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At least 19 recordsLinked to original sources
PubMed1992

Percutaneous injuries during surgical procedures.

OBJECTIVE: To study the numbers and circumstances of percutaneous injuries (eg, needle sticks, cuts) that occur during surgical procedures. Surgical personnel risk infection with blood-borne pathogens from percutaneous injuries; some injuries might also place patients at risk by exposing them to a health care worker's blood. DESIGN: Observers present at 1382 surgical procedures recorded information about the procedure, the personnel present, and percutaneous injuries that occurred. SETTING: Four US teaching hospitals during 1990. PARTICIPANTS: Operating room personnel in five surgical specialties. MAIN OUTCOME MEASURES: Numbers and circumstances of percutaneous injuries among surgical personnel and instances in which surgical instruments that had injured a worker recontacted the patient's surgical wound. RESULTS: Ninety-nine injuries occurred during 95 (6.9%) of the 1382 procedures. Seventy-six injuries (77%) were caused by suture needles and affected the nondominant hand (62 injuries [63%]), especially the distal forefinger. The risk of injury adjusted for confounding variables by logistic regression was higher during vaginal hysterectomy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.6 to 7.5) and lower during certain orthopedic procedures (OR, 0.2; CI, 0.1 to 0.7) than during 11 other types of procedures (reference group; OR, 1.0). Use of fingers rather than an instrument to hold the tissue being sutured was associated with 35 injuries (35%). Eighty-eight injuries (89%) were sustained by resident or attending surgeons; in 28 (32%) of the 88 injuries in surgeons, the sharp object that caused the injury recontacted the patient. CONCLUSION: Percutaneous injuries occur regularly during surgery, placing surgical personnel and, to a lesser extent, patients at risk for infection with blood-borne pathogens. Many such injuries may be preventable with changes in devices, techniques, or protective equipment; all such measures require careful evaluation to determine their efficacy in reducing injury and their effect on patient care.

Accidents, Occupational↗
PubMed1992

Developing a workable infection control policy for the dental laboratory.

An enforced infection control policy in a laboratory will reduce occupational exposure to blood-borne pathogens and other infectious diseases and protect the dental laboratory personnel from exposure to infective disease. An outline of a workable laboratory infection control policy based on "Occupational Exposure to Bloodborne Pathogens" requirements is presented.

Containment of Biohazards↗
PubMed1992

Surgical glove perforation and maxillofacial trauma: to plate or wire?

The technique of interdental wiring was compared with a small-plate osteosynthesis technique (SPO) in a prospective study of surgical glove perforations acquired during the treatment of mandibular fractures. Using the SPO technique there was a significant reduction in the incidence of skin penetrating injuries in the surgeon (P less than 0.005) and assistant surgeon groups (P less than 0.05). The reduction in the incidence of glove perforation in the assistant surgeon group was very highly significant in the SPO series (P less than 0.001). The reduction in the surgeon group was not significant. No difference was noted in the scrub nurse group. The small-plate osteosynthesis technique has the advantage of reducing the risk of intraoperative cross-infection transmitted by hand contamination or penetrating injury. The recommended precautions for preventing the transmission of blood-borne pathogens are reviewed.

Bone Plates↗
PubMed1992

Variability in reprocessing policies and procedures for flexible fiberoptic endoscopes in Massachusetts hospitals.

BACKGROUND: Concern is increasing regarding the risk of transmission of blood-borne pathogens by means of improperly reprocessed medical devices. METHODS: On-site surveys of policies and practices were performed in 18 reprocessing areas in eight randomly selected hospitals in Massachusetts to assess current practices for reprocessing of flexible fiberoptic endoscopes. Manufacturers' and internal written protocols, were reviewed, employees were interviewed, and procedures were observed. Reprocessing included high-level disinfection in 17 of 18 areas, with 16 areas using 2% glutaraldehyde; ethylene oxide gas sterilization was used in one area. RESULTS: Considerable interhospital and intrahospital variability was found in high-level disinfection procedures, including equipment, contact time (range 10 to 45 minutes), disinfectant testing, and rinsing. Disinfection of internal channels was inadequate in three areas, recommended sterilization of biopsy forceps was not performed in five, and written protocols were unavailable in three. Ad hoc deviation from established written or verbal protocols occurred in eight areas during reprocessing of flexible fiberoptic endoscopes from patients known to have AIDS; ethylene oxide sterilization was used in seven areas and a separate device was used in one. Interviews with personnel revealed that lack of knowledge of high-level disinfection contributed to the discrepancies between policy and practice. CONCLUSIONS: We conclude that reprocessing of flexible fiberoptic endoscopes is inconsistent and potentially ineffective. Knowledge that a flexible fiberoptic endoscope was used for a patient with AIDS influences practice.

Acquired Immunodeficiency Syndrome↗
PubMed1992

In vivo binding and clearance of circulating antigen by bispecific heteropolymer-mediated binding to primate erythrocyte complement receptor.

We have used the avidin/biotin system to construct soluble, cross-linked bispecific heteropolymers containing mAb to both the primate E C receptor and the DNP group. These heteropolymers facilitate in vitro binding of DNP-bovine gamma-globulin (DNP-BGG) to both human and squirrel monkey E. Intravenous injection in squirrel monkeys of DNP-BGG followed by heteropolymer leads to E binding and clearance from the circulation of a significant fraction of both heteropolymer and DNP-BGG, without lysis or clearance of the E. This methodology may potentially be used to treat a variety of infectious diseases and other syndromes associated with blood-borne pathogens.

Animals↗
PubMed1992

Preventing human immunodeficiency virus transmission in the podiatric practice. The role of the podiatric medical assistant.

Rationales for the design and implementation of infectious disease control programs include protecting the health of patients and staff, reducing the risk of vulnerability in litigation, and complying with the regulatory environment that mandates such programs. The development and implementation of a comprehensive infectious disease control program is not a difficult project. The Universal Precautions Policy created by the CDC outlines basic recommendations for preventing the transmission of HIV. OSHA regulations also provide step-by-step guidelines that simplify adaptation of the CDC's policy to the podiatric medical practice. The execution of an effective infectious disease control program can be accomplished by the use of 10 basic protocols for the podiatric practice. These protocols provide the basis for policy, training, follow-up, and documentation. Design and implementation of this process within a podiatric medical practice can reduce dramatically the risk of inadvertent transmission of HIV and other blood-borne pathogens.

Acquired Immunodeficiency Syndrome↗
PubMed1992

HIV-associated tuberculosis in developing countries: clinical features, diagnosis, and treatment.

This article reviews the clinical aspects and diagnosis of HIV-associated tuberculosis in developing countries, and summarizes WHO's recommendations for treatment. According to WHO estimates (early 1992) over 4 million persons worldwide have been infected with HIV and tuberculosis; 95% of them are in the developing countries. Clinical features of HIV-associated pulmonary tuberculosis in adults are frequently atypical, particularly in the late stage of HIV infection, with non-cavitary disease, lower lobe infiltrates, hilar lymphadenopathy and pleural effusion. More typical post-primary tuberculosis with upper lobe infiltrates and cavitations is seen in the earlier stages of HIV infection. Extrapulmonary tuberculosis is reported more frequently, despite the difficulties in diagnosing it. WHO's recent guidelines recommend 6-month short-course chemotherapy with isoniazid, rifampicin, pyrazinamide and ethambutol for patients with HIV-associated tuberculosis. The older 12-month regimen without rifampicin is much less effective. Streptomycin should not be used, because of the risk of transmitting blood-borne pathogens through contaminated needles. Thioacetazone should be abandoned, because of severe adverse reactions observed among HIV-infected patients. The roles of preventive chemotherapy and BCG vaccination for prevention of tuberculosis are also briefly discussed.

Adolescent↗
PubMed1992

Biology of factor IX.

Hemophilia B, one of two common hereditary bleeding disorders, is caused by a deficiency of factor IX in the circulation. Molecular mechanisms of hemophilia B are highly heterogeneous including gene deletions, insertions, complex rearrangements, and a large number of point mutations. Currently, hemophilia B is treated by plasma protein replacement therapy. This therapy is effective but exposes patients to possible side effects and complications such as infection of blood-borne pathogens including hepatitis viruses and HIV-1. Intensive efforts to develop alternative, safer therapies for hemophilia B, including somatic gene therapy, are now under way.

Amino Acid Sequence↗
PubMedDate not supplied

Evaluation of a needle-free intravenous access system.

Needle-stick injuries are one of the most severe hazards faced by nurses today. The most physically and emotionally devastating type of injury is from a needle contaminated with human immunodeficiency virus (HIV), but far more likely to occur is infection with other blood-borne pathogens, especially hepatitis B. The daily threat of needle-stick injuries adds yet another dimension of concern to the stresses inherent in working in a health care facility. Health care workers at greatest risk are those who manipulate needles and draw blood samples on a regular basis. With this concern in mind, a study was launched to evaluate a needle-free I.V. access system with respect to the following research objectives: 1) to assess the prevention/reduction of needle-stick risks and injuries; 2) to identify associated reduction in expenses; 3) to implement product and ease of use; and 4) to assess nursing satisfaction levels. This article describes the methodology used and the results of the study.

Catheters, Indwelling↗
PubMedDate not supplied

Immunological characterization of pulmonary intravascular macrophages.

Pulmonary intravascular macrophages (PIMs) are lung macrophages found apposed to the endothelium of pulmonary capillaries. In many species, they are responsible for the clearance of blood-borne particulates and pathogens; however, little else is known about their roles as immunologic effector cells. We compared PIMs with pulmonary alveolar macrophages (PAMs) to determine the relative immunological activities of these two cell populations. Our results suggested that both populations possess similar phagocytic and bactericidal activities. In assays measuring cytotoxicity, PIMs were more cytotoxic than PAMs against virally infected target cells; however, differences between these macrophage populations were not as marked when noninfected targets were used. LPS-stimulated PIMs produced more T-cell proliferative cytokines than PAMs, and both populations of nonstimulated macrophages produced similar amounts of the cytokines. In contrast, PAMs produced more TNF alpha and NO2- than PIMs when both populations were stimulated with LPS; however, nonstimulated PAMs and PIMs produced similar amounts of TNF alpha and NO2. These data suggest that bovine PIMs are immunologically active. Differences between the degrees of activity of PIMs and PAMs indicate that these macrophage populations may have different roles in lung surveillance.

Animals↗
PubMed1992

Neisserial surface variation: how and why?

Neisseria gonorrhoeae exhibits striking variability in several of its surface components (pili, Opa proteins and lipooligosaccharide) in vivo and in vitro. Such flagrant variation of this mucosal pathogen's surface components contrasts sharply with changes in single surface components of blood-borne trypanosomes and borreliae. Despite these differences, similar molecular events are sometimes involved.

Animals↗