A Case-crossover Study of Sharps-related injuries

描述(由申请人提供)：锐利的医疗设备造成的伤害很常见，估计每年有40万至80万美国医护人员受伤。受伤的医护人员面临血液传播病毒疾病的风险，包括乙肝和丙型肝炎、艾滋病毒感染和其他不常见的疾病。评估和治疗与锐器有关的伤害的直接医疗费用每年约为5亿美元。尽管最近采用了更安全的医疗设备，但与锐器相关的伤害风险仍然高得令人无法接受。对于这些损伤之前潜在的可预防的一过性致病因素知之甚少。 在这份修订后的申请中，我们建议对从波士顿和巴尔的摩的六家医院招募的1000名遭受锐器相关伤害的医护人员进行病例交叉研究。我们将评估以下领域的风险因素：1)与工作人员有关的因素，如匆忙、疲劳、分心和愤怒情绪；2)与程序有关的因素，如不常见、不寻常或紧急程序；3)与工作场所有关的因素，如工作人员短缺、加班或随叫随到；4)与设备有关的因素，如使用异常或故障的设备。我们还将评估不同特征的工人之间的风险差异，如年龄、性别、职业和既往与锐器相关的伤害病史。将评估持续暴露环境(如手术室)和间歇性暴露环境(如住院病房和门诊)中风险因素的影响。 在一项试点研究中，对90名医护人员进行了电话采访。40名是护士，28名是实习生。在我们的初步发现中，锐器相关损伤的风险增加与冲刺(RR 5.1，95%CI 3.0-8.7)、愤怒(RR 4.7，95%CI 1.9-12.2)、分心(RR 8.6，95%CI 4.3-17.2)和多次通过(RR 3.1，95%CI 1.6-3.5)有关。在人手不足的情况下，以及在血腥的手术领域工作的外科医生中，有风险更高的趋势。这项研究的成功完成可能会确定医院获得性锐器相关损伤的可改变的危险因素。这一知识可能导致个人和系统层面的风险降低干预。

DESCRIPTION (provided by applicant): Injuries caused by sharp medical devices are common with an estimated 400,000 to 800,000 American healthcare workers injured each year. Injured healthcare workers are at risk for blood-borne viral illnesses, including hepatitis B and C, HIV infection and other less common diseases. The direct medical costs of evaluating and treating sharps-related injuries is approximately $500 million annually. Despite the recent adoption of safer medical devices, the risk of sharps-related injury remains unacceptably high. Relatively little is known about potentially preventable transient etiologic factors that immediately precede these injuries. In this revised application we propose to conduct a case-crossover study of 1,000 healthcare workers who sustain a sharps-related injury recruited from six hospitals in Boston and Baltimore. We will evaluate risk factors in the following domains: 1) worker-related factors such as rushing, fatigue, distraction and feelings of anger 2) procedure-related factors such as uncommon, unusual or emergency procedures 3) workplace-related factors such as working short-staffed, overtime or while on-call and 4) device-related factors such as use of an unusual or malfunctioning device. We will also evaluate differences in the risks between workers with differing characteristics such as age, gender, profession, and history of prior sharps-related injuries. The effect of risk factors in continuous exposure settings such as operating rooms and intermittent exposure settings such as inpatient units and outpatient clinics will be evaluated. In a pilot study 90 healthcare workers were interviewed by telephone. Forty were nurses and 28 were trainees. Twenty were injured while scrubbed in an operating room or procedure suite and 15 had known exposures to HIV or hepatitis C. Among our preliminary findings, an increased risk of sharps-related injury was associated with rushing (RR 5.1, 95% Cl 3.0-8.7), anger (RR 4.7, 95% Cl 1.9-12.2), distraction (RR 8.6, 95% Cl 4.3-17.2), and multiple passes (RR 3.1, 95% Cl 1.6-3.5). There were trends toward higher risk while working short staffed, and among surgeons working in a bloody operative field. Trends toward lower risk were seen with emergency procedures, and while being taught.Successful completion of this study may identify modifiable risk factors for hospital-acquired sharps-related injuries. This knowledge may lead to individual and systems level risk-reduction interventions.