Christine McGuire-Wolfe

A multifaceted pilot program to promote hand hygiene at a suburban fire department

BACKGROUND Firefighters (FFs) and Emergency Medical Services (EMS) personnel provide care in uncontrolled settings, where the risk of hand contamination is great and opportunities for handwashing are few. Knowledge, attitudes, and beliefs about hand hygiene in this group have not been well reported. METHODS Written surveys were administered to FFs and EMS personnel to assess their practices, attitudes, and beliefs before and after installation of alcohol hand gel dispensers, hanging of reminder posters, and completion of PowerPoint training. RESULTS A majority of the participants (n = 131; 58.5%) indicated they had not received any training on hand hygiene from the fire department before the intervention. Responses to Likert scale questions about attitudes, practices, and beliefs regarding handwashing did not reveal any statistically significant differences between preintervention and postintervention surveys; however, responses to direct questions about the impact of the intervention were more promising. CONCLUSIONS Implementation and evaluation of an intervention to target groups of EMS personnel and FFs can guide future efforts to improve hand hygiene practices in this distinctive group.

Contribution of a winged phlebotomy device design to blood splatter.

BACKGROUND Despite a proliferation of phlebotomy devices with engineered sharps injury protection (ESIP), the impact of various winged device designs on blood splatter occurring during venipuncture procedures has not been explored. OBJECTIVES To evaluate the potential for blood splatter of 6 designs of winged phlebotomy devices. DESIGN A laboratory-based device evaluation without human subjects, using a simulated patient venous system. METHODS We evaluated 18 winged phlebotomy devices of 6 device designs by Terumo, BD Vacutainer (2 designs), Greiner, Smith Medical, and Kendall (designated A-F, respectively). Scientific filters were positioned around the devices and weighed before and after venipuncture was performed. Visible blood on filters, exam gloves, and devices and measurable blood splatter were the primary units of analysis. RESULTS The percentages of devices and gloves with visible blood on them and filters with measurable blood splatter ranged from 0% to 20%. There was a statistically significant association between device design and visible blood on devices ([Formula: see text]) and between device design and filters with measurable blood splatter ([Formula: see text]), but not between device design and visible blood on gloves. A wide range of associations were demonstrated between device design and visible blood on gloves or devices and incidence of blood splatter. CONCLUSIONS The results of this evaluation suggest that winged phlebotomy devices with ESIP may produce blood splatter during venipuncture. Reinforcing the importance of eye protection and developing a methodology to assess ocular exposure to blood splatter are major implications for healthcare personnel who use these devices. Future studies should focus on evaluating different designs of intravascular devices (intravenous catheters, other phlebotomy devices) for blood splatter.

AUTOMATED AND MANUAL MEASUREMENT OF THE FORCES REQUIRED TO USE RETRACTABLE INTRAMUSCULAR SYRINGES

The purpose of this study is to compare the forces required to activate retractable intramuscular safety syringes using healthcare worker researchers vs. a computer-controlled system. The force required to activate three commercially available retractable safety syringes was measured using two methods: (1) a manually-operated digital force gauge (DFG) and (2) a completely automatic computer-controlled universal testing machine (UTM). To simulate the clinical setting, saline was drawn into the barrel of each syringe before testing and ejected either during or before force measurements were recorded. There was a statistically significant difference in activation force between the two researchers and the UTM (p < 0.001) for 2/3 devices tested. There was a wide discrepancy in activation forces between the three brands of devices regardless of the testing method. The results imply that a human element exists in the injection process that cannot be discounted. Future studies should explore the sum of forces involved with an injection, the notion of training HCWs to modify these forces, and the relationship between force and occupationally-acquired hand and wrist injuries. Minimizing the impact on the healthcare worker who may give hundreds of injections per day with these syringes should be a priority for those involved in the health field.

Response to effectiveness and cost-effectiveness of public access automatic defibrillator (AED) programs.

Winkle’s review1 regarding the effectiveness and costeffectiveness of public-access automated external defibrillator (AED) programs concludes that the cost of such programs can range from

A previously unidentified risk of needlestick injury in the emergency medical services setting

1 million to

Sharps Usage Patterns and Hazards Among Firefighters and Emergency Services Personnel at a Suburban Fire Department

10 million per quality-adjusted life year saved, asserts that this degree of expenditure is not consistent with the generally accepted expenditure of healthcare dollars, and suggests that placement of AEDs at high-visibility sites is ‘‘probably’’ good for overall public awareness of sudden cardiac death. Our experience in establishing and maintaining a community public-access AED program, based in county buildings, courthouses, recreation centers, libraries, nutrition dining sites for the elderly, and large public-transportation vehicles in a suburban community, provides anecdotal evidence about the costs and benefits of such a program. Winkle’s evaluation of the cost of public-access AED programs against generally accepted healthcare expenditures compares incongruent categories. In our county, the funds utilized to purchase the AEDs, distribute restocking supplies, and provide cardiopulmonary resuscitation (CPR) and AED training for employees at targeted sites were not allocated from traditional healthcare payment sources. These funds were a small portion of a penny sales tax enacted to assist with support of public-service functions within the county. In <3 years, we have had 2 successful resuscitations as the result of placement of AEDs in county locations, as well as providing CPR/AED training to approximately 70% of employees serving in departments that interact with the public. The first incident occurred on a public-transportation bus, where the rescuer was a bus driver. The second incident occurred at a recreation center in front of a large crowd at a basketball game and involved cooperation between several parks department employees. In both instances, the individual was aged <60 years, was initially in ventricular fibrillation, and received 1 shock from an AED. Both patients were responsive, in sinus rhythm when emergency medical services arrived, and subsequently discharged from the hospital to a home environment. The details of these incidents underscore the ability of a successful resuscitation in a public place to educate civilians. Winkle’s conclusion that AEDs are ‘‘probably’’ good for improving public knowledge about sudden cardiac death minimizes the positive impact of these witnessed resuscitations. The population utilizing the public-transportation system typically lives within a tightly knit community of Hispanic migrants and African Americans of low socioeconomic status. Within 48 hours of the event on the bus, the details had spread to the public-housing developments and were a topic of frequent conversation. At the recreation center, approximately 100 civilians witnessed the patient’s collapse and subsequent cyanosis, the resuscitation efforts, and the patient’s ability to answer questions at the time of emergency medical services’ arrival. In both instances, the strength of the message to the individuals who observed the CPR efforts and use of the AED, as well as individuals who heard the details secondhand in the retelling of the story, far exceeds that of a typical public-service announcement. These real-life vignettes of AED successes are priceless and one significant benefit of community-access AED programs.