Дисертації з теми "Needlestick injuries"

Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, School of Engineering, System Design and Management Program, 2017.<br>Cataloged from PDF version of thesis.<br>Includes bibliographical references (pages 89-90).<br>Each year, 385,000 needlesticks and other sharps-related injuries are sustained by hospital-based healthcare workers in U.S. (CDC, 2015). Out of the overall sharps injuries, approximately 67% are caused by needlestick devices ("CDC: Stop Sticks, Sharps Injuries," 2013). Numerous pathogens can be transmitted through needlestick injuries, but the three most common pathogens are Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus. There are processes in place to reduce needlestick injuries such as work-practice control, engineering control, personal protective clothing and equipment, employee training, etc., but they have not eliminated needlestick injuries. The purpose of this thesis is to investigate the systematic causes of needlestick injuries in Massachusetts hospitals. System thinking process is used to define the needlestick system, interaction between stakeholders and see how injuries affect the needlestick system. System Dynamics model is also used to illustrate the pathway of the root causes of needlestick injuries. By using system thinking, current literature, stakeholder interviews, and knowledge from shadowing at one of the reputable hospitals in Boston, a systematic solution is proposed. The proposed solution addresses the root causes of needlestick injuries: professional pressure, high patient load/long hours, and patient-centric safety culture. The proposed solution also includes methods to address underreporting. Professional pressure and high patient load is addressed by creating programs that focus on improving self-care and reducing level of fatigue for the healthcare workers. In order to change the patient-centric safety culture, to patients and healthcare workers focused safety culture, the current prevention methods are reiterated. Furthermore, programs to create awareness of needlestick injuries, which forces doctors and nurses to consciously think about needlestick injury safety is proposed. An example is given of sharps injury prevention in surgeon's "time-out" checklist, similar to what is used at the Boston hospital. Finally, to address underreporting, programs to provide quick and easy reporting process are proposed for the healthcare workers. An important complement to the reporting system is a safety culture, where the healthcare workers do not feel fear of reporting due to repercussion on their jobs. A holistic solution is needed for a complex problem such as needlestick injuries. Only with a systematic solution that focuses on all of the root causes of needlestick injuries can they truly be reduced to a negligible amount.<br>by Jolly Pradhan.<br>S.M. in Engineering and Management

In 2015 Dr. Pratiksha Vaghela started the “Stop Poking Me” campaign which was aimed at curbing the increase in the number of needlesticks at the James A. Haley Veteran Affairs Hospital (JAHVA). The data for needlesticks was collected by the Occupational Medicine Clinic (OMC) between Oct 2013 and Oct 2016. We then obtained the original data from Dr. Vaghela’s project and compared the data to assess whether the new implementations have truly decreased the number of needlesticks. There was a 23.6% reduction in the number of needlesticks between 2013 and 2016 and even more importantly a 60.1% reduction between 2015 and 2016. Our project shows that the decrease correlates to the implementation of the “Stop Poking Me” campaign.

Thesis (MBA)--Stellenbosch University, 2001.<br>ENGLISH ABSTRACT: Daily more than 300 000 health care workers in South Africa are to a lesser or greater extent exposed to the risk of deadly viruses which can be transferred through neediestick injuries. It is estimated that currently 9,8 million people in South Africa are HIV positive. This high incidence of HIV has a great impact on the danger of infection from neediestick injuries. It is estimated that 44 000 neediestick injuries takes place annually in South Africa. Despite such a high risk there are currently few safety regulations or official efforts to prevent or determine the true impact and incidence of needlesticks in South Africa. This study project investigated the number of neediestick injuries that could potentially be prevented by the use of needles with safety features and estimated the ranges of benefits and costs of using such safety devices. With the financial constraints that are imposed on South African hospitals, infection control through the use of safety syringes makes economic sense. Prevention of infections is clearly far cheaper than cure.<br>AFRIKAANSE OPSOMMING: Daagliks word meer as 300 000 gesondheids personeel in Suid Afrika in 'n mindere of meerdere mate blootgestel aan die risiko van lewens gevaarlike viruse wat deur middel van naaldprik ongelukke oorgedra kan word. Hierdie risiko word spesifiek in Suid Afrika verhoog deur die hoë insidensie van HIV. Dit word beraam dat daar tans 9,8 miljoen mense in Suid Afrika is wat HIV positief is. Daar word beraam dat daar tans 44 000 naaldprik ongelukke per jaar in Suid Afrika plaasvind. Ten spyte van die hierdie hoë risko is daar tans min veiligheids regulasies of amptelike pogings om die omvang en voorkoming van naaldprik insidente te bepaal nie. Hierdie studie het die getal naaldprikke wat voorkom kan word deur die gebruik van veiligheids inspuitnaalde ondersoek en het die voordele en kostes van sulke veiligheidsmaatreëls beraam. Gegewe die finasiële druk wat ons tans in Suid Afrikaanse hospitale ondervind, is bewys dat die gebruik van veiligheids inspuitnaalde ekonomiese sin maak. Voorkoming op hierdie manier is bewys as 'n ver goedkoper opsie as nasorg.

Objectives: Risk associated with needlestick injuries (NSI) in health care workers (HCWs) in Taiwan has not been characterized. We conducted this investigation to study 1) the prevalence and yearly incidence of NSI in HCWs in Taiwan, and the risk factors associated with NSIs; 2) reporting behavior when a NSI was sustained; and 3) seroprevalence of blood-borne pathogens among inpatients. Combination of the above information allowed for risk estimation for contracting hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in HCWs. Methodology: A cross-sectional questionnaire survey for life-time experience and frequency of NSI was conducted in a random sample from four strata of accredited hospitals according to the number of employees, from July 1996 to June 1997 in Taiwan. All full time employees, including physicians, nurses, technicians, and supporting personnel were recruited. Seroprevalence was examined for HBV, HCV and HIV among inpatients six years in age or older in one teaching hospital during July 1997 to June 1998. Results: A total of 10,469 health care workers were recruited from 16 out of 132 accredited hospitals and 82.6% (8,645) completed the survey, including nurses (61.0%), physicians (16.1%), medical technicians (14.9%), supporting personnel (7.9%). The prevalence of NSI were 93.1%, 86.6%, 78.3%, 61.0% in nurses, physicians, technicians, and supporting personnel respectively. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 times per person in the past 12 months. Of the most recent episodes of NSIs, ordinary syringe needles accounted for 80.3% (95% CI, 79.4% - 81.2%) of hollow-bore needles associated incidents, and 74.1% (95% CI, 72.8% - 75.4%) of them were contaminated. The most frequently reported circumstance was the "Breakdown of Universal Precautions", recapping-related behaviors (81.6%, 95% CI 80.3% - 82.9%) of HCWs. More than a quarter (27.8%, 2,399) of HCWs were unprotected (either not vaccinated or having an unknown serological status) against HBV. Seroconversion in stuck HCWs was reported 1.8% for HBV (135), 0.2% (18) for HCV, 0.2% (15) for both HBV and HCV, 0.1% (5) for syphilis and less than 0.1% (2) for HIV. ^M A total of 81.8% of NSIs were unreported. Similarly, high incidence of NSI and low reporting rate were also found in student nurses. Seroprevalence of HBV, HCV, and HIV among inpatients were found higher than the reported rate in source patients of this survey. Seroprevalence of HBsAg was 16.7% in hospitalized patients, 1.7% positive for HBeAg, 12.7% for Anti-HCV, and 0.8% for Anti-HIV. Different seroprevalence rates of HBsAb (+), HBsAg (+), Anti-HCV (+), Anti-HIV (+) in different seasons were also found significant (p<0.001). The risk of seroconversion to HBV was thus estimated to be 0.003 ~ 0.008 time per person-year, HCV 0.003 ~ 0.007 per person-year, and HIV 0.4 ~ 1.2 /100, 000 person-year. Considering the number of HCWs in Taiwan, a total of 330 ~ 917 HCWs will seroconvert to HBV (+) in a year, 330 ~ 880 HCWs seroconvert to HCV (+), and less than one to two HCWs seroconvert to HIV (+). Conclusions: Needlestick and sharps injuries were highly prevalent among Taiwanese HCW and across job categories. Risk of seroconversion is real and significant. Preventive measures are warranted for reduction of contracting blood-borne pathogens in HCWs in Taiwan.

"This study uses two examples of occupational health and safety problems encountered in nine major hospitals to illustrate that hospitals fail to identify, evaluate and share information adequately. The two safety examples used are 1. Needle-stick incidents 2. The potential for injuries associated with floor cleaning methods."<br>Masters Degree in Applied Science, Occupational Health and Safety

The aim of the study was to explore the reasons why health workers reported their occupationally acquired needle stick injury. The secondary reasons for this study was to be able to identify the factors that contributed to the choice to report as well as the feelings health workers experienced during and after the injury.

Thesis (Master of Nursing)--Cape Peninsula University of Technology, 2019<br>Background: Like other health care providers, nursing students are unprotected from occupational dangers such as sharp object injuries (SOIs) due to imperfect knowledge and experience. These students face a great risk of exposure to blood borne infections by pathogens such as HIV and the hepatitis B and C viruses while executing their clinical actions in hospitals. SOIs are a significant problem for nursing students, as they increase the risk of contracting blood-borne infections. Purpose: The purpose of this study was to determine nursing students' knowledge and practices related to SOIs and their management at a university in the Western Cape Province. Objectives: The objectives of this study include determining the occurrence of SOIs, and knowledge of risk of SOIs, as well as the reporting and management of SOIs at a university in the Western Cape. Method and sample: A cross-sectional descriptive survey was conducted with nursing students from the second to fourth year of study, registered at a university in the Western Cape Province for the 2017 academic year. Quota sampling was applied to select respondents who, after providing informed consent, then completed and handed the self- administered questionnaires back to the researcher on the same day that they were distributed. Data were obtained from nursing students about whether or not they had experienced an SOI, what they did after the SOI, their perception of the risk, and management of and preventive measures for SOIs. Validity and reliability were ensured, and all ethical principles were adhered to. SPSS was used for the quantitative data analysis. Results: A total of 252 nursing students from the second to fourth years participated in this study. The average age of respondents was 24 years, with a minimum of 19 and maximum of 46 years; 211 (83.7%) of them were females. During their course 63 (25%) respondents experienced SOIs; only 42 (66.67%; N=63) of them reported the occurrence of an SOI, most (25 or 59.52%) reporting it to the professional nurse in charge. The highest occurrence of SOIs was reported by fourth-year students (26 respondents, 41.3%). It was found that 21 (33.3%) of SOIs were not reported, and the main reason for this was because there was little or no perception of associated risk (15, 71.43%). Forty-six (73.02%) respondents experienced a single SOI, while 11 (17.46%) had two SOIs, 4 (6.35%) reported having had three SOIs, and one each (1.59%) had more than four and more than ten SOIs. The activity causing most of the SOIs was administration of medication by injection (48 cases, 76.2%), and in most cases (57, 90.47%) the instruments causing injury were needles or hollow-bore needles. Most of the affected respondents squeezed the puncture site after the SOI (42, 66.7%), followed by washing the area with water and soap (40; 63.5%), and cleaning the site with antiseptic (15, 23.8%). Among those students exposed to SOIs, only 22 (52.4%) had undergone blood tests, and very few of them took post-exposure prophylaxis or treatment (16, 25.40%). The emotion that most of them felt after the SOI was fear (42, 66.7%), and the main reason for not getting treatment was fear of side effects (18, 38.29%). Also, only 61 (24.2%) respondents reported recapping needles after use, while most reported incomplete vaccination against hepatitis B (195, 77.38%). The main reason for not using personal protective equipment (PPE) was noted as the unavailability thereof at the institution (43, 49.4%). Conclusion: This study documented a low rate of reporting SOIs among nursing students. It is plain that there are inadequate levels of knowledge and practice related to SOI management among these students at a university in the Western Cape. One would imagine that because the majority of nursing students had a measure for the practice of universal precautions and used PPE, their management after exposure to SOIs during work training in hospital would be efficient. This was not the instance in this study, where application of these actions in their practical training was poor.

Medical trainees (medical students and resident physicians) are at high risk of sharps injury (needlestick injury). High rates of sharps injury in this population and the risk incurred by exposure to bloodborne pathogens poses a threat both to medical trainees who are at risk for bloodborne pathogen exposure and to training institutions for legal and financial reasons. This study examines the prevalence of sharps injuries in medical trainees at the University of South Florida and compares that to data on sharps injuries in US medical trainees. Data from the present study was compared to previously collected USF medical trainee sharps injury data. Results from this study demonstrated that residents had higher rates of sharps injury than medical students. A prior USF study of similar data from academic years 2002-2008 had similar findings. This study demonstrated a peak in sharps injury rate in first year residents, similar to the prior USF study. Resident rates remained highest in Surgery and lowest for Psychiatry and Pediatrics. This information can be used to focus hazard analysis and risk reduction efforts at USF Health. This data can also be combined with the known efficacy of simulated training experience should encourage increased use of USF’s center for advanced medical simulation (CAMLS) to increased procedural experience in medical students and junior residents and decrease their exposure to bloodborne pathogens by increasing knowledge and procedural safety.

Because of their relative inexperience in performing procedures and handling sharps devices, medical students and resident physicians are considered to be at high risk for sharps injuries. A higher rate of sharps injuries for medical trainees implies a higher risk for occupationally-acquired infection with bloodborne pathogens and may have financial and legal implications for training institutions. This study examines the prevalence of sharps injuries among US medical students and resident physicians. A systematic review of the literature yielded 10 studies that gave data on sharps injuries for US medical students or residents, and those data were combined with data from our institution to produce pooled prevalences. Results from our institution showed that residents had a significantly higher risk of sharps injuries than medical students. While sharps injuries increased with students' years of training, residents' rates decreased with increasing level of training. Resident rates were highest in the department of Surgery and lowest for Pediatrics. Comparing pooled prevalences of US trainees revealed that residents were 6 times more likely than medical students to have a sharps injury. This information can be used by training programs to inform changes in residency training curricula and infection control policies, as well as to forecast Worker's Compensation and long-term disability insurance coverage requirements. Medical training institutions must continue to provide opportunities for students and residents to perfect their procedural skills, but at the same time, trainees must be protected from the risk of sharps injuries and exposure to bloodborne pathogens.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-13T11:13:59Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Thaís de Arvelos Salgado - 2014.pdf: 1262659 bytes, checksum: f5f6c4703743d2bdb330aa4168a4b5f5 (MD5)<br>Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-13T11:14:52Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Thaís de Arvelos Salgado - 2014.pdf: 1262659 bytes, checksum: f5f6c4703743d2bdb330aa4168a4b5f5 (MD5)<br>Made available in DSpace on 2015-01-13T11:14:52Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Thaís de Arvelos Salgado - 2014.pdf: 1262659 bytes, checksum: f5f6c4703743d2bdb330aa4168a4b5f5 (MD5) Previous issue date: 2014-08-15<br>Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq<br>Most recorded accidents with biological material are related to accidents in Health Care Facilities, which are considered unhealthy environments where the group with the highest exposure is professionals in the healthcare field. However, it should be understood that, any individual who passes through a healthcare facility is exposed to biological risk. The objectives of this study were: to identify the profile of victims of accidents with biological material, occurring in healthcare facilities among those with no presumed risk; to identify the frequency and profile of accidents in this group; to classify pre and post-exposure conduct in accidents with biological material in this group. This retrospective epidemiological study was conducted based on data from two service centers and accident reporting services: Hospital for Tropical Diseases in the State of Goias, Brazil, and the Center of Reference on Worker's Health (CEREST) in the city of Goiania. The two databases were linked. This study analyzed accidents reported by workers who were not trained in healthcare practice that had accidents with biological material inside the healthcare service independent of their professional duties. The study received approval in two Ethics Committee reports, the Hospital for Tropical Diseases, under protocol No. 033 / 2010, and by the IRB of the Hospital das Clinicas, Federal University of Goias, under protocol 414258/2013. There were 8,568 records of accidents with biological material recorded between 1989 and June 2012, 181 of these (2.1%) occurred in health services among those with no presumed risk. The highest frequency of accidents occurred among people between 20 and 29 years, female, and the most frequent occupation was the receptionist's office or lab, followed by administrative assistant. Needlestick accidents were most common (91.7 %) and involved a needle lumen, with higher incidence among females, and blood was the most common biological material. With regard to the circumstances of the accidents, most occurred due to inappropriate disposal of sharps, 20.1% referred to assistance activities such as recapping of needles, injections, or punctures, and material processing support procedures. Less than half of the subjects were vaccinated (49.7 %) against hepatitis B. The source patient was identified in 64 (35.6 %) cases, and of these, 43 (67.2 %) did not undergo serological testing. Post-exposure prophylaxis was recommended in 41 (22.6 %) and immunotherapy in 58 cases (32.0 %), and in 96 (53.0 %) cases completed, 74.0% indicated giving up clinical and laboratory monitoring. There were gaps in the data recorded in the notification forms, which reveals the need for professional training for the correct completion of notifications and active search for cases for follow-up. Data support the fact that healthcare facilities should have a organizational structure focused on resolution, prepared to provide care and / or refer the victim to postexposure prophylactic measures, since the office needs to be responsible for people who have accidents in their area, once the injured person, regardless of the employment relationship becomes a "victim of an accident with biological material" and in need of care, to minimize the risk of disease by taking proper preventive measures after the accident.<br>A maioria dos registros de acidente com material biológico é referente aos acidentes ocorridos nos Estabelecimentos Assistenciais de Saúde (EAS), que são ambientes considerados insalubres, onde o grupo de maior exposição são os profissionais da área da saúde. Entretanto compreende-se que qualquer indivíduo que transite pelos EAS está exposto ao risco biológico. Os objetivos deste estudo foram: identificar o perfil das vítimas de acidentes com material biológico ocorridos em Estabelecimentos de Assistência à Saúde entre pessoas sem risco presumido; identificar a frequência e o perfil dos acidentes nesse grupo; caracterizar as condutas pré e pós-exposição nos casos de acidentes com material biológico nesse grupo. Estudo epidemiológico retrospectivo, realizado com base de dados de duas instituições de atendimento e registro de acidente com material biológico do Estado de Goiás: Hospital de Doenças Tropicais (HDT), e o Centro de Referência em Saúde do Trabalhador (CEREST) regional de Goiânia. Foi realizado olinkage dos bancos de dados. Foram analisadas as fichas de registro de acidentes com pessoas sem risco presumido que se acidentaram com material biológico em um serviço de saúde independente do exercício profissional. O estudo foi aprovado em dois Comitês de Ética em Pesquisa, o do Hospital de Doenças Tropicais, sob o protocolo nº 033/2010 e do Hospital das Clínicas da Universidade Federal de Goiás, sob o protocolo 414258/2013. Totalizaram 8.568 registros de acidentes com MB registrados de 1989 a junho de 2012, desses 181 (2,1%) ocorreram em serviços de saúde com pessoas sem risco presumido. A maior frequência de acidentes ocorreu com pessoas de idade entre 20 e 29 anos, do sexo feminino e ocupação de recepcionista de consultório ou laboratório, seguida de auxiliar administrativo. Os acidentes foram predominantemente percutâneos (91,7%) e envolvendo agulha com lúmen com maior ocorrência entre o sexo feminino, e o sangue foi o material biológico mais presente. Entre as circunstâncias de acidente, o maior número ocorreu pelo descarte inadequado de perfurocortantes e 20,1% se referiam a atividades assistenciais, como reencape de agulha, injeções ou punções, processamento de material e auxílio em procedimento o que evidenciou uma relação dessas pessoas com os cuidados assistenciais. Menos da metade dos sujeitos era vacinada (49,7%) contra hepatite B. O paciente-fonte foi identificado em 64 (35,6%) casos, e desses, 43 (67,2%) não realizaram testes sorológicos. A profilaxia pós-exposição foi recomendada em 41 (22,6%) casos e a imunoprofilaxia em 58 (32,0%) e de 96 (53,0%) casos concluídos, 74,0% indicava abandono do acompanhamento clínicolaboratorial. Houve falha nos registros de dados nas fichas de notificação, o que revela a necessidade de capacitação dos profissionais para o correto preenchimento das notificações e busca ativa dos casos para o acompanhamento. Os dados apontam para o fato de que os EAS devem ter uma estrutura organizacional resolutiva, preparada para providenciar e/ou encaminhar o acidentado para as medidas profiláticas pós-exposição, pois o serviço deve se responsabilizar pelo indivíduo que se acidenta nos seus espaços físicos, uma vez a pessoa acidentada, independente do vínculo trabalhista passa à condição de “vítima de acidente com material biológico” e a carecer de cuidados para a minimização diminuição do risco de adoecimento pela adoção das medidas preventivas após o acidente.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2015-03-09T12:38:51Z No. of bitstreams: 2 Tese - Dulcelene de Sousa Melo - 2014.pdf: 2519714 bytes, checksum: 4f67d9c30eabd06ee38bfa5b831390e4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)<br>Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2015-03-09T12:39:08Z (GMT) No. of bitstreams: 2 Tese - Dulcelene de Sousa Melo - 2014.pdf: 2519714 bytes, checksum: 4f67d9c30eabd06ee38bfa5b831390e4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)<br>Made available in DSpace on 2015-03-09T12:39:08Z (GMT). No. of bitstreams: 2 Tese - Dulcelene de Sousa Melo - 2014.pdf: 2519714 bytes, checksum: 4f67d9c30eabd06ee38bfa5b831390e4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-01-31<br>Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG<br>INTRODUCTION: The health of workers, in their everyday work, are exposed to various risks, among which, biological. This represents a danger important to public health, which may, in addition to physical injury, have broader implications, and impact various aspects of their lives. OBJECTIVE: To analyze the personal and professional implications of exposure to biological material for healthcare workers. METHODOLOGY: A qualitative study conducted with ten workers in the healthcare field who experienced accidents with biological material and who were treated by a reference healthcare service in Goiania, Brazil. Data were collected between October and November 2012, through interviews using the critical incident technique. Data processing used the content analysis methods proposed by Bardin, with the additional aid of Atlas ti 6.0 software. The discussion of findings was presented using theoretical frameworks of complex thinking from the perspective of Edgar Morin, as well as cultural theory of risk by Douglas. RESULTS: From the narratives of those experiences, for ten healthcare workers treated by three units of reference specializing in situations of exposure to biological material, four categories of analysis emerged: personal implications; professional implications, the workplace and risk management, and reference service and risk management. The results showed great psychological distress expressed through feelings of fear of contamination of self and family, worry, despair, lack of protection, guilt, anger, insecurity, introspection, helplessness, uncertainty, and awkwardness, among others. This suffering was reflected in the three spheres of interaction, as well as relationships between exposed workers. On the other hand, some might experience the solidarity from co-workers, patients, and professionals during service, through gestures and relationships that help in coping with tensions when such a situation arises. The structures in place at work and in referral services showed contradictions in such situations: support / helplessness; commitment / disengagement; climate of security / insecurity; careful / careless; organization / disorganization, respect / disrespect; acceptance / leaving at the mercy of fate. The accident was established as the driving force for workers to pay attention to their own safety and change their routines in this context, extending this reflection not only to themselves, but for those who they interact with professionally interaction. CONCLUSION: The experiences of these workers shows antagonistic, contradictory, and complementary aspects of complex systems for the health services worker. It suggests the need for a greater appreciation and consideration of the psycho-emotional consequences experienced by workers, along with review of treatment procedures as to their effectiveness and problem solving that improve quality of life to the healthcare worker.<br>INTRODUÇÃO: Os trabalhadores da área da saúde, no cotidiano laboral, estão expostos a diversos riscos, dentre os quais o biológico. Esse representa um agravo de importância para a saúde pública, que pode, para além da injúria física, gerar implicações e repercussões de ordem diversas em suas vidas. OBJETIVO: Analisar as implicações pessoais e profissionais da exposição ao material biológico para o trabalhador da área de saúde. METODOLOGIA: Estudo qualitativo realizado com dez trabalhadores da área da saúde, acidentados com material biológico e atendidos pelos serviços de saúde de referência do município de Goiânia - GO. Os dados foram coletados no período entre outubro e novembro de 2012, por meio de entrevista utilizando a técnica do incidente crítico. Para o tratamento dos dados utilizou-se a análise de conteúdo proposta por Bardin, com auxílio complementar do programa Atlas ti 6.0. A discussão dos achados se deu sob vários referenciais teóricos, dentre os quais a teorias do pensamento complexo e cultural do risco. RESULTADOS: Das narrativas das experiências/vivencias, socializadas por dez trabalhadoras da área da saúde, que foram atendidas por três das unidades de referência para a assistência em situação de acidente com material biológico emergiram duas unidades temáticas: implicações pessoais e profissionais do acidente ocupacional com material biológico; o serviço de saúde e a gestão do risco. Os resultados evidenciaram grande sofrimento psíquico expresso por meio dos sentimentos de medo de contaminação para si e família, preocupação, desespero, desproteção, culpa, indignação, insegurança, introspecção, desamparo, incerteza, constrangimento, entre outros. Esse sofrimento repercutiu nas três esferas do convívio e inter-relação das trabalhadoras acidentadas. Por outro lado, puderam experienciar a solidariedade por parte de colegas de trabalho, paciente e profissional, durante o atendimento, por meio de gestos e relações que ajudam no enfrentamento das tensões que tal situação aflora. As estruturas de atendimento no local de trabalho e nos serviços de referência demonstraram a contradição em tais situações: apoio-desamparo; compromisso-descompromisso; clima de segurança-insegurança; cuidado-descuidado; organização-desorganização; respeito-desrespeito; acolhendo ou deixando-o à mercê da própria sorte. Observou-se que o acidente constitui-se como força propulsora na perspectiva de olhar para a própria segurança e alterar a rotina no contexto laboral com extensão não só para si, mas para aqueles que estão no seu convívio profissional. CONCLUSÃO: A vivencia/experiência do trabalhador evidencia aspectos antagônicos, contraditórios e complementares dos sistemas complexos: trabalhador-serviços de saúde. Sugere a necessidade de uma maior valorização e consideração dos aspectos psico-emocionais vivenciados pelos trabalhadores, revisão da linha de cuidados de atendimento quanto à sua efetividade e resolutividade que agreguem qualidade de vida ao trabalhador da área da saúde.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2016-09-09T17:59:04Z No. of bitstreams: 2 Tese - Zilah Cândida Pereira das Neves - 2016.pdf: 2900186 bytes, checksum: cfefb1ed9137da82dc5cb133b19682f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)<br>Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-12T14:30:18Z (GMT) No. of bitstreams: 2 Tese - Zilah Cândida Pereira das Neves - 2016.pdf: 2900186 bytes, checksum: cfefb1ed9137da82dc5cb133b19682f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)<br>Made available in DSpace on 2016-09-12T14:30:18Z (GMT). No. of bitstreams: 2 Tese - Zilah Cândida Pereira das Neves - 2016.pdf: 2900186 bytes, checksum: cfefb1ed9137da82dc5cb133b19682f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-30<br>Accidents with biological material are reportable events, health care workers (TAS), victims of these accidents may be exposed to the hepatitis B and C and HIV, among others. The aims of this study were: to analyze the epidemiology of occupational accidents with biological material among health care workers of the metropolitan area of Goiania-GO (general); describe the socio-demographic and occupational profile of health care workers, victims of occupational accidents with biological material; describe the profile of accidents with biological material among health care workers; characterize the adoption of pre-exposure behaviours related to the latest accident; identify the serological status related to hepatitis B, C and HIV in victims of occupational accidents involving biological material and source patients, and establish the demographic and employment factors associated with the occurrence of multiple accidents among health care workers of the metropolitan area of Goiania-GO. Epidemiological Cross and analytical study which included all registration records of accidents involving biological material of HCW from two sources: A - records of injured HCW in a reference hospital for notification in Goiania, from the first record in 1989 to 2010, and B - records of Sinan, including the first record in 2006 until those available at 31/12/2014. Linkage of databases was performed and data analyzed using the Statistical Package for Social Sciences (SPSS). Socio-demographic and employment variables were the predictor variables and have suffered more than one accident, the outcome. Univariate analysis was performed and variables with P<0.10 were included in a logistic regression model. Ethical precepts were followed (Approval Ethics Committees: 033/2010 and 414.258/2013). A total of 11,536 accidents were recorded from 1989 to December 2014. Of these, 9,575 (83.0%) occurred among HCW and the majority was female. It was found that 665 (7.5%) of the HCW experienced more than one accident, while 70 (0.8%) experienced three or more accidents, totaling 8,825 victims. Nursing staff, auxiliary cleaning, physician, and dental and laboratory teams were the ones who were more frequently hurted, respectively. Most of the victims had completed high school (3,719 (48.0%). Blood/serum/plasma were the biological materials found to be the most involved (6,480/67.7%), at the time of administering medications/vascular access puncture occurring in 2.759 (28.9%), and involving needles with and without lumen in 6,097 (63.7%). A total of 6,653 (75.4%) HCW were vaccinated for hepatitis B. Incomplete information on Sinan records such as, use of PPE (gloves, masks, boots and safety glasses) and serological markers (HBsAg; Anti-HBs, Anti-HCV and Anti-HIV) was found to be the major factor that hampered data analysis. Age, type of material, and organic fluid were predictors risk factor for multiple accidents involving biological material among health care workers.<br>Os acidentes com material biológico são eventos de notificação compulsória. Os trabalhadores da área da saúde (TAS), vítimas desses acidentes, podem se expor aos vírus das hepatites B e C e HIV, dentre outros. Foram objetivos deste estudo: analisar a epidemiologia dos acidentes ocupacionais com material biológico entre trabalhadores de serviços de saúde, da região metropolitana de Goiânia-GO (geral); descrever o perfil sociodemográfico e laboral dos trabalhadores de serviços de saúde, vítimas de acidentes ocupacionais com material biológico; descrever o perfil dos acidentes com material biológico entre trabalhadores dos serviços de saúde; caracterizar a adoção das condutas pré-exposição relacionadas ao último acidente; identificar a situação sorológica referente às hepatites B, C e HIV, das vítimas de acidentes ocupacionais com material biológico e dos pacientes-fonte e estabelecer os fatores sociodemográficos e laborais associados à ocorrência de múltiplos acidentes entre trabalhadores de serviços de saúde da região metropolitana de Goiânia-GO (específicos). Estudo epidemiológico, transversal e analítico no qual foram incluídas todas as fichas de registro de acidentes de trabalho com material biológico de TAS a partir de duas fontes, A prontuários de TAS acidentados em um hospital de referência para notificação no município de Goiânia, desde o primeiro registro em 1989 até 2010 e B - fichas do Sinan, incluindo o primeiro registro em 2006, até os disponíveis em 31/12/2014. Foi realizado o Linkage dos bancos de dados que foram processados e analisados no Statistical Package for the Social Sciences (SPSS). As variáveis sociodemográficas e laborais foram as variáveis preditoras e ter sofrido mais de um acidente, o desfecho. Foi realizada a análise univariada, e as variáveis que apresentaram valor de p < 0,10 foram incluídas em um modelo de regressão logística. Preceitos éticos foram seguidos (aprovações em Comitês de Ética: 033/2010 e 414.258/2013). Foram registrados 11.536 acidentes, no período de 1989 a dezembro de 2014. Destes registros, 9.575 (83,0%) ocorreram entre os trabalhadores da área de saúde e a maioria era do sexo feminino. Verificou-se que 665 (7,5%) TAS sofreram mais de um acidente, 70 (0,8%) apresentaram três ou mais acidentes, perfazendo 8.825 vítimas. A equipe de enfermagem, o auxiliar de limpeza, médicos e a equipe de odontologia e de laboratório foram os que mais se acidentaram, respectivamente. A maioria das vítimas possuía o ensino médio completo 3.719 (48,0%). O sangue/soro/plasma foram os materiais biológicos mais envolvidos 6.480(67,7%), no momento de administrar medicamentos/punção de acesso vascular em 2.759 (28,9%), com o envolvimento de agulhas com e sem lúmen em 6.097 (63,7%). Em 6.653 (75,4%) dos TAS vacinaram para hepatite B. Para várias informações, predominou a falta de registro nas fichas do Sinan que dificultou a análise: uso dos EPI (luvas, máscaras, botas e óculos) e marcadores sorológicos (HBSAG; Anti-HBs, AntiHCV e o Anti-HIV). Verificou-se que idade, tipo de material, fluido orgânico foram fatores de risco preditores para múltiplos acidentes envolvendo material biológico, entre os trabalhadores dos serviços de saúde.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2014-11-06T20:32:32Z No. of bitstreams: 2 Dissertação- Liwcy Keller de Oliveira Lopes Lima- 2012.pdf: 870422 bytes, checksum: 431b648a9e85b9fc37769b57a0dc46e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)<br>Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-11-10T20:09:55Z (GMT) No. of bitstreams: 2 Dissertação- Liwcy Keller de Oliveira Lopes Lima- 2012.pdf: 870422 bytes, checksum: 431b648a9e85b9fc37769b57a0dc46e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5)<br>Made available in DSpace on 2014-11-10T20:09:55Z (GMT). No. of bitstreams: 2 Dissertação- Liwcy Keller de Oliveira Lopes Lima- 2012.pdf: 870422 bytes, checksum: 431b648a9e85b9fc37769b57a0dc46e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-05-07<br>Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq<br>Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG<br>The dental care practice is characterized by the constant possibility of the staff and patients exposure to biological material (BM) potentially contaminated with infectious various agents, and requiring the epidemiology expertise of these exposures in order to develop the risk management procedures. The present study aimed to analyze the epidemiology of occupational accidents with exposure to BM among dental professionals and students in the State of Goias, and as specific goals, to ferify the frequency and profile of the accidents with biological material exposure among the dental care students and professionals enrolled in a reference hospital with service in compliance with occupational exposure to BM, to characterize the pre-and postexposure behavior and monitoring program recommended for this population and to analyze the socio-demographic and labor factors related to the accidents with BM by percutaneous exposure between dental care professionals and students assisted in a reference service. This is an epidemiological, retrospective and analytical study developed in a referral hospital for the treatment of occupational accidents with exposure to BM of the State of Goiás. All records of the accidents with BM between dental care professionals and students attended in this institution by December 2010 were analysed. Data were collected by completing a standardized form containing personal information, description of the accident, time elapsed between the accident and the first service, and post-exposure and prophylaxis procedures. The data were analyzed by SPSS 15.0 and the OpenEpi 2.3.1., Statistical analysis was performed by descriptive frequency measures and univariate analysis using qui-square and Fisher exact test. 628 accidents were recorded between dental care professionals and students from 1996, the year of first registration, to 2010, in which 77.1% were women. Some individuals reported more than one accident, totalling 701 accidents with exposure to BM that comprise the study population. Among the accidents, the majority (97, 13.8%) occurred in 2008 and 48.6% between dentists. In 92.2% of cases, hepatitis B vaccination status of the victims was described, and out of these, 70.8% received all three doses. In 84.9% of cases there was no record of the completion of anti-HBs by the victims. The accidents were predominantly (658, 93.9%) percutaneous, being the needle the instrument that caused the injury in 49.7%. Performing any dental care procedure was the most comum circumstance in which the accidents occurred most frequently (388, 55.4%), and the finger, the body area most affected (493, 70.3%). We highlight the lack of information in many cases, especially in relation to BM involved in the accident, the use of personal protective equipment at the time of the accident, where the victims performed their activities at the time of the accident and / or were linked and fullfilling of Work Accident Communication form. With the post-exposure procedures, the majority (635, 90.6%) of the institution accidents enrollments occurred within 72 hours, however only 44.9% were in the first two hours. The use of chemoprophylaxis and prophylaxis of hepatitis B in 14.8% and 12.8% of the cases, respectively were recommended. In 82.6% of the accidents, the patients were identified, and their HIV, HBV and HCV condition ignored in 93.6% of records. Among the accidents in which the victim must return to the intitution for the post-exposure follow up (264, 37.7%), only 20.8% returned and 3.8% were discharged. Accidents by percutaneous exposures showed a high prevalence for all variables analysed. It was observed that the higher is the demand for the service the less is the individual chance to undergo a percutaneous exposure (p = 0.000). The occurrence of accidents among dental auxiliaries was significant (p = 0.016) compared to dentists. The lack of data in the records of the institution reveals the need for greater disclosure of ministerial protocols for caring the victims of occupational accidents by BM among professionals responsible for this service. The integration of biosafety, infection control procedures for dental care practice and prevention and prophylaxis for BM accidents issues with undergraduate, graduate courses should develop and provide effective behavior changes.<br>A prática odontológica é caracterizada pela constante possibilidade de exposição tanto da equipe quanto dos pacientes a material biológico (MB) potencialmente contaminados com diversos agentes infecciosos, sendo necessário o conhecimento da epidemiologia dessas exposições para o desenvolvimento de medidas de gerenciamento de risco. O presente estudo teve como objetivo geral analisar a epidemiologia dos acidentes ocupacionais com exposição a MB entre profissionais e estudantes de odontologia em Goiás e como específicos verificar a frequência e o perfil dos acidentes com MB em estudantes e profissionais de odontologia atendidos em um serviço de referência para atendimento à exposição ocupacional com MB, caracterizar as condutas pré e pós-exposição e de acompanhamento recomendadas para essa população e analisar os fatores sociodemográficos e laborais associados à ocorrência de acidentes com MB por exposição percutânea entre profissionais e estudantes de odontologia atendidos em um serviço de referência. Trata-se de um estudo epidemiológico, retrospectivo e analítico desenvolvido em um hospital de referência para o atendimento de acidentes ocupacionais com exposição a MB do Estado de Goiás. Foram analisadas todas as fichas de registro de acidente com MB entre profissionais e estudantes de odontologia atendidos nessa instituição até dezembro de 2010. Os dados foram coletados por meio do preenchimento de um formulário padronizado contendo informações pessoais, descrição do acidente, tempo decorrido entre o acidente e o primeiro atendimento, condutas pós-exposição e medidas profiláticas. Os dados foram analisados pelo SPSS 15.0 e pelo OpenEpi 2.3.1., foi realizada análise estatística descritiva pelas medidas de frequência e análise univariada por meio de testes qui-quadrado e exato de Fisher. Foram notificados 628 acidentes entre profissionais e estudantes de odontologia no período de 1996, ano do primeiro registro, a 2010, sendo que 77,1% eram do sexo feminino. Alguns indivíduos relataram mais de um acidente, totalizando assim 701 acidentes com exposição a MB que compõem a população do estudo. No ano de 2008 houve a maior frequência de registros de acidentes (97; 13,8%) e desses 18,6% eram CD. Em 92,2% dos casos, a situação vacinal contra hepatite B dos acidentados foi descrita, sendo que desses 70,8% receberam as três doses. Em 84,9% dos casos não havia registro da realização do anti-HBs pelas vítimas. Os acidentes foram predominantemente (658; 93,9%) percutâneos, sendo a agulha o instrumento causador da lesão em 49,7%. Durante a realização de algum procedimento odontológico, foi a circunstância em que os acidentes mais ocorreram (388; 55,4%), e o dedo da mão a área corporal mais atingida (493; 70,3%). Destacou-se a ausência de informações em diversos casos, principalmente em relação ao MB envolvido no acidente, uso de equipamento de proteção individuaI no momento do acidente, instituições onde as vítimas exerciam suas atividades no momento do acidente e/ou eram vinculadas e o preenchimento da Comunicação de Acidente de Trabalho. Quanto às condutas pós-exposição, na maioria (635; 90,6%) dos acidentes, o atendimento na instituição ocorreu em até 72 horas, entretanto apenas 44,9% foram nas primeiras duas horas. Foi recomendado o uso de quimioprofilaxia e profilaxia da hepatite B em 14,8% e 12,8% dos casos, respectivamente. Em 82,6% dos acidentes, os pacientes-fonte eram passíveis de identificação, sendo a condição dos mesmos, quanto à infecção pelo HIV, HBV e HCV, ignorada em 93,6% dos registros. Entre os acidentes em que a vítima deveria retornar ao ambulatório para a realização do acompanhamento pós-exposição (264; 37,7%), apenas 20,8% retornaram e 3,8% receberam alta. Os acidentes por exposições percutâneas apresentaram alta prevalência para todas as variáveis analisadas. Observou-se que quanto maior a procura pelo atendimento, menor a chance do indivíduo ter sofrido uma exposição percutânea (p=0,000). A ocorrência de acidentes entre auxiliares de saúde bucal foi significativa (p=0,016) comparada às CD. A ausência de dados nos registros da instituição revela a necessidade de maior divulgação dos protocolos ministeriais para o atendimento às vítimas de acidentes ocupacionais por MB entre os profissionais responsáveis por esse atendimento. A inserção de conteúdos como prevenção e controle de infecção na prática odontológica e medidas pré e pósacidentes com MB, nos cursos de graduação, aperfeiçoamento e pós-graduação têm o potencial de resultar em mudanças efetivas nas condutas.

M.P.H., Faculty of Health Science, University of the Witwatersrand, 2011<br>Needlestick Injuries (NSI) that occur at Kimberley Hospital Complex (KHC) are reported by various categories of staff ranging from general workers to managers. They are regarded as medico-legal events and are classified as specific adverse events (AE). An AE is defined as any unexpected, unintended, unwanted event or circumstance that could have or did lead to unintended or unexpected harm, loss or damage. Although there were regular meetings related to NSI, there has been no systematic analysis of applicable data related to employees at KHC. The aim of this study was therefore to describe the NSI at KHC over a 1 year period (1 Jan 2009 – 31 Dec 2009) in order to obtain baseline information which will contribute towards improved planning of targeted preventive strategies in this setting. Methodology: A descriptive cross-sectional study was undertaken. This involved a retrospective review of selected hospital records relating to NSI reported by employees during this study period. No primary data was collected. Results: A total of 32 employees reported NSI during the study period. The prevalence of NSI was 2% of overall staff compliment. The highest reported prevalence was amongst the doctors (13, 10.4%) and the lowest amongst the general assistants (5, 0.6%). The majority of NSIs occurred during the recapping activity (20, 62.5%), was reported by female employees (27, 84.4%), took place mainly during normal working hours (23, 72%), and were mostly located within the Internal Medicine Department (10, 31.3%). About a third of the employees who reported NSIs were between 26 to 35 years (31%). The total treatment costs including drugs and vaccines provided during the study period were R 13 509.12, and the total laboratory test costs were R20 978.24. Overall the costs for drugs, vaccines and laboratory tests that made up the post-exposure measures amounted to R34 487.36. Results from this study suggest that reporting of NSI and other adverse events involving employees should be handled separately from those of patients. It is also important to profile the diverse employees that maybe at risk for this specific exposure and ensure that they are provided with the necessary training in this regard. There is a need to strengthen the relationship between the Quality Assurance Unit and the Wellness Clinic in order to optimize utilization of data regarding reported NSIs. Strategies to prevent NSIs should consider training on a regular basis and supervisors should work more closely with safety representatives in preventing NSIs.

M.A.<br>The aim of this research was to explore the lived experience of three medical doctors after experiencing a needle stick injury. Needle stick injuries were defined as injuries, self-inflicted or by colleagues, where a needle punctures or lacerates the skin. There is an associated risk of HIV transmission via a needle stick injury, which prompted the exploration of the psychological aspects of the injury. The research was contextualised in terms of South Africa’s spiralling rate of HIV infection, as a result of which, it is reasonable to expect that doctors will increasingly be treating HIV positive patients. The research explored an area that has largely been untouched by researchers. The literature study showed that as regards needle stick injuries, the focus tends to be on the injury itself, the risk of HIV transmission and the causal patterns surrounding it, rather than on the psychological consequences. The research takes the form of an exploratory study and as such it applied qualitative research methodology. Semi-structured interviews were used, as it allowed for the greatest flexibility. In addition, the semi-structured interviews allowed the doctors the freedom to introduce and explore areas that were outside the questions posed by the researcher. The interviews were conducted at a place of the doctors choosing and all were recorded. For reasons of confidentiality, no names have been used and dates of qualification etc have been deliberately vague. The research found that the doctors experienced anxiety and fear after their injuries. Furthermore, it shows how friends, family and colleagues left them to deal with these feelings unaided. Broad themes of emotional deprivation, isolation, the doctor as patient and responsibility and support, were identified. Lastly the research found that the doctors learnt from their experiences and were able to demonstrate more compassion towards colleagues who had similar experiences, which they had previously been unable to show. It is hoped that this research and its findings will provide some insight onto the experiences after such an injury, and perhaps prompt further research into an area that has largely been left untouched.

碩士<br>高雄醫學大學<br>職業安全衛生研究所<br>89<br>Health-care workers (HCWs) were easily transmitted contagious diseases after exposure to needlestick or sharps injuries. The pathogens of these diseases included hepatitis B and C viruses, human immunodeficiency virus, and syphilis virus. In May, 1993, Kaohsiung Medical University Hospital implemented the protection program of needlestick injury inside the hospital. To evaluate the performance of this program, we conducted this study to compare the difference of needlestick injury mechanism, infection awareness of participants, distribution of infections, and reported rate between before and after the implementation of this program. We used two methods to estimate the incidence rate of needlestick and sharp injuries: one is "total amount of syringe devices purchased" and the other is "total amount of syringe devices used" as denominator. We found the incidence rates were 1.1×10-4 and 3.4×10-4, respectively. The annual incidence rates of needlestick injury and infective needlestick injury were 0.4 and 0.2 time per person, respectively. In our study we found that 29.5% of needlestick injury in our hospital had reported and received further medical attentions. 48.6% of those cases were injured by infectious sharps. Even though we implemented the protection program of needlestick injury, the reported rate was still relatively low.

碩士<br>高雄醫學大學<br>職業安全衛生研究所碩士班<br>93<br>Needlestick injuries are one of the most important occupational injuries for healthcare workers. According to the investigation, the percentage of healthcare workers who ever sustain a needlestick injury at workplace is about 87.3% in Taiwan. Needlestick injuries have a substantially greater risk of almost 20 types of disease transmission, such as HBV、HCV、HIV/AIDS、syphilis. In addition, it can cause negative effect psychologically and physically, not mentioning the vast amount of medical cost. Therefore, it is suggested that timely analyzing the data of needlestick injuries and assessing the cost can effectively prevent and control the incidence of needlestick injuries. In view of this, this study investigated a medical center, using epidemiology of needlestick injuries, statistics of medical cost, and investigation of special group-cleaner as indication for the related unit to improve needlestick injuries. A cross-sectional study was conducted among 452 reported healthcare workers who sustained needlestick injures at a medical center in the midland during 2001 to 2003. Not only the cause of needlestick injury was investigated, but also the occurred medical cost as well as injury tracking time was calculated. In December 2004, a questionnaire was used as a tool to assess the actual situation of needlestick injuries on cleaners and the difference among knowledge、attitude and behavior of them. The result showed that among all needlestick injury workers, the mean age was 29.2, and the mean service seniority was 4.0 years. The majority occupation were nurses(54.0%)、followed by medical doctors (12.8%)、medical students(7.5%), and cleaners(6.4%). Most injuries was happened in general wards (38%) and operation rooms (23%). The incidence of needlestick injury among medical doctors was 3%, nurses 0.4%, medical students 3.6%, and in-house cleaners 0.3%. 90% of overall injured healthcare workers were not effected Hepatitis B and had antibody for hepatitis B virus. The study shows occupation has significant difference among cause、time、place、service seniority, and etc (P<0.05). In view of medical cost, the average outpatient visits caused by needlestick injuries are 2.3 per person and mean examination was 2.0 per person. Average time spent on tracking down the cause was 43.5 minutes and medical cost was NT$2,869/per person. Considering different transmitted diseases on tracking cost, NT$1,840/per person was cost when no diseases occurred on needlestick injuries, NT$2,017 was cost when the source was Hepatitis B patients, NT$2,553 for syphilis positive, and NT$8,096 for HIV/AIDS positive. As for the questionnaire by cleaners, 190 out of 206 questionnaires were effective (or response rate 92%). Among 190 effective questionnaires, the mean age was 46.5 and 90.5% were women. Mean service seniority was 5.2 years. In-house cleaners were 34.7%, while outsourced cleaners were 65.3%. Most of their education was primary school level, accounting for 56.2% of 190 cleaners. Only 30.3% of the cleaners had hepatitis B virus antibodies. Besides, 68.8% had been accepted on-the-job training to avoid needlestick injuries. 17 persons had reported needlestick injury, accounting for 8.9% of the group. Most injuries were occurred in general wards, which is 52.9%. There were significant difference among sex、age、unit、service seniority、education、religion、knowledge and attitude of needlestick injuries as risk factors in work status (P<0.05)。 Conclusion：This study showed that encouraging the injection of hepatitis B vaccines on healthcare workers not only can effectively prevent incidence of hepatitis B transmission through needlestick injuries but also decrease related medical cost. Therefore, the administration unit should consider the possibility to accomplish hepatitis B vaccine on healthcare workers to reduce risk of infected diseases. Furthermore, the result showed high risk of needlestick injuries on cleaners, which may be due to the low level of education and knowledge of needlestick injuries. It is suggested that enhancing management and further education are important keys to avoid this type of injuries.

碩士<br>國立陽明大學<br>醫務管理研究所<br>103<br>Abstract Needlestick and sharp injuries (NSIs) are a common occupational hazard and the main cause of infectious blood and body-fluid transmitted disease for hospital medical staff. Risks of NSIs in physicians, however, have long been neglected while physicians often act as a team leader during clinical practice. The purpose of this study is to update the prevalence of NSIs in physicians and identify their underlying risk factors. A nationwide survey of “Workplace health and safety needs in hospitals” conducted in 70,622 medical staffs (including physicians, nurses and other medical professionals) at 100 hospitals by the National Health Department in Ministry of Health and Welfare of Taiwan between May to August of 2011 was adapted. Among which the survey questionnaires returned by 4,310 physicians were the foci of the current study. As a result, 912 (21.2%) needlestick injuries and 698 (16.2%) sharp injuries were reported respectively in the total 4,310 questionnaires. Further analysis revealed that the risk factors of occupational NSIs were heightened by age (<35 y), education level (college or underneath), years in practice (between 2 to 5 years), total working hours in the most recent week (>84 hrs), places of practice (operational room, delivery room, general ward or emergency room), hospital levels of service (medical center), daily sleep time (≦5 hrs), having habits of smoking and/or drinking and being in a high work pressures or strong depressed moods. In conclusion, the present study shows that the actual rate of NSI incidence in physicians might be higher than that notified in the Exposure Prevention Information Network (EPINet) or inferred from data in previous retrospective studies. The affecting factors of NSI events involve physician’s clinical experiences, extent of risk exposure, compliance of preventive measures and work overload. In addition to encouraging hospitals to impose NSI incidence report and audit of preventive measures, it is suggested that hospitals should dedicate in removing the obstacles that reduce physician’s compliance of NSI preventive measures during their everyday practices and in developing needle protective measures that are customized to the needs of high-risk groups. Hospitals should also strengthen the hands-on skills for needlestick or sharp protection in physician’s early stages of career, and pay attention to physician’s over workload underlying NSI events for sake of both physicians’ and patients’ safety. Future researchers should conduct both qualitative and quantitative study, in which in-depth interviews need to be done immediately after NSI events in order to understand the reasons behind so as to identify behavioral predictors and countermeasures of NSI. Key words: Needlestick injury, sharp injury, physicians

碩士<br>高雄醫學大學<br>職業安全衛生研究所<br>89<br>The purpose of this study was to understand the circumstance of needlestick/sharp injuries during the period of practical training and the effect of the intervention. The subjects of this study were the graduating nursing students. The first questionnaire was finished after the period of practical training. Then, the interventions, education and handbooks followed. The second questionnaire was completed four months after being graduated . There were 527 valid questionnaires, the average age was 17.8 years old, and were female. This situation of injuries during practical training stated under﹕the prevalence of percutaneous injuries or injuries with blood exposure accidents(BEAs) was 50.1%、18.2%,respectively. Only 38.6% of students who were injured reported their injuries to teachers or staffs . The targets of answering complete correct for HbsAg and HbsAb was 36%. To analyze the relation of injuries by logistic regression, the result stated that time of practical training was significant. After there were 107 objects to go into nurses. The prevalence of injuries or BEAs was 5.2%、14%. The reporting rate after injuries was 55.6%. The post-test questionnaire was shown 56.6% of subjects should be recapped with one hand. After intervention, the circumstance of percutaneous injuries is reducing （McNemar test P＜0.001）. After intervention, the injuries are decreasing. From the result of this study, the author discovers﹕the perception of HbsAg and HBsAb should be enhanced, the skill of standard is important and to fulfill the report after injuries, to improve the safety of the devices﹔and to consider that whether the nursing students who are under the statutory age suit to carry out the practical training.

碩士<br>臺灣大學<br>醫療機構管理研究所<br>95<br>Needlestick and sharps injuries (NSIs) are the main issue of occupational safety among healthcare workers injuries because of the potential risk of transmission of infectious diseases. The purposes of this study include:(1)understanding the occurrence and reporting rate of NSIs among doctors and nurses in a medical center; (2)identifying associated factors with NSIs. From May 10th to May 30th in 2007, purposive sampling of subjects was conducted for this cross-sectional survey in a medical center, by means of structured questionnaires. From 418 doctors and 814 nurses , 251 and 814 completed questionnaires were respectively obtained with response rates of the doctors and nurses being 60.0% and 80.5% respectively (totally 73.5%). The results of this study are as follow: (1) Totally, 45.5% of the subjects experienced NSI in the previous year with an average of occurrence 0.76 events/ person/year. 43% of NSI events involved contamininated devices. Doctors and nurses had NSIs with averages of occurrence to be 0.74 events/doctor/yearand 0.77 events/nurse/year respectively. (2) 62.3% of NSI events were reported. The reasons of no motivation in reporting NSI events included the complicated procedure of reporting NSI events, no known infection diseases in the involved patients and lack of enough time for reporting. (3) The commonest devices of NSIs were syringe-needles and opening an ampoule or vial in descending order. The most common medical procedure causing NSIs was recapping of syringe needles. (4) On recalling the recent ten times of handling syringe needles, the subjects got the averages of disposal of uncapped syringe needles directly to the collecting boxes, recapping synringe needles by single hand and recapping by double hands to be 5.95 times, 2.46 times and 1.56 times respectively. (5) Of the mean occurrences of NSIs, male was higher than female and doctors were higher than nurses. Besides, the Bachelors were the highest considering educational level. The mean occurrences were highest at surgery wards, followed by operation rooms, but lowest at intensive care units. The younger and lesser job experience of the subjects, the higher were the occurrences of NSIs. (6) The better knowledge about NSIs of the subjects, the lesser was the occurrence. The better attitude of subjects to NSIs, the lesser was the occurrence. (7) The knowledges of female subjects about NSIs were better than these of males. The subjects from department of internal medicine got the highest knowledge score while those from the operation rooms got the lowest score. Those who had ever received educational courses about NSIs got higher score than those uneducated. (8) Considering scoring of attitudes to NSIs, females were higher than males and nurses higher than doctors. In addition, the subjects in operation rooms got the highest score while those in Department of Surgery got the lowest. (9) The scores of knowledge about and attitudes to NSIs got significantly positive Pearson correlation with the frequencies of disposing uncapped syringe needles while the scores of attitudes got significantly positive Pearson correlation with frequencies of uncapped syringe needles. (10) The important predictive factors in occurrence of NSIs are education level and attitude scores. Logistic regression indicated that the odds ratio in NSIs of those getting Bachelor degree to those getting Master degree or higher degree is 2.646(95% C.I.=1.106–6.330). The important predictive factors in contaminated NSIs included titles, departments and net attitudes. Besides, the odds ratio in NSIs of doctors to nurses was 2.302 (95% C.I.=1.127-4.704) and the odds ratio of subject in operation room to subjects in intensive care units was 3.895 (95% C.I.=1.682-9.017). In conclusion, the highest risk group of NSI included doctors, those working in operation room and the less experienced. The most important predictive factor in NSI was attitude of each staff. The outcome of this study may provide information for improving safety policy in hospital.

A research project submitted in partial fulfilment of the requirements for the degree of Master’s (Industrial/Organisational Psychology) in the Faculty of Humanities, University of the Witwatersrand, Johannesburg, March 2017<br>A South African study, based on a sample of 208 medical personnel working in public and private institutions, was conducted in order to determine whether job demands and job resources led to differences in the propensity to comply with Needlestick Injury (NSI) intervention scores. Three self-report questionnaires were completed by the participants, namely the self-developed demographic questionnaire, the Job Demands-Resources Scale (JDRS) which measured job demands and resources, and thirdly the self-developed Propensity to Comply with Interventions for Needlestick Injuries Scale (PCINS) which measured the propensity to comply with interventions for NSIs. Accidental needle stick, as well as sharp, injuries occur frequently within the medical context and are associated with high risks for blood-borne infections (Adefolalu, 2014). Specifically within South Africa blood-borne infections such as HIV carry heavy significance. Needlestick injuries often go unreported by healthcare professionals, and these injuries are widely prevalent. The researcher aimed to explore the job demands and resources that contribute to and mitigate against these injuries. Therefore support for the analysis of job demands and resources and the propensity to comply with NSI interventions exists. The results of the study suggested that there were mostly no significant differences between Job Demands and Resources and the propensity to comply with NSI Interventions scores. However significant relationships were found between length of shift and the propensity to comply with NSI interventions and growth opportunities and the propensity to comply with NSI interventions. The findings did not follow the proposed hypotheses that job demands would lead to a decrease in the propensity to comply with NSI interventions and job resources would lead to an increase in the propensity to comply with NSI interventions as longer length of shift (job demand) led to an increase in propensity to comply with NSI interventions and an association between high levels of growth opportunity (job resource), and low levels of propensity to comply with NSI interventions, was found.<br>GR2018

Please read the abstract (Summary) in the section 00front of this document<br>Dissertation (MMed)--University of Pretoria, 2007.<br>School of Health Systems and Public Health (SHSPH)<br>MMed<br>Unrestricted

碩士<br>國立成功大學<br>環境醫學研究所<br>86<br>Needlestick injury is among the most common types of accidental exposureresulting in the documented transmission of hepatitis B and C virus for hospital personnel. Health care workers in emergency department are know to be at high risk of exposure to needle and blood body fluid accidents. However, the prevalenceand predisposing factors of these injuries are unknown in Taiwan. The purpose of this survey was to understand the experience of needlestick injury & exposure tobody fluid in health care worker and estimate risk hepatitis B and hepatitis Cthrouth the way. Therefore, we began to survey the prevalence of needlestickinjuries & exposure to body fluid in emergency department among health careworkers, and the hepatitis B & hepatitis C carrier seroprevalence in emergencydepartment patients. A quedtionnaire survey of 372 health care workers in 14 hospitals, including medical centers, district hospitals, local and local teaching hospital in Taiwan wasconducted. The prevalence of ever having needlestick of sharp injuries at workwas as high as 91.9% in this group. Concerning the most recent episode ofneedle/sharp injury, approximately 55.3% of the episodes were caused by ordinaryneedles, and most frequently duo to recapping(21.3%). Approximately 80.5% ofthe people who were ever stuck stated that they did not report the most recentevent to their employers or the hodpital administration. The reported frequencies ofinjuries caused by needles and other sharps were 1.43 and 1.54/person/year,respectively. The frequencies of exposure to blood and other body fluids were0.98/person/year to non-intact skin, 0.28/person/year to the eyes, 0.13/person/ yearto mucosa membrane of nose, and 0.16/person/year to mucosa membrane of mouth. To assess exposure or infectious risk about hepatitis B and hepatitis C afterneedlestick injury, we began to survey hepatitis B and hepatitis C carrierseroprevalence in emergency department. We collected 872 serum samples ispatients older than 6 years and who require to phlebotomy. Anonymous study ofthese blood samples include testing HBsAg, HBeAg, and anti-HCV by enzyme-linked immuno-sorbent assay(ELISA). One hundred thirty-one of 872(15%) werepositive for HBsAg and among 131 HBsAg positive 20(16.1%) were HBeAgpositive. Hepatitis B seroprevalence was highest among patients aged 30 to 40 years, males, and low urbanization. Theses were statistically significant between heaptitisB and above variables. Hepatitis C seroprevalence was 12.6%(110 samples), and highest above 50 years, males, and low urbanization. The relation betweenhepatitis C and age was statistically significant. After this survey, we referredneedestick injury among health care workers in emergency department and many references, then we estimated that infectious risk of hepatitis B and hepatitis Cthrough contaminated needlestick injury was 0.001-0.008 and 0.003-0.004, and life-time risk was 0.03-0.25 and 0.10-0.13. The exposure risk of hepatitis B and hepatitis C through blood and body fluid from patience was 0.06 and 0.05. It wasconcluded that, needlestick and sharps injuries in the health care workers inemergency department were high, with potential hazards of transmitting infectiousdisease, such as hepatitis B or C. Precaution, education, and protective equipmentwill be warranted to reduce the needle and sharps injuries in health care workers inTaiwan.

Background: Accidental exposure to patients’ body fluids (BFs) is an occupational hazard among health care workers (HCWs). The study aimed at describing the patterns of exposure to patients’ BFs among HCWs at a university hospital in Ethiopia. Methods: A contextual descriptive cross-sectional design was used for this study. Self-administered questionnaires were used to collect data. Results: The one year and professional life prevalence of occupational exposure to patients’ BFs among HCWs was 33.5% and 66.5% respectively. Circumstances that led to participants’ exposures to patients’ BFs include needle stick injuries to fingers and splashes to the eyes (82.4%); conducting procedures included blood withdrawal (10.8%) and inserting intravenous infusions (8.1%) and recapping of used needles (12.2%). Conclusion: Findings of this study generally indicated that occupational exposures to patients’ BF of different types and circumstances were common among all categories of HCWs in the study site. This high finding of BF exposure should not be over looked. HCWs should follow the universal precaution protocol and PEP need to be strengthened<br>Health Studies<br>M.A. (Public Health)

This study aimed to provide evidence on knowledge of attitudes toward standard precautions (SPs) and its practice of Healthcare Workers (HCWs) in government and private hospitals in Botswana. It utilised descriptive cross-sectional methodology. A range of significant findings were revealed. Good practice of SPs was noted more amongst the HCWs in government than in private hospitals. Knowledge of SPs amongst HCWs in government hospital was significantly and positively correlated to good practice of SPs. Registered Nurses (RNs) had better knowledge of SPs than HealthcareAssistants (HCAs).There was no significant difference between RNs and HCAs practice of SPS and attitudes toward the same. No significant difference in the knowledge, attitudes and practice of SPs was noted between General Practitioners (GPs) and RNs. No significant difference in the knowledge, attitudes and practice of SPs was observed between GPs and HCAs. The study findings have implications for the application of SPs in practice<br>Health Studies<br>M.A. (Public Health)