International Healthcare Worker Safety Center

Bibliography

Latest update: February 1, 2006

(1) Surveillance of significant occupational exposure to bloodborne viruses in healthcare workers: 1 July 1996 to 30 June 2004. Communicable Disease Report 2005; 15(4):3-4.
ABSTRACT: The Health Protection Agency's Centre for Infections (CFI) has this week published Eye of the Needle, the latest report from the surveillance of significant occupational exposure to bloodborne viruses (BBVs) in healthcare workers (HCWs) (1). This report includes significant occupational exposure incidents reported to the CFI between 1 July 1996 and 30 June 2004 from reporting centres. There are currently 150 reporting centres scattered throughout England, Wales, and Northern Ireland.

(2) Anonymous. OR becomes last frontier for move to sharps safety. Hospital Employee Health 2005; 24(12):149-155.
ABSTRACT: ACS endorses blunt needles, spurring change. American operating rooms may finally be ready to move toward sharps safety. The American College of Surgeons (ACS) has endorsed the use of blunt suture needles and is poised to begin an educational push to reduce one of the most persistent remaining causes of sharps injuries. While sharps injuries have declined overall by about one-third, suturing injuries have remained stable.

(3) Association of periOperative Registered Nurses. AORN guidance statement: sharps injury prevention in the perioperative setting. AORN Journal 2005; 81(3):662-666.
ABSTRACT: Occupational exposure to bloodborne pathogens via percutaneous injuries is one of the most serious dangers perioperative team members face on a daily basis. The risk of sustaining a percutaneous injury can be decreased through employee education, clear communication, device engineering, and focused work practice controls. Risk reduction strategies should include specific practices aimed at reducing the unique risks of percutaneous injuries encountered in the perioperative environment. AORN recognizes the various settings in which perioperative RNs practice, and the suggested risk reduction strategies in this guidance statement are intended to be adaptable to any setting where surgical or other invasive procedures are performed

(4) Dix K. Best Practices for Purchasing Managers. Infection Control Today 2005; 9(7):34-38.
ABSTRACT: Purchasing managers for the healthcare community face a unique challenge--obtaining the best vales possible for the healthcare facility while ensuring that patient safety and infection control issues are kept at the forefront.

(5) Ellis K. Sharp Thinking: The Role of Technology and Education in Promoting Sharps Safety. Infection Control Today 2005; 9(7):20-24.
ABSTRACT: Infection control practitioners (ICPs) are intimately aware of the potential danger to healthcare workers (HCWs) posed by bloodborne pathogens via accidental needlestick accidental injuries. While the exact prevalence of such injuries is unknown, the National Institute for Occupational Safety and Health (NIOSH) estimates put the number somewhere between 600,000 and 800,000 per year. Furthermore, about half of these are not reported. Other studies actively seeking to monitor the rate of needlestick injuries have reported as many as 839 injuries per 1,000 HCWs. The cost that facilities must absorb to manage these injuries is significant, and can become catastrophic if the injury results in the acquisition of an infectious disease.

(6) Fry DE. Occupational blood-borne diseases in surgery. [Review] [25 refs]. American Journal of Surgery 2005; 190(2):249-254.
ABSTRACT: BACKGROUND: Human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) infections are transmitted by blood exposure. Surgeons have been concerned about the risks of blood exposure in the operating room as a potential source of occupational infections from these viruses. The actual risk and frequency of operating room transmission remains poorly understood by many surgeons. METHODS: The pertinent recent literature on the pathophysiology, diagnosis, prevention, and treatment of HIV, HBV and HCV were reviewed to address the current understanding of these viruses as occupational risks to surgeons. RESULTS: HIV transmission to surgeons has not been documented in the United States by the Centers for Disease Control. HIV transmission from a surgeon to a patient in the environment of the operating room, as well as transmission from an HIV-infected surgeon to a patient, has not been documented. HBV infection of surgeons has declined with the general acceptance of the HBV vaccine. HCV infection remains a real risk for transmission in the operating room, given that no vaccine is currently available and that the overall number of chronically infected patients remains quite high. CONCLUSION: The risk of occupational infection from known viral pathogens for surgeons is low, but it is not zero. Effective barriers, modified patterns of behavior, and prompt responses to blood exposure events are the best methods for prevention. [References: 25]

(7) Health Protection Agency Centre for Infections, National Public Service for Wales, CDSC Northern Ireland. Eye of the Needle. Surveillance of Significant Occupational Exposure to Bloodborne Viruses in Healthcare Workers. Seven-year report. 2005.
Ref Type: Report
ABSTRACT: This report includes significant occupational exposure incidents reported to the HPA between 1st July 1996 and 30th June 2004 from reporting centres, currently 150, geographically scattered throughout England and four actively reporting centres in Wales and one actively reporting entre in Belfast in Northern Ireland.

(8) Hogan A. Gaps and successes of safety device market conversion. Materials Management in Health Care 2005;(November 2005).
ABSTRACT: Technology and the engineering of safety devices has increased since the promulgation of the Bloodborne Pathogens Standard (BPS) (29 CFR 1910.1030) in 1991.
As a result, OSHA revised its enforcement procedures in 1999 (CPL 02-02-069) to include guidance for its compliance safety and health officers to begin citing health care employers for failure to use safety devices where their use is feasible and effective.
The Needlestick Safety and Prevention Act (NSPA), passed unanimously by Congress in 2000, further amplified the need for safety device adoption and use.

(9) Hopkins S. Safety and the 'Stick'. Advance/Laboratory 2005; 14(6):30-42.
ABSTRACT: In March 2000, the CDC estimated that more than 380,000 percutaneous injuries from contaminated sharps occur annually among healthcare workers in the United States. Estimates also indicate that 600,000-800,000 work-related needlestick injuries occur annuall in the United States--about half of which go unreported. And at an avaerage hospital, workers incur approximately 30 reported needlestick injuries per 100 beds per year. Thus, it's extremely important that healthcare workers are aware of how these injuries occur, how to prevent them and what to do in case of injury.

(10) Libois A, Fumero E, Castro P, Nomdedeu M, Cruceta A, Gatell JM et al. Transmission of hepatitis C virus by discarded-needle injury. Clinical Infectious Diseases 2005; 41(1):129-130.
ABSTRACT: SIR -- The transmission of virus infection by percutaneous injuries from needles discarded in public settings is assumed to be biologically possible but has remained unproven. To date, no reports have been published of cases in which this route of virus transmission may have occurred [1]. We report clearly documented hepatitis C virus (HCV) seroconversion that occurred after an injury that involved a discarded needle.

(11) McCormick R. The No-Hands Technique for Sharps. Outpatient Surgery Magazine 2005; VII(7):75-76.
ABSTRACT: One of our nurses was injured by a sharp during a procedure on an HIV-positive patient about 15 years ago. The injury didn't result in a bloodborne pathogen, but it did raise concern about sharps handling. To put a positive spin on a potentially negative situation, we developed rules for the handling of sharps devices, including their passing in the OR. Here's what we did, and how you can enhance sharps safety in your facility.

(12) Panlilio AL, Cardo DM, Grohskopf LA, Heneine W, Ross CS, U.S.Public Health Service. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. Morbidity & Mortality Weekly Report 2005; Recommendations & Reports. 54(RR-9):1-17.
ABSTRACT: This report updates U.S. Public Health Service recommendations for the management of health-care personnel (HCP) who have occupational exposure to blood and other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens have been changed. This report emphasizes adherence to HIV PEP when it is indicated for an exposure, expert consultation in management of exposures, follow-up of exposed workers to improve adherence to PEP, and monitoring for adverse events, including seroconversion. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns

(13) Perry J, Jagger J. Cutting sharps risks in ICUs and CCUs. Nursing 2005; 35(8):17.
ABSTRACT: With many crisis situations, fast-paced ICUs and CCus place nurses at high risk for exposure to bloodborne pathogens. Nurses in these units often perform high-intensity therapies and rapid interventions. Critically ill patients need more procedures and blood tests, so nurses use more sharps. In addition, some invasive and diagnostic procedures, such as thoracentesis, are more commonly performed in ICUs than inother patient units.

(14) Perry J, Jagger J. Slash sharps risk for surgical personnel. Nursing 2005; 35(11 Suppl):28-29.
ABSTRACT: Injury patterns for OR staff members differ from those in other healthcare settings. For this reason, tailor safety strategies to the OR environment to reduce injuries and blood exposures in this setting.

(15) Perry J, Jagger J. Pass with care in the OR. Nursing2005 2005; 35(2):70.
ABSTRACT: Surgical personnel have unique injury patterns and n eed specific strategies tailored to the OR to reduce sharps injuries and potential blood exposures. An additional challenge for nurses is the fact that although nurses are more likely than surgeons to be injured, surgeons choose which devices to use. Nurses must speak up and call for safer devices and procedures whenever they are available.

(16) Perry J, Jagger J. FAQs about implementing safety devices. Nursing 2005; 35(10):74-76.
ABSTRACT: Questions are bound to come up as facilities work to comply with standards on needle-stick safety from the Occupational Safety and Health Administration (OSHA). Here are several frequently asked questions (FAQs) and our answers.

(17) Perry J, Jagger J. Sharps safety update: "Are we there yet?". Nursing 2005; July 2005:17.
ABSTRACT: More than 4 years have passed since the Needlestick Safety and Prevention Act became law. The revised Bloodborne Pathogens Standard, issued by the Occupational Safety and Health Administration (OSHA), emphasizes using safety-engineered devices to reduce health care workers' risk of needle-stick injuries. Here, we'll update you on recent progress and highlight areas that need improvement.

(18) Perry J. How to Handle a Bleeding Surgeon. Outpatient Surgery Magazine 2005; February 2005:82-84.
ABSTRACT: OR workers have to mentally multitask when sharps are in use, focusing simultaneously on patient and worker safety. The human tendency is to devise a pecking order, and most often, patient safety comes first. Even if there is unexpected bleeding during a procedure, and speed becomes a factor, patient safety is still at the fore, right? This is by no means wrong — it's just that you must give worker safety nearly as much attention. An orthopedic surgeon is performing a lengthy hip replacement case. Working in the patient's open body cavity, where visualization is difficult, he uses his fingertips to guide the suture needle tip as he places the bone pins. A sharp pain in his finger tells him he's been stuck by the needle. Withdrawing his hand, he sees both layers of his glove are torn and blood dripping from the wound. He reports the needlestick to the OR administrator, and asks: What's our procedure for reporting potential exposures to patients? Good question. What's yours?

(19) Pruss-Ustun A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. American Journal of Industrial Medicine 2005; 48(6):482-490.
ABSTRACT: BACKGROUND: The global burden of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infection due to percutaneous injuries among health care workers (HCWs) is estimated. METHODS: The incidence of infections attributable to percutaneous injuries in 14 geographical regions on the basis of the probability of injury, the prevalence of infection, the susceptibility of the worker, and the percutaneous transmission potential are modeled. The model also provides the attributable fractions of infection in HCWs. RESULTS: Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIV infections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries. The fraction of infections with HCV, HBV, and HIV in HCWs attributable to occupational exposure to percutaneous injuries fraction reaches 39%, 37%, and 4.4% respectively. CONCLUSIONS: Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs). These infections are highly preventable and should be eliminated. Am. J. Ind. Med. 48:482-490, 2005. (c) 2005 Wiley-Liss, Inc

(20) Pyrek K. Risky Business Occupational Hazards & the Healthcare Worker. Infection Control Today 2005; 9(9):26-34.
ABSTRACT: While hospitals are designed to be places of treatment and healing for patients, they present a significant number of occupational hazards to healthcare workers (HCWs).
A survey of registered nurses by the American Nurses Association revealed that stress/overwork, disabling back injuries, and contracting a bloodborne disease were the top three health and safety concerns.

(21) Schraag J. Avoiding the Point: Sharps Safety Best Practices for HCWs. Infection Control Today 2005; 9(9):36-41.
ABSTRACT: Sharps safety goes beyond the infection control (IC) team, encircling every aspect of today's healthcare systems. Reducing the risks presented by occupational exposure begins with awareness, proper compliance, education, and special care in handling and disposal of sharps.

(22) Silverman R. Assess your sharps injury prevention program. Mlo: Medical Laboratory Observer 2005; 37(4):20-21.
ABSTRACT: Sharps injury prevention programs are intended to reduce the risks associated with the use of needles and other sharps.

(23) Stoker R. Sharps Safety in the Laboratory. Advance/Laboratory 2005; 14(11):77.
ABSTRACT: Barbara was a lab tech who worked the graveyard shift. Her job included drawing blood and testing blood and urine samples in the hospital laboratory. On one occasion she was called tao the emergency room in the morning to draw blood on an HIV-positive drug abuser. As Barbara was attempting to draw the addict's blood, the individual became violent, jerking her arm around after the needle was already in her vein. The needle pulled out and stabbed deep into Barbara's left thumb.
Unfortunately, this story is true. Barbara soon seroconverted to HIV and later gave birth to a beautiful daughter who was HIV positive as well. This type of needlestick injury could have been prevented with the right safety equipment. Working in a labratory can be dangerous, with some hospitals reporting that one-third of nursing and laboratory staff suffer needlestick and other sharps injuries each year.

(24) Tuboku-Metzger J, Chiarello L, Sinkowitz-Cochran RL, Casano-Dickerson A, Cardo D. Public attitudes and opinions toward physicians and dentists infected with bloodborne viruses: results of a national survey. Am J Infect Control 2005; 33(5):299-303.
ABSTRACT: BACKGROUND: There has been no recent assessment of public attitudes and opinions concerning risk of bloodborne virus transmission during health care. METHODS: Seven items in the 2000 annual Healthstyles survey were used to assess current attitudes and opinions about health care providers infected with human immunodeficiency virus (HIV) and the risk of bloodborne virus transmission during health care in a sample of approximately 3000 US households. RESULTS: Of the 2353 respondents, 89% agreed that they want to know whether their doctor or dentist is infected with HIV; 82% agreed that disclosure of HBV or HCV infection in a provider should be mandatory. However, 47% did not believe that HIV-infected doctors were more likely to infect patients than doctors infected with HBV or HCV. Opinions were divided on whether HIV-infected providers should be able to care for patients as long as they use good infection control: only 38% thought that infected providers should be allowed to provide patient care. CONCLUSIONS: These findings suggest that improved public education and risk communication on health care-associated bloodborne infections is needed

(25) Weiss ES, Makary MA, Wang T, Syin D, Pronovost PJ, Chang D et al. Prevalence of blood-borne pathogens in an urban, university-based general surgical practice. Annals of Surgery 2005; 241(5):803-807.
ABSTRACT: OBJECTIVE: To measure the current prevalence of blood-borne pathogens in an urban, university-based, general surgical practice. SUMMARY BACKGROUND DATA: Human immunodeficiency virus (HIV), hepatitis B, and hepatitis C represent significant occupational hazards to the surgeon. While the incidence of these blood-borne pathogens is increasing in the general population, little is known about the current prevalence of these exposures among patients presenting for surgery. METHODS: We studied 709 consecutive operative cases (July 2003 to June 2004) in a university practice that provides all inpatient, emergency department, and outpatient consultative general surgical services. Trauma cases and bedside procedures were excluded. Data collected included HIV, hepatitis B and C test results, type of operation, age, sex, and history of intravenous drug use. RESULTS: Testing for blood-borne pathogens was performed in 53% (N = 373) of 709 patients based on abnormal liver function tests, neutropenia, history of IV drug use, or patient request. Thirty-eight percent of all operations (142/373) were found to involve a blood-borne pathogen when tested: HIV (26%), hepatitis B (4%), hepatitis C (35%), and coinfection with HIV and hepatitis C (17%). Forty-seven percent of men tested positive for at least 1 blood-borne pathogen. Seventy-three different types of operations were performed, ranging from Whipple procedures to amputations. Soft-tissue abscess procedures 48% (34/71) and lymph node biopsies 67% (10/15) (P < 0.01) were most often associated with blood-borne pathogens. Infections were more common among men (P < 0.01), patients 41 to 50 years of age (P < 0.01), and patients with a history of intravenous drug use (P < 0.01). CONCLUSIONS: HIV and hepatitis C infections are common in an urban university general surgical practice, while hepatitis B is less common. In addition, certain operations are associated with significantly increased exposure rates. Given the high incidence of these infections, strategies such as sharpless surgical techniques should be evaluated and implemented to protect surgeons from blood-borne pathogens

(26) Intensive OSHA inspection produces citations, fines. Hospital Employee Health 2004; 23(3):39.
ABSTRACT: A wall-to-wall, comprehensive Occupational Safety and Health Administration (OSHA) inspection resulted in 41 alleged health and safety violations and $91,500 in fines for New Britain (CT) General Hospital.

(27) Safety needles lead price hikes. Hospital Materials Management 2004; 29(2):1-4.
ABSTRACT: Syringes and needle prices will rise in the coming year, ending a stable period marked by large group contracts and vendor consolidation.
How much will prices rise? That depends on whether and to what extent a hospital elects to convert to newer, more expensive safety devices

(28) Medicare bill closes needle safety gap. Hospital Employee Health 2004; 23(2):25-27.
ABSTRACT: A small section in the massive new Medicare law brings all hospitals into compliance with the bloodborne pathogens standard. State and local hospitals now will be subject to the same provisions--including the involvement of frontline health care workers--as other hospitals that fall under the purview of the U.S. Occupational Safety and Health Administration (OSHA).

(29) How do you counsel law enforcement officers on bodily fluid exposures? Journal of Occupational & Environmental Medicine 2004; 46(5):510-513.
ABSTRACT: Exposure to bloodborne pathogens (BBP) remains an important occupational problem for many occupations, law enforcement officers included among them. The risk for infection with bloodborne pathogens is disproportionately high in law enforcement officers because the groups with which they come in contact, suspects and inmates in U.S. jails and prisons, have high rates of preincarceration intravenous (IV) drug use. Indeed, the rate of IV drug use among inmates is 25% to 40% compared with 0.6% in the general population. This results in high rates of infection with blood-borne pathogens such as hepatitis B (HBV) and hepatitis C (HCV) and human immunodeficiency virus (HIV). The rates of HBV serologic markers range from 19% to 47% in inmates versus 5% in the general population, and the prevalence of HCV infection in inmates is reported to range from 15% to 38% versus 1% to 2% in healthcare workers (HCWs) and 0.05% to 1.5% in the general population. The sero-prevalence of HIV in prisons depends on the region of the country. Rates vary from 0% in Iowa to 27% in New York City. The number of confirmed AIDS cases in state and federal prisons is approximately 54 per 10,000 inmates compared with 9 per 10,000 persons in the nonincarcerated U.S. population. The rates of HIV infection among female inmates are higher than that for males. Law enforcement personnel have varying levels of risk depending on the likelihood of direct contact with high-risk individuals and the geographic region

(30) Needlestick injury. HIV-related emotional distress is compensable. AIDS Policy & Law 2004; 19(7):3.
ABSTRACT: BODY:
Case name: Galland, et al. v. Meridia Health System Inc., No. C.A. 21763 (Ohio Ct. App. 03/24/04).
Ruling: An order of summary judgment in favor of a hospital was reversed in the case of a 5-year-old's possible exposure to HIV.
What it means: Possible exposure to the HIV virus coupled with a physical injury made a claim of emotional distress due to exposure to HIV compensable, an Ohio appeals court said.

(31) Behrman AJ, Allan DA. Occupational exposure to bloodborne pathogens.[see comment][comment]. Annals of Internal Medicine 2004; 140(6):492.
ABSTRACT: TO THE EDITOR: Dr. Seibert's painful story of occupational HIV exposure (1) should resonate with all clinicians. In our program, which serves 2 teaching hospitals, we have evaluated more than 5000 employees with body fluid exposures since 1988, using Centers for Disease Control and Prevention guidelines (2). Specific measures we have found useful to minimize health care worker anxiety and facilitate postexposure prophylaxis include 1) orienting hospital staff to report body fluid exposures immediately to the occupational medicine clinic or the emergency department, 2) implementing triage protocols to minimize waiting times, 3) providing 24-hour consult coverage of occupational medicine by experienced physicians, 4) offering confidential HIV testing for health care workers through the occupational medicine clinic, 5) providing "starter packs" of antiretroviral agents to minimize treatment delays, 6) using individualized follow-up to rapidly provide health care workers with laboratory results on their source patients and themselves, 7) monitoring health care workers for side effects during and after postexposure prophylaxis, and 8) facilitating confidential follow-up testing for HIV and hepatitis virus infection if indicated.
These interventions, along with accurate assessment of risk magnitude, timely source-patient testing, and appropriate consultation for questions of HIV drug resistance, have increased health care workers' willingness to seek evaluation and treatment immediately after exposures. Definitive postexposure prophylaxis, if needed, is generally begun within 2 hours of exposure. The anxiety and risk associated with body fluid exposures can be decreased by accessing a hospital's dedicated treatment program.

(32) Berguer R, Heller PJ. Preventing sharps injuries in the operating room. Journal of the American College of Surgeons 2004; 199(3):462-467.
ABSTRACT: In the past, percutaneous injuries and mucocutaneous exposures were considered to be an accepted occupational hazard for the surgeon. Although the potential for injury, exposure, and contraction of blood-borne disease was well known, there were no attempts to reduce risk of such events. When the human immunodeficiency virus was described in 1981 we began to pay greater attention to health care worker safety in the operating room. In 1983 the Centers for Disease Control and Prevention (CDC) recommended "caution" when handling body fluids from patients suspected of having AIDS. Initially HIV and AIDS were considered to be rare and confined to particular groups at high risk. This inaccurate notion changed rapidly as the disease reached epidemic proportions, and by 1987 the CDC recommended "Universal Precautions,"[1] which state that blood and body fluid precautions be used with all patients. It was at this time that the CDC made their first recommendations for use of appropriate barrier protection and against resheathing contaminated needles. In 1991 The Occupational Safety and Health Administration required use of Universal Precautions with the enactment of the Bloodborne Pathogen Standard. [2] This standard has been revised and updated several times, most recently in 2001. [3] Although discovery of AIDS and HIV was the driving force behind development of Universal Precautions, it is widely appreciated that many serious illnesses can be contracted through contact with contaminated blood and body fluids. Unfortunately the published literature indicates that surgeons demonstrate poor compliance with Universal Precautions. [4] Perhaps even more unfortunate is the failure of Universal Precautions and the Bloodborne Pathogen Standard to fully address the needs of the high-risk operating room environment. Injuries to surgeons and scrub personnel continue to occur.

(33) Berry AJ. Needle stick and other safety issues. [Review] [59 refs]. Anesthesiology Clinics of North America 2004; 22(3):493-508.
ABSTRACT: Percutaneous injuries such as accidental needle sticks are associated with the greatest risk for occupational transmission of blood-borne pathogens such as hepatitis B and C viruses and HIV. This article presents data on the risk of transmission of these viruses after needle sticks, offers strategies for prevention of injuries from sharp objects, and discusses postexposure prophylaxis recommendations. [References: 59]

(34) Forns X, Martinez-Bauer E, Feliu A, Garcia-Retorillo M, Martin M, Gay E et al. Nosocomial Transmission of HCV in the Liver Unit of a Tertiary Care Center. Hepatology 2004; 41(1):115-122.
ABSTRACT: Despite its medical and legal implications, there are no prospective studies analyzing the incidence and mechanisms involved in the nosocomial transmission of hepatitis C virus (HCV) in liver units. This study prospectively investigates the nosocomial transmission of HCV in the liver unit of a tertiary care center from August 2000 to October 2002. The median prevalence of HCV infection among hospitalized patients was 50%. Anti-HCV- negative patients admitted to the liver unit during the study period were prospectively followed, and serum markers of HCV infection were repeated 6 months after discharge. All known risk factors for HCV transmission (including the physical allocation of HCV-infected and noninfected patients during hospitalization) were recorded. Complete follow- up data were available in 1,301 (84.5%) of 1,540 patients. Six patients (0.46%) acquired HCV infection (annual incidence: 0.27/100 admissions). Phylogenetic analyses of recovered HCV sequences identified the source of infection as an HCV- infected roommate (3 cases) and a patient receiving care by the same nurse team (1 case). The most relevant risk factors associated with HCV acquisition were duration of hospitalization (> 10 days; OR, 35; 95% CI, 1.96-622) and hospitalization with an HCV-infected roommate (>5 days; OR, 12; 95% CI, 1.39-103). In fact, HCV infection occurred in 1.7% of the 357 patients hospitalized longer than 10 days. In conclusion, HCV nosocomial infection appears to occur via patient-to- patient transmission in liver units, particularly in individuals who require long hospitalizations. Continuous reinforcement of universal prevention measures and, when possible, isolation of patients at higher risk might further reduce nosocomial HCV transmission.

(35) Gorman C. Wash Those Hands! Time 2004;81.
ABSTRACT: Nearly 10% of Americans who are admitted to a hospital pick up an infection while they are there. Sometimes the culprit is a germ that they've brought with them to the hospital--typically some bacteria on the skin that follow the path of a needle or catheter into the body. But most hospital infections are transmitted from one patient to another by doctors, nurses and other health-care workers. No, doctors and nurses aren't carrying vials of disease-causing bugs and cracking them open at bedside. Often the germs are hitching a ride on the hands of hospital workers.

(36) Gray J. Blunting sharps injuries. Nursing Standard 2004; 19(3):3.
ABSTRACT: Needlestick injuries rank alongside back injury as a daily danger for nurses. The number of healthcare workers infected with hepatitis C in the course of their work leapt to six in 2003, compared to three in the previous five years--all contracted through needlestick injuries.

(37) Hernandez Navarrete MJ, Campins MM, Martinez Sanchez EV, Ramos PF, Garcia dC, I, Arribas Llorente JL et al. [Occupational exposures to blood and biological material in healthcare workers. EPINETAC Project 1996-2000]. [Spanish]. Medicina Clinica 2004; 122(3):81-86.
ABSTRACT: BACKGROUND AND OBJECTIVE: The bloodborne injury is the most frequent risk in healthcare workers. Among them, the hollow-bore needlesticks are the most associated with the risk of acquire a bloodborne infection. In this study, occupational percutaneous injuries and risk factors associated to hollow-bore needlesticks registered in a national multicenter surveillance system are described. PATIENTS AND METHOD: Prospective and analytical study of percutaneous injuries registered in the surveillance system EPINETAC (Exposure Prevention Information Network) in Spain between 1996-200. A descriptive analysis of the variables related to the exposed healthcare worker, the exposure and their mechanism and the source patient is performed. The incidence rates were calculated by 100 occupied beds and by job category. A multivariable analysis is performed in order to know the risk factors most associated to hollow-bore needle. RESULTS: 16,374 percutaneous injuries has been registered, which 87% are hollow-bore needlesticks. The incidence rate has been 11.8 expositions per 100 occupied beds. Midwives are the most risky workers (9 injuries per 100 occupied beds). The risk factors most associated to hollow-bore needlesticks are the following: job category of midwife (OR = 7.5 95% CI, 4.1-13.7) and student nurse (OR = 2.1; 95% CI, 1.2-3.7), recapping (OR = 28.8; 95% CI, 16.5-50.6), working in venipuncture room (OR = 3.3; 95% CI, 1.2-9.5) or in the dialysis unit (OR = 2.5; 95% CI, 1.4-4.3). CONCLUSIONS: The incidence of occupational percutaneous injuries in Spain is similar to those described in other countries using comparable surveillance systems. The risk of hollow-bore needlestick is directly related to job category, work experience, work area and the activities that the healthcare worker does

(38) Kuroiwa C, Suzuki A, Yamaji Y, Miyoshi M. Hidden reality on the introduction of auto-disable syringes in developing countries. Southeast Asian Journal of Tropical Medicine & Public Health 2004; 35(4):1019-1023.
ABSTRACT: With the growing concerns about the risk of unsafe injections (e.g. unsterilized injection practices), WHO, UNICEF and UNFPA decided to introduce the auto-disable (AD) syringe for immunization in the world. The AD syringe is designed to be automatically locked after a single use, hence no chance of reuse. Consequently, the risk of infection can be reduced for the recipient. On the other hand, the management of increased medical waste is becoming difficult, as the waste volume of AD syringes would be 200 times as much as those of sterilizable syringes. The used and improperly disposed AD syringes could be a huge source of blood-borne infections and environmental pollution at the community level. This study attempted to explore the present situation with regard to the introduction of AD syringes for immunization in Lao PDR. We conclude that reviewing the present 'safe injection' policy is urgently required in Lao PDR, as well as in other developing countries where the disposal system for medical wastes is not yet well established

(39) Lee J, Botteman M, Nicklasson L. A Systematic Review of the Economic and Humanistic Burden of Needlestick Injury in the United States. American Journal of Infection Control 32[3], E43. 2004.
Ref Type: ABSTRACT
ABSTRACT: OBJECTIVE: Despite safety precaution legislation, needlestick injuries (NI) continue to occur among hospital workers (HW). Prospective studies suggest the incidence of NIs may be as high as 839 per 1000 HWs per year, significantly higher than that reported through passive surveillance. We reviewed the economic and humanistic burden of NIs to inform policymakers of the need for and value of interventions aimed at reducing that burden.
METHODS: We conducted a systematic literature synthesis on the economic and humanistic burden of NIs in the United States from 1990 to 2003.
RESULTS: Twelve formal economic studies reporting the cost of NIs were identified. Depending on methodology and infection control protocol, the medical costs of a NI range from $51 to $3,766. These figures exclude the cost of expensive long-term complications (e.g., HIV, hepatitis), work time lost from seeking and receiving care, and legal liability. In addition, HWs experience significant fear, anxiety, and emotional distress following a NI, at times resulting in occupational and behavioral changes. In contrast, the cost to prevent a NI using safety devices ranges from $1,186 to $2,571. This is consistent with estimates of what HWs and society are willing to pay to avoid sharps injuries.
CONCLUSIONS: A NI carries significant economic and humanistic costs. While preventing NIs requires investments in safer technologies, it is economically warranted, especially when considered within the context of other commonly accepted injury-prevention interventions. Continued efforts should be pursued to decrease the incidence of NIs, especially among those at higher risk of serious injury

(40) Marini MA, Giangregorio M, Kraskinski JC. Complying with the Occupational Safety and Health Administration's Bloodborne Pathogens Standard: implementing needleless systems and intravenous safety devices. [Review] [12 refs]. Pediatric Emergency Care 2004; 20(3):209-214.
ABSTRACT: Preventing the transmission of bloodborne pathogens to healthcare workers has been a mission and a challenge of the healthcare industry for over 20 years. The development of the Occupational Safety and Health Administration Bloodborne Pathogens Standard in 1991 and the passing of the Needlestick Safety Act in 2000 mandated hospitals to develop an Exposure Control Plan to protect workers from these pathogens. Children's Hospital Boston began implementation of a needleless system in 1993. Employees readily accepted these systems into practice, because they were convenient and easy to use. A marked decrease in exposures to bloodborne pathogens naturally followed, which is consistent with the national data.The transition to intravenous (i.v.) safety devices at Children's Hospital began in 2000 and proved to be more of a challenge. First, the clinicians must choose a safety product, which requires developing and implementing a trial plan with potential catheters. This selection process is especially difficult in pediatrics where successful placement of the smallest-gauge catheter, no. 24, is imperative. After choosing an i.v. safety product, successful transition is dependent upon the thoroughness of i.v. safety device training and a commitment by the clinicians to the use of these products. Although the number of needlestick injuries and subsequent transmission of bloodborne pathogens have been further reduced with the use of i.v. safety devices, needlestick injuries still occur. This results from a lack of familiarity with the engineering of the device and therefore poor technique or a failure to activate the safety mechanism. Staff resistance due to loss of expertise with the new device and patient care concerns are additional barriers to the use of these new products. Addressing these obstacles and providing adequate training for all clinicians were required for successful implementation of these i.v. safety devices. [References: 12]

(41) Matthews MS, Plastic Surgery Educational Foundation DATA Committee. Safer sharps. Plastic & Reconstructive Surgery 2004; 113(2):747-749.
ABSTRACT: The dangers of disease transmission from bodily fluids through exposure to needlestick and other sharps injuries are well known. The Centers for Disease Control estimates that 600,000 to 800,000 occupational needlestic injuries occur in healthcare workers yearly, that half of these go unreported, and that 62 percent of sharps injuries in hospitals are caused by hollow-bore needles.

(42) Muntz JE, Hultburg R. Safety syringes can reduce the risk of needlestick injury in venous thromboembolism prophylaxis. Journal of Surgical Orthopaedic Advances 2004; 13(1):15-19.
ABSTRACT: Patients undergoing major orthopaedic surgery of the lower extremities are at high risk of developing venous thromboembolism (VTE). Pharmacologic thromboprophylaxis has greatly reduced the likelihood of VTE. The most effective medications are administered once or twice daily by subcutaneous injection, a drug delivery route associated with an increased risk of needlestick injury. Awareness of the potential lethality of needlestick injuries has increased during the past decade, resulting in the development of national safety guidelines from the Occupational Safety and Health Administration on the handling and management of needles and other sharps. This article reviews the potential risks and costs associated with needlestick injury during the administration of VTE prophylaxis in patients undergoing major orthopaedic surgery. The development of novel anticoagulants and accompanying devices to prevent needlestick injury is also discussed

(43) Nelson R. Needlestick injuries: going but not gone? American Journal of Nursing 2004; 104(11):25-26.
ABSTRACT: In 1997 Lisa Black, RN, was trying to aspirate blood from a line in the arm of a patient with advanced AIDS. When the patient jerked suddenly, the needle she was using to flush the line punctured the skin of one of her palms. Despite postexposure treatment, she became infected with HIV and hepatitis C.

(44) Numaguchi Sakamoto F, Morimoto T, Shimbo T. Blue Ribbon ABSTRACT Award, Best International ABSTRACT Award: Cost-Effectiveness of Safety Devices in Preventing Hepatitis C Infection due to Percutaneous Injuries in Japanese Healthcare Workers—A Markov Model Analysis. American Journal of Infection Control 32[3], E12-E13. 2004.
Ref Type: ABSTRACT
ABSTRACT: BACKGROUND: High incidence of hepatitis C virus (HCV) infection among Japanese healthcare workers (HCWs) following a percutaneous injury (PI) has been reported in multiple studies. A lack of regulations mandating the use of safety devices and their high costs prevent many Japanese hospitals from purchasing these devices to prevent PIs. A few studies have evaluated the cost-effectiveness of safety devices from hospital administrators' perspectives using data from a single hospital; however, the results have been equivocal. The cost-effectiveness of safety devices has never been analyzed from the perspective of the Japanese government, which that compensates medical costs incurred by PIs from known infective sources.
METHODS: We constructed a Markov model to assess the cost-effectiveness of two types of safety devices—winged steel needles and intravenous catheters—in preventing HCV infection due to PIs from the Japanese government's perspective. Clinical and utility data were obtained from published studies. Costs were based on both published and unpublished data in Japan. Cost-effectiveness was measured by yen per quality-adjusted life year (¥/QALY).
RESULTS: The baseline analyses showed the use of both types of safety devices to be cost-effective. Costs of safety and conventional winged steel needles per QALY were ¥4680 and ¥5220, respectively. Safety winged steel needles were no longer dominant when they reduced PI incidence by less than 46% (maximum incremental cost ¥1650/QALY), the prevalence of HCV infection in patients was less than 7% (maximum incremental cost ¥740/QALY), and their cost exceeded ¥8230/QALY (maximum incremental cost ¥6380/QALY). For IV catheters, costs of safety and conventional devices per QALY were ¥18,850 and ¥20,010 respectively. The use of safety IV catheter lost its dominance when the safety device reduced PI incidence by 80% or less (maximum incremental cost ¥9670/QALY), the prevalence of hepatitis C infection in patients was 7% or less (maximum incremental cost ¥4310/QALY), and their cost exceeded ¥38,670/QALY (maximum incremental cost ¥26,220/QALY).
CONCLUSIONS: From the Japanese government's perspective, use of safety winged steel needles and IV catheters is cost-effective in preventing HCV infection due to PIs. Creating legal and financial incentives for hospitals to use safety devices and reinforcing needlestick prevention activities will result in lower costs of safety devices as well as higher reduction rates in PIs, which will further enhance the cost-effectiveness of these devices

(45) Panlilio AL, Orelien JG, Srivastava PU, Jagger J, Cohn RD, Cardo DM et al. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998.[see comment]. Infect Control Hosp Epidemiol 2004; 2 5(7):556-562.
ABSTRACT: OBJECTIVE: To construct a single estimate of the number of percutaneous injuries sustained annually by healthcare workers (HCWs) in the United States. DESIGN: Statistical analysis. METHODS: We combined data collected in 1997 and 1998 at 15 National Surveillance System for Health Care Workers (NaSH) hospitals and 45 Exposure Prevention Information Network (EPINet) hospitals. The combined data, taken as a sample of all U.S. hospitals, were adjusted for underreporting. The estimate of the number of percutaneous injuries nationwide was obtained by weighting the number of percutaneous injuries at each hospital by the number of admissions in all U.S. hospitals relative to the number of admissions at that hospital. RESULTS: The estimated number of percutaneous injuries sustained annually by hospital-based HCWs was 384,325 (95% confidence interval, 311,091 to 463,922). The number of percutaneous injuries sustained by HCWs outside of the hospital setting was not estimated. CONCLUSIONS: Although our estimate is smaller than some previously published estimates of percutaneous injuries among HCWs, its magnitude remains a concern and emphasizes the urgent need to implement prevention strategies. In addition, improved surveillance could be used to monitor injury trends in all healthcare settings and evaluate the impact of prevention interventions

(46) Patrick RW. Ouch! Sharps and the needle-stick challenge. Emergency Medical Services 2004; 33(10):139.
ABSTRACT: Needle-sticks and related sharps exposures occur all too often in the prehospital setting. Prevention is the goal. If the unfortunate happens, report the exposure to your employer immediately, following the steps listed above, to ensure appropriate follow-up care. ESO management should establish sound policy with supporting procedures so that every provider can comply with the applicable expectations

(47) Perry J. The CDC Workbook: Total sharps-injury improvement. Outpatient Surgery Magazine 2004; 5(6):84-85.

(48) Perry J, Robinson ES, Jagger J. Needle-stick and sharps-safety survey. Getting to the point about preventable injuries. Nursing2004 2004; 34(4):43-47.
ABSTRACT: In the Septmeber issue of Nursing 2003, readers were invited to participate in a needle-stick and sharps-safety survey. A total of 498 nurses responded to the questions, providing insightful comments about the utilization of safety-engineered devices.

(49) Perry J, Jagger J. A tale of two safety conversions. Nursing2004 2004; 34(6):70.

(50) Perry J, Jagger J. OSHA cracks downon sharps-safety violators. Nursing2004 2004; 34(3):68.
ABSTRACT: The Occupational Safety and Health Administration (OSHA) is cracking down on facilities that don't comply with sharps-safety regulations. Two citations issued in 2003 show that health care facilities must fully comply with OSHA's requirement to use safety-engineered sharp devices or pay a price.

(51) Perry J, Robinson ES, Jagger J. Needle-Stick and Sharps-Safety Survey. Nursing2004 2004; 34(4):43-47.
ABSTRACT: In the September issue of Nursing2003, readers were invited to participate in a needle-stick and sharps-safety survey. A total of 498 nurses responded to the questions, providing insightful comments about the availability and utilization of safety-engineered devices.
The survey results reflect progress in implementing safety devices and preventing sharps injuries in the health care workplace, and provide information about areas of noncompliance. The results also underscore the need for ongoing efforts in implemenating safety technology for all procedures where it's available and appropriate and for continued vigilance in monitoring compliance.

(52) Perry J, Jagger J. Tips on implementing safety devices. Nursing2004 2004; 34(8):73.
ABSTRACT: The National Institute for Occupational Safety and Health Web site, www.cdc.gov/niosh/topics/bbp/safer, offers five steps for implementing safety-engineered sharps, along with tips from health care facilities that have followed them.

(53) Perry J, Jagger J. Getting the most from your personal protective gear. Nursing 2004; 34(12):72.
ABSTRACT: Prevent dangerous exposures to blood and body fluid by correctly putting on, using, and removing personal protective equipment (PPE). To void or limit contact with blood and body fluids (BBF), follow these guidelines from the Centers for Disease Control and Prevention.

(54) Perry J. Survey Says Sharps Safety Lagging. Outpatient Surgery Magazine 2004; 5(9):99.
ABSTRACT: What does your sharps-safety training program look like? Are safety sharps widely availa ble to your staff? For many of you, the answers might not be what they ought to be. According to the results of a survey, many healthcare facilities aren't doing a very good job of training workers on how to use safety sharps correctly and consistently, and many employees don't even have access to them.
The survey showed that sharps-safety implementation, three-and-a-half years after OSHA mandated it, is a mixed picture. Of the nearly 500 nurses who responded, 13 percent said they don't use or seldome use safety devices in their facilities. Many with access to safety devices said they'd had little or no training on how to use them.

(55) Perry J. Only Total Safety-Sharps Compliance Will Do. Outpatient Surgery Magazine 2004; 5(January 2004):59-61.
ABSTRACT: A recent citation by the Occupational Safety and Health Administration (OSHA) shows that facilities that are in the process of converting to safety devices, and have made substantial progress in doing so, are still subject to fines for using conventional devices when safety alternatives are available.

(56) Perry J, Jagger J. Getting the most from your personal protective gear. Nursing2004 2004; 34(12):72.
ABSTRACT: Prevent dangerous exposures to blood and body fluid by correctly putting on, using, and removing personal protective equipment (PPE). To avoid or limit contact with blood and body fluids (BBF), follow these guidelines from the Centers for Disease Control and Prevention.

(57) Perry J, Jagger J. Collecting umbilical cord blood. Nursing2004 2004; 34(10):20.
ABSTRACT: Since the Needlestick Safety and Prevention Act was passed more than 3 years ago, health care facilities in the United States have made substantial progress in implementing safety-engineered devices. But for some specialized procedures, finding a safe alternative to sharp devices can still be challenging. One example is umbilical cord blood collection.

(58) Perry J. One Surgeon's Crusade for Safer Ors. Outpatient Surgery Magazine 2004; 5(2):68-70.
ABSTRACT: Mark avis, MD, is a gynecologic surgeon, an OR-safety consultant and author of the book Advanced Precautions for Today's OR: The Operating Room Professional's Handbook for the Prevention of Sharps Injuries and Bloodborne Exposures.

(59) Perry J, Jagger J. Administering smallpox vaccine: A two-pronged risk. Nursing2004 2004; 34(1):30.
ABSTRACT: Administering smallpox vaccine doubles your risks: exposure to the patient's blood and body fluids and exposure to vaccinia (the virus in the vaccine) through an accidential needle stick or inadvertent inoculation. Related to the smallpox virus, live vaccinia poses a risk of mild to life-threatening adverse reactions if you're accidentally inoculated.

(60) Perry J, Jagger J. A tale of two safety conversions. Nursing2004 2004; 34(6):70.
ABSTRACT: Since the Needlestick Safety and Prevention Act took full effect in April 2001, health care facilities have been switching to safety-engineered needle devices. Here's how two hospitals tailored the process to their needs.

(61) Perry J, Jagger J. Ground-Breaking Citations Issued By OSHA For Failure To Use Safety Devices. AOHP Journal 2004; 24(3):20-22.
ABSTRACT: Maximum Penalty Issued to Nursing Home for " Willful" Violation. Two citations issued by the Occupational Safety and Health Administration (OSHA) in the last six months--to Beaver Valley Nursing and Rehabilitation Home (BVNRH) and its parent company Northern HealthFacility, Inc., in Beaver Falls, Pennsylvania, and Montefiore Medical Center in New York City--show that the federal agency is looking for full compliance with the requirement to use safety-engineered sharp devices, and that it is willing to impose big fines when they are not implemented facility-wide. Since the bloodborne pathogens standard (BPS) was revised in 2001 to clarify and emphasize the requirement to use safety devices to reduce bloodborne pathogen exposure risk, the number of citations issued by OSHA for BPS violations has increased dramatically. These two citations, however, break new ground--one for the size of the fine imposed, the other for its detail and scope. In both cases, the facilities are contesting the citations.

(62) Perry J. The CDC Workbook: Total Sharps-injury Improvement. Outpatient Surgery Magazine 2004; June 2004:84-85.
ABSTRACT: Let me walk you through a new online workbook from the Centers for Disease Control and Prevention (CDC) that offers the most comprehensive program yet for implementing and maintining a sharps-injury prevention program.

(63) Perry J, Metules T. How to avoid needlesticks. RN 2004; 67(11):28ns2-28ns7.
ABSTRACT: In 2000, the Needlestick Prevention and Safety Act made it mandatory for hospitals to provide nurses with safety devices for sharps injury protection and to solicit their input on which ones to select. Yet, nearly four years later, many healthcare facilities are still not fully compliant.
Hospitals that don't take the law seriously could face big fines. In fact, one facility was recently fine $70,000--the maximum penalty for a willful violation--for failing to provide frontline workers with safety devices. The facility had to shell out an additional $22,000 for deficiencies in its exposure control plan and another $5,000 for failing to remove a single sharps disposal container that was filled to the top.
These citations represent a milestone in needlestick safety. While the facility above did take some steps, OSHA sent a message that partial compliance is not good enough.

(64) Pugliese G, Bartley JM. On point. Reducing sharps injuries in the ES department. Health Facilities Management 2004; 17(5):35-39.
ABSTRACT: On a daily basis, housekeeping, laundry and other types of environmental services personnel are at risk of being injured by contaminated sharps while performing their routine duties. Sharps injuries can occur when emptying trash containers, replacing over-filled sharps disposal containers, picking up glass or sharps from the floor, or processing laundry or linens in which sharps have been placed by other health care personnel

(65) Rogues AM, Verdun-Esquer C., Buisson-Valles I., Laville MF., Lasheras A., Sarrat A. et al. Impact of safety devices for preventing percutaneous injuries related to phlebotomy procedures in health care workers. Am J Infect Control 2004; 32(8):441-444.
ABSTRACT: BACKGROUND: Use of protective devices has become a common intervention to decrease sharps injuries in the hospitals; however few studies have examined the results of implementation of the different protective devices available. OBJECTIVE: To determine the effectiveness of 2 protective devices in preventing needlestick injuries to health care workers. METHODS: Sharps injury data were collected over a 7-year period (1993-1999) in a 3600-bed tertiary care university hospital in France. Pre- and postinterventional rates were compared after the implementation of 2 safety devices for preventing percutaneous injuries (PIs) related to phlebotomy procedures. RESULTS: From 1993 to 1999, an overall decrease in the needlestick-related injuries was noted. Since 1996, the incidence of phlebotomy-related PIs has significantly decreased. Phlebotomy procedures accounted for 19.4% of all percutaneous injuries in the preintervention period and 12% in the postinterven