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）：由敏锐的医疗设备造成的伤害很常见，估计每年受伤的40万至80万美国医疗保健工人。受伤的医疗保健工作者有血源性病毒疾病的风险，包括丙型肝炎，艾滋病毒感染和其他不太常见的疾病。评估和治疗与夏普相关的伤害的直接医疗费用每年约5亿美元。尽管最近采用了更安全的医疗设备，但与夏普相关的伤害的风险仍然令人难以置信。关于在这些伤害之前的潜在可预防的瞬时病因因素知之甚少。 在此修订的应用中，我们建议对1000名医护人员进行案例分解研究，这些研究人员维持从波士顿和巴尔的摩的六家医院招募的夏普相关伤害。我们将评估以下领域中的危险因素：1）与工人相关的因素，例如匆忙，疲劳，分心和愤怒感2）与程序相关的因素，例如罕见，不寻常或紧急程序3）与工作场所相关的因素，例如工作短暂的工作，加班，加班或杂货和4）与设备相关的因素以及4）使用诸如使用的设备诸如使用型或Malfunsial或Malfunialsimains confuline consectim consection inseptim and of Malfunsimains。我们还将评估具有不同特征的工人之间的风险差异，例如年龄，性别，职业和先前与夏普相关的伤害的历史。将评估风险因素在连续暴露环境中的影响，例如手术室和间歇性暴露设置，例如住院单位和门诊诊所。 在一项试点研究中，通过电话采访了90名医护人员。四十是护士，28名是学员。 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）。在工作人员工作短缺时以及在一个流血的手术领域工作的外科医生中，有较高风险的趋势。紧急程序和教导时，可以看到较低风险的趋势。该研究的成功完成可能会发现与医院获得的与Sharps相关的伤害的可修改风险因素。这些知识可能导致个人和系统级别的风险降低干预措施。