„Með hreinum höndum“ - Handhreinsun á Landspítala

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Needle stick injuries, bodyfluid exposure and bites among health care workers in Landspitali University Hospital during the years 1986-2011. A descriptive study

Inngangur Heilbrigðisstarfsmenn geta smitast af lifrarbólgu B, lifrarbólgu C eða HIV í vinnu sinni verði þeir fyrir stunguóhappi, líkamsvessamengun eða biti (atvik) frá smitandi sjúklingi (áhættuatvik). Algengustu tildrög stunguóhappa tengjast holum nálum og smithættan er mest í tengslum við þær. Markmið rannsóknarinnar voru þrjú. Draga fram mynd af atvikum meðal starfsmanna Landspítala (LSH). Greina hlutfall áhættuatvika og hve margir starfsmenn hafa smitast í kjölfar þeirra. Meta áhrif klínískra leiðbeininga um viðbrögð við stunguóhappi eða líkamsvessamengun. Aðferð Rannsóknin er afturskyggn lýsandi nýgengisrannsókn. Unnið var úr tilkynningum atvika frá starfsmönnum LSH fyrir tímabilið 1986-2011. Hlutfall atvika var reiknað eftir aldri, kyni, starfsstéttum og tildrögum, hlutfall áhættuatvika var reiknað af öllum atvikum. Reiknað var p-gildi og 95% öryggisbil fyrir mun á hlutföllum starfsstétta og tildrögum atvika á LSH og sjö erlendra rannsókna. Einnig var reiknað p-gildi og 95% öryggisbil fyrir mun á hlutföllum starfsmanna og sjúklinga sem fóru í blóðprufur eftir atvik, fyrir og eftir innleiðingu klínískra leiðbeininga. Niðurstöður Alls voru tilkynnt 3587 atvik á tímabilinu, af þeim voru 94 áhættuatvik (2,6%) sem oftast voru tengd sjúklingi með lifarbólgu C (64,9%). Í tveimur tilvikum smituðust starfsmenn af HCV eða í 3,2% tilvika þegar sjúklingur var smitandi af lifrarbólgu C. Hlutfall starfsmanna sem fóru í blóðprufur eftir atvik hækkaði marktækt eftir innleiðingu klínískra leiðbeininga (p<0,001) og einnig hlutfall sjúklinga (p<0,001). Tildrög atvika á LSH voru frábrugðin því sem kemur fram í erlendum rannsóknum og hlutfall tilkynninga frá læknum og læknanemum var lágt. Holar nálar tengdust stunguóhöppum í 54,7% tilvika. Ályktun Þar sem meira en 50% stunguóhappa tengjast holum nálum má vænta þess að innleiðing öryggisnála og öryggishluta fækki marktækt stunguóhöppum tengdum holum nálum. Fræðsla um grundvallarsmitgát, rétta umgengni við beitta og oddhvassa hluti og mikilvægi tilkynningar á atviki er nauðsynleg.Introduction Needle stick, body fluid exposure and bites (injury) put health care workers (HCW) at risk of hepatitis B, C and HIV infections. Most needle stick are caused by hollow needles and the highest infection risk is by hollow needles. The aim of the study is to descripe injury rate among HCW at Landspitali University Hospital (LUH). Descripe infections rate among HCW at LUH. Evaluate the effects of clinical guidelines concerning needle stick injuries and body fluid exposure. Methods Retrospective descriptive study of analyzed reported injuries during 1986-2011. Injuries proportion was calculated according to HCW profession‘s age, gender and origins of injuries. Proportion of high risk injuries was calculated upon total injuries. Confident interval and p value were calculated for the difference amongst various professions and origins of injuries in LUH and seven international studies. Furthermore, comparable calculations between HCW and patients were undertaken by comparing blood samples taken before and after the introduction of clinical guidelines. Results Injuries of 3587 were reported and calculated. High risk injuries were 94 or 2,6% of total injuries, 64,9% of them were related to hepatitis C infections. Two occurrences of HCW became infected from hepatitis C or 3,2% of total infected hepatitis C patients. Furthermore, significantly higher rate of HCW (p<0,001) and patients (p<0,001) undertook blood samples test after introduction of clinical guidelines. Incidents at LUH were significantly different in comparison to international studies. Few reports were from physicians and medical students. Hollow needles caused 54,7% of needle stick injuries. Conclusion Since hollow needles caused more than 50% of needles stick injuries, introduction of saftey needles and safety devices can significantly reduce needle stick injuries at LUH. Education concerning standard precaution, handling of needles and sharp devices are crucial, and it is critical to report to reduce infection risk.Velferðarráðuneytið (áður heilbrigðisráðuneytið) styrkti gerð gagnagrunnsins sem rannsóknin byggir á

Epidemiology of needlesticks at Landspítali University Hospital during the years 1986-2011. A descriptive study.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn.Verði heilbrigðisstarfsmenn fyrir stunguóhappi, líkamsvessamengun eða biti (óhappi) tengt smitandi sjúklingi (áhættuóhappi) geta þeir smitast af lifrarbólguveiru B (HBV), lifrarbólguveiru C (HCV) eða HIV. Smithættan er mest í tengslum við stunguóhöpp af völdum holra nála. Markmið rannsóknarinnar var að lýsa faraldsfræði tilkynntra óhappa starfsmanna Landspítala og greina vanskráningu þeirra. Afturskyggn lýsandi rannsókn.Unnið var úr tilkynningum óhappa frá starfsmönnum Landspítala tímabilið 1986-2011. Hlutfall óhappa var reiknað eftir aldri og starfsstéttum og dreifing óhappa eftir tildrögum og deildum fundin. Hlutfall áhættuóhappa var fundið og hlutfall starfsmanna sem voru bólusettir gegn HBV þegar óhapp varð. Hlutfall vanskráðra óhappa var áætlað fyrir tímabilið 01.01.2005-31.12.2011. Á tímabilinu urðu að minnsta kosti 4089 óhöpp en 3587 þeirra voru tilkynnt og blóðrannsókn framkvæmd hjá 2578 starfsmönnum. Nálægt þriðjungur óhappa tengdist því að ekki var unnið samkvæmt grundvallarsmitgát og holar nálar tengdust stunguóhöppum í 54,7% tilvika. Hlutfall tilkynninga frá læknum og læknanemum var lágt, eða 17,9%. Á tímabilinu reyndust 50,3% starfsmanna bólusettir gegn HBV þegar óhapp varð. Áhættuóhöpp voru 2,6% tilkynntra óhappa, oftast tengd sjúklingi með HCV. Tveir starfsmenn smituðust af HCV á tímabilinu. Áætluð vanskráning óhappa reyndist 28,0% á árunum 2005-2011. Þar sem mörg óhöpp tengjast röngum vinnubrögðum má vænta þess að fræðsla um grundvallarsmitgát og rétta umgengni við beitta og oddhvassa hluti fækki óhöppum. Þar sem holar nálar tengdust rúmlega helmingi stunguóhappa má vænta þess að innleiðing öryggisnála og öryggishluta fækki stunguóhöppum tengdum holum nálum. Hvetja þarf enn frekar til HBV-bólusetningar og tilkynninga á óhöppum. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Needlesticks, bodyfluid exposure and bites (incident) put healthcare workers (HCWs) at risk of hepatitis B, C and HIV particularly if patients are infected (high risk incident). The risk of infection is greatest from bore-hollow needles. The aim of the study was to describe the epidemiology of reported incidents and evaluate underreporting by HCWs at Landspítali University Hospital (LUH). A retrospective descriptive study of reported incidents during 1986-2011. The ratio of incidents was calculated according to the HCWs age and profession and distribution by source and wards. The ratio of high risk incidents and vaccination status against HBV at time of incident was determined as well as underreporting during 01.01.2005-31.12.2011. Results: At least 4089 incidents occured during the study period but 3587 were reported and blood samples taken from 2578 patients. Approximately a third of the incidents were associated with non-compliance with standard precaution and 54,7% of needlesticks were associated with bore-hollow needles. Few reports came from physicians and medical students (17,9%). During the study period 50,3% HCWs were vaccinated against HBV at time of incident. High risk incidents were 94 (2.6%), mostly related to hepatitis C (64,9%). Two HCWs became infected with HCV. During 2005-2011 underreporting was estimated to be 28,0%. Conclusion: Improved education of standard precaution when handling needles and sharps at LUH may reduce the number of incidents. Introduction of safety-needles and safety-devices may greatly reduce needlesticks as a large number of incidents were associated with hollow needles. Improved HBV vaccination among HCWs and reporting incidents should be encouraged