Clinical Data
Clinical data supporting single-handed scalpel blade removals.
Foytl J, Chisholm F, Varsou O. Sharps Injuries during Dissection: A Five-Year Retrospective Study in the Context of Safety. Anat Sci Educ. 2020 Mar;13(2):158-167.
Summary
The supplementation of lecture-based anatomy teaching with laboratory sessions, involving dissection or anatomical specimens, is commonly used. Hands-on dissection allows students to handle instruments correctly while actively exploring three-dimensional anatomy. However, dissection carries a potential risk of sharps and splash injuries. The aim of this study was to quantify the frequency rate of such cases per 1,000 student-hours of dissection and identify potential factors than might influence safety in anatomy laboratories. Data were retrospectively collected from September 2013 to June 2018 at the University of St Andrews, Scotland, UK. Overall, 35 sharps injuries were recorded in undergraduate medical students, with a frequency rate of 0.384 and no splash cases. The following factors might have contributed to increased safety influencing frequency rates: single-handed blade removal systems; mandatory personal protective equipment; and having only one student dissecting at a given time. The authors propose that safety familiarization alongside standardized training and safety measures, as part of an evidence-based culture shift, will instill safety conscious behaviors and reduce injuries in anatomy laboratories.
A. Wong, H. Nguyen, R. Eley, M. Sinnott, “Purchase data: a proxy for safety status,” Journal of Hospital Infection, Volume 105, Issue 4, 2020, Pages 657-658, ISSN 0195-6701
Summary
This study demonstrated the use of purchase data to determine the incidence of sharps injuries in a major tertiary referral hospital in Australia. The incidence rates of injuries per 100,000 items purchased were 2.65 and 12.60 for syringe needles and scalpel blades, respectively. These figures were lower than those reported previously using this method. The incidence rate for injuries with suture needles, which had not been reported previously, was 31.89/100,000 items purchased. Incidence data calculated in this manner may be used in conjunction with purchase cost estimates to inform policy and practices on institutional staff safety measures.
Hostiuc, Sorin & Curca, George & Ceausu, Mihai & Rusu, Mugurel & Niculescu, Elena & Dermengiu, Dan. (2011). Infectious risks in autopsy practice. Romanian Journal of Legal Medicine. 19. 183-188.
Summary
The purpose of this article is to analyze whether after proper decontamination using standardized methods there are still infectious markers in the autopsy room, suggestive for the possibility of contacting infectious diseases from previous autopsies. In order to analyze the presence and severity of residual risk we performed the following procedures: air sampling for bacterial agents, microbiological identification on surfaces and immunoassays for viruses/agents with slow growth/ no growth on culture mediums. After autopsy room disinfection we found an increased number of Gram positive cocci (especially enteric), a decreased number of Gram negative bacteria and two positive immune reactions – one for HVB and one for HIV. As a conclusion, standard prophylactic procedures must always be used, as autopsy-related infectious risk is significantly increased compared to other specialties. Also, standard disinfection has a limited value in removing viral traces, leading to a residual infectious risk.
Fuentes, Hector et al. ‘“Scalpel Safety”: Modeling the Effectiveness of Different Safety Devices’ Ability to Reduce Scalpel Blade Injuries’. 1 Jan. 2008 : 83 – 89.
Summary
The objective of this study was to analyse and compare the potential effectiveness of two safety strategies in reducing scalpel blade injuries. The two strategies examined were safety scalpel vs. a single-handed scalpel blade remover combined with a hands free passing technique (HFPT) (e.g. passing tray or neutral zone). Methods: This was a retrospective study involving review of a 550-bed adult metropolitan tertiary referral hospital’s sharps injuries database, chart review, and hypothetical modelling of the data to determine potential preventable injuries. The modelling was done twice, firstly assuming 100% effectiveness of each safety device and secondly using previously published activation rates for “active” safety devices which were considered to be a more accurate reflection of real-life work practices. Results: A total of 141 scalpel injuries were reported between 1987 and 2003. Clinical charts were reviewed for 137 of these injuries. Just under 50% of injuries were sustained while the scalpel was in use and these were assumed to be not preventable. Assuming 100% effectiveness for each safety device resulted in 72 injuries being prevented by safety scalpels and 69 injuries being prevented by a combination of a single-handed scalpel blade remover and an HFPT. When injury prevention was calculated using published data on activation rates for “active” safety devices, the number fell to as low as 12 for safety scalpel and to 61 for the combination of a single-handed scalpel blade remover and an HFPT. Conclusion: Both safety strategies are potentially effective in reducing scalpel blade injuries. However the safety scalpels are active devices and as such are subject to widely variable activation rates. We recommend use of a single-handed scalpel blade remover in combination with an HFPT as this can potentially prevent 5 times as many injuries as safety scalpels.
Oh HS, Yoon Chang SW, Choi JS, Park ES, Jin HY. Costs of postexposure management of occupational sharps injuries in health care workers in the Republic of Korea. Am J Infect Control. 2013 Jan;41(1):61-5.
Summary
Costs of postexposure treatment of sharps injuries (SIs) in health care workers (HCWs) are an economic burden in many countries. This study analyzed the costs associated with SIs in HCWs in the Republic of Korea.
Between October 1, 2005, and February 28, 2006, general information on SIs among HCWs and the direct costs (eg, laboratory, pharmacy, medical and surgical treatments) and indirect costs eg, (loss of working days) were collected prospectively from 34 hospitals nationwide.
A total of 700 SIs were documented, 505 of which (72.1%) generated costs. The average costs per SI were pharmacy, 123,091 won (US$129); laboratory tests, 66,958 won ($70); medical services, 26,332 won ($28); and medical treatments, 9,377 won ($10). The average costs of preventive measures were 160,274 won ($168) for hepatitis B virus (HBV), 127,858 won ($134) for hepatitis C virus (HCV), and 139,552 won ($146) for HIV. Of the laboratory tests, 32.9% were HBV-related, 29.4% were HCV-related, and 19.8% were HIV-related. Of postexposure prophylaxes, 34.9% were HB immunoglobulin and 31.4% were HBV vaccines. We estimated that 7,057.5 SIs generated costs, at a total annual cost of 844,587,577 won ($884,385).
Clinical data supporting ampoule openers
KARADAĞ, M. (2010). Occupational exposure to blood and body fluids among a group of Turkish nursing and midwifery students during clinical practise training: Frequency of needlestick and sharps injuries. Japan Journal of Nursing Science, 129–135.
Summary
To ascertain the number of needlestick and sharps injuries (NSSIs) in nursing and midwifery students and to assess the use of universal precautions among injured and non‐injured students.
A survey of a representative sample of nursing and midwifery students who did clinical practise in a hospital was conducted. In total, 203 students met the inclusion criterion of the study. Of these, 141 (69.46%) provided useable data. According to the data, 35.5% of the participating students had experienced a NSSI, 54% of the students had received one NSSI, and 36.0% had two NSSIs. Sixty‐six percent of the injured students had been injured by an ampoule and the majority of injuries occurred in the treatment room. Most of the students had washed their injury with antiseptic solution and 84% had not told anyone about their injury. While 86.5% of the students threw away used needles in the special sharps containers disposal box, 89.4% also stated that they always recapped used needles. Almost all the students had received the hepatitis B vaccine. Only 14% of the students stated that they always wore gloves.