Linda A. Chiarello

Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections

OBJECTIVE To draw up evidence-based guidelines to make injections safer. METHODS A development group summarized evidence-based best practices for preventing injection-associated infections in resource-limited settings. The development process included a breakdown of the WHO reference definition of a safe injection into a list of potentially critical steps, a review of the literature for each of these steps, the formulation of best practices, and the submission of the draft document to peer review. FINDINGS Eliminating unnecessary injections is the highest priority in preventing injection-associated infections. However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the prevention of access to used needles. CONCLUSION The availability of best infection control practices for intradermal, subcutaneous, and intramuscular injections will provide a reference for global efforts to achieve the goal of safe and appropriate use of injections. WHO will revise the best practices five years after initial development, i.e. in 2005.

Costs of management of occupational exposures to blood and body fluids.

OBJECTIVE To determine the cost of management of occupational exposures to blood and body fluids. DESIGN A convenience sample of 4 healthcare facilities provided information on the cost of management of occupational exposures that varied in type, severity, and exposure source infection status. Detailed information was collected on time spent reporting, managing, and following up the exposures; salaries (including benefits) for representative staff who sustained and who managed exposures; and costs (not charges) for laboratory testing of exposure sources and exposed healthcare personnel, as well as any postexposure prophylaxis taken by the exposed personnel. Resources used were stratified by the phase of exposure management: exposure reporting, initial management, and follow-up. Data for 31 exposure scenarios were analyzed. Costs were given in 2003 US dollars. SETTING The 4 facilities providing data were a 600-bed public hospital, a 244-bed Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a 3,500-bed healthcare system. RESULTS The overall range of costs to manage reported exposures was

Foundations of the severe acute respiratory syndrome preparedness AND response plan for healthcare facilities

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Nurse staffing and healthcare-associated infections: proceedings from a working group meeting.

4,838. Mean total costs varied greatly by the infection status of the source patient. The overall mean cost for exposures to human immunodeficiency virus (HIV)-infected source patients (n=19, including those coinfected with hepatitis B or C virus) was

Comprehensive prevention of occupational blood exposures: lessons from other countries.

2,456 (range,

Healthcare settings as amplifiers of infectious disease.

907-

Preventing Transmission of Hepatitis B Virus From Surgeons to Patients

4,838), whereas the overall mean cost for exposures to source patients with unknown or negative infection status (n=8) was

Chapter 29 – Infection Control Considerations to Prevent HIV Transmission in Healthcare Settings

376 (range,

Management of multidrug-resistant organisms in health care settings, 2006

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Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis. Vol. 47/No. RR-7.

860). Lastly, the overall mean cost of management of reported exposures for source patients infected with hepatitis C virus (n=4) was