers or ancillary staff. 2-Octyl cyanoacrylates tissue adhesive effectively closes and heals wounds without infection, pain, or erythema. Health care providers can prevent the risk of blood and body fluid exposure from needle-stick injuries through the use of 2-OCA tissue adhesive.

ObjectiveTo understand the psychosocial effects of needlestick injuries (NSIs) among nurses working in different healthcare settings.MethodA total of 5535 fulltime registered nurses (RN) working among secondary referral hospitals (SRH) or...

In 2001, there were an estimated 9.2 million individuals working in healthcare in the United States.1 Despite the use of standard precautions and the introduction of safety-engineered devices, healthcare workers remain at substantial risk of occupational exposure to blood-borne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Estimates of the annual number of percutaneous injuries among U.S. healthcare personnel vary widely but represent a substantial occupational risk. Using national occupational health surveillance data from 1997 and 1998, Panlilio et al. estimated that in the United States there were approximately 384,000 percutaneous injuries annually among hospital-based healthcare workers.2 Despite effective pre-exposure and postexposure prophylaxis for HBV and recent revised recommendations for postexposure prophylaxis after HIV exposure, the best approach to prevent occupational blood-borne infection is the prevention of percutaneous injuries associated with medical devices contaminated with blood. In September 1998, California became the first U.S. state to implement a safe needle device act to decrease the risk of occupational percutaneous injuries. Currently, more than 17 other states have passed similar legislation. In November 2000, the federal Bloodborne Pathogen Safety Act was signed into law, and as of April 30, 2002, the Joint Commission on Accreditation of Healthcare Organizations required full compliance with this act. If properly used, safety devices can be an effective means of reducing the number of percutaneous injuries. In a large study conducted by investigators from the Centers for Disease Control and Prevention and 10 U.S. teaching hospitals during 1993 to 1995, use of phlebotomy devices with safety features significantly reduced phlebotomy-associated percutaneous injuries and was associated with minimal adverse events.3 Activation rates of the safety feature varied according to ease of use, healthcare worker preference, perceived patient adverse events (such as hematoma formation and need for repeat phlebotomy), and devicespecific training. Despite a study demonstrating that use of blunt suture needles decreased the risk of percutaneous exposure during gynecologic surgical procedures, acceptance of these devices in surgical practice remains poor.4 Healthcare facilities can use many types of safetyengineered devices to reduce the number of percutaneous injuries, but these devices have limitations and obstacles to full implementation remain. There is a growing and bewildering assortment of safety devices currently being marketed, some of which require user activation and others with automatically activated safety features. They vary considerably in their ease of use and effectiveness in reducing injury rates, and are not available for certain situations, such as dentistry and arterial line placement. Training and education are necessary to ensure proper use. The increased direct cost of safety devices is another potential obstacle to implementation. The added cost of a needle with a safety feature ranges from pennies for a blood collection needle or syringe with a needle attached to more than $0.70 for an intravenous catheter. The annual cost to a healthcare facility to comply with the federal Safe Needle Device Act is not trivial. Following implementation of the California Safe Needle Device Act in 2000, we estimated that the added cost for safety features for our hospital increased the annual expenditure for needle-containing devices 50%, from $412,000 in 1999 to $825,000 in 2000.5 The benefits of needles with safety features appear to

Background: Standard Precautions (SP) is important in preventing healthcare-associated infections (HAI) as well occupational infection among healthcare workers (HCWs) in healthcare facilities. However, the knowledge and practice of SP among HCWs is still poor. Objectives: To identify the predictors for knowledge and practice of Standard Precautions among HCWs. Materials and Methods: Articles were searched using Pubmed, Medline, Scopus and Google Scholar search engines using keywords “Standard Precautions OR infection control AND knowledge practice”. Types of studies included are analytical observational studies. Only English articles published from 2010 to 2018, accessible as full texts and evaluating multiple components of Standard Precautions were included in the review. Result: There are 10 articles included in this study. Several predictors had been identified through this review such as age, marital status, clinical experience, knowledge, administrative role, grade of hospital and working department, training, history of blood and body fluid exposure and constructs of Health Belief Model (HBM). Conclusion: HBM’s construct is among the important predictors of knowledge and practice on SP. Program aiming at comprehensive education and training about knowledge and practice on SP tailored to the HBM’s construct could help improve the compliance with SP among the HCWs in order to reduce the chances of occupational exposure to infections. Keywords: Standard Precautions, predictors, healthcare workers, knowledge and practice, infection control.

OBJECTIVE To use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms. DESIGN A 10-year retrospective cohort design. SETTING A single large academic teaching hospital. PARTICIPANTS All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF exposures were analyzed. METHODS Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors. RESULTS The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results showed associations were generally stronger for suture needle-related exposures. CONCLUSIONS Results largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types. Infect. Control Hosp. Epidemiol. 2015;37(1):80-87.

Reducing Needlestick Injuries from Active Safety Devices: A Passive Safety-Engineered Device Trial

Additional studies are required to identify risk factors for hepatitis C virus (HCV) transmission to health care workers after occupational exposure to HCV. We conducted a matched case-control study in 5 European countries from 1 January 1991 through 31 December 2002. Case patients were health care workers who experienced seroconversion after percutaneous or mucocutaneous exposure to HCV. Control subjects were HCV-exposed health care workers who did not experience seroconversion and were matched with case patients for center and period of exposure. Sixty case patients and 204 control subjects were included in the study. All case patients were exposed to HCV-infected fluids through percutaneous injuries. The 37 case patients for whom information was available were exposed to viremic source patients. As risk factors for HCV infection, multivariate analysis identified needle placement in a source patient's vein or artery (odds ratio [OR], 100.1; 95% confidence interval [CI], 7.3-1365.7), deep injury (OR, 155.2; 95% CI, 7.1-3417.2), and sex of the health care worker (OR for male vs. female, 3.1; 95% CI, 1.0-10.0). Source patient HCV load was not introduced in the multivariate model. In unmatched univariate analysis, the risk of HCV transmission increased 11-fold for health care workers exposed to source patients with a viral load >6 log(10) copies/mL (95% CI, 1.1-114.1), compared with exposures to source patients with a viral load < or =4 log10 copies/mL. In this study, HCV occupational transmission was found to occur after percutaneous exposures. The risk of HCV transmission after percutaneous exposure increased with deep injuries and procedures involving hollow-bore needle placement in the source patient's vein or artery. These results highlight the need for widespread adoption of needlestick-prevention devices in health care settings, together with other preventive measures.

Trauma care personnel are at risk of occupational exposure to blood-borne pathogens. Little is known regarding compliance with standard precautions or occupational exposure to blood and body fluids among multiple trauma care personnel in Germany. Compliance rates of multiple trauma care personnel in applying standard precautions, knowledge about transmission risks of blood-borne pathogens, perceived risks of acquiring hepatitis B, hepatitis C and human immunodeficiency virus (HIV) and the personal attitude towards testing of the index patient for blood-borne pathogens after a needlestick injury were evaluated. In the context of an advanced multiple trauma training an anonymous questionnaire was administered to the participants. Almost half of the interviewees had sustained a needlestick injury within the last 12 months. Approximately three quarters of the participants were concerned about the risk of HIV and hepatitis. Trauma care personnel had insufficient knowledge of the risk of blood-borne pathogens, overestimated the risk of hepatitis C infection and underused standard precautionary measures. Although there was excellent compliance for using gloves, there was poor compliance in using double gloves (26.4 %), eye protectors (19.7 %) and face masks (15.8 %). The overwhelming majority of multiple trauma care personnel believed it is appropriate to test an index patient for blood-borne pathogens following a needlestick injury. The process of treatment in prehospital settings is less predictable than in other settings in which invasive procedures are performed. Periodic training and awareness programs for trauma care personnel are required to increase the knowledge of occupational infections and the compliance with standard precautions. The legal and ethical aspects of testing an index patient for blood-borne pathogens after a needlestick injury of a healthcare worker have to be clarified in Germany.

To assess the rate and determinants of sharp injuries during the previous 6 months among health care workers at first-level care facilities in two districts of Pakistan. Cross-sectional survey at public, general practitioners and non-licensed private practitioners selected through stratified random sampling. At each facility, we interviewed a prescriber and a dispenser/injection provider about knowledge of bloodborne pathogens transmission and preventive practices, risk perception, and use of precautions and sharp injuries received during the previous 6 months. Multivariable Poisson regression was used to assess the factors associated with the number of sharp injuries. Fifty-four percentage of the 233 workers had at least one injury during the previous 6 months. The overall rate of sharp injuries per person per year was 3.7; among non-physician prescribers (9%), it was 4.3; among dispensers (69%), it was 3.7, and among physicians (18%), it was 2.1. In the multivariable model, work experience, risk perception and type of health care worker were significantly associated with receiving sharp injuries during the previous 6 months. In the model including dispensers only, a higher knowledge score was associated with fewer sharp injuries, while perceived severity of disease and lack of professional qualification were associated with more. Sharp injuries are common in Pakistan. Better knowledge about modes of bloodborne pathogen transmission and professional qualification may reduce their incidence.