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2- Veille documentaire médecine du travail hospitalière Septembre 2002

(2471 lectures)   Format imprimable



Veille documentaire Avril 2002

Occupational health for health Care workers

Literature Follow-up – September 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.

Brazilian dental students' knowledge and attitudes towards HIV infection.

Occupational accidents among nursing personnel caused by perforating instruments.

Sharps injury: prevention and management.

Occupational Transmission of Hepatitis C Virus.

Hepatitis C: transmission, treatment and occupational risk.

Vaccination.

Scientists join smallpox vaccine controversy.

Observational study of vaccine efficacy 14 years after trial of hepatitis B vaccination in Gambian children.

Critical evaluation of smallpox vaccination for laboratory workers.

Economic Analysis of Influenza Vaccination and Antiviral Treatment for Healthy Working Adults.

Supplementary statement for the 2002-2003 influenza season: update on oculo-respiratory syndrome in association with influenza vaccination.

Airborne transmission.

Risk of Tuberculin Skin Test Conversion among Health Care Workers: Occupational versus Community Exposure and Infection.

Contact transmission.

Disease transmission, professionnal to patient

Other

Physical hazards.

Ionizing radiations.

Musculoskeletal disorders.

Chemical hazards.

Occupational exposure to cytotoxic drugs in two UK oncology wards.

Biological monitoring of hospital personnel occupationally exposed to antineoplastic agents.

Personal exposure level and environmental ethylene oxide gas concentration in sterilization facilities of hospitals in Japan.

Allergy.

Infection Control

Stress – Mental disorders.

Working on Stress.

Zero tolerance of violence against healthcare staff.

Challenging the myth of the 12-hour shift: a pilot evaluation.

Other

Miscellaneous.

Doctors' perceptions of drinking alcohol while on call: questionnaire survey.

Education for nurses returning to practice.

Barriers to healthy eating in the nursing profession: Part 1.

Barriers to healthy eating in the nursing profession: Part 2.

Evidence Based Medicine.

Documents en Français.

Reglementation.

Articles& documents en Français.

 

MeSH Terms for Occupational Health for Health Care Workers

Accidents, Occupational

Air Pollutants, Occupational

Attitude of Health Personnel

Blood-Borne Pathogens*

Disease Transmission, Patient-to-Professional

Disease transmission, professionnal-to-patient

Evidence-Based Medicine

Health Personnel

Multiple chemical sensitivity

Nursing Staff/psychology*

Occupational diseases

Occupational Exposure

Universal Precautions

Methodology

Medline search using above mentionned key-words

Systematic follow-up of major periodicals

Biological hazards

Blood exposures

Brazilian dental students' knowledge and attitudes towards HIV infection.

Oliveira ER, Narendran S, Falcao A.

AIDS Care 2002 Aug;14(4):569-76

The purpose of this study was to investigate a group of Brazilian dental students' knowledge about HIV infection, the infection control measures utilized by the dental students, and students' attitudes towards treating HIV/AIDS patients. The study population consisted of 250 dental students from Universidade Federal da Bahia, Brazil, who were treating patients in clinics of the university and extra-mural rotations at the time of the study. The survey instrument was a self-administered questionnaire which consisted of 32 pre-coded questions and two open-ended questions. The overall response rate to the questionnaire was 54%. More than 80% of respondents (N = 135) considered every dental patient a potential HIV carrier. A majority of the students were aware of the association between HIV and Kaposi's sarcoma (92.5%), oral candidiasis (90.3%) and oral hairy leukoplakia (52.7%). A gender difference was observed in students' knowledge of oral manifestations and infection control measures, with females having better knowledge than males (p < 0.05). Because of certain inadequacies in knowledge and infection control practices among respondents, a curriculum focusing on the management of HIV/AIDS, including infection control and legal issues is recommended.

Occupational accidents among nursing personnel caused by perforating instruments

Tomazin CC, Benatti MC.

Rev Gaucha Enferm 2001 Jul;22(2):60-73

The purpose was to conduct a survey on work accidents which occur due to sharp cutting instruments. The population studied consisted of nursing personnel who had suffered work accidents. A sample of 22 female workers was selected and the individuals were interviewed. The average age of this sample was 38 years old and there were 59.1% nursing assistants, 22.7% nurses, 9.1% nursing technicians and 9.1% nursing attendants. The highest number of accidents occurred during the month of June and most of them around 3 PM. Most of the accidents reported were from the neonatal unit. The hands were the most affected parts of the body and the majority of the accidents were due to perforating instruments. When the accidents occurred, 50% were wearing gloves and 86.4% were vaccinated.

Sharps injury: prevention and management.

May D, Brewer S.

Nurs Stand 2001 Apr 25-May 1;15(32):45-52;

quiz 53-4 Nurs Stand. 2001 Sep 12-18;15(52):26-7.

Nurses are at risk of infection through injuries caused by infected sharps and needles. The authors discuss the prevention and management of such injuries.

Occupational Transmission of Hepatitis C Virus

Janine Jagger; Vincenzo Puro; Gabriella De Carli; Arthur J. Lunsk; Mark S. Sulkowsky; Stuart C. Ray; David L. Thomas

JAMA 2002;288:1469

Hepatitis C: transmission, treatment and occupational risk.

Washer P.

Nurs Stand 2001 Jun 20-26;15(40):43-6

There is a risk to nurses of contracting hepatitis C through occupational exposure, although in the UK infection is mainly limited to intravenous drug users. In this article Peter Washer discusses what is currently known about the virus, mainly focusing on transmission, treatment and the risk of occupational exposure.

Vaccination

Scientists join smallpox vaccine controversy.

Bonn D.

Lancet Infect Dis 2002 Sep;2(9):515

Observational study of vaccine efficacy 14 years after trial of hepatitis B vaccination in Gambian children.

Whittle H, Jaffar S, Wansbrough M, Mendy M, Dumpis U, Collinson A, Hall A.

BMJ 2002 Sep 14;325(7364):569

Objective: To determine the duration of protection from hepatitis B vaccine given in infancy and early childhood. Design: Cross sectional serological study of hepatitis B virus infection in children of various ages 14 years after the start of a trial of vaccination regimens. Setting: Two villages in the Gambia. Participants: Children and adolescents given hepatitis B vaccine in infancy or early childhood: 232 were aged 1-5 years, 225 aged 5-9 years, 220 aged 10-14 years, and 175 aged 15-19 years. Main outcome measures: Vaccine efficacy against infection and against chronic infection in the different age groups. Results: Vaccine efficacy against chronic carriage of hepatitis B virus was 94% (95% confidence interval 89% to 97%), which did not vary significantly between the age groups. Efficacy against infection was 80% (76% to 84%). This was significantly lower in the oldest age group (65%, 56 to 73). Of the uninfected participants in this age group, 36% had no detectable hepatitis B virus surface antibody. Time since vaccination and a low peak antibody response were the most powerful risk factors for breakthrough infection (P<0.001 in each case). Low peak antibody response was also a risk factor for chronic carriage (odds ratio 95, 19 to 466). Conclusions: Children vaccinated in infancy are at increased risk of hepatitis B virus infection in the late teens. The risk of chronic carriage after sexual exposure needs further assessment to determine if booster vaccines are necessary.

Critical evaluation of smallpox vaccination for laboratory workers

S N Isaacs

Occupational and Environmental Medicine 2002;59:573-574

Economic Analysis of Influenza Vaccination and Antiviral Treatment for Healthy Working Adults

Patrick Y. Lee, MD; David B. Matchar, MD; Dennis A. Clements, MD, PhD; Joel Huber, PhD; John D. Hamilton, MD; and Eric D. Peterson, MD, MPH

Ann Intern Med. 2002;137:225-231.

Background: Physicians have several treatment options for influenza, including vaccination and various antiviral therapies. However, the optimal influenza prevention and treatment strategy is unknown.

Objective: To compare the relative health values of contemporary treatment strategies for influenza in a healthy sample of working adults.

Design: Cost-benefit analysis using a decision model.

Data Sources: Previously published data.

Target Population: Healthy employed adults 18 to 50 years of age.

Time Horizon: A complete influenza season.

Perspective: Societal.

Interventions: Eight treatment options (yes or no) based on the possible combinations of vaccination and antiviral therapy (rimantadine, oseltamivir, or zanamivir or no treatment) should infection develop.

Outcome Measures: Cost in U.S. dollars, including the value of symptom relief and medication side effects, which was assigned a monetary value through a conjoint analysis that used a "willingness-to-pay" approach.

Results: In the base-case analysis, all strategies for influenza vaccination had a higher net benefit than the nonvaccination strategies. Vaccination and use of rimantadine, the most cost-beneficial strategy, was $30.97 more cost-beneficial than nonvaccination and no use of antiviral medication. The health benefits of most antiviral treatments equaled or exceeded their costs for most scenarios. The choice of the most cost-beneficial antiviral strategy was sensitive to the prevalence of influenza B and to the comparative workdays gained by each antiviral therapy.

Conclusions: Vaccination is cost-beneficial in most influenza seasons in healthy working adults. Although the benefits of antiviral therapy for persons with influenza infection appear to justify its cost, head-to-head trials of the various antiviral therapies are needed to determine the optimal treatment strategy.

Supplementary statement for the 2002-2003 influenza season: update on oculo-respiratory syndrome in association with influenza vaccination

Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI)

Canada Communicable Disease Report Volume 28 (ACS-6) September 1, 2002

http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/02vol28/28sup/acs6.html

Airborne transmission

Risk of Tuberculin Skin Test Conversion among Health Care Workers: Occupational versus Community Exposure and Infection

Nina M. Larsen, Cara L. Biddle, Mark J. Sotir, Nancy White, Patricia Parrott, and Henry M. Blumberg

Clinical Infectious Diseases 2002;35(7):796-802

A prospective observational cohort study to assess rates of and risk factors for tuberculin skin test (TST) conversion among health care workers (HCWs) was conducted at an urban hospital located in a high tuberculosisincidence area in 19941998. All hospital employees undergoing required testing every 6 months were included. A total of 69 (1.2%) of 5773 susceptible employees had a documented TST conversion (overall rate, 0.38 per 100 person-years worked). No significant difference existed in conversion rates among employees with frequent, limited, or no patient contact. HCWs with a TST conversion lived in zip codes with higher tuberculosis case rates (P .05). In multivariate analysis, TST conversion was associated with history of bacille Calmette-Guérin vaccination (relative risk [RR], 11.63), annual salary <$20,000 (RR, 3.67), and increasing age. In the setting of an effective tuberculosis infectioncontrol program, TST conversion rates were low, and risk of conversion among HCWs was associated most strongly with nonoccupational factors.

Contact transmission

Disease transmission, professionnal to patient

Other

Physical hazards

Ionizing radiations

Musculoskeletal disorders

Chemical hazards

Occupational exposure to cytotoxic drugs in two UK oncology wards

Ziegler E, Mason H J, Baxter P J

Occup Environ Med 2002 Sep 01;59(9):608-612

Aims: To investigate the potential exposure to cytotoxic drugs of staff on two oncology wards in a large district, UK hospital under normal working conditions. Methods: Cytotoxic drug exposure was monitored in urine samples, surface wipes, and on disposable gloves by using a number of commonly used marker drugs, namely cyclophosphamide, ifosfamide, methotrexate, and the platino coordinated drugs. Questionnaire data on their work practices, potential exposure, use of protective personal equipment, and relevant training were collected from nursing, domestic, and clerical staff on two oncology wards. Results: The majority of staff were female with a mean age of 31 years. Roughly half of the staff studied were specifically trained nurses with an average of 3.5 years experience of administering cytotoxic drugs. No cytotoxic drug preparation or reconstitution was carried out on the wards. Disposable gloves, plastic armlets and aprons, but not eye protection, were invariably worn where there was potential exposure to cytotoxics. No cytotoxic drug was detected in any of the staff's urine samples. Isolated disposable latex gloves from nurses administering drugs showed some contamination, as did some surfaces within the wards' sluice rooms, but not in the ward areas where the drugs were stored and checked prior to administration. Conclusions: The risk management strategies in place, including use of personal protective equipment, staff training, and other organisational measures, have ensured that internal exposure is lower than the detection limits for the current biological monitoring methods. Levels of contamination appear significantly lower than earlier, non-UK published studies where different risk management strategies were in place and, in particular, ward staff may have been involved in some degree of cytotoxic drug reconstitution.

Biological monitoring of hospital personnel occupationally exposed to antineoplastic agents.

Roberta Turci, Cristina Sottani, Anna Ronchi and Claudio Minoia.

Toxicology Letters, Volume 134, Issues 1-3, 5 August 2002, Pages 57-64.

To detect trace amounts of urinary cyclophosphamide (CP), ifosfamide (IF) and methotrexate (MTX), sensitive and specific high-performance liquid chromatography/ tandem mass spectrometry (HPLC-MS/MS) procedures, incorporating either liquid-liquid (for CP and IF), or solid-phase, extraction (for MTX) have been developed. Urinary platinum (Pt) was also detected using inductively coupled plasma-mass spectrometry (ICP-MS). These methods showed acceptable imprecision and inaccuracy. The limit of detection (LOD) was 50 ng/l for CP and IF, 200 ng/l for MTX and 1 ng/l for Pt. Biomonitoring was performed on two consecutive days on nine subjects preparing, and seven administering, antineoplastic drugs. Urine was collected at the beginning, at the end and during the work shift. Eighteen urine samples were positive for CP (range: 50¯10031 ng/l), whereas IF was detected in one subject only (153 ng/l). LOD was never exceeded for MTX. In urine samples from nurses and pharmacy technicians, Pt was detected in three subjects (range 920¯1300 ng/l). These findings were compared with the results from a previous survey carried out in the same hospital when different work practices were in use. The proposed methods are simple, fast and reliable and can be used to identify exposure of hospital personnel handling antineoplastic drugs.

Personal exposure level and environmental ethylene oxide gas concentration in sterilization facilities of hospitals in Japan.

Hori H, Yahata K, Fujishiro K, Yoshizumi K, Li D, Goto Y, Higashi T.

Appl Occup Environ Hyg 2002 Sep;17(9):634-9

Personal and environmental (stationary) ethylene oxide (EO) gas concentrations in gas sterilization facilities were measured at six workplaces in five hospitals. An ethylene oxide gas monitor (3M #3551) was used for both personal and stationary samplings. A gas detector tube was also used for instantaneous sampling. In most workplaces, the personal exposure levels of EO were below the detection limit of the gas monitor. Most of the time-weighted average (TWA) concentrations by the stationary sampling were below the threshold limit value of EO (TLV-TWA = 1 ppm), but in one workplace, more than 4 ppm of EO were detected in front of the sterilizer in a clean room during a 24-hour measurement, although all the personal exposure levels were below the detection limit. Method of aeration after the sterilization was very important for reducing the EO exposure. The EO gas concentrations in two workplaces where sufficient aeration was carried out were below the detection limit in all the stationary samples. In one workplace where insufficient aeration was performed, EO was detected from 16 of 17 stationary samples, and more than 90-200 ppm of EO was determined by the gas detector tube near the worker's face at the moment when the door of the sterilizer was opened and the sterilized materials were removed.

Allergy

Infection Control

Stress – Mental disorders

Working on Stress

European Agency for Safety and Health at Work

http://agency.osha.eu.int/publications/magazine/5/en/MAGAZINE5_EN.PDF

Zero tolerance of violence against healthcare staff.

Beech B.

Nurs Stand 2001 Jan 3-9;15(16):39-41

A government campaign aimed at stopping violence against healthcare staff is a start in dealing with the problem of aggression in the workplace. Staff attitudes will also need to be addressed, particularly in those areas where violence has become an accepted part of the job, if zero tolerance is to be achieved.

Challenging the myth of the 12-hour shift: a pilot evaluation.

Bloodworth C, Lea A, Lane S, Ginn R.

Nurs Stand 2001 Apr 4-10;15(29):33-6

AIM: The aim of this pilot evaluation was to assess whether changing a nursing shift pattern to incorporate 12-hour shifts would have positive effects for patients and staff in a ward environment. METHOD: All nurses, night sisters and therapists in contact with the ward during the trial were asked to complete a questionnaire. Data on sickness, agency use, 'untoward incidents' and spread of unsocial hours were also analysed to see what effects a change in shift pattern had. RESULTS: The new shift pattern offered benefits for patients through improved communication, increased continuity of care and more content staff. In addition, staff complied to the Working Time Regulations (DTI 1998) with no change to their unsocial hour pay. There was also a reduced need for agency nurses. CONCLUSION: This study illustrated the potential a new nursing shift pattern involving 12-hour shifts has for patient care, as well as for staff job satisfaction and efficient management of the ward. Twelve-hour shifts are infamous in nursing and many studies cite exhausted and dissatisfied staff as a reason for the negative press (Fitzpatrick et al 1999, Todd et al 1993). In particular, Todd et al (1989) claimed that the quality of patient care was negatively affected on wards that used a 12-hour shift pattern. The study reported here challenges Todd et al's work (1989, 1993) by demonstrating the benefits a change in shift pattern to 12-hour shifts can have for patients and staff in a ward environment.

Other

Miscellaneous

Doctors' perceptions of drinking alcohol while on call: questionnaire survey.

Ahmad T, Wallace J, Peterman J, Desbiens NA.

BMJ 2002 Sep 14;325(7364):579-80

Education for nurses returning to practice.

Quant T.

Nurs Stand 2001 Jan 10-16;15(17):39-41

Barriers to healthy eating in the nursing profession: Part 1.

Faugier J, Lancaster J, Pickles D, Dobson K.

Nurs Stand 2001 May 23-29;15(36):33-6

AIM: The aim of this study commissioned by the NHS Executive North West was to identify the main areas of the nurse's working environment that prevent healthy eating, to ascertain if nurses have enough nutritional knowledge to make informed choices, and to review sources, availability and quality of food provided for nursing staff. METHOD: A purposive sample size of 126 nurses from across eight healthcare sites in the North West region completed questionnaires. RESULTS: Shift patterns and failure to take breaks were identified as the two main barriers to healthy eating by respondents. However, satisfaction with food on offer and a supportive environment were also identified as important influences. CONCLUSION: Several recommendations were made as a result of the study. Ideally, nurses should take regular breaks. Food should carry nutritional labelling and nutritional information should be displayed at healthcare sites in a more imaginative and innovative way. More refrigerated vending machines with a selection of healthier options should be supplied. Packed lunches or plated salads obtainable from restaurants by evening and night-shift nurses should be offered, in addition to a better selection of sandwiches and other food choices outside the hours of 9 am to 5 pm, Monday to Friday. Nurses should be encouraged to drink the recommended amount of eight glasses of water per day (Health and Fitness Tips 2000) by providing adequate water dispensers. The possibility of having separate catering facilities for staff who wish to avoid patients and visitors during breaks should be explored.

Barriers to healthy eating in the nursing profession: Part 2.

Faugier J, Lancaster J, Pickles D, Dobson K.

Nurs Stand 2001 May 30-Jun 5;15(37):33-5

AIM: This is the second of two articles that report on work commissioned by the NHS Executive North West, to explore the perceived barriers to healthy eating within the nursing profession. METHOD: Observations were made of catering facilities within eight healthcare sites (six acute hospitals, an NHS walk-in centre and an NHS Direct site) across the North West region. Twenty four unstructured interviews were conducted with nurses and three were sampled from each healthcare site. RESULTS: Four main themes emerged as barriers to healthy eating: availability; variety; distance from catering facilities; and breaks/staffing levels/workload issues CONCLUSION: Respondents in this study do not consider their working environments to be conducive to healthy eating practices.

Evidence Based Medicine

Documents en Français

Reglementation

Articles& documents en Français

  

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