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PubMed2002

Availability of dental services for patients with blood-borne viruses.

Dental practitioners were surveyed, using a self-completed postal questionnaire, to assess their attitudes to managing patients with blood-borne viruses (BBV) and to identify dental services available for such patients in North Nottinghamshire. Questionnaires were completed by 79 (65.3%) of the 121 practitioners from 43 (82.7%) of the 52 study practices. Previous BBV experience was reported by 44 (55.7%), 31 (39.2%), 20 (25.3%) respondents for hepatitis B (HBV), hepatitis C (HCV), HIV, respectively. Over two-thirds would maintain existing patients with subsequently diagnosed BBV on their lists, approximately one-third would accept new BBV patients. Risk factors for BBV of homo/bisexuality and injecting drug use were not asked by 71 (89.9%) and 49 (62.0%) practitioners, respectively. Universal precautions were employed by 67 (84.8%) practitioners regardless of the patient's status and by seven practitioners for known BBV patients. The advice of the General Dental Council, British Dental Association, and the use of universal precautions are discussed.

Blood-Borne Pathogens↗

PubMed1994

Differences in the perceptions of HIV risk amongst dental care providers in Western Australian clinics.

This paper examines the perceived risk of occupationally contracting HIV among dental care providers. This examination is based upon responses to a mailed questionnaire from all registered dentists (76 per cent response rate, n = 550) and dental therapists (63 per cent response rate, n = 208) in Western Australia during 1992. Results indicate that: 1) dental care providers who perceive a high risk of occupationally contracting HIV report a more conservative, cautious approach to HIV infection than do providers who perceive less risk of contracting the virus; 2) dental therapists are more likely than dentists to report a higher degree of perceived risk of occupationally contracting HIV; and 3) dentists are more likely than dental therapists to perceive compliance with universal precaution guidelines in dental practices in which they work. Reasons are presented for a suspicion that both sets of perceptions may be exaggerated. The need to educate dental therapists on the realistic risks of occupationally contracting HIV and to educate dentists on the value of compliance (and of appearing to comply) with universal precaution guidelines in order to help reduce undue stress and hindrances in the provision of safe and effective dental care in this era of AIDS concludes this paper.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

General and oral manifestations of human immunodeficiency virus infection: a general overview with guidelines for infection control in the dental practice.

The human immunodeficiency virus (HIV-1), responsible for the acquired immunodeficiency syndrome, has in the span of a decade become an epidemic of global proportions. Oral lesions, head and neck diseases are often the first manifestations of HIV-1 infection and AIDS. It is essential for all dentists to familiarize themselves with the oral manifestations of HIV-infection as well as the dental management of such manifestations. In addition to all health care, professionals should become acquainted with the "universal precautions" recommended by the Centers for Disease Control, in order to protect themselves, their staff, and their patients to minimize, if not totally eliminate, any risk of infectious disease transmission in the health care setting. This paper presents a general overview of the human immunodeficiency virus; oral manifestations of HIV-infection; "universal precautions" and guidelines for the control of infection in the dental practice.

HIV Infections↗

PubMed2005

Compliance with Universal/Standard Precautions among health care workers in rural north India.

BACKGROUND: Universal Precautions (UPs) and more recently Standard Precautions have been widely promoted in high-income countries to protect health care workers (HCWs) from occupational exposure to blood and the consequent risk of infection with bloodborne pathogens. In low-income countries, the situation is very different: UPs are often practiced partially, if at all, thereby exposing the HCWs to unnecessary risk of infection. The aim of this study is to describe rural north Indian HCWs knowledge and understanding of UPs and identify predictors of compliance to target intervention programs appropriately. METHODS: A cross-sectional survey was undertaken, involving 266 HCWs (response rate, 87%) from 7 rural north Indian health care settings. Information was gathered regarding compliance with UPs and a range of other relevant variables that potentially influence compliance (eg, demographic information, perception of risk, knowledge of bloodborne pathogen transmission, perception of safety climate, and barriers to safe practice). RESULTS: Knowledge and understanding of UPs were partial, and UPs compliance was suboptimal, eg, only 32% wore eye protection when indicated, and 40% recapped needles at least sometimes. After controlling for confounding, compliance with UPs was associated with being in the job for a longer period, knowledge of bloodborne pathogen transmission, perceiving fewer barriers to safe practice and a strong commitment to workplace safety climate. CONCLUSION: Interventions to improve UPs compliance among HCWs in rural north India need to address not only their knowledge and understanding but also the safety climate created by the organizations that employ them.

Adult↗

PubMed1999

Counselling patients with hepatitis C.

Hepatitis C virus (HCV) is usually but not exclusively transmitted by the parenteral route. Some precautions are recommended for infected patients as well as his/her close contacts and family members. The risk of sexual transmission and from household contacts is very low. Use of condoms is only recommended in cases of multiple partners and for those at high risk of transmission. Some personal objects should not be shared, i.e. razors, toothbrushes and nail clippers, but it is not necessary to avoid sharing eating utensils. Sexual partners may be tested for anti-HCV HCV-positive individuals should refrain from donating blood, organs and tissue. Clear and evidenced-based information should be provided to patients as to the means of prevention with special attention to individual risk groups such as IV drug abusers. The risk of HCV transmission after needlestick injury, although low, justifies universal precaution measurements for health-care workers. Nosocomial transmission has been described after medical procedures, especially haemodialysis and endoscopy. Thus, disinfection procedures as well as universal precautions are essential for all health-care workers. It is also important for HCV patients to inform health-care workers beforehand about their HCV status. Perinatal transmission is rare and is usually related to the degree of maternal viral load. Pregnancy is not contra-indicated in HCV. infected individuals and breast-feeding is allowed. Finally, HCV patients with active disease should be advised to refrain from alcohol intake, especially during antiviral therapy. After HCV infection it is necessary to consider not only diagnostic and therapeutic steps but also the risk of transmission in the patient's circle and consequences for the patient.

Counseling↗

PubMed2002

1st- and 2nd-year medical student exposure to emergency medicine.

BACKGROUND: Medical societies in emergency medicine (EM) have recommended teaching EM topics in the preclinical years of medical school. However, the magnitude of integrating an EM curriculum into the 1st and 2nd year of medical school is unknown. PURPOSE: The purpose of this survey was to determine the extent and type of exposure to EM in the 1st and 2nd years of medical schools in the United States. METHODS: The deans of all allopathic and osteopathic medical schools in the country were surveyed by mail. The survey took the form of a questionnaire and had seven questions that included type of exposure, number of students, length of the exposure, learning objectives, lectures, laboratory, textbook, evaluation process and grades, departmental status, board certification, emergency department volume, and size of the medical school class. The data were analyzed with SPSS software. RESULTS: The survey was returned by 84 of the 125 (67.2%) medical schools in the country. The average class size was 129.0 students. As many as 63.9% of the medical schools responding provided EM exposure in the 1st year and 54.3% in the 2nd year. The 1st-year exposure most frequently used more than one type of teaching activity (47.4%), observation (12.3%), cardiopulmonary resuscitation training (15.8%), universal precautions (7.0%), and other (17.5%). None taught physical diagnosis. The various teaching activities lasted anywhere from hours (27.5%), to days (25.3%) or weeks (52.5%), with a mean of 2.25 weeks. Second-year exposure most frequently included multiple activities (49.0%), observation (16.3%), or other activities (14.3%); a few taught physical diagnosis (8.2%), cardiopulmonary resuscitation training (6.1%), or universal precautions (6.1%). These teaching activities lasted from hours (20.6%), to days (14.7%) or weeks (64.7%), with a mean of 2.44 weeks. CONCLUSIONS: Most U.S. medical schools provide EM exposure in the first 2 years of medical school, lasting slightly more than 2 weeks in length most frequently covering multiple topics.

Curriculum↗

PubMed1994

Respiratory care practitioners' attitudes toward patients with AIDS.

OBJECTIVE: To assess attitudes of respiratory care practitioners about AIDS and patients with AIDS. DESIGN: A questionnaire that explored attitudes about AIDS was disseminated throughout southern New Jersey. Identity of individual responders was protected carefully. RESULTS: One hundred fifty-nine responses were received. The majority of responders favored identification of patients with AIDS, segregation of those patients into AIDS wards, and then avoidance of the AIDS wards. There was some bias against patients with known high-risk behaviors (especially drug abuse), but once a patient had AIDS the fear of getting AIDS was the only factor that correlated (p = 0.001) with the desire to avoid AIDS patients. Thirty-nine percent of responders said that they used universal precautions less than 90 percent of the time, and no factor (including fear of AIDS and markers of education) predicted which therapists did not consistently use them. CONCLUSIONS: The desire to avoid AIDS represents a rational desire not to become infected with the HIV virus. This study documents an identify-and-avoid philosophy in lieu of careful use of universal precautions. Educational efforts need to emphasize that the use of precautions represents the only truly effective means of preventing infection with the AIDS virus and other communicable diseases.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Transmission routes of HCV infection in dialysis.

Nosocomial transmission of hepatitis C virus (HCV) to haemodialysed patients, strongly suspected in epidemiological studies, has recently been unequivocally demonstrated by molecular virology reports. Potential transmission mechanisms include staff hands, dialysis monitors, and equipment items shared between patients. The respective involvement of each of these vectors in HCV transmission has not been determined. There is no conclusive data on the reality of HCV transmission by dialyser re-use. Prevention of HCV transmission relies on the use of erythropoietin, blood donor screening for anti-HCV antibodies and the application of 'Universal Precautions' (Atlanta CDC). In contrast, isolation of anti-HCV-positive dialysed patients does not appear to be warranted by prospective studies, as it might increase the risk of co-infection by different HCV strains, would entail additional costs and be at best partially effective. Recent data have shown that HCV transmission may be prevented by the observance of the 'Universal Precautions' without having to isolate HCV+ patients.

Cross Infection↗

PubMed1994

The acquisition of practical skills by U.S. medical students.

Increasing interest in skills training has been prompted by concerns over risks posed by new, complex clinical environments and the need for medical students to function effectively in such settings. To gain a better idea of the type of instruction currently provided to U.S. medical students, a national survey was conducted in 1991. A survey instrument was prepared after a literature review on practical skills training. Eleven skill and knowledge areas were selected for analysis; six were considered "basic" and five "advanced." Mailings were directed to the deans of 126 U.S. medical schools. Based on a 94% response rate (118/126), the skill and knowledge areas taught most commonly included universal precautions, phlebotomy, intravenous line placement, advanced cardiac life support, and suturing lacerations. Fifty-one (43%) of 118 respondents reported that they conducted "transition courses" for practical skills training. At most such institutions, basic skills were taught more frequently than advanced skills. Where there was no transition course, formal instruction was provided in standing courses and clerkships. The survey indicates that five skills areas are formally taught in the majority of U.S. medical schools. These include universal precautions, phlebotomy, starting intravenous lines, suturing lacerations, and advanced cardiac life support. In most cases, evaluation and certification procedures are infrequent. Further studies are necessary to gain a better idea of what practical training should be undergone by all U.S. medical students.

Clinical Competence↗

PubMed2000

Attitudes and beliefs of Singapore health care professionals concerning HIV/AIDS.

AIM OF STUDY: This study examines the beliefs and attitudes of Singapore doctors, dentists, and nurses concerning HIV/AIDS and persons living with HIV/AIDS (PWAs). METHOD: A mail survey was done of all doctors and dentists in Singapore as well as a random sample of 1,500 nurses from the Singapore Nursing Board Register. RESULTS: The results showed that respondents held accurate beliefs concerning transmission of HIV via sex and needle sharing but a significant proportion also expressed belief in transmission via everyday social contact. Respondents were aware of universal precautions when treating persons with HIV/AIDS but tended to be overly cautious in low/no risk situations. A substantial proportion of respondents indicated little or no knowledge or experience with AIDS-related conditions and the majority believed that most health care professionals are unprepared to care for PWAs. Further, there was evidence of substantial stigmatisation and fear of treating PWAs, both of which were significantly and negatively correlated with accuracy of beliefs about HIV transmission and universal precautions. CONCLUSION: These results point to important misconceptions about HIV/AIDS held by Singapore health care professionals as well as stigma towards and fear of treating PWAs. These are areas that need to be addressed through better professional education concerning HIV/ AIDS. This education needs to address both the factual misconceptions about HIV/AIDS as well as the stigma associated with this disease and the fears that health care professionals have of treating PWAs.

Acquired Immunodeficiency Syndrome↗

PubMed1994

[Occupational injuries with risk of transmission of blood-borne pathogens. A study of a 2-year material from the Holstebro Central Hospital].

In order to illuminate causes of accidental occupational exposure of the house staff at the Central Hospital of Holstebro (CHH) to the potential hazards of HIV- and HBV-transmission, all cases of reported injuries occurring in 1991-1992 have been analysed. Needleprick lesions were found to account for the great majority of the reported cases (71%). Sixty-six percent of all injuries were self-inflicted during medical procedures, while 34% were caused by another person, either directly (simultaneous contact of two persons with the contaminated sharp object) or indirectly as a result of carelessness or negligence. Seventy-two percent of the analysed exposures could have been avoided if the staff had complied with Universal Precautions recommended since 1988. In order to estimate the amount of unreported cases, all nurses and laboratory technicians currently employed at CHH were asked to complete an anonymous questionnaire reviewing their past (1991-1992) mucocutaneous and percutaneous exposures to blood or body fluids. Only 28% of the injuries recalled by the subjects had been reported. If the risk of occupational transmission of blood-borne diseases is to be minimized, additional effort must be made to clarify the principles of the Universal Precautions policy. It is of great importance that all injuries are reported by way of an easy reporting procedure which is efficient and familiar to the staff at any time.

Accidents, Occupational↗

PubMed1998

The use and failure rates of protective equipment to prevent blood and bodily fluid contamination in the obstetric health care worker.

OBJECTIVE: To determine the frequency of use and the failure rate of protective equipment by obstetric staff during common obstetric procedures. METHODS: A prospective observational study was conducted of multiple obstetric procedures. The presence, area of specialty, level of training, and gender of each team member were recorded along with the use of protective equipment (cap, mask, eyewear, gown, gloves, and shoe protection). These observations were recorded by two trained observers. Blood and bodily fluid contamination of the protective equipment was quantified and recorded for each person. A forensic medicine reagent (Luminol; Cluefinders Inc., Tampa, FL) was used to detect trace amounts of blood on the inner surface of a selected subset of gowns that had gross external contamination but no obvious penetration. RESULTS: Two hundred forty-one obstetric procedures were observed involving 1022 medical personnel. The use of at least one piece of protective equipment was noted 88% of the time. Compliance with universal precautions by attending and resident physicians in all deliveries (vaginal, forceps, vacuum, cesarean) was observed in 65 (25.2%) medical personnel. The use of protective equipment varied by the type of procedure, area of specialty, and level of training of the team member. In the gowns examined with the forensic medicine reagent, 44% of the cases demonstrated laboratory evidence of penetration. The frequency of gown failure varied with the type of surgical gown used. CONCLUSION: Despite the mandate in the medical community for universal precautions, the rate of compliance remains low. However, even among the compliant medical staff, protective equipment labeled as impenetrable has a high failure rate.

Blood↗

PubMed2005

Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings.

BACKGROUND: Approximately 3 million health care workers (HCWs) experience percutaneous exposure to bloodborne viruses (BBVs) each year. This results in an estimated 16,000 hepatitis C, 66,000 hepatitis B, and 200 to 5000 human immunodeficiency virus (HIV) infections annually. More than 90% of these infections are occurring in low-income countries, and most are preventable. Several studies report the risks of occupational BBV infection for HCWs in high-income countries where a range of preventive interventions have been implemented. In contrast, the situation for HCWs in low-income countries is not well documented, and their health and safety remains a neglected issue. OBJECTIVE: To describe the extent of occupational exposure to blood and the risk of BBV infection among a group of HCWs in rural north India. METHODS: A cross-sectional survey of HCWs from 7 rural health settings gathered data pertaining to occupational exposure to blood and a range of other relevant variables (eg, demographic information, compliance with Universal Precautions, perception of risk, knowledge of BBVs). A mass action model was used to estimate the risk of occupational BBV infection for these HCWs over a 10-year period. RESULTS: A total of 266 HCWs returned questionnaires (response rate, 87%). Sixty-three percent reported at least 1 percutaneous injury (PI) in the last year (mean no. = 2.3) and 73% over their working lifetime (mean no. = 4.2). Predictors of PI during the last year were hospital site, job category, perception of risk, and compliance with Universal Precautions. CONCLUSION: The high level of occupational exposure to blood found among this group of rural north Indian HCWs highlights the urgent need for interventions to enhance their occupational safety to prevent unnecessary nosocomial transmission of BBVs.

Accidents, Occupational↗

PubMedDate not supplied

Care and treatment of scabies.

In these days of Universal Precautions, the staff nurse can and should work with all patients as if they had a potentially infectious disease. A case in point is scabies which mimics many dermatological conditions and is transmitted by direct contact. Scabies is caused by infestation with the mite Sarcoptes scabiei, and can be a problem in nursing homes and hospitals, particularly among patients who are debilitated and require extensive hands-on care. A scabies outbreak need not result in chaos or epidemic. If nursing staff are well trained in Universal Precautions, especially handwashing, much transmission could be prevented. Moreover, if scabies is recognized early, accurately documented, and quickly treated, a scabies outbreak could be readily contained.

Cross Infection↗

PubMed1994

Mandatory HIV testing and occupational therapists.

OBJECTIVES: As the prevalence of human immunodeficiency virus (HIV) increases, so does the prevalence of HIV-positive health care workers. This study explored what effect this will have on occupational therapy service provision. Attitudes and policies of 118 occupational therapy administrators were examined in relation to mandatory testing for HIV, attitudes on treating HIV-positive patients, working with HIV-positive staff members and students, and use of Centers for Disease Control's guidelines on universal precautions. METHODS: A stratified sample of 200 occupational therapy administrators, drawn proportionally from all occupational therapy fieldwork centers, was sent questionnaires. The respondents (N = 118) were asked questions reflecting policy and attitude regarding HIV-positive staff members, students, and patients and mandatory testing. Descriptive statistics and chi-square analyses were computed to examine variances related to policy, ethics, and attitudes. RESULTS: Few occupational therapy departments have policies regarding HIV-positive health care workers or students. Those policies in place involve disability discrimination acts and using universal precautions. More than one third of the respondents support mandatory testing of all health care workers and notifying patients if their occupational therapist is HIV-positive. A large minority of respondents would either refuse to hire or train an HIV-positive therapist or student, or would restrict patient care responsibilities. CONCLUSIONS: Although most occupational therapy administrators adhere to CDC guidelines and anti-discrimination policies, some concern and fear was expressed regarding HIV transmission through occupational therapy practice. This may result in administrative decisions regarding work and training responsibilities that are unnecessarily restrictive, such as limiting all patient care responsibilities.

AIDS Serodiagnosis↗

PubMed1999

[Nursing and the prevention of biological risks: from education to professional activity].

OBJECTIVE: To discover the training nursing students receive regarding prevention and control of infection inside hospital settings and the means of self-protection as well as making people aware of the need to improve this training if deemed necessary. METHODS: This is a transversal descriptive study which took place in the nursing schools in Spain. Data was gathered by means of a questionnaire each respondent filled in by themselves. The lack of a response was also studied. A followup meeting was held with those who participated in this study to seek consensus in the search for solutions to those necessary changes detected. RESULTS: 86% responded to the questionnaire. During the course of career preparation, these were the average number of hours dedicated to various areas of study: 34.5 to Biological Statistics, 40 to Epidemiology, 28 to Infectious Diseases, 29 to Microbiology, 9 to Infection Control, 11 to Concepts of Aspesis and Antisepsis, and 36 to Methods of Research and Investigation. More than 50% of the professors teaching these classes are licensed nurses. Student followup during their clinical practice was carried out basically by nurses in university hospitals. 39% of nursing schools teach the concept and content for universal precautions prior to clinical practice. In the majority of public nursing schools, the followup of a student after a biological accident is carried out by the preventive medicine service, whereas this is done by the school insurance company in private nursing schools. Therefore, significant differences exist. COMMENTS: The theoretical knowledge taught is adequate; the number of hours dedicated to each subject varies among the schools; it is necessary to come to an agreement on the minimum levels of training required before engaging in clinical practice in a safe manner. Universal precautions should be taught in all schools before clinical practice occurs.

Cross-Sectional Studies↗

PubMed1991

Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit.

PURPOSE: Acinetobacter calcoaceticus var. anitratus is an important nosocomial pathogen that has been associated with environmental reservoirs. An increased isolation rate of A. anitratus in our intensive care units (ICUs), from 0.03% (two of 7,800) to 0.5% (seven of 1,300) (p less than 0.00003), prompted an investigation. PATIENTS, METHODS, AND RESULTS: Ten patients were admitted to the surgical ICU and nine to the medical ICU during the outbreak period (late December 1987 to January 1988). Controls were all patients on the units who were not infected or colonized with the transmitted strain of A. anitratus. Three patients had A. anitratus pneumonia. A throat culture prevalence survey demonstrated three patients colonized with A. anitratus. Cases were placed in a cohort and symptomatic cases treated. An epidemiologic investigation was conducted to identify reservoirs and modes of transmission. Latex gloves were being used for universal precautions without routine changing of gloves between patients. Environmental sources culture-positive for A. antitratus included a small volume medication nebulizer and gloves in use for patient care. Plasmid typing showed that plasmid profiles of isolates from two symptomatic patients, two colonized patients, the nebulizer, and the gloves were identical. Other A. anitratus ICU isolates had distinct plasmid profiles. All patients with the transmitted strain had been in the surgical ICU. The need for changing gloves between patients and contaminated body sites was reinforced. CONCLUSION: Gloves, used incorrectly for universal precautions, may potentially transmit A. anitratus.

Acinetobacter Infections↗

PubMed1997

Prevalence and epidemiological characteristics of hepatitis B and C infections among doctors and dentists in Nigeria.

A random sample of seventy five doctors and dentists at the University College Hospital, Ibadan, Nigeria, was surveyed. They were offered anonymous testing for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), antibodies to hepatitis B core antigen (anti-HBc) and to hepatitis C virus (anti-HCV) by enzyme immunoassay. The results suggest a high prevalence of hepatitis B virus (HBV) with a high potential of transmissibility, as well as a high prevalence of HCV infection. Most of the doctors and dentists use universal precaution for protection against viral hepatitis less than 50% of the occasions when they carry out procedures on their patients. Infection with HBV was associated with type of specialty (surgeons and dentists) and lack of HBV vaccination (p < 0.05). After logistic regression, these factors were independently associated with HBV infection (p < 0.05). Sixty (80%) of these health care workers had not received prior HBV vaccination. The unvaccinated personnel were more likely to be surgeons, dentists, less than 37 years of age and have fewer years of professional activity (p < 0.05). After logistic regression, only the fewer years of professional activity remained independently associated with lack of vaccination (p < 0.05). We conclude that to reduce the occupational exposure of HBV, universal precautions must be rigorously adhered to when doctors and dentists carry out procedures on their patients. It is necessary that these health care workers are vaccinated with HBV vaccine and the currently anticipated HCV vaccination, if not immune. No recent study exists that exclusively addresses this problem in health care workers in tropical Africa.

Adult↗