- Email: [email protected]
Prevention of needlestick injuries among health care workers
www.ajicjournal.org Vol. 39 No. 4
substantial proportion of line-related infections can be prevented.2,3 Nevertheless, as previously demonstrated, the important discrepancy between knowledge of recommendations on one hand and daily practice on the other is most likely the key contributing factor in this important problem.4-7 In an aim to bridge the gap between what is actually known and what is actually done, Dr. Balamongkhon and Dr. Thamlikitkul nicely described in a past issue of AJIC their findings of the implementation of chlorhexidine gluconate for central line site care to prevent line-related infection.8 The authors found a decrease of line-related infections in subjects in whom site care was performed using chlorhexidine gluconate compared with povidone-iodine (3.2 vs 5.6 episodes per 1000 catheter-days, respectively; OR, 3.26; 95% CI: 0.97-10.92).8 Although the latter difference was only of borderline significance, this report adds quite important information to the literature. Nevertheless, while reading the report by Dr. Balamongkhon and Dr. Thamlikitkul, some questions were raised that would provide additional information with respect to this topic of interest. First, can the authors give data on the number of line-related infections according to the site of insertion, ie, internal jugular, subclavian, and femoral vein, respectively? Similarly, it would be valuable to have extra data on the number of line-related infections according to the type of catheter used. Last, with all these data available, we would like to recommend building a logistic regression model to identify risk factors independently associated with occurrence of line-related infections. We would appreciate if the authors could further elaborate to this. Liesbeth Delesie, RN, MNSca Stijn I. Blot, RN, MNSc, PhDa,b,d Tom Vanacker, RN, MNScc Dominique M. Vandijck, RN, MSc, MA, PhDa,b,d Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgiuma Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgiumb Department of Healthcare, Ghent University Hospital, Ghent, Belgiumc Faculty of Healthcare, University College Ghent, Ghent, Belgiumd Correspondence should be addressed to: Dominique M. Vandijck, Ghent University Hospital, Ghent University, Department of General Internal Medicine and Infectious Diseases, De Pintelaan 185, 9000 Ghent, Belgium. E-mail: [email protected]
References 1. Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, De Waele JJ, et al. Clinical and economic outcomes in critically ill patients with
Letters to the Editor
2. 3.
4.
5.
6.
7.
8.
347
nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005;41:1591-8. Vandijck DM, Blot SI. Recurrent catheter-related bloodstream infections: risk factors and outcome. Int J Infect Dis 2007;11:371-2. Young EM, Commiskey ML, Wilson SJ. Translating evidence into practice to prevent central venous catheter-associated bloodstream infections: a systems-based intervention. Am J Infect Control 2006; 34:503-6. Blot SI, Labeau S, Vandijck D, Van Aken P, Claes B. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Intensive Care Med 2007;33:1463-7. Labeau S, Vandijck DM, Claes B, Van Aken P, Blot SI. Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: an evaluation questionnaire. Am J Crit Care 2007;16:371-7. Labeau S, Vereecke A, Vandijck DM, Claes B, Blot SI. Critical care nurses’ knowledge of evidence-based guidelines for preventing infections associated with central venous catheters: an evaluation questionnaire. Am J Crit Care 2008;17:65-71. Vandijck DM, Labeau SO, De Somere J, Claes B, Blot SI; executive board of the Flemish Society for Critical Care Nurses. Undergraduate nursing students’ knowledge and perception of infection prevention and control. J Hosp Infect 2008;68:92-4. Balamongkhon B, Thamlikitkul V. Implementation of chlorhexidine gluconate for central venous catheter site care at Siriraj Hospital, Bangkok, Thailand. Am J Infect Control 2007;35:585-8.
doi:10.1016/j.ajic.2008.02.009
Prevention of needlestick injuries among health care workers To the Editor: With major interest, we read the work by Slater et al reporting their findings of an educational program aimed to reduce needlestick injuries (NSI), and subsequently the risk of bloodborne virus (BBV) transmission, among Australian health care workers.1 Nevertheless, because the authors did not include the definition used to describe a NSI, or the total number of respondents who previously experienced a NSI, we wonder whether they also considered other occupational exposures to blood, serum, plasma, or other body fluids as a result of biting; blood transfusion; or infection via a wound, lesion, or gash in the skin or via mucocutaneous splashes of the mouth, nose, or eyes as a needlestick injury, as mentioned in the recommendations of the Centers for Disease Control and Prevention.2 As such, the estimated risk of transmission of BBV as well as the device nominated with the highest risk of transmission of BBV could both represent an important underestimation of the real prevalence among their study cohort. We conducted a similar study surveying 495 undergraduate nursing students.3 Overall, 23.3% of students reported to have had a needlestick injury during their training. The low prevalence observed might be explained by the fact that only 25.9% of students
348
American Journal of Infection Control May 2011
Letters to the Editor
knew the correct definition of a needlestick injury. In addition, 28.8% of needlestick injuries were not reported to an employee health service, with lack of knowledge regarding the correct procedure to follow after having had a needlestick injury as the most common reason given for not reporting such an injury (41.6%). According to the findings by Slater et al, the vast majority of our respondents (28.1%) would like to have prevention of needlestick injuries more highlighted during their courses. Lack of knowledge of infection control measures and less professional experience have been shown to be the key reasons for nonadherence to evidence-based guidelines.4-7 Although the results of the current study are a good addition to the literature and, as such, of particular interest when developing and introducing preventive measures to increase both patients and health care workers safety, we would appreciate if the authors could reply to the above-mentioned issue. Dominique M. Vandijck, RN, MSc, MA, PhDa,b,c Sonia O. Labeau, RN, MNScb,c Stijn I. Blot, RN, MNSc, PhDa,b,c Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgiuma Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgiumb Faculty of Healthcare, University College Ghent, Ghent, Belgiumc Correspondence should be addressed to: Dominique M. Vandijck, Ghent University Hospital-Ghent University, Department of General Internal Medicine and Infectious Diseases, De Pintelaan 185, 9000 Ghent, Belgium. E-mail: [email protected]
References 1. Slater K, Whitby M, McLaws ML. Prevention of needlestick injuries: the need for strategic marketing to address health care worker misperceptions. Am J Infect Control 2007;35:560-2. 2. Centers for Disease Control and Prevention. Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 1998;47:1-33. 3. Vandijck DM, Labeau SO, De Somere J, Claes B, Blot SI; executive board of the Flemish Society for Critical Care Nurses. Undergraduate nursing students’ knowledge and perception of infection prevention and control. J Hosp Infect 2008;68:92-4. 4. Blot SI, Labeau S, Vandijck D, Van Aken P, Claes B. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Intensive Care Med 2007; 33:1463-7. 5. Labeau S, Vandijck DM, Claes B, Van Aken P, Blot SI. Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilatorassociated pneumonia: an evaluation questionnaire. Am J Crit Care 2007;16:371-7. 6. Clarke SP. Hospital work environments, nurse characteristics, and sharps injuries. Am J Infect Control 2007;35:302-9. 7. Labeau SO, Vereecke A, Vandijck DM, Claes B, Blot SI; executive board of the Flemish Society for Critical Care Nurses. Critical care nurses’ knowledge of evidence-based guidelines for preventing infections associated with central venous catheters: an evaluation questionnaire. Am J Crit Care 2007;17:65-71. doi:10.1016/j.ajic.2007.11.012
substantial proportion of line-related infections can be prevented.2,3 Nevertheless, as previously demonstrated, the important discrepancy between knowledge of recommendations on one hand and daily practice on the other is most likely the key contributing factor in this important problem.4-7 In an aim to bridge the gap between what is actually known and what is actually done, Dr. Balamongkhon and Dr. Thamlikitkul nicely described in a past issue of AJIC their findings of the implementation of chlorhexidine gluconate for central line site care to prevent line-related infection.8 The authors found a decrease of line-related infections in subjects in whom site care was performed using chlorhexidine gluconate compared with povidone-iodine (3.2 vs 5.6 episodes per 1000 catheter-days, respectively; OR, 3.26; 95% CI: 0.97-10.92).8 Although the latter difference was only of borderline significance, this report adds quite important information to the literature. Nevertheless, while reading the report by Dr. Balamongkhon and Dr. Thamlikitkul, some questions were raised that would provide additional information with respect to this topic of interest. First, can the authors give data on the number of line-related infections according to the site of insertion, ie, internal jugular, subclavian, and femoral vein, respectively? Similarly, it would be valuable to have extra data on the number of line-related infections according to the type of catheter used. Last, with all these data available, we would like to recommend building a logistic regression model to identify risk factors independently associated with occurrence of line-related infections. We would appreciate if the authors could further elaborate to this. Liesbeth Delesie, RN, MNSca Stijn I. Blot, RN, MNSc, PhDa,b,d Tom Vanacker, RN, MNScc Dominique M. Vandijck, RN, MSc, MA, PhDa,b,d Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgiuma Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgiumb Department of Healthcare, Ghent University Hospital, Ghent, Belgiumc Faculty of Healthcare, University College Ghent, Ghent, Belgiumd Correspondence should be addressed to: Dominique M. Vandijck, Ghent University Hospital, Ghent University, Department of General Internal Medicine and Infectious Diseases, De Pintelaan 185, 9000 Ghent, Belgium. E-mail: [email protected]
References 1. Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, De Waele JJ, et al. Clinical and economic outcomes in critically ill patients with
Letters to the Editor
2. 3.
4.
5.
6.
7.
8.
347
nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005;41:1591-8. Vandijck DM, Blot SI. Recurrent catheter-related bloodstream infections: risk factors and outcome. Int J Infect Dis 2007;11:371-2. Young EM, Commiskey ML, Wilson SJ. Translating evidence into practice to prevent central venous catheter-associated bloodstream infections: a systems-based intervention. Am J Infect Control 2006; 34:503-6. Blot SI, Labeau S, Vandijck D, Van Aken P, Claes B. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Intensive Care Med 2007;33:1463-7. Labeau S, Vandijck DM, Claes B, Van Aken P, Blot SI. Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: an evaluation questionnaire. Am J Crit Care 2007;16:371-7. Labeau S, Vereecke A, Vandijck DM, Claes B, Blot SI. Critical care nurses’ knowledge of evidence-based guidelines for preventing infections associated with central venous catheters: an evaluation questionnaire. Am J Crit Care 2008;17:65-71. Vandijck DM, Labeau SO, De Somere J, Claes B, Blot SI; executive board of the Flemish Society for Critical Care Nurses. Undergraduate nursing students’ knowledge and perception of infection prevention and control. J Hosp Infect 2008;68:92-4. Balamongkhon B, Thamlikitkul V. Implementation of chlorhexidine gluconate for central venous catheter site care at Siriraj Hospital, Bangkok, Thailand. Am J Infect Control 2007;35:585-8.
doi:10.1016/j.ajic.2008.02.009
Prevention of needlestick injuries among health care workers To the Editor: With major interest, we read the work by Slater et al reporting their findings of an educational program aimed to reduce needlestick injuries (NSI), and subsequently the risk of bloodborne virus (BBV) transmission, among Australian health care workers.1 Nevertheless, because the authors did not include the definition used to describe a NSI, or the total number of respondents who previously experienced a NSI, we wonder whether they also considered other occupational exposures to blood, serum, plasma, or other body fluids as a result of biting; blood transfusion; or infection via a wound, lesion, or gash in the skin or via mucocutaneous splashes of the mouth, nose, or eyes as a needlestick injury, as mentioned in the recommendations of the Centers for Disease Control and Prevention.2 As such, the estimated risk of transmission of BBV as well as the device nominated with the highest risk of transmission of BBV could both represent an important underestimation of the real prevalence among their study cohort. We conducted a similar study surveying 495 undergraduate nursing students.3 Overall, 23.3% of students reported to have had a needlestick injury during their training. The low prevalence observed might be explained by the fact that only 25.9% of students
348
American Journal of Infection Control May 2011
Letters to the Editor
knew the correct definition of a needlestick injury. In addition, 28.8% of needlestick injuries were not reported to an employee health service, with lack of knowledge regarding the correct procedure to follow after having had a needlestick injury as the most common reason given for not reporting such an injury (41.6%). According to the findings by Slater et al, the vast majority of our respondents (28.1%) would like to have prevention of needlestick injuries more highlighted during their courses. Lack of knowledge of infection control measures and less professional experience have been shown to be the key reasons for nonadherence to evidence-based guidelines.4-7 Although the results of the current study are a good addition to the literature and, as such, of particular interest when developing and introducing preventive measures to increase both patients and health care workers safety, we would appreciate if the authors could reply to the above-mentioned issue. Dominique M. Vandijck, RN, MSc, MA, PhDa,b,c Sonia O. Labeau, RN, MNScb,c Stijn I. Blot, RN, MNSc, PhDa,b,c Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgiuma Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgiumb Faculty of Healthcare, University College Ghent, Ghent, Belgiumc Correspondence should be addressed to: Dominique M. Vandijck, Ghent University Hospital-Ghent University, Department of General Internal Medicine and Infectious Diseases, De Pintelaan 185, 9000 Ghent, Belgium. E-mail: [email protected]
References 1. Slater K, Whitby M, McLaws ML. Prevention of needlestick injuries: the need for strategic marketing to address health care worker misperceptions. Am J Infect Control 2007;35:560-2. 2. Centers for Disease Control and Prevention. Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 1998;47:1-33. 3. Vandijck DM, Labeau SO, De Somere J, Claes B, Blot SI; executive board of the Flemish Society for Critical Care Nurses. Undergraduate nursing students’ knowledge and perception of infection prevention and control. J Hosp Infect 2008;68:92-4. 4. Blot SI, Labeau S, Vandijck D, Van Aken P, Claes B. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Intensive Care Med 2007; 33:1463-7. 5. Labeau S, Vandijck DM, Claes B, Van Aken P, Blot SI. Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilatorassociated pneumonia: an evaluation questionnaire. Am J Crit Care 2007;16:371-7. 6. Clarke SP. Hospital work environments, nurse characteristics, and sharps injuries. Am J Infect Control 2007;35:302-9. 7. Labeau SO, Vereecke A, Vandijck DM, Claes B, Blot SI; executive board of the Flemish Society for Critical Care Nurses. Critical care nurses’ knowledge of evidence-based guidelines for preventing infections associated with central venous catheters: an evaluation questionnaire. Am J Crit Care 2007;17:65-71. doi:10.1016/j.ajic.2007.11.012