Non-pharmacological measures in preterm newborns submitted to arterial puncture / Medidas no farmacológicas en recién nacidos prematuros sometidos a la punción arterial / Medidas não farmacológicas em recém-nascidos pré-termo submetidos à punção arterial

ABSTRACT Objective: to assess pain in preterm newborns and to compare the neonatal and therapeutic variables with the total scores of the Neonatal Facial Coding System of preterm newborns submitted to arterial puncture exposed to music and 25% oral glucose. Method: a comparative study with 48 recordings of preterm newborns - Group 1, music (26); Group 2, glucose 25% (22) - individually analyzed by three trained nurses, after Kappa of at least 80%. Results: the variables and the pain scores of the groups did not present statistical significance (p < 0.05) according to the Neonatal Facial Coding System. 80.8% of the preterm infants in Group 1 had a higher quantitative score ≥ 3 in the neonatal variables (gender, type of delivery), and therapeutic variables (type of oxygen therapy, place of hospitalization, type of puncture). Conclusion: There was no difference when comparing the music and glucose 25% groups and the variables studied.

RESUMEN Objetivo: evaluar el dolor en recién nacidos prematuros y comparar las variables neonatales y terapéuticas con las puntuaciones totales del Neonatal Facial Coding System de los recién nacidos prematuros sometidos a una punción arterial expuestos a la música y glucosa al 25% por vía oral. Método: estudio comparativo con 48 fi lmaciones de los recién nacidos prematuros divididos en el Grupo 1 - música (26) y el Grupo 2 - glucosa al 25% (22). Las fi lmaciones fueron analizadas individualmente por tres enfermeras capacitadas después de coefi ciente Kappa de al menos 80%. Resultados: las variables y puntuaciones de dolor de los grupos no fueron estadísticamente signifi cativas (p<0,05) de acuerdo con el Neonatal Facial Coding System. En el Grupo 1, 80,8% de los recién nacidos prematuros mostraron mayores cantidades de puntuaciones ≥ 3 en las variables neonatales (sexo, tipo de parto) y las variables terapéuticas (tipo de la terapia de oxígeno, lugar de internación, tipo de punción). Conclusión: No hubo diferencias cuando se comparan los grupos de música y de glucosa al 25% y las variables estudiadas.

RESUMO Objetivo: avaliar a dor em recém-nascidos pré-termo e comparar as variáveis neonatais e terapêuticas com os escores totais da Neonatal Facial Coding System de recém-nascidos pré-termo submetidos à punção arterial exposto à música e glicose 25% oral. Método: estudo comparativo com 48 fi lmagens de recém-nascidos pré-termo - Grupo 1, música (26); Grupo 2, glicose 25% (22) - analisadas individualmente por três enfermeiras treinadas, após Kappa de no mínimo 80%. Resultados: as variáveis e os escores de dor dos grupos não apresentaram signifi cância estatística (p < 0,05) de acordo com o Neonatal Facial Coding System. 80,8% dos prematuros do Grupo 1 apresentaram um maior quantitativo de escores ≥ 3 nas variáveis neonatais (sexo, tipo de parto) e, variáveis terapêuticas (tipo de oxigenoterapia, local de internação, tipo de punção). Conclusão: Não houve diferença ao se comparar os grupos da música e da glicose 25% e as variáveis estudadas.

Risk Factors for Hepatitis C Virus (HCV) Infection in Areas with a High Prevalence of HCV in the Republic of Korea in 2013

BACKGROUND/AIMS: The prevalence of hepatitis C virus (HCV) infection in Busan, Gyeongnam, and Jeonnam Provinces in Korea is more than twice the national average. This study aimed to examine whether demographic and lifestyle characteristics are associated with HCV infection in these areas. METHODS: A case control study was performed at three study hospitals. HCV cases were matched with two controls for sex and age. Patient controls were selected from non-HCV patients at the same hospital. Healthy controls were subjects participating in medical checkups. Conditional logistic regression models were used. RESULTS: A total of 234 matched-case and patient- and healthy-control pairs were analyzed. The significant risk factors for both controls were sharing razors (adjusted odds ratio [aOR], 2.39 and 3.29, respectively) and having more than four lifetime sexual partners (aOR, 2.15 and 6.89, respectively). Contact dockworkers (aOR, 1.91) and tattoos (aOR, 2.20) were significant risk factors for the patient controls. Transfusion (aOR, 5.38), a bloody operation (aOR, 5.02), acupuncture (aOR, 2.08), and piercing (aOR, 5.95) were significant risk factors for the healthy controls. Needle stick injuries and intravenous drug abuse were significant in the univariate analysis. CONCLUSIONS: More education concerning the dangers of sharing razors, tattoos and piercings is required to prevent HCV infection. More attention should be paid to needle stick injuries in hospitals and the community.

Occupational exposure to blood and body fluids amongst health care workers in a teaching hospital of the Sukkur, Sindh

Health care workers [HCWs] are at risk of infection with blood-borne viruses in the course of their work. Over 90% of these infections are occurring in low-income countries and most are preventable. However, the situation in the teaching hospitals has always been thought to be much better than the public health facilities in other hospitals. The focus of the study was on assessing the exposure frequency amongst HCWs in a teaching hospital in the Sukkur. Cross-Sectional Study. This study was conducted at Ghulam Mohammad Mahar Medical College Hospital, Sukkur, Sindh from November 2011 to December 2011. A cross-sectional survey amongst HCWs involved in collecting blood samples and administering injections in all wards of the hospital was conducted. Selection of study participants was by simple random sampling. A pre-tested questionnaire was administered by unlinked, anonymous method. Total sample studied was 70. The proportion of HCWs experiencing exposure to blood body fluid splash [BBF] and needle stick injury [NSI] during last one week was 47.1% and 31.43%, respectively. The incidence density of BBF exposure was 537.14 per 100 person years and that of NSI episodes was 228.57 per 100 person years. The reasons for not using personal protective equipment [PPE] ranged from busy schedule [37.14%], non use of PPE by co-workers [67.14%], emergencies [91.43%] risk that patients may get offended by PPE use by HCWs [27.14%] to discomfort while using PPE [24.29%]. All components of PPE were available as per only 34.24 percent. The high level of occupational exposure to blood and body fluids and consequent risk of infection amongst a group of HCWs in the Teaching Hospital highlights the urgent need for interventions to enhance to the occupational safety of workers

Behavioral and Healthcare-Associated Risk Factors for Chronic Hepatitis C Virus Infection in Korea

The risk factors related to hepatitis C virus (HCV) infection showed geographic and temporal differences. We investigated HCV-related risk factors in Korea where intravenous drug use (IVDU) is uncommon. The HCV-related risk factors were investigated in a prospective, multicenter chronic HCV cohort (n = 711) using a standardized questionnaire in four university hospitals. The results were compared with those of 206 patients with chronic liver diseases not related to either of HCV or hepatitis B virus infection (comparison group). The IVDU was found in 3.9% and remote blood transfusion (> or = 20 yr ago) in 18.3% in HCV cohort group, while that in comparison group was in none and 5.3%, respectively. In a multivariate logistic analysis, transfusion in the remote past (odds ratio [OR], 2.99), needle stick injury (OR, 4.72), surgery (OR, 1.89), dental procedures (OR, 2.96), tattooing (OR, 2.07), and multiple sexual partners (2-3 persons; OR, 2.14, > or = 4 persons; OR, 3.19), were independent risk factors for HCV infection. In conclusion, the major risk factors for HCV infection in Korea are mostly related to conventional or alterative healthcare procedures such as blood transfusion in the remote past, needle stick injury, surgery, dental procedure, and tattooing although multiple sex partners or IVDU plays a minor role.

Behavioral and Healthcare-Associated Risk Factors for Chronic Hepatitis C Virus Infection in Korea

The risk factors related to hepatitis C virus (HCV) infection showed geographic and temporal differences. We investigated HCV-related risk factors in Korea where intravenous drug use (IVDU) is uncommon. The HCV-related risk factors were investigated in a prospective, multicenter chronic HCV cohort (n = 711) using a standardized questionnaire in four university hospitals. The results were compared with those of 206 patients with chronic liver diseases not related to either of HCV or hepatitis B virus infection (comparison group). The IVDU was found in 3.9% and remote blood transfusion (> or = 20 yr ago) in 18.3% in HCV cohort group, while that in comparison group was in none and 5.3%, respectively. In a multivariate logistic analysis, transfusion in the remote past (odds ratio [OR], 2.99), needle stick injury (OR, 4.72), surgery (OR, 1.89), dental procedures (OR, 2.96), tattooing (OR, 2.07), and multiple sexual partners (2-3 persons; OR, 2.14, > or = 4 persons; OR, 3.19), were independent risk factors for HCV infection. In conclusion, the major risk factors for HCV infection in Korea are mostly related to conventional or alterative healthcare procedures such as blood transfusion in the remote past, needle stick injury, surgery, dental procedure, and tattooing although multiple sex partners or IVDU plays a minor role.

Needle stick injury and HIV risk among health care workers in North India.

Objectives: To determine the occurrence of needle stick injuries among various categories of health care workers (HCWs), the causal factors, and the circumstances under which these occur. 2. To explore the possibilities of measures to prevent these through improvement in knowledge, attitude, and practice. Materials and Methods: The study was conducted in two government tertiary level hospitals. Study sample comprised 107 HCWs, providing medical care in two government tertiary level hospitals of Chandigarh. Subjects were enquired about their exposure to needle prick injuries during patient management in the last 6 months and also the action taken following exposure. The statistical tools employed were: ratio, proportions, and other basic methods of data interpretation. Results: The study among 107 HCWs included 27 doctors (25.2%), 68 nurses (63.5%), and 12 paramedics (11.2%), with 87 (81.3%) being females. The prevalence of needle stick injury and exposure to blood was reported by 73 (68.2%) participants. The main factor ascribed for this exposure was heavy patient load (42.5%). The maximum accidents occurred during emergency care (30.1%). Most common action following exposure was cleaning with spirit (46.3%). Only 51 (47.7%) of HCWs admitted following universal precautions. Among those exposed, only 10 (13.7%) persons had undergone HIV testing. Conclusion: Two-thirds of HCWs were exposed to needle stick injuries. Lack of awareness about post-exposure prophylaxis (PEP) was found.

Knowledge and beliefs among health care workers regarding hepatitis B infection and needle stick injuries at a tertiary care hospital, Karachi

Hepatitis B virus [HBV] infection is a recognized occupational risk for health care workers [HCWs]. This study aimed to assess the knowledge and beliefs of HCWs regarding HBV transmission and needle stick injuries [NSIs]. A cross-sectional questionnaire based KAP study was conducted at Civil Hospital, Karachi, during the period of January to September 2006. HCWs were inquired about possible modes of HBV transimission and association with NSIs. Data were entered using Epilnfo 6.04d software. Statistical analysis was performed using SPSS 12.5 software. A total of 343 HCWs participated, and those answered at least 5 correct modes of HBV transmission were considered knowledgeable. Knowledgeable group was more likely to report NSIs [p<0.006], more vaccinated [p<0.001] and were also more likely to attend awareness session [p< 0.009]. Overall knowledge were inadequate and behaviour and attitude towards clinical practices were found compromised. To reduce the occupational risk, effort should be focused to establish effective infection control program and training of staff

[Epidemiological features of needle stick injuries among nursing staff]

Injury with contaminated sharp devices like used needles is the great potential risk factor in nursing staff. Severity of infectious complications of these injuries demonstrated the value of prophylactic activities. To evaluate epidemiologic features of needle stick injuries and coverage of Hepatitis B vaccine among nursing staff in Bualisina hospital in Qazvin from March 2007 to March 2008. In this cross sectional descriptive study, data of needle stick injuries if staff was gathered by direct interview. For statistical analysis were used t student, chi square and Fisher exact test. P value above 0.05 was considered statistically significant. In this period among 172 nurses, 55 subjects experienced needle stick injuries [32%]. There was no statiscally relationship between needle stick injuries with educational level, gender, and related training courses; but there was a statiscally relationship between the injuries and the number of continous shifts. Reporting the injury to the hospital supervisors was statiscally significant in nurses who had university education. According to undesirable complications of needle stick injuries, it is considered to organize educational programs in order to decreasing continues shifts in nursing staff and emphasis major priority of prevention methods

Frequency of acute hepatitis C after needle stick injury and its treatment outcome

To determine the frequency of acute HCV infection after needle stick injury and its treatment outcome. Patients with HCV positive needle stick injury and reporting within 72 hours of incident were selected. Co-infections with HBV, HDV, HIV, hematological disorders and depression were excluded. Anti-HCV was done at presentation and those testing positive were excluded. HCV RNA was done after two weeks or anti-HCV after six weeks of incident. Those testing positive were kept under observation for 16 weeks for spontaneous resolution. After this period HCV RNA and Genotype were done and therapy with Peg-interferon was started. Rapid, early and sustained virological responses were checked. Two hundred eight patients with HCV positive needle stick injury were selected, 10 [4.8%] developed acute HCV infection out of them one [10%] had spontaneous recovery during the observation period of 16 weeks. seven [77.8%] achieved rapid virological response and eight [88.9%] achieved sustained virological response. Acute HCV is an uncommon disease to diagnose; it has favorable response to therapy if initiated early after a strict surveillance of patients for 8-16 weeks

Evaluation of 19 cases of inadvertent globe perforation due to periocular injections.

BACKGROUND: Inadvertent globe perforation due to periocular injection is a serious iatrogenic complication. AIM: To study risk factors, management and visual outcome of inadvertent globe perforation during periocular injection, in cases referred to a tertiary eye care center. DESIGN AND SETTING: Retrospective study at a tertiary referral center with a single investigator. MATERIALS AND METHODS: Nineteen consecutive cases with a clinical diagnosis of globe perforation were studied (1998-2004). Clinical setting, risk factors, clinical presentation, management and visual outcome were analyzed. RESULTS: Retrobulbar injections 6 (32%), peribulbar injections 10 (53%) and subconjunctival injections 3 (16%) were responsible for inadvertent globe perforation. Anesthetists accounted for 6 (32%) injections and 13 (69%) were referred from high volume community settings. Anesthetists identified the mishap on the table in 17% (1 out of 6) of cases and the ophthalmologists in 69% (9 out of 13) myopia was present in 10 (53%). Breaks were located inferotemporally in nine eyes. Four underwent laser and cryopexy, 14 (74%) underwent vitreous surgery. Visual acuity greater than 20/200 was achieved in 12 patients. CONCLUSION: Myopia was found to be a significant risk factor. Inferotemporal breaks were common. Anesthetists were more likely to miss this complication when it occurred. In this series, intervention salvaged vision in a significant number of eyes.

Riesgo ocupacional del personal de salud por exposición a elementos cortopunzantes en el periodo 2003-junio 2006 / Occupational risk of health personnel due to exposure to cutting and piercing instruments during the period of 2003- june 2006

Los accidentes cortopunzantes son fuente importante de adquisición de infecciones transmitidas por sangre tales como hepatitis B, HIV, y hepatitis c. Los trabajadores hospitalarios habitualmente se encuentran expuestos a una importante variedad de factores de riesgo laborales, que pueden provocar accidentes de trabajo y enfermedades ocupacionales diversas

Tuberculous skin ulcer following needle-prick injury in a health care professional.

A case of cutaneous inoculation tuberculosis in a 25-year old health care professional is reported. The diagnosis was confirmed by histopathology and isolation of Mycobacterium tuberculosis by BACTEC 460TB radiometric method. Rapid healing of the ulcer was noted in response to surgical debridement and specific anti-tuberculous therapy.

Acidente com material biológico em hospital universitário do oeste do Paraná / Accidents with biological material in a university hospital from west Paraná

Estudo descritivo, retrospectivo realizado com o objetivo de investigar os acidentes de trabalho com material biológico, que envolveram trabalhadores e estagiários, ocorridos em 2003 e 2004 num hospital universitário do Paraná. Na coleta dos dados foi utilizado o formulário eletrônico da Rede de Prevenção de Acidente de Trabalho-REPAT. Dentre os 586 trabalhadores do quadro funcional do hospital, houve registro de 20 (3,4%) trabalhadores acidentados em 2003 e 23 (3,8%) em 2004, o que representou acréscimo de 15% nas notificações de um ano para o outro

Surveillance of needle stick injuries [NSI] and sharp injuries at two centers in Pakistan

A base line studies to assess the Needle Stick Injuries [NSI] and sharp injuries and its outcome in health care providers. Descriptive study. Based on collection of relevant data spreading over a period of five years [from 1995-2000] from two tertiary care centers one public and other private. This study was conducted in 1342 healthcare workers [Public sector 612 and private sector 730]. Individuals comprising of doctors, nurses, laboratory technicians, operation theatre Staff and staff in other department of tertiary care centers. The method involved was proper filling of NSI Protocol form and informing directly concerned department and laboratory investigations for Hepatitis B Virus [HBV], Hepatitis C Virus [HCV] and Human Immunodeficiency Virus [HIV] at both the centers and additional Hepatitis G Virus [HGV] and culture at only one center [Public center]. Total positive cases at public sector hospital were 364 [59.5%] out of 612 and 317 [43.4%] out of 730 at private sector hospital. Out of 612 NSI cases there were 260 [42.5%] HBV, 64 [10.5%] HCV, 03 [0.5%] HGV 01[0.1%], bacterial infection 36[5.9%] and 248[40.5%] negative at public sector hospital. At private sector hospital out of 730 NSI cases there were 272 [37.3%] HBV, 42 [5.7%] HCV, 03 [0.4%] HIV and [413 56.6%] were negative. Data collected was analyzed by statistical tests. NSI is a major healthcare workers problem. It is necessary to deal with it amicably and effectively

Fratura de agulha durante punção subaracnóidea: relato de caso / Needle fracture during spinal puncture: case report

JUSTIFICATIVA E OBJETIVOS: Depois da introdução das agulhas de fino calibre (26G, 27G e 29G) e a conseqüente diminuição da incidência de cefaléia pós-punção da dura-máter, a raquianestesia vem sendo cada dia mais empregada. Suas complicações são pouco freqüentes. Recentemente, entretanto, foi observada uma complicação aparentemente rara, de fratura da agulha durante punção subaracnóidea. O objetivo deste relato é registrar o fato e aventar as possíveis causas e sua prevenção. RELATO DO CASO: Paciente do sexo masculino, 53 anos, 90 kg, 175 cm, portador de hipertensão arterial sistêmica crônica e insuficiência renal crônica apresentou-se, em caráter de urgência, para transplante renal. Foi proposta a administração de morfina subaracnóidea visando analgesia pós-operatória. Inicialmente tentou-se, sem sucesso, punção em L3-L4 com agulha 27G, seguiu-se tentativa de punção em L2-L3 quando se percebeu deformação da agulha. Ao ser retirada a agulha partiu-se, permanecendo um fragmento de 43 mm no ligamento interespinhoso de L2-L3, confirmado por fluoroscopia. Foi induzida anestesia geral e procedeu-se exploração cirúrgica guiada por fluoroscopia com retirada do fragmento da agulha. A seguir, o transplante renal foi realizado sem intercorrências. CONCLUSÕES: A diminuição do calibre das agulhas, que trouxe a vantagem da redução da incidência de cefaléia pós-punção da dura-máter, fez também com que elas se tornassem mais frágeis. Em casos onde os ligamentos são mais resistentes e a punção tentada mais de uma vez, pode haver deformação do material que fica susceptível a quebra. Conclui-se que em situações em que há resistência aumentada à passagem da agulha ou dificuldade de punção, o risco de sua deformação e a possibilidade de fratura devem ser confrontados com as vantagens do uso de agulhas de fino calibre.

High ear piercing--a dangerous craze.

Ear piercing is a primitive tradition among the human being. It reflects the culture of many religions, tribes, and communities, predominately adopted by the females. We reported a sixteen years old girl with painful swelling of both pinnas for last one month following piercing the pinna. She was treated locally by general practitioner without significant improvement. On examination frank abscess were detected in both pinna. Under general anesthesia incision drainage and deep curettage was done. She was treated with ciprofloxacin 750 mg 12 hourly for 2 weeks and recovery was uneventful. After one month she developed unsightly cauliflower ear. With this report we want to sensitize our community regards the risk of transmission of needle prick diseases and deformity of pinna following ear piercing

Knowledge, attitude and practices among health care workers on needle-stick injuries.

OBJECTIVE: This study aimed to assess the knowledge, attitude and practices among health care workers on needle stick injuries. METHODS: A 15-item questionnaire was administered to seventy health care workers including nurses and paramedical staffs from different departments of Kathmandu Medical College and Teaching Hospital to measure knowledge, attitude and practices on needle stick injuries. RESULTS: Results showed that 4% and 61% of health care workers, respectively, were unaware of the fact that hepatitis B and hepatitis C can be transmitted by needle-stick injuries. 52 subjects (74%) had a history of needle-stick injuries and only 21% reported the injuries to the hospital authority. Only 23% were in the habit of using gloves for phlebotomy procedures all the time. 79% were of the impression that needle should be recapped after use. Only 66% were aware of Universal Precaution Guidelines. 16 subjects (23%) were negative for HBsAg, Anti-HCV and Anti-HIV and 54 subjects (77%) do not know about their immune status. 42 subjects (60%) had been vaccinated against hepatitis B, while 28 subjects (40%) were not vaccinated against hepatitis B. Only 6 subjects (14%) had been tested for Anti-HBs antibody after hepatitis B vaccination. CONCLUSION: The survey revealed that knowledge of health care workers about the risk associated with needle-stick injuries and use of preventive measures was inadequate. A standing order procedure (SOP) should be formulated regarding needle-stick injuries in all the health institutions. It should outline precautions to be taken when dealing with blood and body fluids. It should also contain reporting of all needle-stick injuries. Health care workers should be made aware of hazards, preventive measures and post-exposure prophylaxis to needle-stick injuries. A hospital-wide hepatitis immunization programme should also be started.