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  • International Healthcare Worker Safety Center Bibliography April 2010

    1. Allegranzi B, Sax H, Bengaly L et al. Successful implementation of the World Health

    Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol 2010; 31(2):133-141. ABSTRACT: Objective. To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country. Design. A before-and-after study from December 2006 through June 2008, with a 6-month baseline evaluation period and a follow-up period of 8 months from the beginning of the intervention. Setting. University Hospital, Bamako, Mali. Participants. Two hundred twenty-four healthcare workers. Methods. The intervention consisted of introducing a locally produced, alcohol- based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Hand hygiene infrastructure, compliance, healthcare workers' knowledge and perceptions, and handrub consumption were evaluated at baseline and at follow-up. Results. Severe deficiencies in the infrastructure for hand hygiene were identified before the intervention. Local handrub production and quality control proved to be feasible, affordable, and satisfactory. At follow-up, handrubbing was the quasi-exclusive hand hygiene technique (93.3%). Compliance increased from 8.0% at baseline to 21.8% at follow-up ([Formula: see text]). Improvement was observed across all professional categories and medical specialities and was independently associated with the intervention (odds ratio, 2.50; 95% confidence interval, 1.8-3.5). Knowledge enhanced significantly ([Formula: see text]), and perception surveys showed a high appreciation of each strategy component by staff. Conclusions. Multimodal hand hygiene promotion is feasible and effective in a low-income country. Access to handrub was critical for its success. These findings motivated the government of Mali to expand the intervention nationwide. This experience represents a significant advancement for patient safety in developing countries

    2. Carlson AL, Perl TM. Health Care Workers as Source of Hepatitis B and C Virus Transmission. Clin Liver Dis 2010; 14(1):153-168. ABSTRACT: Transmission of hepatitis B and C from health care workers to patients remains rare in developed medical care systems but may be more common in systems that are still developing. Since the 1970s, at least 69 health care workers infected with hepatitis B or C have been implicated in transmission of their infection. This likely underestimates the magnitude of the problem. In this article, risk factors associated with transmission are reviewed and infection prevention and control practices outlined. Management of infected providers is also discussed. National guidelines are compared, highlighting different countries' approaches to this complex challenge

    3. Dolan SA, Felizardo G, Barnes S et al. APIC position paper: Safe injection, infusion, and medication vial practices in health care. Am J Infect Control 2010; 38(3):167-172. ABSTRACT: Outbreaks involving the transmission of bloodborne pathogens or other microbial pathogens to patients in various types of health care settings due to unsafe injection, infusion, and medication vial practices are unacceptable. Each of the outbreaks could have been prevented by the use of proper aseptic technique in conjunction with basic infection prevention practices for handling parenteral medications, administration of injections, and procurement and sampling of blood. This document provides practice guidance for health care facilities on essential safe injection, infusion, and vial practices that should be consistently implemented in such settings.

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    4. Donnenwirth E. This Top Doc Uses Safety Scalpels - Do You? Outpatient Surgery Magazine 2010; March:65-69. ABSTRACT: Richard Weiner, MD, became a proponent of sharps safety after watching a sdrub tech slice open her hand on an exposed blade hiden in a jumble of instruments. Thanks to his leadership and a few educational pushes of my own, safety scalpels are new commonplace in the ORs here at Winchester (Mass.) Hospital. While it's not always easy to get surgeons to switch out the tools of their trade, you can coax them to try safety scalpels by highlighting the improved designs and newer features available on the market today, including:

    5. Gainsbury S, Lomas C. 'Myths' could leave nurses in danger of sharps injuries. Nursing times.net 2010 Mar 16. ABSTRACT: Nurses will reamin at risk of unnecessary sharps injuries because half of trusts are unlikely to switch to safer needles, despite new European legislation. Myths around the cost of safer devices will hinder their introduction in many cases, according to documents seen by Nursing Times. European ministers ruled last week that risk assessments should be done in all areas where sharps are used and safety devices, such as retractable needles, introduced where a risk of injury is found. A similar law was adopted in the US almost a decade ago and led to hospitals universally adopting safety syringes and needless devices. An NHS trial of safety-only needles at University Hospitals Birmingham Foundation Trust led to a 70 per cent reduction in needlestick injuries over four years.

    6. Gershon RR, Magda LA, Canton AN et al. Pandemic-related ability and willingness in home healthcare workers. Am J Disaster Med 2010; 5(1):15-26. ABSTRACT: OBJECTIVE: To assess pandemic-related attitudes and behavioral intentions of home healthcare workers (HHCWs). DESIGN: Cross-sectional survey. SETTING: New York City. PARTICIPANTS: A convenience sample of 384 HHCWs. MAIN OUTCOME VARIABLES: Ability and willingness to report to work during a pandemic influenza outbreak. RESULTS: A large proportion of HHCWs reported that they would be either unable or unwilling (or both) to provide care to their current (83 percent) or new (91 percent) patients during a pandemic. Ability was significantly associated with not having children living at home, having alternatives to mass transportation, not having a spouse/partner employed as a first responder or healthcare worker, and having longer tenure (ie, six or more years) in homecare. During an outbreak, 43 percent of HHCWs said they would be willing to take care of current patients and only 27 percent were willing to take care of new patients. Willingness to care for both current and new patients was inversely associated with fear for personal safety (p < 0.01). Provision of key elements of a respiratory protection program was associated with decreased fear (p < 0.05). Most participants (86 percent) had not received any work-based, pandemic-related training, and only 5 percent reported that their employer had an influenza pandemic plan. CONCLUSIONS: Given that a large majority of the participating HHCWs would either be unable or unwilling to report to duty during a pandemic, potential shortfalls in this workforce may occur. To counter this, organizations should focus on strategies targeting intervenable barriers to ability and to willingness (ie, the provision of a vaccine and respiratory protection programs)

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    7. Hamel M, Zoutman D, O'Callaghan C. Exposure to hospital roommates as a risk factor for health care-associated infection. Am J Infect Control 2010; 38(3):173-181. ABSTRACT: Background: Numerous patient- and hospital-level characteristics have been established as risk factors for the transmission of health care-associated infections (HAIs). Few studies have quantitatively assessed the impact of exposure to hospital roommates on the acquisition of infections. This study evaluated the association between roommate exposures and the risk of HAIs. Methods: A retrospective cohort of adult patients admitted to a Canadian teaching hospital between June 30, 2001, and December 31, 2005, was studied. Exposures were characterized as total daily roommate exposures and daily unique roommate exposures. Outcomes examined were methicillin-resistant Staphylococcus aureus (MRSA), vancomycin- resistant Enterococcus (VRE), and Clostridium difficile. Results: The number of roommate exposures per day was significantly associated with MRSA and VRE infection or colonization (MRSA: hazard ratio [HR] = 1.10, 95% confidence interval [CI] = 1.05 to 1.15; VRE: HR = 1.11, 95% CI = 1.02 to 1.21), and with C difficile infection (HR = 1.11, 95% CI = 1.03 to 1.19). A significant association also was found for number of unique roommate exposures per day and VRE (HR = 1.15, 95% CI = 1.02 to 1.28). Conclusions: The significant associations found between daily roommate exposures and the infection outcomes suggest a possible role for limiting patient-to-patient contact in an infection prevention and control program in this facility. These findings have implications for the deployment and design of acute care hospitals

    8. Henderson DK, Dembry L, Fishman NO et al. SHEA guideline for management of healthcare workers who are infected with hepatitis B virus, hepatitis C virus, and/or human immunodeficiency virus. Infect Control Hosp Epidemiol 2010; 31(3):203-232. ABSTRACT: This guideline provides the updated recommendations of the Society for Healthcare Epidemiology of America (SHEA) regarding the management of healthcare providers who are infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or the human immunodeficiency virus (HIV). For the reasons cited in the guideline, SHEA continues to recommend that, al