OCCUPATIONAL EXPOSURES TO BODY FLUIDS AND BEHAVIORS REGARDING THEIR PREVENTION AND POST-EXPOSURE AMONG MEDICAL AND NURSING STUDENTS AT A BRAZILIAN PUBLIC UNIVERSITY

A cross-sectional study was conducted to assess the frequencies and characteristics of occupational exposures among medical and nursing students at a Brazilian public university, in addition to their prevention and post-exposure behavior. During the second semester of 2010, a self-administered semi-structured questionnaire was completed by 253/320 (79.1%) medical students of the clinical course and 149/200 (74.5%) nursing students who were already performing practical activities. Among medical students, 53 (20.9%) suffered 73 injuries, which mainly occurred while performing extra-curricular activities (32.9%), with cutting and piercing objects (56.2%), in the emergency room (39.7%), and as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%) in the operating room or wards (72.2%), and as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instructions on previously received exposure prevention; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 49.3% and 35.1% did not bother to find out the source patient's serological results post-exposure; and 1.4% and 18.9% officially reported injuries. In conclusion, this study found high frequencies of exposures among the assessed students, inadequate practices in prevention and post-exposure, and, consequently, the need for training in “standard precautions” to prevent such exposures

Identifying the Cricothyroid Membrane: A Comparison of Palpation, Laryngeal Handshake and Ultrasound Background

Publications have demonstrated limitations in identifying the cricothyroid membrane (CTM) by palpation (P; <40% accurate),1 and superiority of laryngeal handshake (LH; 62%) and ultrasound (US; >90%).12 We compared the accuracy, confidence and speed of these techniques when employed by experienced operators and novices. Ethical approval was provided by the University of St Andrews, School of Medicine, Ethics Committee. Three medical students (with no prior teaching or experience in using ultrasound) and three anaesthetists underwent three hours of formal training, including a structured step-by-step approach to all techniques. They were then asked to identify the CTM in 11 female simulated patients (SPs). Using a randomised pattern, SPs were serially assessed until all techniques had been used by all operators on all SPs. Accuracy was determined by comparison to ultrasound assessment by two experts. Operators were asked to rate their confidence (0 - 10) after each assessment, and each was timed. There was no statistically significant difference in accuracy of any method overall (P 69.7% vs LH 61.12% vs US 77.27%; p = 0.187). Operators were significantly more confident using ultrasound compared to palpation (6.67 vs 5.88; p = 0.019), but took significantly longer than with palpation or laryngeal handshake (69.58 sec vs 36.65 vs 39.20; p <0.001). Experienced operators were significantly quicker (37.88 vs 59.07 sec, p <0.001) and more confident (6.52 vs 5.92, p = 0.011), but no more accurate (73.74% vs 65.66%, p = 0.279). There was no statistically significant difference in accuracy, confidence or speed between the two operator groups for any technique (palpation, laryngeal handshake or ultrasound). Conventional palpation, after formal training, may be more successful than previously reported. Despite increased confidence associated with ultrasound, this technique was no more successful and took longer. Experienced operators were significantly quicker when performing assessments, and more confident, but no more accurate. Arguably, ultrasound is best used prior to commencing airway management, potentially in conjunction with another method of assessment. References: 1. Drew T, McCaul CL. Br J Anaesth 2018; 121 (5): 1173-1178. 2. Kristensen MS, Teoh WH, Rudolph SS. Br J Anaesth 2016; 117 (S1): i39-i48. Funding: This work was funded by the Scottish Airway Group

Identifying the Cricothyroid Membrane (CTM) with Ultrasound, Laryngeal Handshake and Conventional Palpation Clinical Trials Registered Study Protocol

Registered clinical trials study protocol for "Identifying the cricothyroid membrane in healthy subjects: a comparison of three techniques to assess accuracy, confidence and speed". Trial ID: ACTRN12619001288112