A Case-crossover Study of Sharps-related injuries

锐器相关伤害的病例交叉研究

• 批准号: 6919158
• 负责人: MURRAY A MITTLEMAN
• 金额: $ 25.81万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6919158
• 关键词: accident proneness; age difference; angers; attention; behavioral /social science research tag; biomedical equipment safety; clinical biomedical equipment; clinical research; emergency health services; experience; fatigue; gender difference; hospital personnel; human subject; injury; injury prevention; interview; laboratory accident /infection; occupational health /safety; questionnaires; statistics /biometry

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.

描述（由申请人提供）：尖锐医疗器械造成的伤害很常见，估计每年有 400,000 至 800,000 名美国医护人员受伤。受伤的医护人员面临着感染血源性病毒性疾病的风险，包括乙型和丙型肝炎、艾滋病毒感染和其他不太常见的疾病。每年评估和治疗锐器相关伤害的直接医疗费用约为 5 亿美元。尽管最近采用了更安全的医疗设备，但锐器相关伤害的风险仍然高得令人无法接受。对于这些损伤发生之前可能发生的暂时性病因，人们知之甚少。 在这个修订后的应用程序中，我们建议对从波士顿和巴尔的摩的六家医院招募的 1,000 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) 与工人相关的因素，例如匆忙、疲劳、分心和愤怒情绪 2) 与程序相关的因素，例如不常见、异常或紧急程序 3) 与工作场所相关的因素，例如工作人员短缺、加班或待命，以及 4) 与设备相关的因素，例如使用异常或故障设备。我们还将评估具有不同特征（例如年龄、性别、职业和既往锐器相关伤害史）的工人之间的风险差异。将评估手术室等连续暴露环境和住院病房和门诊诊所等间歇暴露环境中风险因素的影响。 在一项试点研究中，90 名医护人员接受了电话采访。 40 名护士和 28 名实习生。 20 人在手术室或手术室擦洗时受伤，15 人已知接触过 HIV 或丙型肝炎。在我们的初步发现中，锐器相关伤害的风险增加与冲撞有关（RR 5.1，95% Cl 3.0-8.7） ）、愤怒（RR 4.7，95% Cl 1.9-12.2）、分心（RR 8.6，95% Cl 4.3-17.2），以及多次通过（RR 3.1，95% Cl 1.6-3.5）。在人员短缺以及在血腥手术区域工作的外科医生中，存在风险更高的趋势。在紧急程序和教学中可以看到风险降低的趋势。成功完成这项研究可以确定医院获得性锐器相关伤害的可改变的风险因素。这些知识可能会导致个人和系统层面的风险降低干预措施。