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Biomedical subjects

J Jagger

Publications and source records attributed to J Jagger.

At least 37 records · Page 2Linked to original sources
PubMed1996

Percutaneous injuries in anesthesia personnel.

Anesthesia personnel are at risk for occupationally acquired blood-borne infections from human immunodeficiency virus, hepatitis viruses, and others after percutaneous exposures to infected blood or body fluids. The risk is greater after an infected, blood-contaminated, percutaneous injury, especially from a hollow-bore blood-filled needle, than from other types of exposures. Few data are available on the specific occupational hazards to anesthesia personnel from needles and other sharp devices. Fifty-eight percutaneous injuries (PIs) from anesthesia personnel in nine hospitals were analyzed. Thirty-nine of 58 PIs were from contaminated devices (all needles), and 19 were from uncontaminated devices or of unknown contamination status. Forty-three percent of contaminated percutaneous injuries (CPI) were classified as moderate (some bleeding) or severe (deep injury with profuse bleeding), and most were to health-care workers' hands. Fifty-nine percent of CPI were potentially preventable. Eighty-seven percent of CPI were from hollow-bore needles, and 68% of these were potentially preventable. The largest categories of devices causing CPI were needle on syringe, intravenous (i.v.) or arterial catheter needle-stylet, suture needle, and standard hollow-bore needle for secondary i.v. infusion. Most CPI occurred between steps of a multistep procedure (8%), were recapping related (13%), or occurred at other times after use (41%). No CPI were reported from use of needlestick-prevention safety devices. The devices and mechanisms of injury identified in this study provide specific data that may lead to prevention strategies to reduce the risk of PI.

Anesthesiology↗
PubMed1996

Contact lens care in the unconscious.

We present a case of gradual visual loss in a patient after a severe road traffic accident. The cause of visual loss was prolonged contact lens wear. We stress the importance of excluding contact lens wear and suggest a method for bedside examination of an unconscious patient to detect the presence of contact lenses.

Adult↗
PubMed1995

The risks of occupational exposure and infection by human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in the dialysis setting. Italian Multicenter Study on Nosocomial and Occupational Risk of Infections in Dialysis.

BACKGROUND: The dialysis setting has been recognized as a high-risk environment for transmission to both patients and health care personnel of blood-borne infections, such as hepatitis B virus, hepatitis C virus, and HIV. METHODS: A seroprevalence survey of HIV, hepatitis B virus, and hepatitis C virus infection among 1002 patients and a subsequent 1-year surveillance study of percutaneous injuries and skin and mucous membrane contaminations were carried out among 527 health care workers in nine Italian dialysis units. The risks of occupational acquisition of HIV, hepatitis B virus, and hepatitis C virus infections among health care workers were calculated according to a deterministic model. RESULTS: HIV antibody, hepatitis B surface antigen, and hepatitis C antibody prevalences among patients were 0.1%, 5.1%, and 39.4%, respectively. A total of 67 percutaneous injuries, 29 mucous membrane contaminations, and 271 skin contaminations were reported by health care workers. The risk of acquiring infection was calculated to be 4000 and 8000 times lower for HIV than for hepatitis B and C, respectively. CONCLUSIONS: The risks of infection with HIV, hepatitis B, and hepatitis C for health care workers at dialysis units differ greatly and depend on the demographic profile and medical history of patients undergoing dialysis. To minimize the risk of exposure to HIV and other blood-borne pathogens, efforts must continue to increase compliance with universal precautions. Needle designs incorporating safety features and improvements in dialysis equipment design are also needed to avoid potential exposure.

Blood-Borne Pathogens↗
PubMed1995

An outbreak of needlestick injuries in hospital employees due to needles piercing infectious waste containers.

OBJECTIVES: To investigate the cause of an outbreak of needlestick injuries (NSIs) in hospital employees. SETTING: A 700-bed university hospital. DESIGN: Outbreak investigation, laboratory evaluation of a medical waste disposal device, cost analysis. METHODS: Employee health department records were reviewed of workers suffering sticks from needles piercing fiberboard-contaminated material containers (CMCs). A laboratory evaluation of needle-puncture resistance properties of the CMCs was performed using a testing apparatus. The cost of a hospital waste disposal program using fiberboard CMCs was compared with the cost of a program using rigid plastic (polypropylene) boxes. RESULTS: During 40 months of surveillance in 1986 and from 1989 to 1991, only one NSI had occurred from a needle piercing a CMC. During 9 months in 1993, 13 NSIs occurred due to needles piercing CMCs (P < .001). No clinical illness resulted from the NSIs. The outbreak was halted by a temporary change to plastic (polypropylene) boxes for sharps disposal ($4.92 to $23.33/cu ft) until receipt of a box with a newly designed solid fiberboard liner ($1.25/cu ft). CMC liners used during the epidemic had a mean needle puncture resistance of 527 g, as compared with 660 g for liners used before the outbreak (P < .001). The new solid fiberboard liner has a mean puncture resistance of 1,765 g. A program of waste disposal using fiberboard CMCs was found to cost approximately one-seventh the cost of a program using plastic boxes for disposal of infectious waste. CONCLUSION: A program for infectious waste disposal using fiberboard CMCs can be safe and cost-effective if appropriate standards for puncture resistance are met.

Containment of Biohazards↗
PubMed1995

The risk of occupational exposure to blood and body fluids for health care workers in the dialysis setting. Italian Multicenter Study on Nosocomial and Occupational Risk of Infections in Dialysis.

In 1991, to assess the risk of occupational exposure to blood or other body fluids in health-care workers (HCWs) working in the dialysis setting, properly trained interviewers used standardized questionnaires asking the 583 HCWs employed in 19 Italian dialysis units to recall exposures sustained in the previous year. On a total of 208,498 dialyses performed in the previous year, 105 (5 per 10,000 dialyses) needlesticks, and 579 (28 per 10,000 dialyses) skin/mucous membrane contaminations were recalled. Recapping injuries were recalled in 38 cases (1.8 per 10,000 dialyses), but 67 needlestick injuries (4.1 per 10,000 dialyses) occurred during other circumstances (p = 0.006). The highest rate of skin/mucous membrane contaminations were recalled during the dialysis patient care, but more than one third of exposures occurred in other circumstances (break in blood circuit, disposal, contamination with blood-soiled equipment. To minimize the risk of occupational exposure to blood efforts must continue to increase compliance with Universal Precautions; moreover, needle designs incorporating safety features to prevent sticks are needed.

Blood-Borne Pathogens↗
PubMed1994

(0)-(0) = 0.

Explore the source record for details and available documents.

General Surgery↗
PubMed1992

Serum cortisol levels predict infarct size and patient mortality.

We have investigated prospectively the serum cortisol response to acute myocardial infarction in 70 consecutive patients admitted to a coronary care unit and we have shown that the levels are significantly raised early in the course of the illness and prior to elevation of the cardiac specific enzyme fraction, creatine kinase MB. The magnitude of the cortisol response is related to the size of the ensuing infarction (rs = 0.54) as calculated from the total creatine kinase MB release (P < 0.001) and very high levels (> 2000 mumol/l) are predictive of mortality (P < 0.05). Serum cortisol levels may have a role in the early identification of myocardial infarction and in predicting those patients with a poor prognosis.

Anistreplase↗
PubMed1992

The Critikon ProtectIV catheter issue.

Most healthcare professionals have already read about the union grievance over the Critikon ProtectIV catheter filed at San Francisco General Hospital. The union's position was that the catheter which is designed to prevent needlesticks during insertion and removal, should be used in all applications at the hospital, rather than only in those that seemed to present greater risk of injury or infection. HHMM believes that engineering controls--specifically safety needles--should be fundamental to a good exposure control plan for bloodborne pathogens. If the primary pathway of exposure is the needlestick and the point of the control plan is to reduce needlesticks, then it is hard to refute the logic that safety devices are the best approach. The following material consists of the statement made by Dr. Peter Lurie to the grievance committee at San Francisco++ General and a letter from Dr. Janine Jagger presenting initial data on the effectiveness of the ProtectIV catheter in reducing injuries. Both are reprinted with permission. HHMM offers these documents for the information they contain, as well as for the guidance they offer in how to begin evaluating safety needle devices.

Acquired Immunodeficiency Syndrome↗