O HIV e o trabalhador de enfermagem frente ao acidente com material perfurocortante: [revisão] / HIV and the nursing professional in face of needlestick accidents: [review] / El VIH y el trabajador de enfermería frente a accidentes con material punzocortante: [revisión]

O estudo tem como objetivo identificar a produção científica sobre o acidente de trabalho do profissional de enfermagem com material biológico contaminado por HIV e caracterizar os fatores predisponentes aos acidentes de trabalho, assim como os procedimentos realizados pós-exposição ao material perfurocortante potencialmente contaminado pelo HIV. É uma revisão de literatura, cuja busca bibliográfica por palavras-chave foi realizada por meio da base de dados LILACS a partir de 2000. Constatou-se que os fatores predisponentes à ocorrência dos acidentes de trabalho com perfurocortantes estão relacionados tanto às condições de trabalho, como as condições individuais. Frente a estes acidentes, os trabalhadores de enfermagem têm necessidade de conhecer as condutas pós-exposição ao material perfurocortante potencialmente contaminado pelo HIV. Concluímos que a adoção das precauções-padrão no trabalho em saúde é condição fundamental para a segurança dos trabalhadores, independente da área de atuação, pois o número de casos de HIV é crescente.

The goal of this study was to identify the scientific production about work-related needlestick accidents among nursing professionals involving HIV-contaminated biological material, as well as to characterize the pre-existing factors to such accidents, such as procedures occurring after the exposure to potentially HIV-contaminated needlestick material. This is a literature review, whose bibliographic search for keywords was carried out within the LILACS databases from the year 2000 onward. This study confirms that pre-existing factors for the occurrence of work-related needlestick accidents are related to work conditions as much as to individual conditions. In face of these accidents, the nursing workers need to know the conducts concerning post-exposure to potentially HIV-contaminated needlestick material. We conclude that the adoption of standardized precautions when working in healthcare is a fundamental condition for worker safety, independently of their area of expertise, given the increasing number of HIV cases.

El estudio tiene como objetivo identificar la producción científica sobre accidentes de trabajo de profesionales de enfermería con material biológico contaminado por VIH y determinar las características de los factores que los favorecen, así como los procedimientos realizados posteriores al accidente con material punzocortante potencialmente contaminado por VIH. Revisión bibliográfica a través de palabras claves en la base de datos LILACS a partir del año 2000. Se constató que los factores que predisponen estos accidentes de trabajo se relacionan tanto con las condiciones de trabajo como con las condiciones individuales. Es necesario que los trabajadores de salud conozcan las conductas en casos de accidente punzocortante por VIH. Concluimos que la adopción de medidas patrón es una condición fundamental para la seguridad de los trabajadores, independientemente del área de trabajo, pues el número de casos con VIH esta en aumento.

[Prevalence of needlestick injuries among the healthcare professionals in Zahedan medical sciences university]

Injury by sharp instruments and needles are major occupational health hazard for healthcare workers. This study was conducted to determine the prevalence rate and causes of injuries due to needle stick in healthcare workers in Zahedan University of Medical Sciences. In a cross-sectional study, 231 healthcare workers of university hospitals of Zahedan University of Medical Sciences were selected at random in 2007. Data were collected through questionnaire and were analyzed by SPSS 13. From all cases 77.1% were female 56.4% of them were expert, and 50.7% were nurses. Their mean age were 34 +/- 8.1 years. Needle stick prevalence was 64.9% during the whole history of career, and 57.2% of them had experiences of needle stick more than twice. Most cases of injuries were related to using needle 55.4%, and they were mostly prone to injury during injection and phlebotomy, 55.6%. The multivariate regression analysis showed that injury due to sharp instruments in university graduates was 60% less compared to those with high school or less, and the injury risk increases 5% in each year of increase in working experience. The findings of this study highlight the importance of training and preventive measures in healthcare centers particularly among high risk group

Prevalence and Causes of stick injuries, in medical personnels of Kurdistan University's hospitals and dealing with such injuries due to contaminated sharp tools in 1383

Needle stick injuries can cause transmission of 3 important blood viruses [HCV-HBV-HIV] to health care personnel. Generally these injuries inflict loss of life and property on the health care personnel, so that the medical associations of different industrial countries have scheduled important plans in order to take care of patients, provide personnel education and guarantee the health of physicians and medical staff. Considering the prevalence rate of blood-borne diseases in African and Asian countries, as well as our country, it is important to scrutinize the reasons and prevalence rate of these injuries to take proper preventive measures. This study was conducted with the aim of determination of the prevalence rate of needle stick injuries in the personnel of health care centers of Kurdistan's medical university. This descriptive-Analytic study was conducted in the university's hospitals. A questionnaire including necessary information was designed and sent to the personnel of the hospitals. The sampling method was census. 847 individuals filled out the questionnaires. The collected data were analyzed by means of SPSS statistical software. The findings of this study showed that the majority [73.7%] of the subjects were female. The mean age was [36.1 +/- 7.07] years old. Most of the subjects had the bachelor degree [47.9%]; [74.5%] of them were nurses, 5.5% midwives, 3.3% anesthetists, 7.7% personnels of the laboratory and 9% were the radiology staff. About 57.5% of the subjects had experienced splashing of blood or secretions into their mouth or eyes. In most cases, needles and angiocatheters were responsible for injuries in 43.77% and 35.3% of the cases respectively. According to the staffs opinion the most important predisposing factors included haste and being inundated with work. There was a significant difference between professions and needle stick injuries [p<0.05]. Prevention of needle stick injuries should be regarded a priority. Providing safe medical equipments regardless of their costs, in addition to necessary education for health care staff, should be taken into consideration. Special centers for treatment and follow up of the injured personnel should be allocated

Impacted woodstick needles in the antrum: a unique foreign body.

Three cases of impaction and penetration of a unique type of foreign body in the gastric antrum are reported. The foreign body-woodstick needles-used to staple leaves together to produce disposable leaf-plates (khalli-patra) was accidentally swallowed with food and presented as a case of acute abdomen. Awareness of this possibility is essential for a timely diagnosis in regions where the practice of using khalli-patra is in vogue, particularly eastern India.

Groin dressing after cardiac catheterization. Comparison between light dressing with thin transparent tape (Tegaderm) and conventional tight/pressure dressing with an elastic adhesive bandage (Tensoplast).

Post cardiac catheterization puncture site care is usually done with a tight pressure dressing by an elastic adhesive bandage (Tensoplast) due to the belief that it should prevent bleeding. The practice is uncomfortable to the patients. The authors compared a new way of dressing using light transparent tape (Tegaderm) to the conventional tight pressure one. 126 post coronary angiography patients were randomized to have their groins dressed either with Tensoplast or with Tegaderm. Patients ambulated 8 hours after the procedures. The groin was evaluated for pain, discomfort and bleeding complications. 49 per cent in the Tensoplast vs 26.9 per cent in the Tegaderm group experienced pain (p value of 0.01). 55.5 per cent in the Tensoplast group vs 11.1 per cent in the Tegaderm group reported discomfort. 4.7 per cent in the Tensoplast vs 1.6 per cent in the Tegaderm group developed bleeding or hematoma. Dressing of the puncture site after cardiac catheterization with Tegaderm was more comfortable than the conventional Tensoplast without any difference in bleeding complications.

Bisected macula following retrobulbar steroid injection.

A case of bilateral accidental globe penetration during administration of retrobulbar steroid for bilateral optic neuritis is discussed. One eye with bisected macula was managed successfully by vitrectomy, internal gas tamponade, and postoperative laser to the edges of the retinal tear. The fellow eye was blind due to central retinal artery occlusion.

Management of ocular perforations resulting from peribulbar anaesthesia.

PURPOSE: To analyze the clinical presentation and outcome of treatment for globe perforation secondary to peri-bulbar anaesthesia. METHODS: Eight patients (3 females and 5 males) aged 66-84 years were included in the study. Ocular perforations were suspected in 3 cases before or during surgery, in 4 cases diagnosis was established within one week and in one case at 3 weeks. Three patients underwent indirect argon laser photocoagulation to seal the retinal break, one patient had cryotherapy, 3 patients underwent a pars plana vitrectomy with fluid gas exchange and endo-laser; and one patient refused any further treatment. RESULTS: The final visual acuity after a mean follow up of 14 months was better than 6/9 in 2 patients, between 6/9-6/12 in 4 patients, and perception of light in 2 patients. CONCLUSION: If diagnosed early and treated adequately, a majority of patients with globe perforation during periocular anaesthetic could be saved.

Incidencia de cefalea postraquia en pacientes jóvenes. Estudio doble ciego, comparativo con Atraucan 26, Quincke 26 y Whitacre 27 / Postdural puncture headache incidence in young patients. A double blind comparative study with Atraucan 26, Quincke 26 and Whitacre 27

La cefalea postraquídea (CPR) es el efecto secundario de la anestesia subaracnoidea más temido por los pacientes y sus médicos. Se han descrito diversos determinantes que intervienen en el desarrollo de CPR siendo el tamaño del orificio dural producido por la aguja espinal el que ha recibido mayor atención. El advenimiento de agujas espinales de pequeño calibre y con puntas con diseño especial ha logrado disminuir el tamaño de esta perforación en la duramadre y con ello abatir significativamente la incidencia de CPR a cifras de 1 a 2 por ciento, dependiendo de los autores consultados, del tipo de pacientes estudiados y de otros determinantes de cefalea postraquídea. Se estudiaron 100 pacientes, de alto riesgo para desarrollar CPR, de 18 a 35 años, a los cuales se les realizaron procedimientos quirúrgicos por debajo de la metámera T6 bajo anestesia subaracnoidea utilizando agujas Atraucan 26 (n=34), Quincke 26 (n=33) y Whitacre 27 (n=33) y fueron observados durante un periodo postoperatorio mínimo de 10 días. Dos pacientes del grupo total desarrollaron cefalea postraquídea en el segundo y séptimo día postanestésico la cual cedió en un caso con medidas conservadoras y en el otro con la aplicación de un parche peridural hemático. Un paciente pertenecía al grupo Atraucan 26 y el otro al grupo de Whitacre 27. Estos resultados muestran una incidencia global del 2 por ciento y por grupos de 2.9 por ciento con Atraucan 26, 3.0 por ciento con Whitacre 27 y 0 por ciento con Quincke 26, sin diferencia estadística significativa (p>0.05). Se concluye que el desarrollo de cefalea postraquídea en pacientes jóvenes se presenta entre el 0 por ciento y el 3 por ciento dependiendo del tipo de aguja que se utilice. La cefalea postpuncional no debe de ser considerada como un obstáculo para que este grupo de enfermos reciba los beneficios de la anestesia subaracnoidea