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F4.1 Injuries and Illnesses in Nurses in Delhi-Joshi TK, Jugal Kishore, Sagar B, Singh B

Introduction: Occupational hazards in health care workers including nurses are well recognized, more so in developing countries due to inadequacy of health and safety programs.

Objectives: To study the frequency of injuries and illnesses in nursing care workers in a teaching hospital in Delhi.

Sample: A sample of 123 nurses out of 400 working in different health care facilities under Delhi Government.

Tools: Each subject filled up a Pre-tested Self Reporting Questionnaire after giving an informed oral consent.

Variables: Number of injuries occurring in last one week, abuse and violence at workplace, illness status, vaccination, use of PPE, and general socio-demographic data was collected.

Analysis: Data was analysed using WHO software package Epi-Info. Appropriate statistical tests were applied.

Result: There were 4016.2 needle prick injuries per 100 nurses years. Most injuries occurred in operation theatre and medical ward. Nearly 10% reported workplace abuse and violence. Low back pain was reported in 33.3%, sprain in 6% and burns in 1.6% of nurses. The range of illnesses reported was varied and a total of 36.6% were on medication. The contact with blood infected with HIV was 17.4%, and with Hepatitis B 27.0%. Such contact was more frequent in operation theatre, burn and medical wards. Majority (80%) reported the availability of gloves. However, only 47.8% reported using them always. 54.5% were vaccinated against hepatitis B. 22% reported glove allergy presenting as itchy skin (84%). Use of tobacco products and alcohol was not reported.

Conclusion: Injuries and illnesses were frequent in nursing care workers. Immunization and use of protective equipment was not universal despite availability. There is an urgent need for health surveillance and well-designed training program to prevent injuries and illnesses in Delhi.


F4.2 Sharps-Related Injuries in California Healthcare Facilities: Preliminary Results From the Sharps Injury Registry-Gillen M, Davis M, Lewis J, McNary J, Boyd A, Curran C, Cone J

Background: Senate Bill 2005 (Thompson) mandated that the California Department of Health Services (CDHS) collect information on sharps-related injuries from healthcare facilities, on a voluntary basis. Under contract with the University of California, San Francisco, a Sharps Injury Registry was created. The aims of the registry are 1) to collect statewide data on sharps injuries; 2) to disseminate this information in aggregate form; and 3) to assist healthcare workers and facilities in making informed decisions to better protect care providers from sharps injuries and life-threatening illnesses.

Methods: A letter inviting participation in the registry was sent to California hospitals, home health agencies, and skilled nursing facilities (n = 2,654) along with a sample sharps injury log. Data was accepted in all formats, including hand-written, electronic, and summary reports.

Analysis: As of 12/31/99, reports of approximately 2,000 sharps injuries from 213 facilities have been received. Data has been collected on the following variables: type of facility, date/time of injury, sex, age, job classification, department, procedure being performed by the original user of the sharp (e.g., injection), procedure being performed by a non-original user of the sharp, when indicated (e.g., cleaning room), circumstances surrounding the injury, body part, type of device, activation of safety mechanism, when appropriate, and the employee's opinion regarding safety equipment use and work practice controls. (Note: Data is currently being reviewed by the CDHS and will be released in the near future.)

Conclusions: Despite the voluntary nature of this project, these findings represent an attempt to collect sharps injury data on a statewide basis. Accepting non-standardized data makes interpretation of the results more complex. However, they may enable employers to make informed choices on work practices they foster and the devices they use to minimize the risk of sharp-related injuries to health care workers.


F4.3 Characterization of Needlestick Injuries and Development of Prevention Strategies-Frederick LJ, Williams JM

It is estimated that 590,000 needlestick injuries (NSI) occur among healthcare workers each year. Although the standard has been in effect since 1992, NSI continue to be a major problem among healthcare workers. In spite of education programs and the greater availability of engineering controls, recapping of needles continues and safer needles and needleless systems, when instituted, are not always accepted. Needles continue to be left in inappropriate places or improperly disposed of in regular trash where downstream workers can get injured. Requirements of the Bloodborne Pathogens Standard include reporting of NSI, however, many go unreported and fewer than 10% are recorded on the OSHA 200 log.

This study examined the characteristics surrounding NSI among a group of healthcare workers in a 380-bed tertiary hospital over a two-year period. A list of injured employees was generated from an Emergency Department database using International Classification of Disease (ICD) codes. The following information about each injury was obtained from medical records: work activity at time of injury, where injury occurred in the institution, type of device used and job classification. A literature review was conducted to identify available NSI controls. Eighty-six incidents were identified and descriptively analyzed. The most common work activities (65%) were procedural (e.g., starting or discontinuing intravenous therapy equipment) followed by disposal-related activities (22%). The most common procedure involved manipulation of IV therapy equipment; five percent involved recapping. By analyzing the injury data from this study and the information from the literature review, risk factors and prevention strategies for NSI were identified and categorized using an injury analysis model known as Haddon's Matrix. The findings of this study can be useful in developing prevention programs aimed at reducing the risk of NSI in healthcare facilities.


F4.4 Does Occupational Exposure Account for Excess Injury Risk: Serious Eye Injuries in the U.S. Army-Smith GS, Lincoln AE, Wong TY, Amoroso PJ, Vinger PF, Bell NS

Purpose: To determine if occupational exposure explains demographic variations (age, sex and race) in ocular trauma among U.S. Army soldiers.

Methods: The study population consisted of all U.S. Army personnel on active duty between 1980-1997. Hospitalization and personnel data were provided by the Total Army Injury and Health Outcomes Database. Serious occupational eye injuries were defined as any injury or foreign body affecting the eye or adnexa requiring hospitalization that occurred while on duty. Rates of ocular trauma were calculated for both broad occupational groups and selected specific jobs. Multivariate logistic regression models were used to evaluate the independent effect of broad and specific occupation on the risk of ocular trauma.

Results: The overall rate for on-duty hospitalized eye injuries for all persons in the military was 27.5 per 100,000 person-years (PY), though it varied widely by occupation. Men had 3.2 times the risk of women (95% CI: 2.7, 3.8), which was reduced to 2.3 after adjusting for broad occupational group, and 2.0 after adjusting for specific job. Whites experienced significantly higher rates than blacks (Incident rate ratio (IRR) = 1.3, 95% CI: 1.2, 1.4) and the excess changed little after adjustment for occupational exposure. Crude age-specific rates consistently rose from the oldest group (41+ years) to the youngest group (17-20 years old) (IRR=6.7, 95% CI: 5.0, 9.2). For some specific jobs, age was directly related to increased risk but demonstrated an inverse risk for others, suggesting an age-job interaction.

Conclusion: Most studies have found that demographic differences in injury rates are much reduced when occupational exposure is accounted for. However, using occupation to control for exposure, we found that young, white men in the U.S. Army maintained the highest risk of work-related ocular trauma, even when performing work activities very similar to those of other demographic strata.



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Content Source: National Institute for Occupational Safety and Health (NIOSH) Division of Safety Research