2. HEALTH RISK ASSESSMENT OF NEEDLE STICK/SHARPS INJURIES TO HEALTH CARE WASTE HANDLERS IN A TERTIARY HOSPITAL
BY: RICARDO M. MIRANDA, C.E.,S.E. (MAY 2011)
ABSTRACT:
INTRODUCTION: HEALTH CARE WASTE (HCW) HANDLERS IN THE HOUSEKEEPING DEPARTMENT OF HOSPITALS ARE EXPOSED TO NEEDLE STICK.SHARPS INJURIES (NSSIs) AND ARE AT THE RISK OF EXPOSURE TO HBV, HCV, AND HIV INFECTIONS IN THEIR WORK. THIS GROUP OF WORKERS IS AT A DISADVANTAGE AS THEY ARE NOT USUALLY EMPLOYED DIRECTLY BY HOSPITALS IN THE PHILIPPINES BUT OUTSOURCED FROM CLEANING SERVICES AND MAINTENANCE COMPANIES. THE PRINCIPAL OBJECTIVE OF THIS STUDY IS TO PREPARE A HEALTH RISK ASSESSMENT MODEL FOR HOSPITALS BASED ON A RESEARCH STUDY IN AN 800-BED TERTIARY HOSPITAL IN THE PHILIPPINES THAT WILL ASSESS THE RISK OF NEEDLE STICK INJURIES TO THOSE WORKERS AND THEIR PREDISPOSITION TO THE HBV, HCV AND HIV INFECTIONS AFTER EXPERIENCING SUCH INJURIES.
METHODS: THE ELEMENTS OF THE HEALTH RISK ASSESSMENT MODEL CONSIST OF: (1) IDENTIFYING THE HAZARDS FROM PREVIOUS NEEDLE STICK/SHARPS INJURIES; (2) DEVELOPING DOSE (INDEPENDENT, PREDICTOR VARIABLES) VERSUS RESPONSE (DEPENDENT, OUTCOME VARIABLES) RELATIONSHIPS; (3) PREPARING EXPOSURE ASSESSMENT TO DESCRIBE WHAT INJURIES ARE CURRENTLY EXPERIENCED OR ANTICIPATED UNDER DIFFERENT CONDITIONS BY THE AT-RISK POPULATION OR SIMILAR RISK ASSESSMENT AS APPLIED TO LARGER POPULATIONS WITH SIMILAR ENVIRONMENTS; AND (4) CHARACTERIZING THE RISKS BY DETERMINING THE ESTIMATED INCIDENCE OF NEEDLE STICK INJURIES TO WASTE HANDLERS IN THE HOSPITAL, AND THE PROBABILITY OF INFECTION WITH HBV, HCV AND HIV, AND THE FRACTION OF HBV, HCV AND HIV INFECTIONS AMONG THE WASTE HANDLERS THAT CAN BE ATTRIBUTED TO NEEDLE STICK/SHARPS INJURIES.
A RETROSPECTIVE, CROSS SECTIONAL STUDY OF SHARPS/NEEDLE STICK INJURY INCIDENT (N=18) AND A SURVEY OF WASTE HANDLERS WHO ARE AT RISK FRO NEEDLE STICK INJURIES (N=74) WAS PREPARED USING THE TWO (2) SETS OF INTERVIEWER-ASSISTED, SELF-ADMINISTERED CONFIDENTIAL QUESTIONNAIRES. THE FIRST GROUP OF RESPONDENTS (N=18) CONSISTED OF NEEDLE STICK INJURY REPORTS FROM HOSPITAL RECORDS THAT USE EXPOSURE PREVENTION INFORMATION NETWORK [EPINet] SURVEILLANCE FORMS DEVELOPED BY THE UNIVERSITY OF VIRGINIA, USA AT HE HOSPITAL FROM 2006-2010 AND INTERVIEWS WITH ALL 7 WASTE HANDLERS STILL WORKING AT THE HOSPITAL WHO HAVE EXPERIENCED AT LEAST ONE (1) NEEDLE STICK INJURY BETWEEN 2006 TO 2010. THE 2ND GROUP OF RESPONDENTS WAS A SYSTEMATIC SAMPLE (N=74 WITH 9% MARGIN ERROR) OF WASTE HANDLERS OF THE TOTAL OF 188 WASTE HANDLERS WHO ARE AT RISK OF SHARPS/NEEDLE STICK INJURIES IN THE HOSPITAL AS OF THE YEAR 2010. SELECTED SECTIONS OF THE HOSPITAL WERE OBSERVED TO COMPLEMENT THE INTERVIEWS AND QUESTIONNAIRES. RESEARCH DATA WERE ANALYZED USING SPSS VERSION 17. FOR ELEMENTS 3) EXPOSURE ASSESSMENT AND 4) RISK CHARACTERIZATION, THE WHO MODEL DEVELOPED BY PRUSS-USTUN (2003 AND 2005) WAS ANALYZED FOR THE CALCULATING: (A)THE PROPORTION SUSCEPTIBLE AND THE BASELINE INCIDENCE OF INFECTION OF THE SUSCEPTIBLE PROPORTION OF THE GENERAL POPULATION OF HOSPITAL BASED PERSONNEL; (B) THE PROPORTION OF WASTE HANDLERS SUSCEPTIBLE TO HBV, HCV AND HIV INFECTION, AND BASELINE INCIDENCE OF INFECTION OF THE SUSCEPTIBLE PROPORTION OF WASTE HANDLERS AT RISK IN THE HOSPITAL; (C) THE ESTIMATE OF THE BASELINE NUMBER OF INFECTIONS AMONG WASTE HANDLERS, THE INCIDENCE OF INFECTIONS FROM NEEDLE STICK/SHARPS INJURIES, THE NUMBER OF INFECTIONS AND THE FRACTION OF INFECTIONS IN WASTE HANDLERS ATTRIBUTABLE TO NEEDLE STICK/SHARPS INJURIES IN THE HOSPITAL. THE REPLICABILITY OF THE MODEL FROM A SINGLE HOSPITAL SETTING WAS ANALYZED AND STUDIED.
ABSTRACT:
INTRODUCTION: HEALTH CARE WASTE (HCW) HANDLERS IN THE HOUSEKEEPING DEPARTMENT OF HOSPITALS ARE EXPOSED TO NEEDLE STICK.SHARPS INJURIES (NSSIs) AND ARE AT THE RISK OF EXPOSURE TO HBV, HCV, AND HIV INFECTIONS IN THEIR WORK. THIS GROUP OF WORKERS IS AT A DISADVANTAGE AS THEY ARE NOT USUALLY EMPLOYED DIRECTLY BY HOSPITALS IN THE PHILIPPINES BUT OUTSOURCED FROM CLEANING SERVICES AND MAINTENANCE COMPANIES. THE PRINCIPAL OBJECTIVE OF THIS STUDY IS TO PREPARE A HEALTH RISK ASSESSMENT MODEL FOR HOSPITALS BASED ON A RESEARCH STUDY IN AN 800-BED TERTIARY HOSPITAL IN THE PHILIPPINES THAT WILL ASSESS THE RISK OF NEEDLE STICK INJURIES TO THOSE WORKERS AND THEIR PREDISPOSITION TO THE HBV, HCV AND HIV INFECTIONS AFTER EXPERIENCING SUCH INJURIES.
METHODS: THE ELEMENTS OF THE HEALTH RISK ASSESSMENT MODEL CONSIST OF: (1) IDENTIFYING THE HAZARDS FROM PREVIOUS NEEDLE STICK/SHARPS INJURIES; (2) DEVELOPING DOSE (INDEPENDENT, PREDICTOR VARIABLES) VERSUS RESPONSE (DEPENDENT, OUTCOME VARIABLES) RELATIONSHIPS; (3) PREPARING EXPOSURE ASSESSMENT TO DESCRIBE WHAT INJURIES ARE CURRENTLY EXPERIENCED OR ANTICIPATED UNDER DIFFERENT CONDITIONS BY THE AT-RISK POPULATION OR SIMILAR RISK ASSESSMENT AS APPLIED TO LARGER POPULATIONS WITH SIMILAR ENVIRONMENTS; AND (4) CHARACTERIZING THE RISKS BY DETERMINING THE ESTIMATED INCIDENCE OF NEEDLE STICK INJURIES TO WASTE HANDLERS IN THE HOSPITAL, AND THE PROBABILITY OF INFECTION WITH HBV, HCV AND HIV, AND THE FRACTION OF HBV, HCV AND HIV INFECTIONS AMONG THE WASTE HANDLERS THAT CAN BE ATTRIBUTED TO NEEDLE STICK/SHARPS INJURIES.
A RETROSPECTIVE, CROSS SECTIONAL STUDY OF SHARPS/NEEDLE STICK INJURY INCIDENT (N=18) AND A SURVEY OF WASTE HANDLERS WHO ARE AT RISK FRO NEEDLE STICK INJURIES (N=74) WAS PREPARED USING THE TWO (2) SETS OF INTERVIEWER-ASSISTED, SELF-ADMINISTERED CONFIDENTIAL QUESTIONNAIRES. THE FIRST GROUP OF RESPONDENTS (N=18) CONSISTED OF NEEDLE STICK INJURY REPORTS FROM HOSPITAL RECORDS THAT USE EXPOSURE PREVENTION INFORMATION NETWORK [EPINet] SURVEILLANCE FORMS DEVELOPED BY THE UNIVERSITY OF VIRGINIA, USA AT HE HOSPITAL FROM 2006-2010 AND INTERVIEWS WITH ALL 7 WASTE HANDLERS STILL WORKING AT THE HOSPITAL WHO HAVE EXPERIENCED AT LEAST ONE (1) NEEDLE STICK INJURY BETWEEN 2006 TO 2010. THE 2ND GROUP OF RESPONDENTS WAS A SYSTEMATIC SAMPLE (N=74 WITH 9% MARGIN ERROR) OF WASTE HANDLERS OF THE TOTAL OF 188 WASTE HANDLERS WHO ARE AT RISK OF SHARPS/NEEDLE STICK INJURIES IN THE HOSPITAL AS OF THE YEAR 2010. SELECTED SECTIONS OF THE HOSPITAL WERE OBSERVED TO COMPLEMENT THE INTERVIEWS AND QUESTIONNAIRES. RESEARCH DATA WERE ANALYZED USING SPSS VERSION 17. FOR ELEMENTS 3) EXPOSURE ASSESSMENT AND 4) RISK CHARACTERIZATION, THE WHO MODEL DEVELOPED BY PRUSS-USTUN (2003 AND 2005) WAS ANALYZED FOR THE CALCULATING: (A)THE PROPORTION SUSCEPTIBLE AND THE BASELINE INCIDENCE OF INFECTION OF THE SUSCEPTIBLE PROPORTION OF THE GENERAL POPULATION OF HOSPITAL BASED PERSONNEL; (B) THE PROPORTION OF WASTE HANDLERS SUSCEPTIBLE TO HBV, HCV AND HIV INFECTION, AND BASELINE INCIDENCE OF INFECTION OF THE SUSCEPTIBLE PROPORTION OF WASTE HANDLERS AT RISK IN THE HOSPITAL; (C) THE ESTIMATE OF THE BASELINE NUMBER OF INFECTIONS AMONG WASTE HANDLERS, THE INCIDENCE OF INFECTIONS FROM NEEDLE STICK/SHARPS INJURIES, THE NUMBER OF INFECTIONS AND THE FRACTION OF INFECTIONS IN WASTE HANDLERS ATTRIBUTABLE TO NEEDLE STICK/SHARPS INJURIES IN THE HOSPITAL. THE REPLICABILITY OF THE MODEL FROM A SINGLE HOSPITAL SETTING WAS ANALYZED AND STUDIED.