Determinants of Emergency Department Procedure- and Condition-Specific Universal (Barrier) Precaution Requirements for Optimal Provider Protection

Kelen, Gabor D.; Hansen, Katrine Bagge; Green, Gary B.; Tang, Nelson; Ganguli, Chandana

doi:10.1016/s0196-0644(95)70201-6

Cited by 17 publications

(10 citation statements)

References 11 publications

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“…Many residents recalled situations involving belligerent patients, time constraints, resuscitations, or recapping needles at the time of their exposures. The importance of situational or ergonomic factors was also demonstrated by Kelen et al 10 These investigators reported in their prospective observational study that an increase in blood or bloody fluid contact was correlated with the procedure type, bleeding from a procedure, active bleeding, completion of procedure, increased triage acuity, and crowded conditions. Although many of these clinical circumstances such as triage acuity are hard to control, certain modifications of work practices have been shown to be effective in minimizing the number of exposures.…”

Section: Discussionmentioning

confidence: 72%

“…Other procedures that were noted to result in frequent facial exposure included wound irrigation, local infiltration, lumbar puncture, urinary catheter placement, and examination of a bleeding patient. 10 They also recommended the need for gown protection for all but the simplest procedures since they noted that even procedures such as the examination of the bleeding patient could result in measurable rates of blood exposure. Exposure of the feet to blood was also noted during certain procedures, such that foot protection should be used under the appropriate circumstances.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, Kelen et al noted that the knowledge of a patient's infectious status significantly decreased the likelihood of blood contacts in their ED, independent of other factors. 10 Knowledge of the source patient's HIV status is currently even more significant in view of the fact that postexposure prophylaxis (PEP) has been demonstrated to be efficacious and is now recom-mended for certain high-risk exposures. 20,21 If a patient's HIV status is available, this knowledge not only will minimize the administration of a potentially toxic chemoprophylaxis regimen to those exposed to an HIV-negative patient's body fluid, but also can be used to prescribe the most appropriate regimen of chemoprophylaxis to the exposed individuals depending on the degree of HIV illness and the source patient's therapeutic regimen.…”

Section: Discussionmentioning

confidence: 99%

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Occupational Exposures to Blood among Emergency Medicine Residents

Lee

Carter

Chiang

et al. 1999

Academic Emergency Medicine

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Abstract. Objectives: To investigate the epidemiologic characteristics of potentially infectious occupational exposures to blood among emergency medicine (EM) residents. Methods: A SAEM-sponsored multiple-choice survey was administered anonymously to all EM residents participating in the 1998 American Board of Emergency Medicine in-service examination. Survey questions included resident demographics, use of universal precautions, frequency and types of exposures to blood, and exposure reporting. Residents who experienced at least one exposure were then asked to complete an additional set of questions referring only to their latest exposure. Mean values were calculated for each variable and differences between groups were compared by chi-square analysis. Results: Three thousand one hundred sixty-two surveys were distributed to the resident participants, and 2,985 surveys (94.4%) were returned. Of the participants, 56.1% reported at least one exposure to blood during their EM training. The frequency of this self-reported exposure increased with advancing EM level of training (43% EM-1, 58% EM-2, 64% EM-3, 76% EM-4, p < 0.001). Of these residents, 36.6% always followed universal precautions, 54% frequently, and 9.4% sometimes, rarely, or never. Those individuals who ''always'' followed universal precautions reported significantly fewer exposures than those who did not (p < 0.005). The latest exposures were most commonly caused by a solid needle or sharp object (39.4%), by a hollow-bore needle (30.6%), or by eye splashes (17.2%). Of these exposures, 71.7% occurred in the ED setting, and only 46.7% of these exposures were reported to health care providers. Conclusion: Emergency medicine residents are frequently exposed to blood, most commonly due to puncture injuries by sharp objects. The rate of exposure reporting is low, which may compromise appropriate postexposure counseling and prophylaxis.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Occupational Exposures to Blood among Emergency Medicine Residents

Lee

Carter

Chiang

et al. 1999

Academic Emergency Medicine

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“…28,29 Up to two-thirds of procedures performed in the ED result in some form of HCP exposure to blood or other body fluid. 30 Most exposures involve the hands. Exposures to the face are more likely to occur during tube thoracostomy, lumbar puncture, or examination of a hemorrhaging patient.…”

Section: Hand Hygienementioning

confidence: 99%

Infection Prevention in the Emergency Department

Liang

Theodoro

Schuur

et al. 2014

Annals of Emergency Medicine

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Infection prevention remains a major challenge in emergency care. Acutely ill and injured patients seeking evaluation and treatment in the emergency department (ED) not only have the potential to spread communicable infectious diseases to healthcare personnel and other patients, but are vulnerable to acquiring new infections associated with the care they receive. This article will evaluate these risks and review the existing literature for infection prevention practices in the ED, ranging from hand hygiene, standard and transmission-based precautions, healthcare personnel vaccination, and environmental controls to strategies for preventing healthcare-associated infections. We will conclude by examining what can be done to optimize infection prevention in the ED and identify gaps in knowledge where further research is needed. Successful implementation of evidence-based practices coupled with innovation of novel approaches and technologies tailored specifically to the complex and dynamic environment of the ED are the keys to raising the standard for infection prevention and patient safety in emergency care.

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“…Safety climate and compliance with safety practices are correlated in those environments. [17][18][19][20][21][22][23][24] Safety climate refers to shared assessments of safety policies, procedures, and practices, 25 26 and the perceptions and expectations that workers have of workplace safety. 27 28 High safety climate levels are associated with decreased occupational injuries, [29][30][31][32][33] which may decrease the incidence of absence due to disability and sickness.…”

mentioning

confidence: 99%

Association of occupation and safety practices with work-injury absence among public hospital employees in Latin America: a study from Costa Rica

et al. 2007

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Background: Injury-related statistics in developing countries are rare. Objective: To assess the relationship between occupational and safety-related risk factors and absences from work during the preceding 6 months due to work-related injury among public hospital employees in Costa Rica. Methods: Data were used from a cross-sectional survey conducted in December 2000 among a stratified random sample of 1000 employees from 10 of the 29 public hospitals in Costa Rica. The questionnaire included sociodemographic data, occupational exposures, and organizational risk factors. A dichotomous variable was created to indicate work-injury absence. At-risk employees (n = 466) were classified as having had a work-injury absence if they reported having been absent for at least 1 day in the preceding 6 months because of a work-related injury. OR and 95% CI were calculated using unconditional logistic regression models.Results: There is a greater likelihood of injury-related absence in non-professional occupational positions (ie, auxiliary personnel (OR = 2.29) and general services employees (OR = 5.55)) than in professional positions, and in employees who show poor compliance with safety practices (OR = 2.03) and have high interference from their job task (OR = 3.79) compared with their counterparts. Conclusions: Work-injury absence appears not only to be a function of work injury, but also a function of occupation and degree of compliance with safety practices.

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Determinants of Emergency Department Procedure- and Condition-Specific Universal (Barrier) Precaution Requirements for Optimal Provider Protection

Cited by 17 publications

References 11 publications

Occupational Exposures to Blood among Emergency Medicine Residents

Occupational Exposures to Blood among Emergency Medicine Residents

Infection Prevention in the Emergency Department

Association of occupation and safety practices with work-injury absence among public hospital employees in Latin America: a study from Costa Rica

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