Abstract
The objective of this study was to describe the mechanisms of percutaneous blood exposure (PCE) among doctors and discuss rational strategies for prevention. Data were obtained as part of a nation-wide questionnaire survey of occupational blood exposure among hospital employed doctors in Denmark. The doctors were asked to describe their most recent PCE, if any, within the previous 3 months. Detailed information on the instruments, procedures, circumstances and mechanisms that caused the PCE was obtained. Of 9375 doctors, 6256 (67%) responded, and 6005 questionnaires were eligible for analysis. Of 971 described PCE the majority were caused by suture needles (n = 483), IV-catheter-stylets (n = 94), injection needles (n = 75), phlebotomy needles (n = 53), scalpels (n = 45), arterial blood sample needles (n = 41) and bone fragments (n = 23). Inattentiveness was the most common cause, contributing to 30.5% of all PCE. Use of fingers rather than instruments was a major cause of injury in surgical specialties and was a contributing cause of 36.9% PCE on suture needles. Common contributing causes when fingers were used (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. It was often argued that instruments were not practical to use or might harm the tissue. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines like recapping only, but other mechanisms like sudden patient movements and ‘acute situation’ were common, especially in the case of PCE on iv-catheter-stylets. It is concluded that the exposure mechanisms of PCE reflect both unsafe routines, difficult working conditions and unsafe devices. Education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.
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References
Mangione CM, Gerberding JL, Cummings SR. Occupational exposure to HIV: Frequency and rates of underreporting of percutaneous and mucocutaneous exposures by medical housestaff. Am J Med 1991; 90: 85–90.
Kjaergard HK, Thiis J, Wiinberg N. Accidental injuries and blood exposure to cardiothoracic surgical teams. Eur J Cardiothorac Surg 1992; 6: 215–217.
Gerberding JL, Littell C, Tarkington A, Brown A, Schecter WP. Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 1990; 322: 1788–1793.
Tokars JI, Bell DM, Culver DH, et al. Percutaneous injuries during surgical procedures. JAMA 1992; 267: 2899–2904.
Lowenfels AB, Mehta V, Levi DA, Montecalvo MA, Savino JA, Wormser GP. Reduced frequency of percutaneous injuries in surgeons: 1993 versus 1988. AIDS 1995; 9: 199–202.
Henderson DK, Fahey BJ, Willy M, et al. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures: A prospective evaluation. Ann Intern Med 1990; 113: 740–746.
Centers for Disease Control. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers. MMWR 1989; 38Suppl 6: 1–37.
Mitsui T, Iwano K, Masuko K, et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology 1992; 16: 1109–1114.
Centers for Disease Control. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987; 36(suppl 2): 1S–18S.
Becker MH, Janz NK, Band J, Bartley J, Snyder MB, Gaynes RP. Noncompliance with Universal Precautions Policy: Why do physicians and nurses recap needles? Am J Infect Control 1990; 18: 232–239.
Hammond JS, Eckes JM, Gomez GA, Cunningham DN. HIV, trauma, and infection control: Universal precautions are universally ignored. J Trauma 1990; 30: 555–558.
Henry K, Campbell S, Collier P, Williams CO. Compliance with universal precautions and needle handling and disposal practices among emergency department staff at two community hospitals. Am J Infect Control 1994; 22: 129–137.
Nelsing S, Nielsen TL, Brønnum-Hansen H, Nielsen JO. Incidence and risk factors of occupational blood exposure: A nation-wide survey among Danish doctors. Eur J epidemiol 1997; 13(1): 0–0.
Corlett MP, England DW, Kidner NL, Attard AR, Fraser IA. Reduction in incidence of glove perforation during laparotomy wound closure by ‘no touch’ technique. Ann Royal Coll Surg 1993; 75: 330–332.
Dauleh MI, Irving aD, Townell NH. Needle prick injury to the surgeon: Do we need sharp needles? J R Coll Surg Edinb 1994; 39: 310–311.
Wright KU, Moran CG, Briggs PJ. Glove perforation during hip arthroplasty. Br J Bone Joint Surg 1993; 75-B: 918–920.
Miller SS, Sabharwal A. Subcuticular skin closure using a ‘blunt’ needle. Ann R Coll Surg Engl 1994; 76: 281.
Atabey A. A new surgical instrument: Nonsticking skin hook. Plastic Reconstruct Surg 1994; 94: 552–554.
Tsang WYW, Chan JKC, Chan SK. Fine-needle aspiration anchor: A simple device to prevent needle-stick injury at fine-needle aspiration. Arch Pathol Lab Med 1993; 117: 1047–1049.
Fisher AA. Protective value of surgical gloves including the ‘cut resistant variety’. CUTIS 1992; 49: 310–312.
Doyle PM, Alvi S, Johanson R. The effectiveness of double-gloving in obstetrics and gynaecology. Br J Obstet Gynaecol 1992; 99: 83–84.
Johnson GK, Nolan T, Wuh HC, Robinson WS. Efficacy of glove combinations in reducing cell culture infection after glove puncture with needles contaminated with human immunodeficiency virus type 1. Infect Control Hosp Epidemiol 1991; 12: 435–438.
Mast ST, Woolwine JD, Gerberding JL. Efficacy of gloves in reducing blood volumes transferred during simulated needlestick injury. J Infect Dis 1993; 168: 1589–1592.
McCormick RD, Maki DG. Epidemiology of needle stick injuries in hospital personnel. Am J Med 1981; 70: 928–932.
Linnemann CC, Cannon C, DeRonde M, Lanphear B. Effect of educational programs, rigid sharps containers, and universal precautions on reported needlestick injuries in health care workers. Infect Control Hosp Epidemiol 1991; 12: 214–219.
Haiduven DJ, DeMaio TM, Stevens DA. A five-year study of needlestick injuries: Significant reduction associated with communication, education and convenient placement of sharps containers. Infect Control Hosp Epidemiol 1992; 13: 265–271.
Ippolito G, De Carli G, Puro V, et al. Device-specific risk of needlestick injury in Italian health care workers. JAMA 1994; 272: 607–610.
Watters J, MacCallum R, Maurice S, Robertson C. Safelon: A new device to reduce needle-stick injuries during intravenous cannulation.
Friedland LR. Universal precautions and safety devices which reduce the risk of occupational exposure to blood-borne pathogens: A review for emergency health care workers. Pediatr Emerg Care 1991; 7: 356–362.
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Nelsing, S., Nielsen, T.L. & Nielsen, J.O. Percutaneous blood exposure among Danish doctors: Exposure mechanisms and strategies for prevention. Eur J Epidemiol 13, 387–393 (1997). https://doi.org/10.1023/A:1007369016717
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DOI: https://doi.org/10.1023/A:1007369016717