Bibliography
June 2008
1. Retractable needles are only part of sharps protection. Nurs
Stand 2008; 22(37):33.
ABSTRACT: The International Health Care Worker Safety Centre in the
Your editorial states that, 'all trusts should ban non-retractable needles'.
However, retractable needles constitute only one approach to needle protection.
There are other safety designs such as hinged cap, sliding sheath and blunted
needles.
Also, other sharp devices such as scalpel blades can injure and infect
healthcare workers. Needle retraction designs cannot be used for all
procedures. For example, for blood gas analysis the needle must be removed from
the blood-filled syringe.
US law permits manufacturers to develop the variety of safety features needed
in a complex healthcare environment. I hope new safety policies in the
2. Aisaka K, Itabashi K, Nagasaka K., Kuroda K, Arita S, Takane
V. Influence of Novel Blunt Needles (Ethiguard) on Safety for Gynecologic
Operations. Obstetrics & Gynecology 2008; 109(4 (supplement)):25S.
ABSTRACT: OBJECTIVE: The present study was performed to evaluate the
safety of the Ethiguard (a new type of blunt needle) by measurement of the
resistance to puncture using a surgical rubber glove and chicken breast meat.
METHODS: The resistance of a surgical glove and chicken breast meat (5
mm and 10 mm thick) to being punctured by three needles, a conventional round
needle (J-765D), Ethiguard CTXB (circle taper extra large blunt), and a usual
type of blunt needle (BP-1) was measured by the computer control system
autograph (AGS-100B; Shimadzu Company, Tokyo, Japan). This procedure was
repeated 10 times on each material.
RESULTS: The values measured for the resistance of the surgical glove to
being pierced by the three needles were 27.110.1, 17515.4, and 352.421.7 g,
respectively (P.001). In contrast, the resistance of the 5-mm and 10-mm
chicken breast meat test pieces to being pierced by the blunt needle was found
to be significantly greater than their resistance to being pierced by the other
two needles (5 mm: 13.82.7, 18.64.2, 45.95.5 g, P.001; 10 mm: 32.44.2,
37.85.8, 77.96.8 g, P.001). These results demonstrated that the
Ethiguard was less likely than the conventional round needle to puncture a
surgical glove, but it had the same capacity as the conventional round needle
to penetrate tissue.
CONCLUSION: The use of the Ethiguard is effective in preventing
needle-stick accidents but still penetrates tissues satisfactorily, and also it
is effective in protecting against such infections as human immunodeficiency
virus (HIV) and hepatitis C virus (HCV).
3. Alamgir H, Cvitkovich Y, Astrakianakis G, Yu S, Yassi A.
Needlestick and other potential blood and body fluid exposures among health
care workers in British Columbia, Canada. Am J Infect Control 2008;
36(1):12-21.
ABSTRACT: BACKGROUND: Health care workers have high risk of exposure to human
blood and body fluids (BBF) from patients in acute care and residents in
nursing homes or personal homes. METHODS: This analysis examined the
epidemiology for BBF exposure across health care settings (acute care, nursing
homes, and community care). Detailed analysis of BBF exposure among the health
care workforce in 3 British Columbian health regions was conducted by Poisson
regression modeling, with generalized estimating equations to determine the
relative risk associated with various occupations. RESULTS: Acute care had the
majority of needlestick, sharps, and splash events with the BBF exposure rate
in acute care 2 to 3 times higher compared with nursing home and community care
settings. Registered nurses had the highest frequency of needlestick, sharps,
and splash events. Laboratory assistants had the highest exposure rates from
needlestick injuries and splashes, whereas licensed practical nurses had the
highest exposure rate from sharps. Most needlestick injuries (51.3%) occurred
at the patient's bedside. Sharps incidents occurred primarily in operating
rooms (26.9%) and at the patient's bedside (20.9%). Splashes occurred most frequently
at the patient's bedside (46.1%) and predominantly affected the eyes or
face/mouth. The majority of needlestick/sharps injuries occurred during use for
registered nurses, during disposal for licensed practical nurses, and after
disposal for care aides. CONCLUSION: The high risk of BBF exposure for some
occupations indicates there is room for improvement to reduce BBF exposure by
targeting high-risk groups for prevention strategies
4. Apisarnthanarak A, Babcock HM, Fraser VJ. The effect of
nondevice interventions to reduce needlestick injuries among health care
workers in a Thai tertiary care center. Am J Infect Control 2008; 36(1):74-75.
ABSTRACT: To the Editor: It is estimated that more than 380,000
needlestick injuries (NSIs) are reported by hospital staff members each year in
the United States.1 In developing countries, health care
workers (HCWs) face even greater risks because of the higher prevalence of
bloodborne pathogens and the use of certain medical equipments, such as
nonretracting finger-stick lancets and glass capillary tubes to test for common
tropical diseases.[2] and [3] Although
safety-engineered devices have been incorporated to help reduce NSIs in the
United States, the role of such devices in developing countries remains
controversial.
5. Boal WL, Leiss JK, Sousa S, Lyden JT, Li J, Jagger J. The
National study to prevent blood exposure in paramedics: Exposure reporting. Am
J Ind Med 2008; 51(3):213-222.
ABSTRACT: BACKGROUND: This survey was conducted to provide national incidence
rates and risk factors for exposure to blood among paramedics. The present
analysis assesses reporting of exposures to employers. METHODS: A questionnaire
was mailed in 2002-2003 to a national sample of paramedics selected using a
two-stage design. Information on exposure reporting was obtained on the two
most recent exposures for each of five routes of exposure. RESULTS: Forty-nine
percent of all exposures to blood and 72% of needlesticks were reported to
employers. The main reason for under-reporting was not considering the exposure
a "significant risk." Females reported significantly more total
exposures than males. Reporting of needlesticks was significantly less common
among respondents who believed most needlesticks were due to circumstances under
the worker's control. Reporting was non-significantly more common among workers
who believed reporting exposures helps management prevent future exposures.
Reporting may have been positively associated with workplace safety culture.
CONCLUSIONS: This survey indicates there is need to improve the reporting of
blood exposures by paramedics to their employers, and more work is needed to
understand the reasons for under-reporting. Gender, safety culture, perception
of risk, and other personal attitudes may all affect reporting behavior. Am. J.
Ind. Med. 51:213-222, 2008. (c) 2008 Wiley-Liss, Inc
6. Byass P, D'Ambruoso L. Cellular telephone networks in
developing countries. The Lancet 2008; 371(9613):650-642.
ABSTRACT: While undertaking community-based follow-ups of maternal deaths in
Burkina Faso and Indonesia, we were struck by the irony of sitting in some of
the world's poorest households, wherein many mothers had died after failing to
access health services, and yet where good cellular telephone signals were
available (figure). From such households it is possible to call anywhere
in the world-but there is generally no designated emergency number nor means of
getting medical advice or assistance via a portable telephone
7. Chopra M, Munro S, Lavis JN, Vist G, Bennett S. Effects of
policy options for human resources for health: an analysis of systematic
reviews. The Lancet 2008; 371(9613):668-674.
ABSTRACT: Background: Policy makers face challenges to ensure an
appropriate supply and distribution of trained health workers and to manage
their performance in delivery of services, especially in countries with low and
middle incomes. We aimed to identify all available policy options to address
human resources for health in such countries, and to assess the effectiveness of
these policy options.
Methods: We searched Medline and Embase from 1979 to September, 2006,
the Cochrane Library, and the Human Resources for Health Global Resource Center
database. We also searched up to 10 years of archives from five relevant
journals, and consulted experts. We included systematic reviews in English
which assessed the effects of policy options that could affect the training,
distribution, regulation, financing, management, organisation, or performance
of health workers. Two reviewers independently assessed each review for
eligibility and quality, and systematically extracted data about main effects.
We also assessed whether the policy options were equitable in their effects;
suitable for scaling up; and applicable to countries with low and middle
incomes.
Findings: 28 of the 759 systematic reviews of effects that we identified
were eligible according to our criteria. Of these, only a few included studies
from countries with low and middle incomes, and some reviews were of low
quality. Most evidence focused on organisational mechanisms for human
resources, such as substitution or shifting tasks between different types of
health workers, or extension of their roles; performance-enhancing strategies
such as quality improvement or continuing education strategies; promotion of
teamwork; and changes to workflow. Of all policy options, the use of lay health
workers had the greatest proportion of reviews in countries with a range of
incomes, from high to low.
Interpretation: We have identified a need for more systematic reviews on
the effects of policy options to improve human resources for health in
countries with low and middle incomes, for assessments of any interventions
that policy makers introduce to plan and manage human resources for health, and
for other research to aid policy makers in these countries
8. Cook J. A safe and effective method to recover missing
surgical needles. Dermatol Surg 2008; 34(3):423.
ABSTRACT: The accountability of all sharps during and at the conclusion of any
dermatologic surgery procedure is of paramount importance to ensure the safety
of both the patient and the health care providers. The identification of the
human immunodeficiency virus served as the impetus for the recognition of
improved operative safety. The majority of percutaneous injuries to health care
workers are needle sticks
9. Crisp N, Gawanas B, Sharp I. Training the health workforce:
scaling up, saving lives. The Lancet 2008; 371(9613):689-691.
ABSTRACT: Over a billion people worldwide have little or no access to health
services and the help and advice of health workers. There is good evidence that
health workers affect health outcomes. The density of health workers is
significant in accounting for rates of maternal mortality, infant mortality, under-5
mortality, and immunisation rates across countries. Similarly, assessments of disease-oriented
country programmes have found that the lack of health workers is one of the
major bottlenecks in implementing evidence-based interventions to improve
maternal and child health, and to address HIV/AIDS, malaria, and tuberculosis.
There is also evidence for the effectiveness of specific cadres of health
workers, including community and mid-level workers. But, as the 2006 World Health Report, Working
Together for Health,highlighted, there is a global shortage of some 4·3
million health workers, with the greatest shortages in the poorest countries.
The causes of the crisis are many, from a global rise in chronic disease and an
ageing population, to poor local working conditions and international
migration.6 But the massive shortfall in production of
trained health workers underpins all other problems. To take one example,
Ethiopia trains about 200 doctors a year for a population of about 75 million;
the UK trains more than 6000 for a population of about 60 million.
10. Doull L, Campbell F. Human resources for
health in fragile states. The Lancet 2008; 371(9613):626-627.
ABSTRACT: Human resources are crucial for a functioning health system. The
global shortage of health workers is evident in many developing countries,
especially in. fragile states-countries
whose governments, for various reasons, cannot or will not deliver core
functions to most of the population.
Building and retaining a skilled and motivated health workforce is
particularly challenging in settings where staff might be under extreme
pressure (eg, during conflicts, long-term underinvestment in the health sector,
and the HIV/AIDS epidemic). Furthermore, for health professionals, there are
growing opportunities that encourage movement from fragile states to search for
better professional and economic environments. The results are shortages of
health staff and an inability to provide even basic health care.
11. Gershon RR, Pogorzelska M, Qureshi KA,
Sherman M. Home health care registered nurses and the risk of percutaneous
injuries: a pilot study. Am J Infect Control 2008; 36(3):165-172.
ABSTRACT: BACKGROUND: Home health care is the fastest-growing sector in the
health care industry, expected to grow 66% over the next 10 years. Yet data on
occupational health hazards, including the potential risk of exposure to blood
and body fluids, associated with the home care setting remain very limited. As
part of a larger study of bloodborne pathogen risk in non-hospital-based
registered nurses (RNs), data from 72 home health care nurses were separately
analyzed to identify risk of blood/body fluid exposure. METHODS: A 152-item
self-administered mailed risk assessment questionnaire was completed by RNs
employed in home health care agencies in New York State. RESULTS: Nine (13%) of
the home health care nurses experienced 10 needlesticks in the 12-month period
before the study. Only 4 of the needlesticks were formally reported to the
nurse's employer. The devices most frequently associated with needlesticks were
hollow-bore and phlebotomy needles, and included 3 needles with safety
features. Exposure was most commonly attributed to patient actions, followed by
disposal-related activities. CONCLUSIONS: These data suggest that home health
care nurses may be at potential occupational risk for bloodborne pathogen
exposure. Risk management strategies tailored to the home health care setting
may be most effective in reducing this risk
12. Glassman A, Becker L, Makinen M, de
Ferranti D. Planning and costing human resources for health. The Lancet 2008;
371(9613):693-695.
ABSTRACT: Human resources are crucial for the provision of health care and
represent the largest single use of public spending on health in developing
countries. Yet countries face an ongoing
challenge when it comes to financing human resources for health (HRH)
sufficiently to sustain an adequate supply of health workers and stimulate
greater productivity and more effective health care.
Several papers prepared for the 2006 World Health Report and the Global Health
Workforce Alliance describe the HRH financing gap and the variables such as
economic growth, government revenues, aid, fiscal sustainability targets, and
priority-setting practices that affect the ability of governments and donors to
increase spending on this input.
Inspired by the global HRH movement, some countries, mostly in Africa, have
undertaken strategic planning exercises to estimate their HRH needs. But these plans rarely include a reliable
analysis of the financing needs or structures required to achieve the desired
levels of care. When they do address costs, they typically use
provider-population ratios to estimate the number of additional staff needed in
each cadre, then multiply those numbers by current public-sector salaries and
allowances (or some assumed salary increment). Shortfalls are determined by
comparing this figure with current and projected health-sector budgets.
Resource mobilisation options via aid and public-sector priority-setting are
then discussed.
13. Gray J. An accidental death. Nurs Stand
2008; 22(24):1.
ABSTRACT: Nurses everywhere will be filled with sorrow at th edeath of their
colleague Juliet Young who contracted HIV as a result of needlestick injury at
work. Last week, a south London inquest
ruled that her death was accidental, and of course that verdict must be right
--Ms. Young accidentally pricked her thumb with a needle while taking blood
from a patient so that she could test blood sugar levels.
14. Hagopian A, Micek MA, Vio F, Gimbel-Sherr
K, Montoyo P. What if we decided to take care of everyone who needed treatment?
Workforce planning in Mozambique using simulation of demand for HIV/AIDS care.
Hum Resour Health 2008; 6(1):3.
ABSTRACT: ABSTRACT: BACKGROUND: The growing AIDS epidemic in southern Africa is
placing an increased strain on health systems, which are experiencing rising
steadily patient loads. Health care systems are tackling the barriers to
serving large populations in scaled-up operations. One of the most significant
challenges in this effort is securing the health care workforce to deliver care
in settings where the manpower is already in short supply. METHODS: We have
produced a demand-driven staffing model using simple spreadsheet technology,
based on treatment protocols for HIV-positive patients that adhere to
Mozambican guidelines. The model can be adjusted for the volumes of patients at
differing stages of their disease, varying provider productivity, proportion
who are pregnant, attrition rates, and other variables. RESULTS: Our model
projects the need for health workers using three different kinds of goals: 1)
the number of patients to be placed on anti-retroviral therapy (ART), 2) the
number of HIV-positive patients to be enrolled for treatment, and 3) the number
of patients to be enrolled in a treatment facility per month. CONCLUSIONS: We
propose three scenarios, depending on numbers of patients enrolled. In the
first scenario, we start with 8000 patients on ART and increase that number to
58 000 at the end of three years (those were the goals for the country of
Mozambique). This would require thirteen clinicians and just over ten nurses by
the end of the first year, and 67 clinicians and 47 nurses at the end of the
third year. In a second scenario, we start with 34 000 patients enrolled for
care (not all of them on ART), and increase to 94 000 by the end of the third
year, requiring a growth in clinician staff from 18 to 28. In a third scenario,
we start a new clinic and enrol 200 new patients per month for three years,
requiring 1.2 clinicians in year 1 and 2.2 by the end of year 3. Other
clinician types in the model include nurses, social workers, pharmacists,
phlebotomists, and peer counsellors. This planning tool could lead to more
realistic and appropriate estimates of workforce levels required to provide
high-quality HIV care in a low-resource settings
15. Lefebvre DR, Strande LF, Hewitt CW. An
enzyme-mediated assay to quantify inoculation volume delivered by suture
needlestick injury: two gloves are better than one. J Am Coll Surg 2008;
206(1):113-122.
ABSTRACT: BACKGROUND: Acquiring a blood-borne disease is a risk of performing
operations. Most data about seroconversion are based on hollow-bore
needlesticks. Some studies have examined the inoculation volumes of pure blood
delivered by suture needles. There is a lack of data about the effect of
double-gloving on contaminant transmission in less viscous fluids that are not
prone to coagulation. STUDY DESIGN: We used enzymatic colorimetry to quantify
the volume of inoculation delivered by a suture needle that was coated with an
aqueous contaminant. Substrate color change was measured using a microplate
reader. Both cutting and tapered suture needles were tested against five
different glove types and differing numbers of glove layers (from zero to
three). RESULTS: One glove layer removed 97% of contaminant from tapered
needles and 65% from cutting needles, compared with the no-glove control data.
Additional glove layers did not significantly improve contaminant removal from
tapered needles (p > 0.05). For the cutting needle, 2 glove layers removed
91% of contaminant, which was significantly better than a single glove (p =
0.002). Three glove layers did not afford statistically significant additional
protection (p = 0.122). There were no statistically significant differences
between glove types (p = 0.41). CONCLUSIONS: With an aqueous needle
contaminant, a single glove layer removes contaminant from tapered needles as
effectively as multiple glove layers. For cutting needles, double-glove
layering offers superior protection. There is no advantage to triple-glove
layering. A surgeon should double-glove for maximum safety. Additionally, a
surgeon should take advantage of other risk-reduction strategies, such as
sharps safety, risk management, and use of sharpless instrumentation when
possible
16. Mbongwe B, Mmereki BT, Magashula A. Healthcare
waste management: current practices in selected healthcare facilities,
Botswana. Waste Manag 2008; 28(1):226-233.
ABSTRACT: Healthcare waste management continues to present an array of
challenges for developing countries, and Botswana is no exception. The possible
impact of healthcare waste on public health and the environment has received a
lot of attention such that Waste Management dedicated a special issue to the
management of healthcare waste (Healthcare Wastes Management, 2005. Waste
Management 25(6) 567-665). As the demand for more healthcare facilities
increases, there is also an increase on waste generation from these facilities.
This situation requires an organised system of healthcare waste management to
curb public health risks as well as occupational hazards among healthcare
workers as a result of poor waste management. This paper reviews current waste
management practices at the healthcare facility level and proposes possible
options for improvement in Botswana
17. McCoy D, Bennett S, Witter S et al.
Salaries and incomes of health workers in sub-Saharan Africa. The Lancet 2008;
371(9613):675-681.
ABSTRACT: Summary: Public-sector health workers are vital to the
functioning of health systems. We aimed to investigate pay structures for health
workers in the public sector in sub-Saharan Africa; the adequacy of incomes for
health workers; the management of public-sector pay; and the fiscal and
macroeconomic factors that impinge on pay policy for the public sector. Because
salary differentials affect staff migration and retention, we also discuss pay
in the private sector. We surveyed historical trends in the pay of civil
servants in Africa over the past 40 years. We used some empirical data, but
found that accurate and complete data were scarce. The available data suggested
that pay structures vary across countries, and are often structured in complex
ways. Health workers also commonly use other sources of income to supplement
their formal pay. The pay and income of health workers varies widely, whether
between countries, by comparison with cost of living, or between the public and
private sectors. To optimise the distribution and mix of health workers, policy
interventions to address their pay and incomes are needed. Fiscal constraints
to increased salaries might need to be overcome in many countries, and
non-financial incentives improved
18. Mechai F, Quertainmont Y, Sahali S et al.
Post-exposure prophylaxis with a maraviroc-containing regimen after
occupational exposure to a multi-resistant HIV-infected source person. Journal
of Medical Virology 2008; 80(1):9-10.
ABSTRACT: We report the case of a health care worker who received a
post-exposure prophylaxis including an investigational drug, maraviroc, after a
needle stick percutaneous injury to an HIV-infected patient with late-stage
disease and harboring a multi-drug resistant virus. Post-exposure prophylaxis
including maraviroc was pursued for a total of 28 days, with a weekly clinical
and biological evaluation. Post-exposure prophylaxis was well tolerated, with
no increase in liver function tests. The health care worker remained
HIV-negative after a 6-month follow-up. (c) 2007 Wiley-Liss, Inc
19. Merli R. CDC Probes Needlesticks, Possible
HIV Infection Among Laundry Workers. American Laundry News 2008; 3/21/08.
ABSTRACT: The Centers for Disease Control and Prevention (CDC) is investigating
as many as four more potential cases of laundry and housekeeping workers
infected with HIV, the virus that causes AIDS, as a result of needlestick
injuries they suffered at work.
20. Mills EJ, Schabas WA, Volmink J et al.
Should active recruitment of health workers from sub-Saharan Africa be viewed
as a crime? The Lancet 2008; 371(9613):685-688.
ABSTRACT: Shortages of health-care staff are endemic in sub-Saharan
Africa. Overall, there is one physician
for every 8000 people in the region. In the worst affected countries, such as
Malawi, the physician-to-population ratio is just 0·02 for every 1000 (one per
50 000). There are also huge disparities between rural and urban areas: rural
parts of South Africa have 14 times fewer doctors than the national
average. These numbers are very
different to those in developed countries: the UK, for example, has over 100
times more physicians per population than Malawi. Furthermore, almost one in ten doctors
working in the UK are from Africa. The insufficiency of health staff to provide
even basic services is one of the most pressing impediments to health-care
delivery in resource-poor settings. The consequences are clearly shown by the
inverse relation that exists between health-care worker density and mortality
21. Mornar SJ, Perlow JH. Blunt suture needle
use in laceration and episiotomy repair at vaginal delivery. Am J Obstet
Gynecol 2008.
ABSTRACT: OBJECTIVE: By surveying obstetricians regarding the use of blunt
suture needles for laceration and episiotomy repair, the purpose of this study
was to determine whether blunt suture needles represent a safe and effective
alternative to sharp needles. STUDY DESIGN: Blunt suture needles were made
available at our institution for repairs at vaginal delivery. Participating
physicians indicated their personal history of needlestick injuries and rated
the blunt suture needle after completing the repair. Categorical variables were
analyzed using Fisher's exact test and a 2-tailed P < .05 was considered
significant. RESULTS: Attending and resident physicians completed 80 surveys,
and 83% reported previous needlestick injuries. Blunt suture needles were rated
as excellent or good by 92.5% (95% confidence interval 84.6 to 96.5%). No
needlestick injuries occurred. CONCLUSION: In an effort to reduce needlestick
injuries, the use of blunt suture needles is safe and effective for repairs at
vaginal delivery
22. Musharrafieh UM, Bizri AR, Nassar NT et
al. Health care workers' exposure to blood-borne pathogens in Lebanon. Occup
Med (Lond) 2008; 58(2):94-98.
ABSTRACT: BACKGROUND: Accidental exposure to blood-borne pathogens (BBPs) is a
risk for health care workers (HCWs). AIM: To study the pattern of occupational
exposure to blood and body fluids (BBFs) at a tertiary care hospital. METHODS:
This study reports a 17-year experience (1985-2001) of ongoing surveillance of
HCW exposure to BBFs at a 420-bed academic tertiary care hospital. RESULTS: A total
of 1590 BBF exposure-related accidents were reported to the Infection Control
Office. The trend showed a decrease in these exposures over the years with an
average +/- standard error of 96 +/- 8.6 incidents per year. In the last 6
years, the average rate of BBF exposures was 0.57 per 100 admissions per year
(average of needlestick injuries alone was 0.46 per 100 admissions). For 2001,
the rates of exposure were found to be 13% for house officers, 9% for medical
student, 8% for attending physicians, 5% for nurses, 4% for housekeeping, 4%
for technicians and 2% for auxiliary services employees. The reason for the
incident, when stated, was attributed to a procedural intervention (29%),
improper disposal of sharps (18%), to recapping (11%) and to other causes (5%).
CONCLUSIONS: The current study in Lebanon showed that exposure of HCWs to BBPs
remains a problem. This can be projected to other hospitals in the country and
raises the need to implement infection control standards more efficiently.
Similar studies should be done prospectively on a yearly basis to study rates
and identify high-risk groups
23. Nsubuga P, White M, Fontaine R, Simone P.
Training programmes for field epidemiology. The Lancet 2008; 371(9613):630-631.
ABSTRACT: Public-health systems are an important subset of the health systems
that are needed to meet the Millennium Development Goals (MDGs). How many
public-health workers will be needed to achieve the MDGs is unknown, but there
is an urgent unmet need. Moreover, even
as the MDGs are being implemented, the newly revised International Health
Regulations call for the establishment of a group of experts in public-health
surveillance and response in all countries.
One strategy that has worked in the building of public-health surveillance and
response systems and the workforce to operate the systems is the implementation
of training programmes in field epidemiology.3 Over the past
27 years, 29 countries have created these programmes in partnership with the US
Centers for Disease Control and Prevention (CDC) and WHO to directly build and
strengthen public-health systems, while simultaneously training future
public-health leaders. The programmes are based on CDC's Epidemic Intelligence
Service which is a 2-year public-health leadership-training programme. More
than 1000 public-health leaders have graduated from the training programmes in
field epidemiology, and many more have completed short courses. Many graduates
of training programmes in field epidemiology have moved into leadership
positions within the ministries of health of their own countries
24. Omaswa F. Human resources for global
health: time for action is now. The Lancet 2008; 371(9613):625-626.
ABSTRACT: Over several decades, a global health-workforce crisis has developed
before our eyes. The crisis is characterised by widespread global shortages,
maldistribution of personnel within and between countries, migration of local
health workers, and poor working conditions.
The factors that led to this crisis include increased demand for care in
developed countries with ageing populations, an upsurge of new and old
pandemics in low-income countries with poorly performing economies, and
neglect. Counterproductive and poorly administered solutions, such as bans and
across-the-board ceilings on recruitment, have aggravated these factors.
25. Ozgediz D, Galukande M, Mabweijano J et
al. The Neglect of the Global Surgical Workforce: Experience and Evidence from
Uganda. World J Surg 2008.
ABSTRACT: BACKGROUND: Africa's health workforce crisis has recently been
emphasized by major international organizations. As a part of this discussion,
it has become apparent that the workforce required to deliver surgical services
has been significantly neglected. METHODS: This paper reviews some of the
reasons for this relative neglect and emphasizes its importance to health
systems and public health. We report the first comprehensive analysis of the
surgical workforce in Uganda, identify challenges to workforce development, and
evaluate current programs addressing these challenges. This was performed
through a literature review, analysis of existing policies to improve surgical
access, and pilot retrospective studies of surgical output and workforce in
nine rural hospitals. RESULTS: Uganda has a shortage of surgical personnel in
comparison to higher income countries, but the precise gap is unknown. The most
significant challenges to workforce development include recruitment, training,
retention, and infrastructure for service delivery. Curricular innovations,
international collaborations, and development of research capacity are some of
the initiatives underway to overcome these challenges. Several programs and
policies are addressing the maldistribution of the surgical workforce in urban
areas. These programs include surgical camps, specialist outreach, and
decentralization of surgical services. Each has the advantage of improving
access to care, but sustainability has been an issue for all of these programs.
Initial results from nine hospitals show that surgical output is similar to
previous studies and lags far behind estimates in higher-income countries.
Task-shifting to non-physician surgical personnel is one possible future alternative.
CONCLUSIONS: The experience of Uganda is representative of other low-income
countries and may provide valuable lessons. Greater attention must be paid to
this critical aspect of the global crisis in human resources for health
26. Ozgediz D, Kijjambu S, Galukande M et al.
Africa's neglected surgical workforce crisis. The Lancet 2008;
371(9613):627-628.
ABSTRACT: Funding priorities in Africa typically favour infectious diseases,
and surgery and perioperative care have been neglected, even though essential
surgical care at district hospitals is more cost effective than some other
highly prioritised interventions, such as antiretroviral therapy for HIV. Recent focus on the workforce needed for
male circumcision to prevent HIV transmission is an exception. Injuries create the greatest surgical burden,
followed by cancers, congenital anomalies, and complications of childbirth.
Few surgical procedures are done in Africa compared with the numbers in
high-income countries, but precise information on the exact unmet need is
lacking. Although workforce limitations
contribute to this shortfall, detailed estimates of surgical and anaesthesia
staff for the continent and individual countries are unavailable or outdated.
27. Parish C. Call for ban on unsafe needles
after inquest into nurse's death. Nurs Stand 2008; 22(24):9.
ABSTRACT: The RCN and Unison have called for a ban on non-retractable needles
to protect staff from the risk of contracting blood-borne infections.
28. Peng B, Tully PJ, Boss K, Hiller JE. Sharps
Injury and Body Fluid Exposure Among Health Care Workers in an Australian
Tertiary Hospital. Asia Pac J Public Health 2008; 20(2):139-147.
ABSTRACT: To examine sharps injury and body fluid exposure among health care
workers, a descriptive epidemiological study was conducted in a 1000-bed
tertiary hospital between 2000 and 2003 using surveillance data of all reported
sharps injuries and body fluid exposures. A total of 640 sharps injuries and
body fluid exposures were reported from hospital and nonhospital staff,
although no seroconversions to HIV, hepatitis B virus, or hepatitis C virus
were observed during the study period. Nurses reported 47% of sharps injuries
and 68% of body fluid exposures, medical staff reported 38% and 16%, and other
nonmedical staff notified 5% and 4%, respectively, while nonhospital staff
reported the rest. Hollow-bore needles accounted for 56% of sharps injuries,
while 11% of the incidents were sustained during recapping and inappropriate
disposal. Further research into Australian work practices, disposal systems,
education strategies, and the use of safety sharps should be emphasized to
implement strategies to reduce work-related injuries among health care workers
29. Pick W. Lack of evidence hampers
human-resources policy making. The Lancet 2008; 371(9613):629-630.
ABSTRACT: In today's Lancet, Mickey Chopra and colleagues describe the
dearth of evidence for policy making on human resources for health. Despite
their study being a systematic review of systematic reviews over a set period,
albeit of reports in English, they make a compelling case for more research to
inform policy makers. At a time when there is a resurgence of interest in this
field, Chopra and colleagues' overview serves as a timely reminder to
researchers that much more information is needed if we are to persuade those
responsible for health services, and especially human resources for health, to
take decisions that will contribute to the solution of the global crisis in the
staffing of health systems
30. Pillay Y, Mahlati P. Health-worker
salaries and incomes in sub-Saharan Africa. The Lancet 2008; 371(9613):632-634.
ABSTRACT: There is global focus on the need to strengthen health systems to
achieve the Millennium Development Goals by 2015, especially in sub-Saharan
Africa. Health workers are a key ingredient of health systems. In today's Lancet,
David McCoy and colleagues1 contribute to the understanding
of public-sector health workers' salaries. In sub-Saharan Africa in particular
the recruitment and retention of public-sector workers are vitally important
for health.
According to the Global Health Workforce Alliance in 2006, sub-Saharan Africa
faces the most chronic shortage of health workers.2 The
Alliance noted that this region has 11% of the world's population and a quarter
of the global burden of disease, but has only 3% of the world's health
workforce and spends less than 1% of the global health expenditure. According
to Physicians for Human Rights, more than 80% of sub-Saharan countries do not
meet WHO's minimum recommendations for the numbers of doctors and nurses.3
And about 65 000 physicians and 70 000 nurses born in Africa were working in
developed countries in 2000
31. Poz MRD. Understanding women's
contribution to the health workforce. The Lancet 2008; 371(9613):641-642.
ABSTRACT: One of my first activities after my appointment as Director of Human
Resources for Health for the State of Rio de Janeiro, Brazil, in 1987, was to
assess and appraise the health workforce at that time. To me, if the government
had a better understanding of its human resources in the health system, it
could better plan and adopt adequate options to improve the health of the
population, while ameliorating the working conditions of its more than 20 000
employees.
Globally, it is estimated that health workers account for some 2·5-10·0% of the
total labour force in a country (Hum Resour Health 2003; 1 : 5).
In Rio de Janeiro, about a third of the health workforce is found in the public
sector. The results from our assessment of the state's health workforce showed
that women were predominantly running the delivery of health-care services in
Rio de Janeiro. And by that I do not just mean nursing aides or cleaning crews;
nor did our figures include the immense burden of informal domestic care
provided by women in the home. No, our analysis revealed that most health-care
providers and administrative workers within the health-care system were women
32. Robinson M, Clark P. Forging solutions to
health worker migration. The Lancet 2008; 371(9613):691-693.
ABSTRACT: All over the world, increased demand from wealthier countries
resulting from ageing populations and medical advances has pulled large numbers
of health workers from some of the world's poorest countries-many of whom are
left with acute shortages of health workers of their own. Africa carries 25% of
the world's disease burden yet has only 3% of the world's health workers and 1%
of the world's economic resources to meet that challenge. Migration, together
with other factors in many source countries such as insufficient health
systems, low wages, and poor working conditions, are key factors determining
low health-worker density in countries with the lowest health indicators, In
Zambia, for example, there are fewer than 0·12 physicians for every 1000
people, whereas Italy enjoys 4·2 physicians for every 1000 people.1
Between 1993 and 2002, Ghana lost 604 trained doctors; roughly half of all
doctors and a third of nurses leave the country after training.2
Globally, WHO estimates that 4·3 million more health workers are required to
achieve the health-related Millennium Development Goals and has identified 57
countries with critical shortages of health workers-36 of these countries are
in Africa
33. Schatz JJ. Zambia's health-worker crisis.
The Lancet 2008; 371(9613):638-639.
ABSTRACT: Zambia has a dire shortage of health workers, with less than a third
the doctor-patient ratio recommended by WHO. But the crisis is gaining new
attention and the southern African nation has become a testing ground for
several initiatives. Joseph J Schatz reports from Lusaka.
Just past the entrance to the sprawling University Teaching Hospital (UTH) in
Lusaka, a yellow sign serves as a stark reminder of the massive health-worker
shortage facing this southern African nation. "Kindly take note that
members of the staff at UTH work under very strenuous and demanding conditions
due to the increase in the disease burden and critical shortages of
manpower", reads the sign, put up after a series of confrontations between
angry patients and over-stretched nurses and doctors. "It may take a bit
of time…Assaulting any member of staff is a criminal offence
34. Schatz JJ. Francis Omaswa: tackling the
shortage of health workers. The Lancet 2008; 371(9613):643-642.
ABSTRACT: Francis Omaswa was working as head of cardiothoracic surgery at
Kenyatta National Hospital in Nairobi, in 1982, leading an open-heart surgery
team, when he decided to take a slight detour. At the invitation of the Association
of Surgeons of East Africa, Omaswa travelled back to Uganda, his homeland, and
set out for a remote mission hospital in the town of Ngora. He spent the next 5
years on an experimental project testing out the most cost-effective ways to
deliver quality health services in a rural African setting. In so doing, he
figured out how to make health systems work. And, according to Omaswa, one
crucial thing about making health systems work is that they need health
workers: "Money cannot take drugs from the airport into the mouths of
humans. You need people. It sounds obvious but the world doesn't work like
that."
More than two decades later, Omaswa looks back on his time in Ngora as a
pivotal training ground for his current role as Executive Director of WHO's Global
Health Workforce Alliance (GHWA). The group, which holds a major conference in
Kampala next month, is charged with coordinating the global response to the
massive shortage of doctors, nurses, and health workers that is paralysing the
health systems of many countries throughout the developing world. "It's
the basis on which I understand health systems and health care in low-income
countries", Omaswa says
35. Taegtmeyer M, Suckling RM, Nguku PM et al.
Working with risk: Occupational safety issues among healthcare workers in
Kenya. AIDS Care 2008; 20(3):304-310.
ABSTRACT: The objective of this study was to explore knowledge of, attitudes
towards and practice of post-exposure prophylaxis (PEP) among healthcare
workers (HCWs) in the Thika district, Kenya. We used site and population-based
surveys, qualitative interviews and operational research with 650 staff at risk
of needlestick injuries (NSIs). Research was conducted over a 5-year period in
five phases: (1) a bio-safety assessment; (2) a staff survey: serum drawn for
anonymous HIV testing; (3) interventions: biosafety measures, antiretrovirals
for PEP and hepatitis B vaccine; (4) a repeat survey to assess uptake and
acceptability of interventions; in-depth group and individual interviews were
conducted; and (5) health system monitoring outside a research setting. The
main outcome measures were bio-safety standards in clinical areas, knowledge,
attitudes and practice as regards to PEP, HIV-sero-prevalence in healthcare
workers, uptake of interventions, reasons for poor uptake elucidated and
sustainability indicators. Results showed that HCWs had the same HIV
sero-prevalence as the general population but were at risk from poor
bio-safety. The incidence of NSIs was 0.97 per healthcare worker per year.
Twenty-one percent had had an HIV test in the last year. After one year there
was a significant drop in the number of NSIs (OR: 0.4; CI: 0.3-0.6; p<0.001)
and a significant increase in the number of HCWs accessing HIV testing (OR:
1.55; CI: 1.2-2.1; p=0.003). In comparison to uptake of hepatitis B vaccination
(88% of those requiring vaccine) the uptake of PEP was low (4% of those who had
NSIs). In-depth interviews revealed this was due to HCWs fear of HIV testing
and their perception of NSIs as low risk. We concluded that Bio-safety remains
the most significant intervention through reducing the number of NSIs.
Post-exposure prophylaxis can be made readily available in a Kenyan district.
However, where HIV testing remains stigmatised uptake will be limited - particularly
in the initial phases of a programme
36. The L. Finding solutions to the human
resources for health crisis. The Lancet 2008; 371(9613):623.
ABSTRACT: Earlier this month, medical workers at Lira Hospital in northern
Uganda went on strike to demand unpaid allowances promised by the government
for working in this war-torn area. Seven patients died. There were reports of
bodies decomposing in wards and women in the maternity ward assisting with each
other's deliveries. This shocking situation serves as a stark reminder of the
reality of the human resources for health crisis in sub-Saharan Africa. It also
highlights the complexities of the crisis, where competing human rights,
health-care needs, and international agendas clash, and in which the poor and most
vulnerable suffer the most.
37. Wada K, Sakata Y, Fujino Y et al. The
Association of Needlestick Injury with Depressive Symptoms among First-year
Medical Residents in Japan. Ind Health 2008; 45(6):750-755.
ABSTRACT: Depressive symptoms among medical residents are common. The objective
of this study was to determine the association of depressive symptoms with
needlestick injury among first-year medical residents (so-called
"intern"). We conducted a prospective cohort study among 107 medical
residents in 14 training hospitals. The baseline survey was conducted in August
2005 and the follow-up survey was conducted in March 2006. Depressive symptoms
were based on the Center for Epidemiological Study of Depression. Factors
associated with depressive symptoms were examined using logistic regression
analysis. For medical residents without depressive symptoms at the baseline
survey, needlestick injury events were associated with depressive symptoms at
the follow-up survey (corrected odds ratio [cOR]=2.98; 95% confidence interval
[CI], 1.16-3.70). Because it was not possible to determine when the medical
residents developed depressive symptoms, it is not possible to definitely
determine causality between needlestick injury and depressive symptoms,
although these findings are suggestive. Therefore, it would seem prudent to
suggest the provision of mental health services to medical residents sustaining
a needlestick injury since this may be helpful in identifying and treating
depression
38. Whitby M, McLaws ML, Slater K. Needlestick
injuries in a major teaching hospital: the worthwhile effect of hospital-wide
replacement of conventional hollow-bore needles. Am J Infect Control 2008;
36(3):180-186.
ABSTRACT: BACKGROUND: Needlestick injury (NSI) with hollow-bore needles remains
a significant risk of bloodborne virus acquisition in health care workers. The
impact on NSI rates after substantial replacement of conventional hollow-bore
needles with the simultaneous introduction of safety-engineered devices (SEDs)
including retractable syringes, needle-free intravenous (IV) systems, and
safety winged butterfly needles was examined in an 800-bed Australian
university hospital. METHODS: NSIs were prospectively monitored for 2 years
(2005-2006) after the introduction of SEDs and compared with prospectively
collected preintervention NSI data (2000-2004). RESULTS: Preintervention
hollow-bore NSI rates over 10 years persisted at a constant rate between 3.01
and 3.77 per 100 full-time equivalent employees (FTE) (P = .31). Rates for 2005
(1.93; 95% CI: 1.48-2.47 per 100 FTE) and 2006 (1.50; 95% CI: 1.11-1.97 per 100
FTE) were significantly lower than the average rate for the preintervention
years (3.39; 95% CI: 2.7-4.24 per 100 FTE, P = .00004). This represents a fall
of 49% (43.1%-55.7%) in hollow-bore NSI, contributed to by the virtual
elimination of NSI related to accessing IV lines. More importantly, high-risk
injuries were also reduced 57% by retractable syringe use with an overall
budgetary increase of approximately US $90,000 per annum. CONCLUSION:
Introduction of SEDs results in an impressive fall in NSI with minimal cost
outlay
39. White SM. Needlestick injuries - a testing
time. Nurs Crit Care 2008; 13(1):1-2.
ABSTRACT: Critical care staff need to be aware of recent changes in the law.
Using the example of human immunodeficiency virus (HIV) and hepatitis screening
after needlestick injuries involving unconscious patients, this editorial will
examine the implications of the Human Tissue Act 2004 (HTA) and the Mental
Capacity Act 2005 (MCA) for critical care practice and explore potential
solutions to the problem.
In response to high-profile public concerns over unethical organ retention at
Alder Hey Hospital and the Bristol Royal Infirmary, the government introduced
the Human Tissue Bill that was enacted as the HTA in 2004 and enforced from 1
September 2006.
40. White SM. Needlestick injuries - a testing
time. Nurs Crit Care 2008; 13(1):1-2.
41. Wicker S, Jung J, Allwinn R, Gottschalk R,
Rabenau HF. Prevalence and prevention of needlestick injuries among health care
workers in a German university hospital. Int Arch Occup Environ Health 2008;
81(3):347-354.
ABSTRACT: OBJECTIVE: Health care workers (HCWs) are exposed to bloodborne
pathogens, especially hepatitis B (HBV), hepatitis C (HCV), and human
immunodeficiency virus (HIV) through job-related risk factors like needlestick,
stab, scratch, cut, or other bloody injuries. Needlestick injuries can be
prevented by safer devices. METHODS: The purpose of this study was to
investigate the frequency and causes of needlestick injuries in a German
university hospital. Data were obtained by an anonymous, self-reporting
questionnaire. We calculated the share of reported needlestick injuries, which
could have been prevented by using safety devices. RESULTS: 31.4% (n = 226) of
participant HCWs had sustained at least one needlestick injury in the last 12
months. A wide variation in the number of reported needlestick injuries was
evident across disciplines, ranging from 46.9% (n = 91/194) among medical staff
in surgery and 18.7% (n = 53/283) among HCWs in pediatrics. Of all occupational
groups, physicians have the highest risk to experience needlestick injuries
(55.1%-n = 129/234). Evaluating the kind of activity under which the
needlestick injury occurred, on average 34% (n = 191/561) of all needlestick
injuries could have been avoided by the use of safety devices. Taking all
medical disciplines and procedures into consideration, safety devices are
available for 35.1% (n = 197/561) of needlestick injuries sustained. However,
there was a significant difference across various medical disciplines in the
share of needlestick injuries which might have been avoidable: Pediatrics
(83.7%), gynecology (83.7%), anesthesia (59.3%), dermatology (33.3%), and surgery
(11.9%). In our study, only 13.2% (n = 74/561) of needlestick injuries could
have been prevented by organizational measures. CONCLUSION: There is a high
rate of needlestick injuries in the daily routine of a hospital. The rate of
such injuries depends on the medical discipline. Implementation of safety
devices will lead to an improvement in medical staff's health and safety
42. Rapid response lowers HIV needlestick
risk: Rural hospitals may not have PEP on stock. Hospital Employee Health 2007;
26(1):6-8.
ABSTRACT: AIDS has forever altered the way health care workers fiew the threat
of infectious disease. Although HCWs had
long been at risk of contracting tuberculosis, hepatitis B, and other serious
diseases, the AIDS epidemic in the 1980s brought a new level of fear -- and a
focous on the need for workplace protections.
43. Study: Gaps persist in HBV immunizations.
Hospital Employee Health 2007; 26(2):21-22.
ABSTRACT: About one in four health care workers who are offered the hepatitis B
vaccine decline to take it, according to a study by the Centers for Disease
Control and Prevention. Although the
occupational risk of acquiring hepatitis B has declined dramatically since the
1980s, health care workers still need to be vigilant about vaccinations, says
Ian Williams, PhD, MS, chief of the Epidemiologic Research and Field
Investigations Team in the Division of Viral Hepatitis at the CDC.
44. Computer-based training not up to OSHA
bloodborne pathogen standard: Program must allow for real-time Q&A. Hospital
Employee Health 2007; 26(3):25-27.
ABSTRACT:Technology has opened new avenues for health and safety training, but
it comes with a caveat: Computer-based modules may not meet the requirements of
the bloodborne pathogen standard.
The U.S. Occupational Safety and
Health Administration (OSHA) requires employers provide "direct access to
a qualified trainer during training," which can include e-mail only if the
trainer is available to respond to the e-mail immediately.
45. Nonhospital health-care workers at
substantial risk of exposure to bloodbornepathogens. 12-20-2007. Columbia University's Mailman
School of Public Health.
ABSTRACT: In one of the largest studies of its kind, researchers from the
Columbia University Mailman School of Public Health assessed the risk of
exposure to bloodborne pathogens among non-hospital based registered nurses
(RNs), and found that nearly one out of 10 of the more than 1100 nurse
participants reported at least one needlestick injury in the previous 12
months.
46. Hospital's liability affirmed over nurse's
needlestick injury. AIDS Policy & Law 2007; 22(12).
ABSTRACT: An appeals court affirmed a ruling that a nurse contracted HIV from a
needlestick injury that occurred four years before she tested positive for the
virus.
On June 30, 1994, Anglea Price was working as a certified nursing assistant for
Christus Health/St. Joseph Hospital.
While drawing blood from a patient with HIV who had developed AIDS,
Price accidently stuck her finger with a needle that she used on the patient. Price immediately reported the needlestick to
her supervisors and went to the hospital's emergency room. She tested negative for HIV on the date of
the incident.
47. Statement on sharps safety. Bull Am Coll
Surg 2007; 92(10):34-37.
ABSTRACT: Sharps injuries and surgical glove tears continue to expose surgeons
and operating room (OR) personnel to the risk of human immunodeficiency virus,
viral hepatitis B, viral hepatitis C, and bacterial infections from patients.
Patients' blood makes contact with the skin or mucous membranes of OR personnel
in as many as 50 percent of operations, with cuts or needlesticks occurring in
as many as 15 percent of operations. Surgeons and first assistants are at
highest risk for injury, sustaining up to 59 percent of the injuries in the
operating room. Scrub personnel have the second highest frequency of injuries
in the OR (19%), followed by anesthesiologists (6%) and circulating nurses
(6%). For surgeons, suture needles are the most frequent source of sharps
injuries.
48. Al-Dwairi ZN. Infection Control Procedures
in Commercial Dental Laboratories in Jordan. J Dent Educ 2007; 71(9):1223-1227.
ABSTRACT: The risk of cross-infection in dental clinics and laboratories has
attracted the attention of practitioners for the past few years, yet several
medical centers have discarded compliance with infection control guidelines,
resulting in a non-safe environment for research and medical care. In Jordan,
there is lack of known standard infection control programs that are conducted
by the Jordanian Dental Technology Association and routinely practiced in
commercial dental laboratories. The aim of this study was to examine the
knowledge and practices in infection control among dental technicians working
in commercial dental laboratories in Jordan. Data were collected from the
dental technicians by a mailed questionnaire developed by the author. The
questionnaire asked respondents to provide demographic data about age and
gender and to answer questions about their knowledge and practice of infection
control measures: use of gloves, use of protective eyeglasses and face shields,
hepatitis B virus (HBV) vaccination, laboratory work disinfection when sent to
or received from dental offices. and regularly changing pot water or pumice slurry.
Of the total respondents, 135 were males (67.5 percent) and sixty-five were
females (32.5 percent) with a mean age of twenty-seven years. The results
showed that 24 percent of laboratory technicians wore gloves when receiving
dental impressions, while 16 percent continued to wear them while working.
Eyeglasses and protective face shields were regularly worn by 35 percent
(70/200) and 40 percent (80/200) of technicians, respectively. Fourteen (14
percent) had received an HBV vaccination, and 17 percent inquired if any
disinfection measures were taken in the clinic. Eighty-six percent of the
technicians reported that pumice slurry and curing bath water were rarely
changed. Only five dental technicians (two males and three females) were
considered to be fully compliant with the inventory of infection control
measures, a compliance rate of 2.5 percent with no significant difference
between males and females (p>0.05). In conclusion, there is lack of
compliance with infection control procedures of dental technicians working in
commercial laboratories in Jordan
49. Allegranzi B, Pittet D.
Healthcare-associated infection in developing countries: simple solutions to
meet complex challenges. Infection Control & Hospital Epidemiology 2007;
28(12):1323-1327.
50. Allos BM, Schaffner W. Transmission of
hepatitis B in the health care setting: the elephant in the room ... or the
mouse? J Infect Dis 2007; 195(9):1245-1247.
ABSTRACT: Most infections with hepatitis B virus in the United States occur as
a result of specific high-risk behaviors. Most, but not all. Approximately 1.2
million people living in the United States have chronic hepatitis B virus
infection [1]. Each year, another 8000 acute infections-mostly in adults-are
reported to the Centers for Disease Control and Prevention (CDC) [1]. Many of
these infections are the result of sexual activity (both heterosexual and
homosexual) or intravenous drug use; however, up to one-third report no risk
factors for infection [2]. Although it is likely that a large number of these
risk-deniers simply are unwilling to acknowledge behaviors they may view as
socially stigmatizing, it also is possible that some have acquired their
hepatitis B infection in nonclassical ways. The blunt epidemiologic tools used
in recent decades to assess risks of transmission have been important and
useful. Nevertheless, finer implements may be needed to tease out smaller but
perhaps substantial risk factors.
51. American Nurses Association. Medication
errors and syringe safety are top concerns for nurses according to new national
study. New Jersey Nurse 2007; 37(4):4-5.
ABSTRACT: SILVER SPRING, MD - June 19, 2007 --The American Nurses Association
(ANA) today announced the findings of the 2007 Study of Injectable Medication
Errors, an independent nationwide survey of 1,039 nurses. According to the research, the overwhelming
majority of nurses (97 percent) say they "worry" about medication
errors, and more than two-thirds (68 percent) believe medication errors can be
reduced with more consistent syringe labeling.
52. Argentero PA, Zotti CM, Abbona F et al.
[Regional surveillance of occupational percutaneous and mucocutaneous exposure
to blood-borne pathogens in health care workers: strategies for prevention].
[Italian]. Medicina del Lavoro 2007; 98(2):145-155.
ABSTRACT: BACKGROUND: Several studies have investigated both the frequency and
modality of occurrence of occupational exposure of health-care workers to
blood-borne pathogens. At the moment no complete epidemiological data are
available covering the hospitals of an entire Region. OBJECTIVES ANd METHODS:
To describe the characteristics of mucocutaneous and percutaneous exposure to
body fluids of the healthcare workers in 47 out of the 56 public hospitals (90%
of a total 15,000 beds, 28,000 health-care workers full time equivalent) in
Piedmont, Northern Italy (4.5 million inhabitants) over a three-year period
(1999-2002), using SIROH (Studio Italiano Rischio Occupazionale da HIV) model
to collect the data. RESULTS AND CONCLUSIONS: 5174 percutaneous injuries
(12.7/100 beds) and 1724 mucocutaneous exposure (4.1/100 beds) were recorded.
Surveillance data were similar to those collected in other multi-hospital
studies. The variability of rates between hospitals was high, most likely due
to the amount of underreporting. The categories most at risk of percutaneous
and mucocutaneous exposure were, respectively, surgeons (9.3/100 surgeons) and
midwives (2.9/100 midwives). Needles (syringe, winged steel, suture) were the
medical devices most frequently involved in percutaneous injuries, 60% of which
occurred after the use of such devices. Eighty-three per cent of healthcare
workers had been HBV-vaccinated versus only 45% of cleaning staff. After
percutaneous injuries with exposure to an HIV positive source only 40% of those
exposed received post-exposure prophylaxis; in the case of mucocutaneous
exposure the rate was 11%. We recorded 2 seroconversions following occupational
exposure to an HCV positive source (risk of seroconversion: 0,2%). In order to
implement preventive programmes the use of safety devices, an increase in the
number of HBV-vaccinated contract workers, the use of chemoprophylaxis for HIV
exposure, and the use of protective equipment are deemed necessary
53. Arora A, Hakim I, Baxter J et al.
Needle-free delivery of macromolecules across the skin by nanoliter-volume
pulsed microjets. Proc Natl Acad Sci U S A 2007; 104(11):4255-4260.
ABSTRACT: Needle-free liquid jet injectors were invented >50 years ago for
the delivery of proteins and vaccines. Despite their long history, needle-free
liquid jet injectors are not commonly used as a result of frequent pain and
bruising. We hypothesized that pain and bruising originate from the deep
penetration of the jets and can potentially be addressed by minimizing the
penetration depth of jets into the skin. However, current jet injectors are not
designed to maintain shallow dermal penetration depths. Using a new strategy of
jet injection, pulsed microjets, we report on delivery of protein drugs into
the skin without deep penetration. The high velocity (v >100 m/s) of
microjets allows their entry into the skin, whereas the small jet diameters
(50-100 mum) and extremely small volumes (2-15 nanoliters) limit the
penetration depth ( approximately 200 mum). In vitro experiments confirmed
quantitative delivery of molecules into human skin and in vivo experiments with
rats confirmed the ability of pulsed microjets to deliver therapeutic doses of
insulin across the skin. Pulsed microjet injectors could be used to deliver
drugs for local as well as systemic applications without using needles
54. Askarian M, Memish ZA,