Anna Garus-Pakowska

Observance of hand washing procedures performed by the medical personnel after the patient contact. Part II

ObjectivesThe Centers for Disease Control and Prevention (CDC) as well as the World Health Organization (WHO) state that adequate hand hygiene maintained by medical personnel is an indispensable prerequisite for controlling nosocomial infections. The recommendations of CDC and WHO emphasize the obligation to wash hands after each contact with a patient, after the exposure to a potentially infectious material or upon the contact with objects surrounding the patient.Materials and MethodsThe study was performed by quasi-observation among the group of 188 medical staff members (nurses and physicians) working in three selected hospitals of the Łódź Province. The procedure of hand washing/disinfection performed directly after the patient contact according to the recommendations of CDC and WHO was observed. The results were subject to statistical analysis (p < 0.05).ResultsDuring 1544 h of observations, 4101 activities requiring hand washing were recorded. The medical personnel followed the hand hygiene procedures after the patient contact in 26.4% of the situations that require hygiene according to the guidelines. The level of observance of the hand washing procedures depended significantly on the type of performed activity, profession, degree of workload, index of activity, and time of duty hours. The mean time of hand washing after patient contact was 9.2 s for physicians and 6.7 s for nurses.ConclusionBoth the level of observance of hygienic procedures after the contact with patients as well as the time of hand washing are insufficient. There is an urgent need to work out educational programs on maintaining proper hand hygiene for medical personnel.

The use of protective gloves by medical personnel

IntroductionTo minimize the risk of cross-infection between the patient and the medical staff, it is necessary to use individual protective measures such as gloves. According to the recommendations of the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), protective gloves should always be used upon contact with blood, mucosa, injured skin or other potentially infectious material.Materials and MethodsThe aim of the study was to evaluate, through quasi-observation, the use of protective gloves by medical staff according to the guidelines issued by the CDC and WHO. The results were subject to statistical analysis (p < 0.05).ResultsDuring 1544 hours of observations, 3498 situations were recorded in which wearing protective gloves is demanded from the medical staff. The overall percentage of the observance of using gloves was 50%. The use of gloves depended significantly on the type of ward, profession, performed activity, number of situations that require wearing gloves during the observation unit and the real workload. During the entire study, as many as 718 contacts with patients were observed in which the same gloves were used several times.ConclusionWearing disposable protective gloves by the medical staff is insufficient.

Knowledge and Attitudes of Dentists with Respect to the Risks of Blood-Borne Pathogens—A Cross-Sectional Study in Poland

Background: To analyze dentists’ knowledge of blood-borne infections, their attitudes towards infected patients, and to determine the frequency of the contact with infectious material; Methods: We surveyed 192 dentists using an anonymous questionnaire. Results: Only a quarter of dentists responded correctly to all questions. 96% of the examined dentists confirmed that they were more cautious during treatment of patients with HBV, HCV and HIV. 25% of all respondents refuse to help infected patients due to concerns about their own health. The dentists occasionally removed protective clothing to make it “easier” to perform specific procedures. The dentists experienced contact with infectious material most frequently by splashes onto the conjunctiva or as a result of superficial injuries. The risk of injury by a medical tool increased with the years of employment. Re-capping needles was associated with an increased risk of injury; Conclusions: Despite the widespread tolerance of people infected with blood-borne viruses and the well-proven low infection risk to medical personnel, dentists continue to be prejudiced and concerned about their own health and may refuse to treat infected patients. It may be assumed that the proportion of refusing treatment is even greater. This attitude should imply the implementation of training in the field of pathogen transmission and the real risk of infection.

Dental awareness and oral health of pregnant women in Poland.

OBJECTIVES The level of dental awareness of a pregnant woman affects the sanitary condition of her own teeth and the health of the child to be born. Poor oral health is considered to be a probable risk factor for the pre-term birth or low birth weight. The aim of this work was to assess the level of oral health knowledge that determines oral health condition of pregnant women in Poland. MATERIAL AND METHODS Empirical data were obtained from the National Monitoring of Oral Health and Its Determinants, financed by the Ministry of Health. This socio-epidemiological study assessed oral health status and dental health awareness, which affects that status. Study subjects included 1380 pregnant women at the age ranging from 15 to 44, randomly-selected from urban and rural environments. Dental health status was recorded in the clinical examination sheets supplied by the World Health Organization, and the socio-medical data were recorded in the questionnaire interview sheets. RESULTS Almost 3/4 of the pregnant women evaluated their dental health as unsatisfactory or poor. Over 60% of the pregnant women rated their knowledge and practical skills concerning care of their own teeth and of the child to be born as limited, inadequate or none. Only 40% of the pregnant women provided right answers to the questions about dental issues. CONCLUSIONS Low oral health awareness results in poor oral health status of the study subjects. A statistical pregnant woman has a total of 13 teeth showing the symptoms of tooth decay or caries. Over 70% of the pregnant women developed gingivitis or periodontitis. There is an urgent need in Poland to make the European principle of treating pregnant women as a dentally vulnerable group obligatory.

Awareness of the Risk of Exposure to Infectious Material and the Behaviors of Polish Paramedics with Respect to the Hazards from Blood-Borne Pathogens—A Nationwide Study

(1) Background: To determine paramedics’ frequency of contact with blood and other body fluids, as well as the analysis of knowledge of paramedics about blood-borne infections, their attitudes to patients infected with blood-borne viruses, and the post-exposure procedures implemented by paramedics; (2) Methods: An anonymous questionnaire among 190 paramedics working in various health care facilities in Poland (adjusted response rate, 76.3%); (3) Results: 78% of paramedics had contact with potentially infectious material at least several times a week. Paramedics’ knowledge on transferring infection was insufficient. Paramedics with longer employment time and better professional experience suffered fewer injuries with used needles/medical tools (p = 0.079). Most frequently reported factors that prevented the use of personal protective equipment were emergency situations (19.5%), skin irritations and contact allergies (19%) and, in the case of protective gloves, reduced manual dexterity (16%). In total, 82% of paramedics were concerned about the risk of being infected with HIV, HBV or HCV as a result of performing their job. In total, 97% of paramedics behaved more carefully while caring for infected patients. In total, 90% of the paramedics never refrained from performing the specific procedures necessary to help the patient whom they knew to be infected; (4) Conclusions: Despite the paramedics’ insufficient theoretical knowledge about the risk of blood-borne infections, the emphasis in the training of future paramedics should be on classes perfecting practical skills, because growing experience significantly reduces the risk of injury.

Work-Related Accidents and Sharp Injuries in Paramedics—Illustrated with an Example of a Multi-Specialist Hospital, Located in Central Poland

(1) Background: An analysis of work-related accidents in paramedics in Poland by presenting the model and trend of accidents, accident rates and by identifying causes and results of accidents; (2) Methods: A retrospective analysis of medical documentation regarding work-related accidents in a multi-specialist hospital, located in central Poland, in the period 2005–2015. The study group included paramedics who had an accident while being on duty; (3) Results: According to hospital records, 88 paramedics were involved in 390 accidents and 265 injuries caused by sharp instruments. The annual accident rate was 5.34/100 employed paramedics. Most of the accidents occurred at night. The most common reason for the accident was careless behaviour of the paramedic, which resulted in joint sprains and dislocations. Injuries accounted for a huge portion of the total number of events. As many as 45% of injuries were not officially recorded; (4) Conclusion: High rates of work-related accidents and injuries caused by sharp instruments in paramedics are a serious public health problem. Further studies should be conducted in order to identify risk factors of accidents, particularly injuries, and to implement preventative programmes, aiming to minimise rates of occupational hazards for paramedics.

Occupational Safety and Hygiene of Dentists from Urban and Rural Areas in Terms of Sharp Injuries: Wound Structure, Causes of Injuries and Barriers to Reporting—Cross-Sectional Study, Poland

(1) Background: Frequent contact of the dentist with potentially infectious material (PIM) is undeniable. The aim of the study was to determine the frequency and type of injuries, as well as to identify barriers to reporting and barriers to the implementation of post-exposure prophylaxis (PEP) among dentists from urban and rural areas. (2) Methods: We surveyed 192 dentists using an anonymous questionnaire. (3) Results: During the 12 months preceding the survey, 63% of dentists from the village and 58.8% of dentists from the city suffered at least one superficial cut, and deep cuts 15.1% and 17.6% respectively. Contact with PIM through spitting on the conjunctiva was 58.9% and 52.1% (village vs. city). Needle stick injuries were 50.4% and fingers were affected in 48.8% cases. The causes of injuries were: inattention 54.7%, rush 27%, unpredictable behavior of the patient 19%, recapping 18.2%. Work in the countryside was associated with a 1.95-times greater chance of not reporting injuries. The distance from a hospital with antiretroviral treatment may be a barrier to the implementation of PEP. (4) Conclusion: The circumstances of the injuries and the reasons for not applying for antiretroviral treatment point to the areas of necessary dentist education in this topic.

Circumstances and Structure of Occupational Sharp Injuries among Healthcare Workers of a Selected Hospital in Central Poland

(1) Background: An analysis of work-related sharp injuries in Healthcare Workers (HCWs) based at a selected hospital in Central Poland by presenting the frequency of accidents, injury rates, and identifying circumstances of Needle Sticks and Sharp Injuries (NSSI) and giving Post-Exposure Procedures (PEP). (2) Methods: A retrospective analysis of medical documentation regarding work-related NSSI at a district hospital located in central Poland; over the period 2010–2017. The study group included HCWs who had an accident while on duty. (3) Results: Most injuries were reported by nurses and staff over 40, on the morning shift. The most common injuries were using a needle. The most exposed part of the body were fingers. The average annual injury rates were: 1.22/100 Nurses; 2.02/100 doctors; 1.34/100 hospital beds; and 8.59/100,000 inpatient days. The rates for 3-year periods, after the implementation of legal regulations were higher than before. Conclusion: Injuries rates are more reliable for comparison than frequency. Legislation on the need to register injuries seems to be necessary. In the supervision of work safety of personnel, reliable reporting of all injuries by the respective HCWs plays a key role.

Did legal regulations change the reporting frequency of sharp injuries of medical personnel? Study from 36 hospitals in Łódź Province, Poland

OBJECTIVES The aim of the study has been to analyze the epidemiological data on sharp injuries among health care workers before and after the implementation of regulations related to the conduct of the register of sharp injuries. MATERIAL AND METHODS We hypothesized that the introduction of legislation would change the existing low reportability of sharp injuries and reporting incidents would increase. In Poland the binding regulations, dating back to 2013, require the employer to keep a record of sharp injuries. Therefore, we compared the data from before and after the entry regulations. Data was collected from the records of occupational exposure/accidents at work in hospitals in the Łódź Province during 2010-2014. The feedback came from 36 hospitals (return index = 51.5%), representing a total annual average of 13 211 medical workers. RESULTS The incidence of injuries did not change significantly over the period 2010-2014, and the number of reported injuries in 2014 (the year when the Regulation had already been effective) was even lower than in the previous years. The average annual injury index was 12.31 injuries per 1000 employees (95% confidence interval: 11.48-13.16/1000). The incidence of injuries among nurses was significantly higher than in other groups of medical professionals (p < 0.05). These injuries most often occur while using needles (p < 0.05). CONCLUSIONS The obligation to record occupational exposures set forth in current regulations is not likely to improve the reliability of reporting the incidents actually taking place. Further research should focus on identifying barriers to reporting cases of exposure to potentially infectious material. Action should be taken to raise awareness of medical personnel about the possible effects of exposure to infectious material, in particular, the benefits of the implementation of early post-exposure procedures. Perhaps it will increase the reporting frequency of sharp injuries of medical personnel. Int J Occup Med Environ Health 2018;31(1):37-46.

[The incidence of accidents at work among paramedics in the years 2001-2013 based on the register of one selected hospital].

BACKGROUND Paramedics are exposed to a number of factors that may have a direct or indirect impact on the risk of an accident at work. The aim of the study was to analyze the incidence of accidents at work among paramedics as well as to discuss risk factors and measures to prevent such cases. MATERIAL AND METHODS The data on accidents at work were obtained from unpublished internal hospital documentation. The results were subjected to statistical analysis. RESULTS In the years 2001-2013 there were 40 events, including 6 collective accidents, in which 41 paramedics of the emergency department were injured. On average, around 3 accidents involving paramedics occurred each year. The accidents happened most frequently in the evening and at night and in the winter months (statistically insignificant relationship). Incorrect behavior of the paramedics was the most common cause of an accident (75.6%) and musculoskeletal injuries (75%) most frequently of upper and lower limbs (55%) were the most common effects of an accident. In none of the cases safety regulations were breached by employees or employer. CONCLUSIONS Accidents among paramedics can be prevented by changing the interior design of and the medical equipment installation in the rear cabin of the ambulance, conducting regular training to upgrade the skills of paramedics and enriching their knowledge about health and safety in their widest meaning. Med Pr 2016;67(2):213-221.