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1- Veille documentaire médecine du travail hospitalière Août 2002

(6063 lectures)   Format imprimable



Veille documentaire Avril 2002

Occupational health for health Care workers

Literature Follow-up – August 2002

JF Gehanno  - Institute of Occupational Health - Rouen University Hospital

Table of Contents

MeSH Terms for Occupational Health for Health Care Workers

Methodology

Biological hazards

Blood exposures

Modes of Transmission of Hemorrhagic Fever

Risk of Hepatitis C Virus Transmission From an Infected Gynecologist to Patients : Results of a 7-Year Retrospective Investigation

Sharps injury recordkeeping activities and safety product use in California health care facilities: : Pilot study results from the sharps injury control program

Willingness to pay to avoid sharps-related injuries: A study in injured health care workers

Exposure to HIV risk during training among medical technologist students of the faculty of allied health science, Chulalongkorn university

Vaccination

Guidelines for Quality Standards for Immunization

Anti-vaccinationists past and present

Influenza vaccination

Survey of NHS staff attitudes to influenza immunisation

Influenza vaccines in adults

Reduced efficiency of influenza vaccine in prevention of influenza-like illness in working adults: a 7 month prospective survey in EDF Gaz de France employees, in Rhone-Alpes, 1996-1997

A survey of the delivery and uptake of influenza vaccine among health care workers

Vaccination against influenza: UK health care workers not on-message

Airborne transmission

Tuberculosis. CDC pushes for sterner measures to protect health care workers

Tuberculosis exposure of patients and staff in an outpatient hemodialysis unit

Sickness absence due to influenza

The management of influenza in people of working age

Nosocomial transmission of influenza

The epidemiology of influenza

Influenza in working populations: an overview

Contact transmission

Disease transmission, professionnal to patient

Other

Physical hazards

Ionizing radiations

Musculoskeletal disorders

Low back pain and lumbago-sciatica in nurses and a reference group of clerks: results of a comparative prevalence study in Germany.

Physical workload of student nurses and serum markers of collagen metabolism

Chemical hazards

Allergy

Infection Control

Infection Control for Gene Therapy: A Busy Physician's Primer

Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial

Stress – Mental disorders

Violence. Occupational hazard in hospitals

Choosing general surgery: insights into career choices of current medical students

Staff stress in the children's hospice: causes, effects and coping strategies

On the job fatigue

Other

Miscellaneous

Parental occupation and neural tube defect-affected pregnancies among Mexican Americans.

Laboratory safety: meeting the challenge

Evidence Based Medicine

Documents en Français

Reglementation

Guide des carrières des personnels hospitaliers non médicaux (Avril 2002)

Prophylaxie des infections invasives à méningocoque

Articles en Français

Recommandations pour la manipulation des médicaments cytotoxiques dans les établissements de soins. Guide du C-CLIN Sud Ouest

Guide canadien d’immunisation Sixième édition – 2002

Violences à l’hôpital : les urgentistes reçus par le ministre de l’intérieur


MeSH Terms for Occupational Health for Health Care Workers

Accidents, Occupational

Air Pollutants, Occupational

Blood-Borne Pathogens*

Disease Transmission, Patient-to-Professional

Disease Transmission, Professional-to-Patient

Evidence-Based Medicine

Health Personnel

Multiple chemical sensitivity

Occupational diseases

Occupational Exposure

Universal Precautions

Methodology

Medline search using above mentionned key-words

Systematic follow-up of major periodicals

Biological hazards

Blood exposures

Modes of Transmission of Hemorrhagic Fever

J. G. Rigau-Pearez; L. J. Morse; L. Borio

JAMA 2002; 288 ( 5):571

To the Editor: In their Consensus Statement on hemorrhagic fever viruses that may be used as biological weapons, Dr Borio and colleagues1 state, "There are no reported cases of person-to-person or nosocomial spread of flaviviruses." At least 2 cases of nosocomial transmission of dengue (a flavivirus) have been reported in the medical literature: one through a needlestick injury and the other through bone marrow transplantation. These events, although rare, suggest that nosocomial spread may also be possible for a more feared flavivirusyellow fever.

Risk of Hepatitis C Virus Transmission From an Infected Gynecologist to Patients : Results of a 7-Year Retrospective Investigation.

Ross, R. Stefan MD. Viazov, Sergei PhD. Thormahlen, Marion MD. Bartz, Lutz MD. Tamm, Jana. Rautenberg, Peter MD. Roggendorf, Michael MD. Deister, Arno MD. and the Incident Investigation Team

Archives of Internal Medicine 2002;162(7):805-810.

Background: Currently, it is not known how often hepatitis C virus (HCV) is transmitted from infected health care workers to patients during medical care. In the present investigation, we tried to determine the rate of provider-to-patient transmission of HCV among former patients of an HCV-positive gynecologist after it was proven that he infected one of his patients with HCV during a cesarean section.

Methods: All 2907 women who had been operated on by the HCV-positive gynecologist between July 1993 and March 2000 were notified about potential exposure and were offered free counseling and testing. The crucial differentiation between HCV transmissions caused by the gynecologist and infections contracted from other sources was achieved by epidemiological investigations, nucleotide sequencing, and phylogenetic analysis.

Results: Of the 2907 women affected, 78.6% could be screened for markers of HCV infection. Seven of these former patients were found to have HCV. Phylogenetic analysis of HCV sequences from the gynecologist and the women did not indicate that the virus strains were linked. Therefore, no further iatrogenic HCV infections caused by the gynecologist could be detected. The resulting overall HCV transmission rate was 0.04% (1 per 2286; 95% confidence interval, 0.008%-0.25%).

Conclusion: To our knowledge, this is the largest retrospective investigation of the risk of provider-to-patient transmission of HCV conducted so far. Our findings support the notion that such transmissions are relatively rare events and might provide a basis for future recommendations on the management of HCV-infected health care workers.

Sharps injury recordkeeping activities and safety product use in California health care facilities: : Pilot study results from the sharps injury control program.

Gillen M, Davis M, McNary J, Boyd A, Lewis J, Curran C, Young CA, Schuller M, Cone J.

Am J Infect Control 2002 Aug;30(5):269-76

BACKGROUND: In 1999, licensed health care facilities in California (N = 2532) were invited to participate in a survey about occupational bloodborne pathogens exposure surveillance activities, recordkeeping methods, and use of safety-enhanced sharps devices.

RESULTS: A total of 1274 facilities responded to the survey from January 1999 through August 1999 (response rate = 50%). Sharps-related injuries were recorded for multiple departments on various forms in diverse manners. Only 66% of hospitals, 37% of home health agencies, and 33% of skilled nursing facilities reported sharps injuries on a mandated sharps injury log. More than 70% of facilities stated that they used some type of safety device or needleless system, but this figure varied by type of device and facility type. Eighty-four percent of general acute care hospitals, 28% of home health agencies and skilled nursing facilities each had evaluated at least 1 safety-enhanced device. Almost 90% of all facilities expressed a need for educational materials on topics such as device selection and evaluation.

CONCLUSIONS: Standardization of surveillance and recordkeeping activities does not exist across facility types. Standards and regulations demand complex recordkeeping activities. Increased funding for distribution of educational materials and on-site training should accompany changes in mandated reporting activities when appropriate. Increased testing and evaluation of devices across facility types are necessary to ensure that safety-enhanced devices are protective of health care workers and patients.

Willingness to pay to avoid sharps-related injuries: A study in injured health care workers.

Fisman DN, Mittleman MA, Sorock GS, Harris AD.

Am J Infect Control 2002 Aug;30(5):283-287

BACKGROUND: Injuries caused by sharp medical devices are common among health care workers and may result in the transmission of human immunodeficiency virus and hepatitis C virus.

OBJECTIVE: The direct medical costs associated with treating these injuries are well characterized but fail to capture the costs of such intangible factors as worker anxiety and distress. The objective of this study was to estimate these intangible costs.

SUBJECTS: Subjects included health care workers reporting sharps-related injuries to 2 hospital occupational health services.

METHOD: A contingent valuation approach was used to assess willingness to pay to avoid sharps-related injuries among recently injured health care workers. Workers were presented with the option of paying out of pocket for a hypothetical injury-prevention device. The median amount of money subjects were willing to pay was estimated with logistic regression, and multivariable regression was performed to assess confounding by worker characteristics and circumstances surrounding injuries.

RESULTS: Study interviews were conducted for 116 subjects; median time from injury to interview was 3 days (range, 0-15). Most subjects were women (73%), and most were nurses (44%) or trainees (32%). The crude median amount subjects were willing to pay to avert injury was $850 (US); when adjusted for patient risk status (human immunodeficiency virus and hepatitis C virus status), and working with an uncooperative patient at the time of injury, median amount increased to $1270.

CONCLUSION: The high median amount sujects were willing to pay to avoid a sharps-related injury suggests that the costs of "intangible" aspects of worker injury, such as anxiety and distress, may equal costs associated with the medical evaluation of these injuries. These costs should be incorporated in economic analyses of sharps-injury prevention.

Exposure to HIV risk during training among medical technologist students of the faculty of allied health science, Chulalongkorn university

J Suwansaksri, V Wiwanitkit, S Sugaroon

Am J Infect Control 2002 Aug;30(5):320

http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchDBfor=iss&id=jic020305

Vaccination

Guidelines for Quality Standards for Immunization

Pierce Gardner, Larry K. Pickering, Walter A. Orenstein, Anne A. Gershon, and Kristin L. Nichol.

Clinical Infectious Diseases    2002;35:503-511

This is an update of the 1997 Quality Standards for Immunization, which is one of a series of guidelines commissioned by the Infectious Diseases Society of America (IDSA) through its Practice Guidelines Committee. This information is presented as a standard-of-care rather than practice guidelines because the evidence for following these recommendations is so strong that they should be implemented with rare exceptions. The purpose of these standard-of-care guidelines is to provide assistance to clinicians who make decisions on providing immunizations to infants, children, adolescents, and adults. This document is a summary of evidence-based guidelines previously developed by national organizations. A standard ranking system was used to determine the strength of the recommendations, and the quality of evidence cited in the literature was reviewed for each guideline. The targeted health care professionals are pediatricians, family practitioners, internists (including specialists), obstetricians, and others who provide immunizations. The panel members are experts in the field of adult and pediatric infectious diseases. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee, and it was approved by the IDSA Council. Indicators for measuring compliance with the standards are included. The document will be posted on the IDSA home page at http://www.idsociety.org/

Anti-vaccinationists past and present

Wolfe RM, Sharp LK.

BMJ 2002 Aug 24;325(7361):430-2.

Influenza vaccination.

Beach J, Hobson J.

Occup Med (Lond)  2002 Aug;52(5):237-8

Survey of NHS staff attitudes to influenza immunisation.

Akinosi B, Ramaiah S, Pugh RN.

Commun Dis Public Health  2002 Jun;5(2):132-3

There was a low uptake of influenza vaccination among health care workers in year 1999-2000. The study aimed to identify reasons for low uptake and to use the results to improve uptake during current and future campaigns.

Influenza vaccines in adults.

Jefferson T, Bianco E, Demicheli V.

Occup Med (Lond)  2002 Aug;52(5):255-8

Available influenza vaccines contain inactivated viruses, either whole or in parts, and are administered parenterally or intranasally. Their composition varies yearly because of viral antigenic shifts and drifts. Vaccines with a composition matching yearly World Health Organization recommendations are 72% [95% confidence interval (CI) = 54-83%] efficacious (prevention of influenza cases caused by influenza viruses A and B). Their effectiveness [capacity to prevent clinical influenza, or influenza-like illness (ILI)] is lower, at 37% (95% CI = 18-52%). A decision to vaccinate an adult population has to take into account the efficacy of the vaccines and their effectiveness (the likely proportion of ILI caused by influenza A and B viruses, amenable to prevention by vaccination), as well as costs and likely compliance. As the yearly levels of circulating A and B viruses are difficult to predict during the decision time for a vaccination campaign, there is a considerable element of uncertainty regarding the likely effectiveness of 'this year's' vaccine.

Reduced efficiency of influenza vaccine in prevention of influenza-like illness in working adults: a 7 month prospective survey in EDF Gaz de France employees, in Rhone-Alpes, 1996-1997.

Occup Med (Lond)  2002 Aug;52(5):281-92

Millot JL, Aymard M, Bardol A.

The efficiency of influenza vaccine was evaluated in the working population by

comparing the percentage of people presenting with an influenza-like illness (ILI) according to their influenza immunization status, drug expenses and workdays lost. A self-completed questionnaire about the vaccination was sent to 5785 people randomly chosen among 18 249 workers. When any sick leave was incurred amongst the respondents (63.3%), of whom 301 were vaccinated and 3362 unvaccinated, a clinical form was completed by the private physician and the medical adviser of the firm (Electricite de France and Gaz de France). A final self-completed questionnaire was sent to people whose sick leave was not documented by a physician's reported diagnosis. In total, we obtained complete data for 90.9% of the sampling. The vaccine coverage rate of 8.2% [95% confidence interval (95% CI) = 7.4-9.0%] was higher in men than in women, increasing with age and professional category. Among the 775 subjects with a medical diagnosis, the vaccine effectiveness was not significant: 27.3% (95% CI = -13.8 to 53.5%). In the unvaccinated group, 9.6% had days absent from work, versus 7.0% in the vaccinated group; the two populations were comparable in terms of clinical symptoms, smoking habits, exposure to respiratory risk factors and chronic pathology. The average duration of sick leave for ILI was not significantly different between vaccinated (0.5 days) and unvaccinated workers (0.6 days). Despite the large size of the population and the occurrence of an epidemic due to a virus closely related to the vaccine strain (A/Wuhan/359/95), the vaccine did not effectively protect the small vaccine group nor result in an economic benefit, whatever the professional group.

A survey of the delivery and uptake of influenza vaccine among health care workers.

Smedley J, Palmer C, Baird J, Barker M.

Occup Med (Lond)  2002 Aug;52(5):271-6

During the 1990s, policies for immunizing fit health care workers against influenza varied between National Health Service (NHS) employers and the uptake of influenza vaccine by NHS staff was poor. In light of recent Department of Health recommendations to immunize key health care staff against influenza, we explored the possible reasons for poor uptake and assessed the impact of an intensive promotion campaign on vaccine acceptance. Among 290 doctors and nurses, the main perceived barriers to influenza immunization were difficulty with practical access to vaccine and lack of time to attend. Following intensive promotion and improved local access to influenza vaccine, the uptake among health care workers was approximately doubled. However, the overall proportion of staff immunized was low (5%) and the immunization rate among medical staff was particularly poor (2%). The practical implications for influenza immunization campaigns aimed at health care workers are discussed.

Vaccination against influenza: UK health care workers not on-message.

Harrison J, Abbott P.

Occup Med (Lond)  2002 Aug;52(5):277-9

Vaccination of health care workers against influenza is considered to be important as a means of protecting patients from nosocomial infection. Vaccine uptake rates have been reported to be no more than 40% and often between 20 and 30%. An evaluation of the performance of UK National Health Service trusts, following a governmental directive to implement vaccination during the winter of 2000-2001, has shown a poor uptake of vaccine. Reasons for accepting or declining vaccine are discussed. There is a need for global leadership on this issue to promote the value of vaccination and to change the behaviour of health care workers.

Airborne transmission

Tuberculosis. CDC pushes for sterner measures to protect health care workers.

AIDS Policy Law  1994 Dec 16;9(23):6

Tuberculosis exposure of patients and staff in an outpatient hemodialysis unit.

Linquist JA, Rosaia CM, Riemer B, Heckman K, Alvarez F.

Am J Infect Control 2002 Aug;30(5):307-310

BACKGROUND: Patients receiving hemodialysis are generally considered to be at increased risk of developing tuberculosis (TB). We evaluated a 13-station chronic outpatient hemodialysis unit associated with a community hospital in northern California. Within 6 months, there were 2 incident source cases in the unit of active smear positive pulmonary tuberculosis; the first in a health care worker (HCW), diagnosed April 3, 1998, and the second in a patient undergoing dialysis treatment in October 1998. We describe the cases; the evaluation of exposures; and the institution of an intentional prospective TB control plan, designed specifically for the unique hemodialysis setting.

METHODS: We evaluated 23 HCWs twice and 89 patients undergoing hemodialysis treatment who were exposed to case 1 and 38 patients who were exposed to case 2. All 23 HCWs had documented prior negative Sierbert purified protein derivative of tuberculin (PPD) status and were retested at 12 weeks after exposure. None of the patients had documentation of PPD status. All of the patients were skin-tested initially with use of the 2-step method, and those with positive test results were offered isoniazid (INH).

RESULTS: One of the 23 HCWs' negative baseline PPD skin test status converted after exposure to case 1, and none of the remaining 22 converted after exposure to case 2. Twelve of 89 exposed patients with no prior skin test record had positive results for PPD after initial testing with the 2-step method. Three of the 12 (25%) patients were treated with INH at the discretion of their attending nephrologist. The 77 patients with negative results for PPD still had negative test results when retested at 3 months. None of 38 patients who underwent dialysis on the same schedule as source case 2 had a converted PPD test. Restriction fragment length polymorphism on TB isolates from both source cases ultimately showed them to be unrelated strains.

CONCLUSION: Our experience with these exposures suggests that TB screening of patient populations undergoing renal dialysis-though they have intrinsic high anergy rates-is advisable with a designed prospective plan before any inadvertent and/or repetitive exposure of that population to active TB. A planned intentional TB control program increases HCW awareness of TB, establishes baselines for evaluation, decreases "panic" in the event of subsequent exposures, and emphasizes the rationale for preventive therapy.

Sickness absence due to influenza.

O'Reilly FW, Stevens AB.

Occup Med (Lond)  2002 Aug;52(5):265-9

In addition to its recognized health effects, influenza has socio-economic consequences, most notably sickness absence and associated work disruption. It may account for 10-12% of all sickness absence from work. Data on the impact of influenza on work are limited. Most research has assessed the impact of an intervention, usually influenza immunization. Within the available literature, there are five randomized controlled trials in the workplace that have assessed the effectiveness of influenza immunization as an intervention: two in the general working population and three in the health sector. If the benefit desired is a reduction in sickness absence as a cost-effective measure, the likely outcome is a modest gain in years when incidence of influenza is increased in the community. There are some distinctive factors in the health care industry: health care workers may exhibit different absence behaviour, they may be more exposed to infection at work and they may pose a risk as a source of nosocomial infection. From the occupational health perspective, how do we best inform employers currently? The cost-effectiveness case has not been absolutely proven. More research appears necessary, including assessment of those factors that influence uptake of influenza immunization. In the interim, a targeted approach to certain job categories may be the way forward.

The management of influenza in people of working age.

Fleming DM.

Occup Med (Lond)  2002 Aug;52(5):259-63

Influenza is common, causing considerable morbidity and sickness absence from work in most winters. Influenza vaccines have been available for >40 years, but are not extensively used in the workforce (in the UK). Amantadine has been available for 25 years as a treatment and prophylactic against influenza A infection, but has scarcely been used. In the last 3 years, two neuraminidase inhibitor antivirals, zanamivir and oseltamivir, have been introduced to the market for the treatment and prophylaxis of influenza A and B infections. This review focuses on aspects of prevention and treatment of influenza appropriate to people of working age. Decisions based on the cost-effectiveness of prevention and treatment options differ when viewed from the perspective of the healthcare provider, the employer or the employee. Options currently available need to be directed to a wider range of people than those conventionally regarded as the target risk group.

Nosocomial transmission of influenza.

Stott DJ, Kerr G, Carman WF.

Occup Med (Lond)  2002 Aug;52(5):249-53

Influenza is a common nosocomial infection. Serious outbreaks occur typically in elderly long-term patients, but have also been reported in renal, transplant and oncology units, neonatal intensive care and paediatrics. It is likely that staff-patient cross-infection is common. Prompt diagnosis of an outbreak lies at the heart of an effective influenza control programme. This requires effective virological surveillance. There are a variety of strategies that can help to prevent spread of influenza in health care settings. Basic infection control should include isolating infected residents, restricting circulation of nursing staff between patients, and restriction of visitors. Annual influenza immunization should be offered to elderly patients, subjects with chronic disease, and those in long-term residential or nursing home care. Vaccination of health care workers has been shown to be effective in protecting elderly patients in long-term care. Use of oral amantadine or rimantadine is an additional possible strategy for prophylaxis or treatment during an outbreak.

The epidemiology of influenza.

Stephenson I, Zambon M.

Occup Med (Lond)  2002 Aug;52(5):241-7

Influenza remains a globally important cause of febrile respiratory illness. Influenza virus activity in the community results in significant mortality, morbidity and economic disruption, particularly in those at high risk of developing complications, such as the elderly and those with underlying chronic medical conditions, including pulmonary disease and diabetes mellitus. The occurrence in Hong Kong in 1997 of avian influenza H5N1 in man, which resulted in six deaths, served to remind us of the importance of continuing surveillance and preparation for the next pandemic.

Influenza in working populations: an overview.

Elder AG.

Occup Med (Lond)  2002 Aug;52(5):239-40

Contact transmission

Disease transmission, professionnal to patient

Other

Physical hazards

Ionizing radiations

Musculoskeletal disorders

Low back pain and lumbago-sciatica in nurses and a reference group of clerks: results of a comparative prevalence study in Germany

Friedrich Hofmann, Ulrich Stössel, Martina Michaelis, Matthias

Nübling, Achim Siegel:

Int Arch Occup Environ Health (2002) 75: 484-490

Objectives. To gain more conclusive evidence on the question of work-related low-back disorders in German nurses, a comprehensive study with several methodological approaches was performed.

Methods. As part of this project, a cross-sectional study on working conditions and prevalence of low back pain, a sample of 3,332 nurses and 1,720 clerks as reference group was investigated by a questionnaire. In this article, final results referring to a sub-sample of 2,207 nurses and 1,177 clerks who had always worked in their profession, so that we could exclude confounding effects of former occupations, will be presented. Excluding the confounding effects of several covariates by logistic regression, we computed relative risks for different pain symptoms.

Results. The data suggest a considerably higher risk of low back pain for nurses than for the reference population of clerks. Results, however, differ markedly when specific pain symptoms are considered. With respect to lumbago-sciatica and sciatica - which have to be regarded as indicators for possible disc herniation - the study group's relative risk is the most elevated (2.88 for point prevalence of lumbago-sciatica/sciatica). Adjusting the results for several confounders and covariates leads to still higher estimations of nurses' relative risk.

Physical workload of student nurses and serum markers of collagen metabolism.

Kuiper JI, Verbeek JHAM, Straub JP, Everts V, Frings-Dresen MHW

Scand J Work Environ Health 2002;28(3):168-175.

Objectives This study explored the association between biomarkers of type I collagen metabolism and exposure to physical workload.

Methods In a prospective cohort study, serum concentrations of markers of type I collagen synthesis and degradation were assessed monthly for student nurses who worked as nurses for a period of 6 months and compared with those of a reference group. The number of patient-handling activities was estimated from observations at the workplace. Linear generalized estimating equations were used to analyze differences in the serum concentrations of the biomarkers between the exposed group and reference group, as well as to analyze whether the number of patient-handling activities was associated with serum concentrations of the biomarkers.

Results Serum concentrations of the biomarkers were found to differ between the groups. The biomarkers reflected a higher anabolism of type I collagen in the exposed group when compared with that of the reference group. An analysis of the effect of the number of patient-handling activities revealed that a higher exposure was associated with higher effective type I collagen synthesis within the exposed group.

Conclusions These results indicate that serum concentrations of these biomarkers of type I collagen metabolism can reflect differences in exposure between contrasting groups, and also varying levels of exposure between persons within an occupation.

Chemical hazards

 

Allergy

 

Infection Control

Infection Control for Gene Therapy: A Busy Physician's Primer

Martin E. Evans and Judith A. Lesnaw

Clinical Infectious Diseases 2002;35:597-605

Gene therapy is being studied for the treatment of a wide variety of acquired and inherited disorders. Retroviruses, adenoviruses, poxviruses, adeno-associated virus, herpesviruses, and others are being engineered to serve as gene therapy vectors and are being administered to patients in a clinical setting. Infection control professionals will be asked to evaluate the use and safety of these agents in their clinics and hospitals. This review summarizes key aspects of the biotechnology and the vectors involved in gene therapy and makes recommendations for infection control.

Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial

Emmanuelle Girou, Sabrina Loyeau, Patrick Legrand, Francoise Oppein, Christian Brun-Buisson.

BMJ 2002;325:362-6.

Objective: To compare the efficacy of handrubbing with an alcohol based solution versus conventional handwashing with antiseptic soap in reducing hand contamination during routine patient care.

Design: Randomised controlled trial during daily nursing sessions of 2 to 3 hours.

Setting: Three intensive care units in a French university hospital.

Participants: 23 healthcare workers.

Interventions: Handrubbing with alcohol based solution (n=12) or handwashing with antiseptic soap (n=11) when hand hygiene was indicated before and after patient care. Imprints taken of fingertips and palm of dominant hand before and after hand hygiene procedure. Bacterial counts quantified blindly.

Main outcome measures: Bacterial reduction of hand contamination.

Results: With handrubbing the median percentage reduction in bacterial contamination was significantly higher than with handwashing (83% v 58%, P=0.012), with a median difference in the percentage reduction of 26% (95% confidence interval 8% to 44%). The median duration of hand hygiene was 30 seconds in each group.

Conclusions: During routine patient care handrubbing with an alcohol based solution is significantly more efficient in reducing hand contamination than handwashing with antiseptic soap.

Stress – Mental disorders

Violence. Occupational hazard in hospitals

CDC/NIOSH 2002

Today more than 5 million U.S. hospital workers from many occupations perform a wide variety of duties. They are exposed to many safety and health hazards, including violence. Recent data indicate that hospital workers are at high risk for experiencing violence in the workplace. According to estimates of the Bureau of Labor Statistics (BLS), 2,637 nonfatal assaults on hospital workers occurred in 1999—a rate of 8.3 assaults per 10,000 workers. This rate is much higher than the rate of nonfatal assaults for all private-sector industries, which is 2 per 10,000 workers.

Several studies indicate that violence often takes place during times of high activity and interaction with patients, such as at meal times and during visiting hours and patient transportation. Assaults may occur when service is denied, when a patient is involuntarily admitted, or when a health care worker attempts to set limits on eating, drinking, or tobacco or alcohol use.

The purpose of this brochure is to increase worker and employer awareness of the risk factors for violence in hospitals and to provide strategies for reducing exposure to these factors.

http://www.cdc.gov/niosh/pdfs/2002-101.pdf

Choosing general surgery: insights into career choices of current medical students.

Gelfand DV, Podnos YD, Wilson SE, Cooke J, Williams RA.

Arch Surg  2002 Aug;137(8):941-5; discussion 945-7

HYPOTHESIS: The number of unfilled general surgery programs in the United States increased from 4 in 1999 to 41 in 2001. This study seeks to determine if changes in student attitudes occurring during their medical school careers and during the third-year general surgery clerkship contribute to a decline in interest in a surgical career. DESIGN: Prospective survey of medical students at a public medical school in California. PARTICIPANTS AND METHODS: Each medical student received a survey via the Internet. Responses were anonymous. Once quantified, chi(2) analysis was used for comparison and analysis of survey results. Comparisons were made between individual class years and on the basis of whether the respondent completed the third-year general surgery clerkship. RESULTS: Of 368 surveys sent, 232 (63%) were successfully completed and included in the study. Comparison of students' attitudes before and after completion of their general surgery clerkship showed that following surgical course exposure more students believed surgery lacked breadth of expertise, limitations over stress, control over one's time, regularity of schedule, adequacy of leisure time, and income commensurate to workload (P<.05). These results are also consistent in comparisons between individual class years. CONCLUSIONS: Data suggest that medical students seem to be more concerned with issues of "controllable lifestyle" such as adequacy of family and/or leisure time, high level of stress, and amount of work and commitment. The erosion of income differential between demanding and less taxing specialties was also an important cause cited for the flagging interest in surgical disciplines.

 

Staff stress in the children's hospice: causes, effects and coping strategies.

Barnes K.

Int J Palliat Nurs  2001 May;7(5):248-54

Although there are an increasing number of hospices opening around the country, the concept of the children's hospice is still relatively new. Although stress involved in giving palliative care to adults has been examined quite extensively, very little work has been done on the impact of caring for children in the hospice setting. This article is a literature review, examining the causes and effects of staff stress in the children's hospice, as well as the factors that enable staff to cope with working in this environment. It concludes that the main causes of stress are often related to conflicts within the staff group, communication problems and role conflict. Poor relationships with the child's family as well as the inability to relieve distressing symptoms the child may be experiencing have also been identified as common sources of stress. Teamwork, good communication and the home-like atmosphere of the hospice all contribute to enabling staff to deal with work stress. Staff support groups may be beneficial, but need to be run well, by someone experienced in leading such groups. Additionally, stress can be reduced by providing staff with the appropriate training and education and by encouraging them to take some responsibility for preventing and relieving stress themselves.

On the job fatigue.

Roch R.

Nurs BC  2001 Dec;33(5):5

Comment on: Nurs BC. 2001 Jun;33(3):32-3.

 

Other

Miscellaneous

Parental occupation and neural tube defect-affected pregnancies among Mexican Americans.

Brender J, Suarez L, Hendricks K, Baetz RA, Larsen R.

J Occup Environ Med 2002 Jul;44(7):650-6

In a case-control study, we examined whether parental occupational exposures were related to neural tube defect (NTD)-affected pregnancies among Mexican Americans living along the Texas-Mexico border. Case women were 184 Mexican-American women with NTD-affected pregnancies; control women were 225 study-area residents who delivered normal babies during the same period as the case women. The women were interviewed in person about maternal and paternal occupations and work exposures during the periconceptional period. Compared with control women, case women were more likely to have had occupational exposures to solvents (odds ratio [OR], infinity; 95% confidence interval [CI], 2.4-infinity) and also were more likely to have worked in cleaning (OR 9.5; 95% CI, 1.1 to 82.2) or health care occupations (OR 3.0; 95% CI, 1.0 to 9.0) than control women. No compelling associations were found between paternal work exposures or occupations and NTDs in offspring in this population.

Laboratory safety: meeting the challenge.

Healthc Hazard Manage Monit  2002 Aug;15(12):1-6

Evidence Based Medicine

Documents en Français

Reglementation

Guide des carrières des personnels hospitaliers non médicaux (Avril 2002) 

Le guide des carrières des personnels hospitaliers non médicaux est un outil destiné aux gestionnaires des ressources humaines des établissements publics de santé. Il est aussi, plus largement un moyen d'information précis et technique à l'intention des fonctionnaires hospitaliers.

Le document présente les grilles indiciaires et les conditions d’avancement de grade des personnels titulaires : personnels de direction, autres personnels administratifs, personnels des services de soins, sages-femmes, psychologues, personnels socio-éducatifs, techniques et ouvriers et des personnels contractuels : médecins du travail, radiophysiciens, informaticiens et aumôniers

Il intègre l’ensemble des modifications statutaires intervenues dans le cadre du protocole du 14 mars 2001 relatif aux filières de la fonction publique hospitalière (seule la grille relative aux directrices d’écoles de sages-femmes actuellement en cours de modification n’a pas été mise à jour).

http://www.sante.gouv.fr/htm/dossiers/hosp_nommed/index.htm

Prophylaxie des infections invasives à méningocoque

Circulaire DGS/SD 5 C n° 2002-400 du 15 juillet 2002 modifiant la circulaire DGS/SD 5 C n° 2001-542 du 8 novembre 2001 relative à la prophylaxie des infections invasives à méningocoque

http://www.sante.gouv.fr/adm/dagpb/bo/2002/02-31/a0312704.htm

Articles en Français

Recommandations pour la manipulation des médicaments cytotoxiques dans les établissements de soins. Guide du C-CLIN Sud Ouest

http://www.cclin-sudouest.com/recopdf/cytotoxpdf.zip

Guide canadien d’immunisation Sixième édition – 2002

La sixième édition du Guide canadien d’immunisation renferme de nombreux changements

par rapport à la version de 1998 tout en tentant de rester facile à consulter.

Chaque chapitre a été révisé en profondeur et mis à jour au besoin. De nouveaux chapitres

ont été ajoutés sur le vaccin contre la varicelle, le vaccin contre la maladie de Lyme

et les vaccins combinés contre l’hépatite A et B. Nous avons aussi ajouté les nouveaux

vaccins conjugués dans le chapitre sur le vaccin contre le pneumocoque et dans celui

sur le vaccin contre le méningocoque. La section sur les effets secondaires a été élargie.

Un chapitre sur les communications contenant de l’information sur les sites Web

recommandés a également été ajouté.

Voici quelques-uns des principaux changements apportés au Guide :

·        utilisation du vaccin contre la varicelle durant une éclosion et chez les travailleurs

·        de la santé;

·        vaccin conjugué contre le pneumocoque pour prévenir une infection grave chez les

·        enfants;

·        vaccin conjugué contre le méningocoque pour aider à contenir cette maladie

·        redoutée;

·        usage limité du vaccin contre la maladie de Lyme, sauf pour ceux qui se rendent

·        dans des régions d’endémie;

·        emploi du vaccin contre l’hépatite A dans la lutte contre les éclosions;

·        usage possible du vaccin contre la coqueluche chez les adolescents;

·        sites Internet intéressants;

·        discussion de l’immunisation avec les patients.

http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/cig-gci/pdf/guide_immuniz_cdn-2002-6.pdf

Violences à l’hôpital : les urgentistes reçus par le ministre de l’intérieur

Le Quotidien du Médecin, 22 aout 2002

"Le ministre de l'Intérieur, Nicolas Sarkozy, a reçu, le lundi 19 août, les médecins urgentistes. La sécurité dans les services d'urgences hospitalières a été au centre des discussions entre le président de l'Association des médecins urgentistes hospitaliers de France (Amuhf), Patrick Pelloux, et le ministre de l’Intérieur. Ont été évoqués les soucis de sécurité que posent les détenus hosp

  

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