Occupational blood exposure beyond needle stick injuries: hospital-based cross-sectional study among healthcare workers in governmental hospitals of Northern Ethiopia

Background Occupational blood exposure is one of the major public health problems that healthcare workers (HCWs) are encountering. Most previous occupational blood exposure studies are delimited to needle stick injury, which could underestimate the real level of blood exposure. On the other hand, others deal with crude blood and body-fluids exposure, which possibly overestimate the magnitude of blood exposure. Therefore, this study aimed at determining the prevalence of occupational blood exposure and identifying associated factors among HCWs in the Southern Tigrai zone governmental hospitals of Northern Ethiopia considering all the potential means of blood exposure (needle stick injury, sharp medical equipment injury, and blood splash) while excluding blood-free body-fluids. Methods A hospital based cross-sectional study design was employed to gather data from randomly selected HCWs in three governmental hospitals from February to March, 2020. A multivariable logistic regression model was used to identify the independent factors associated with the outcome variable. Results From the total of 318 HCWs, 148 (46.5 %) were exposed to blood at least once in their lifetime. Working for more than 40 h per week (AOR= 9.4; 95 % CI: 7.61, 11.41), lack of adequate personal protective equipment (PPE) (AOR=3.88; 95 % CI: 1.64, 5.42), Hepatitis B virus vaccination (AOR=0.54; 95 % CI: 0.12,0.78), recapping used needle sticks (AOR=3.18; 95 % CI: 1.28, 8.83), and lack of infection prevention and patient safety (IPPS) training (AOR=13.5; 95 % CI: 8.12,19.11) were detected to significantly increase the likelihood of occupational blood exposure. Conclusions As nearly half of the HCWs were exposed to blood, reducing work load below 40 h per week by employing additional staff members, supplying adequate PPE, avoiding recapping of used needle sticks, and providing IPPS training for the HCWs should be practiced.

Gambaran Kecelakaan Kerja dan Penyakit Akibat Kerja Dokter Hewan di Denpasar

Abstrak Latar Belakang: Profesi dokter hewan berisiko terhadap penyakit zoonotic yang secara alami dapat ditularkan dari hewan vertebrata ke manusia atau sebaliknya. Kasus kecelakaan kerja juga terjadi seperti tertusuk jarum suntik, digigit, dicakar dan masih banyak lainnya. Oleh karena itu, penelitian ini dilakukan untuk guna memperoleh gambaran kecelakaan dan penyakit akibat kerja pada dokter hewan. Metode: Penelitian ini bersifat deskriptif dan populasinya adalah dokter hewan yang bekerja di klinik atau tempat praktek dokter hewan di Denpasar dengan total sampling 42 orang. Data primer dikumpulkan menggunakan kuisioner. Hasil: Proporsi kecelakaan kerja tertinggi berasal dari kelompok usia antara 25 – 29 tahun yaitu 43%, lama kerja kurang dari 1 tahun yaitu 48% dan jenis kelamin perempuan yaitu 67%. Proporsi kecelakaan kerja berdasarkan klasifikasi seperti jenis kecelakaan paling banyak adalah digigit yaitu 60%, karena peralatan yaitu 67%. Sifat luka yang paling banyak terjadi di permukaan yaitu 62% dan letak luka yang sering terjadi adalah pada tangan yaitu 64% dan penyakit akibat kerja yang sering dialami dokter hewan adalah scabies. Kesimpulan: Penyakit akibat kerja pada dokter hewan dipengaruhi oleh usia, lama kerja, dan jenis kelamin. Untuk jenis kecelakaan yang paling sering terjadi diakibatkan oleh kondisi tidak aman dan tindakan tidak aman. Penyakit akibat kerja yang paling banyak adalah penyakit zoonotik. Oleh karena itu pentingnya penerapan kesehatan dan kesehatan kerja di semua bidang pekerjaan termasuk profesi dokter hewan. Kata kunci : kecelakaan kerja, dokter hewan, penyakit akibat kerja. Abstract Background: The veterinarian profession is high risk of zoonotic diseases that transmitted from vertebrates to humans or vice versa. Occupational accidents such as needle sticks, bites, scratches and many others. Therefore, this research was conducted to obtain an overview of occupational accidents and diseases in veterinarians. Methods: This research is descriptive and the population were veterinarians who work in clinics or veterinary practices in Denpasar with total sampling of 42 persons. Primary data were collected using a questionnaire. Results: The highest proportion of work accidents came from the age group between 25-29 years were 43%, the length of work was less than 1 year, namely 48% and the female gender, namely 67%. The proportion of work accidents based on the classification such as types of accidents was mostly bitten about 60%, because of equipment was 67%. The nature of the wounds that mostly occurred on the surface was 62% and the location of the wounds that often occurred was on the hands about 64% and the occupational disease that was often experienced by veterinarians was scabies. Conclusion: Occupational diseases in veterinarians were influenced by age, length of work, and gender. For the types of accidents that occur most often were caused by unsafe conditions and unsafe actions. Most occupational diseases were zoonotic diseases. Therefore the importance of implementing occupational health and health in all fields of work, including the veterinarian profession. Keywords: occupational accidents, veterinarians, occupational diseases.

Impacting Neonatal Patient Care: Reducing Needle Sticks, with an Extended Dwell Catheter

Highlights Abstract Background: The use and efficacy of extended dwell peripheral intravenous catheters (EPIVs) has been extensively described at scientific conferences and in recent literature. The ramifications of repeated needle sticks include damage to vessels and ultimately the need for more invasive and costly access devices, which clearly support the need for reliable forms of vascular access. Methods: This quality improvement project spanned 4 years, 2017 through 2020, and included 128 patients who required a peripherally inserted catheter as their primary or secondary access site for a prescribed therapy. The EPIV utilized was a 4-cm, 22-gauge catheter made of thermosensitive polyurethane inserted using the Seldinger technique. Results: Over the course of 4 years, 128 patients received an EPIV for 2 or more days, totaling 849 days of therapy. Total insertion attempts were 174 or an average of 1.4 per patient. An estimated number of short PIVs needed for 849 days would have been 404 with 1011 attempts. Resultant savings with EPIV are estimated to be $30,686. Conclusions: Reducing the number of patient peripheral intravenous attempts while extending the dwell time results in less patient trauma, reliable longer-term access, reduced infection risk, reduced supply usage, and savings in terms of nursing time. The ultimate result for preterm newborns is more efficient delivery of care with less cost.

Emergency Pediatric Vascular Access

Vascular access is often needed for pediatric patients being treated in the emergency department. Access is often required to evaluate for acute metabolic emergencies, assess for infectious emergencies, to provide fluid resuscitation, blood product and medication administration. Obtaining vascular access can be a challenge, particularly in young children with small vessels and in critical conditions with dehydration or poor perfusion. The method, site, and size of device used to obtain vascular access primarily depend on the patient’s clinical status, the agent to be administered as well as parental preference. Anatomical differences considering the smaller vessels in pediatric patients and patient discomforts and fear of needle sticks afford challenges that are unique to this population. In addition, it is imperative that the emergency physician is cognizant and has strategies to treat both the child’s and the parent’s anxiety associated with the procedure. The emergency physician should have a level of comfort and knowledge of the various techniques and sites of access that are used for pediatric emergencies.

Assessment of needlestick injuries and hepatitis B and C infection among surgeons

Background<br />Specialist surgeons are at high risk of exposure to hepatitis viruses through occupational exposure to blood or body fluids. Protective measures against occupational exposure to the hepatitis B virus (HBV) and hepatitis C virus (HCV) must be taken in order to prevent infection in surgeons. We aimed to determine the needlestick injuries, and markers HBV and HCV in Iranian surgeons.<br /><br />Methods<br />This study was cross-sectional research, performed in Baqyatallah, Shohada, Rasoul Akram, Sina, Taleghani, and Emam Hossein hospitals (all university hospitals) of Tehran, Iran. Overall 318 eligible surgeons were included. Anonymous questionnaires were used containing data about demographic characteristics, self-reported blood and needlestick contacts, occasional exposures, risk behaviors and vaccination. Also, the blood samples were taken and tested for hepatitis B surface antigen (HBsAg), antibody against Hepatitis B surface antigen (antiHBs) and HCV antibody (HCVAb). Fisher exact test and Kruskal Wallis test were used to analyze the data.<br /><br />Results<br />The mean age of the surgeons was 47.76 ± 8.95 years and 177 of them (55.66%) were male. The average number of needle–sticks was 28.28 ± 16.58 during the surgeons’ working life. Among them, 5 cases (1.59%) were positive for HBsAg and 2 cases (0.66%) were positive for HCVAb. <br /><br />Conclusion<br />In spite of the high needlestick rate in Iranian surgeons, prevalence of hepatitis B and C is not very high among them. A high degree of vigilance and a careful surgical technique is the only means available to prevent the transmission of the viruses.

Self-reported percutaneous injuries of students and interns at the School of Dentistry in Trinidad: A follow up study of an updated sharps protocol

Objective To report the results of a survey of all percutaneous injuries that occurred between 2009 – 2014 among students and interns at the dental school in Trinidad and to evaluate compliance with the protocol for the management of percutaneous injuries. Methods Data was collected via questionnaires administered to 186 clinical students and interns in 2012 and 2014. Data were analysed using SPSS® 17.0 Statistical software. Results A 90% response rate was obtained. Forty-eight persons (29%) reported one or more sharps injuries at the dental school. Of the 76 sharps injuries reported, 55 were percutaneous. Needle sticks and burs accounted for the majority of injuries and mostly occurred while working on patients. There were no significant relationships (p>0.05) between sex nor student year with the occurrence of injuries. 76% of the respondents described their concern for contracting blood borne injuries from sharps injuries as “high.” After injury, 41% of the respondents followed the school’s protocol for sharps injuries. Conclusion The prevalence of percutaneous injuries among students and interns at the UWI dental school in Trinidad is 23% and occur most commonly while working on patients. Compliance with the protocol for percutaneous injuries needs to be improved. The protocol needs to be audited to improve efficiency and reinforced to the students, interns and clinical supervisors during their clinical years.

Quality Improvement Project to Evaluate Fever Management and Appropriateness of Lab Draws in Hospitalized Sickle Cell Disease Patients in a Tertiary Care University Teaching Hospital

Introduction: Sickle cell disease is the most common inherited blood disorder that affects almost 100,000 people in the U.S. Infection is the most common cause of death in these patients. Early identification and initiation of antibiotics given functional asplenia is the key to appropriate management of hospitalized sickle cell disease patients. Approximately 4-5 billion laboratory studies are ordered every year in hospitals. Unnecessary blood tests lead to frequent blood draws and worsening anemia in this already anemic population as well as contribute towards increasing cost of hospital stay. Total national health expenditures in the U.S. is $3.3 trillion (2016) with percent of national health expenditures for hospital care: 32.4%. Objective: We reviewed inpatient admissions of sickle cell disease patients to assess for appropriate work up and timely antibiotic initiation in case of fever. Additionally, we looked up the number of blood draws as well as number of days labs were drawn during the inpatient stay. Methods: This was a retrospective chart review of all patients with sickle cell disease who were admitted to John Dempsey hospital at University of Connecticut with length of stay of at least 3 days between April 2018 to Feb 2019. Results: 57 inpatient admissions were reviewed. Out of 57 admissions, 14 had fever either at the time of presentation or during the hospital stay. Mean time to first blood culture was 56 minutes with 92% (13/14) drawn within 1 hour of fever. Mean time to first antibiotic was 4.58 hours. Antibiotics were initiated in 7% (1/14) in less than 1 hour and 50% (7/14) within 3 hours. Urine culture was checked 78% and chest X-ray was checked 100% of the time in case of fever. On review of 57 patient admissions, labs were checked every single day of hospital stay in 35% (20/57) and if the day of discharge was excluded in 50% (29/57) of the patients. Overall, the labs were checked 82.33 percent of the days patients were hospitalized. On average, labs were drawn 1.14 times per day on each patient. Conclusion: Our project addresses safety, efficiency and timeliness with identification of areas of improvement in febrile sickle cell disease patients. It also addresses patient-centeredness raising awareness for decreased needle sticks for our sickle cell disease patients. There is continuing need to educate our care providers on how to manage fever in sickle cell disease for appropriate work up and early initiation of antibiotics. Also, we need to be more considerate when ordering labs on our patients especially sickle cell disease patients with baseline anemia. This will lead to decreased number of needle sticks and iatrogenic anemia as well as better healthcare resource utilization. Disclosures No relevant conflicts of interest to declare.