Robin Griffiths

Needle Stick Injuries: An Overview of The Size of The Problem, Prevention And Management

Over 20 million dedicated health care providers (HCP) expose themselves to biological, chemical and mechanical hazards everyday. The World Health Organization estimates that approximately 3 million health care providers are exposed to blood and body fluid due to needle stick or sharp injuries annually. Blood and body fluid exposures have resulted in 57 documented cases of HIV seroconversion among healthcare personnel through 2001. Two thousand workers a year become infected with hepatitis C, and 400 contact hepatitis B. There are more than 20 additional types of infectious agents documented to be transmitted through needle sticks. More than 80% of needle stick injuries are preventable with the use of safer needle devices. Legislation has been developed in many countries to protect HCPs by encouraging employers to use best practices to prevent these exposures. Many different protocols for post exposure management of needle stick injuries or blood and body fluid exposure have been proposed. Effectiveness of a protocol depends on early initiation of post exposure management HIV prophylaxis has the smallest window of time treatment has to be started as soon as possible in the first few hours. Hepatitis B Immunoglobulin could be given within the first 7 days. Healthcare institutions should try to develop policies and procedures to reduce needle stick injuries by acting proactively and vaccinating all HCP for hepatitis B and incorporating improved engineering controls into a comprehensive needle stick injury prevention program. In this review, we present historical background, nature and size of the problem followed by the state of the art review of the prevention, management and corporate responsibilities. DOI: 10.4103/1947-489X.210971

A Study of Airline Pilot Morbidity

INTRODUCTION It has long been believed that airline pilots are healthier than the general population. There are a number of reasons why this should be the case. However, there is very little evidence to support this belief as fact. This study investigates the health of the pilot population of an Oceanic based airline compared to the health of the general population. METHODS Pilots who conducted their medical certificate renewal at the airlines medical unit between 1 November 2009 and 31 October 2010 were included. A medical questionnaire was completed by each pilot at the time of their medical certificate renewal. Data from the questionnaire was entered into a database as well as the pilots BMI, blood pressure, lipid profile, and blood glucose level. The comparison population was the population who completed the New Zealand Health Survey (NZHS) between 2006-2007. Demographic, lifestyle characteristics, and health status data from the pilots was compared to the NZHS using a Chi-squared test. RESULTS Included in the study were 595 pilots. With respect to most medical conditions, pilots had a lower prevalence when compared to the general population. Pilots had a higher prevalence of kidney disease (3.3% vs 0.6%) and melanoma skin cancer (19 per 1000 vs 0.4 per 1000). DISCUSSION This study suggests that pilots in New Zealand are healthier than the general population with respect to most medical conditions. The two medical conditions that were identified as being overrepresented in pilots may be the result of the occupational environment.

The occupational health and safety of flight attendants.

In order to perform safety-critical roles in emergency situations, flight attendants should meet minimum health standards and not be impaired by factors such as fatigue. In addition, the unique occupational and environmental characteristics of flight attendant employment may have consequential occupational health and safety implications, including radiation exposure, cancer, mental ill-health, musculoskeletal injury, reproductive disorders, and symptoms from cabin air contamination. The respective roles of governments and employers in managing these are controversial. A structured literature review was undertaken to identify key themes for promoting a future agenda for flight attendant health and safety. Recommendations include breast cancer health promotion, implementation of Fatigue Risk Management Systems, standardization of data collection on radiation exposure and health outcomes, and more coordinated approaches to occupational health and safety risk management. Research is ongoing into cabin air contamination incidents, cancer, and fatigue as health and safety concerns. Concerns are raised that statutory medical certification for flight attendants will not benefit either flight safety or occupational health.

Fatigue in Air Medical Clinicians Undertaking High-acuity Patient Transports

Abstract Background. Fatigue is likely to be a significant issue for air medical transport clinicians due to the challenging nature of their work, but there is little published evidence for this. Objective. To prospectively assess the levels and patterns of fatigue in air medical transport teams and determine whether specific mission factors influenced clinician fatigue. Methods. Physicians and flight nurses from two intensive care interhospital transport teams routinely completed fatigue report forms before and after patient transport missions over a 4-month period. Data collected included subjective ratings of fatigue (Samn-Perelli and visual analog scale), mission difficulty and performance. Multivariate hierarchical logistic and linear models were used to evaluate the influence of various mission characteristics on post-mission fatigue. Results. Clinicians returned 403 fully complete fatigue report forms at an estimated overall return rate of 73%. Fatigue increased significantly over the course of missions, and on 1 of every 12 fatigue reports returned clinicians reported severe post-mission fatigue (that is, levels of 6 or 7 on the Samn-Perelli scale). Factors that impacted significantly on clinician fatigue were the pre-mission fatigue level of the clinician, night work, mission duration, and mission difficulty. Poorer self-rated performance was significantly associated with higher levels of fatigue (r = −0.4, 95% CI −0.5 to −0.3), and for the 6-month period leading up to the study clinicians reported a total of 22 occasions on which they should have declined a mission due to fatigue. Conclusions. These results suggest that clinicians undertaking interhospital transports of even moderate duration experience high levels of fatigue on a relatively frequent basis. In the unique and challenging environment of air medical transport, prior fatigue, long or difficult missions, and the disadvantageous effect of night work on normal circadian rhythms are a combination where there are minimal safety margins for clinicians’ performance capacity. Fatigue prevention or fatigue resistance measures could positively affect air medical clinicians in this context.

Cardiovascular Risk Score and Cardiovascular Events Among Airline Pilots: A Case-Control Study

BACKGROUND A cardiovascular risk prediction score is routinely applied by aviation authorities worldwide. We examined the accuracy of the Framingham-based risk chart used by the New Zealand Civil Aviation Authority in predicting cardiovascular events among airline pilots. METHODS A matched case-control design was applied to assess the association of 5-yr cardiovascular risk score and cardiovascular events in Oceania-based airline pilots. Cases were pilots with cardiovascular events as recorded on their medical records. Each case was age and gender matched with four controls that were randomly selected from the pilot population. To collect data before the events, 5-yr retrospective evaluations were conducted. RESULTS Over a 16-yr study period we identified 15 cases of cardiovascular events, 9 (60%) of which were sudden clinical presentations and only 6 (40%) of which were detected using cardiovascular screening. There were 8 cases (53%) and 16 controls (27%) who had a 5-yr risk of > or = 10-15%. Almost half of the events (7/15) occurred in pilots whose highest 5-yr risk was in the 5-10% range. Cases were 3.91 times more likely to have highest 5-yr risk score of > or =10-15% than controls (OR = 3.91, 95% CI 1.04-16.35). The accuracy of the highest risk scores were moderate (AUC = 0.723, 95% CI 0.583-0.863). The cutoff point of 10% is valid, with a specificity of 0.73, but low sensitivity (0.53). CONCLUSION Despite a valid and appropriate cutoff point, the tool had low sensitivity and was unable to predict almost half of the cardiovascular events.

Blood and Body Fluid Exposure Related Knowledge, Attitude and Practices of Hospital Based Health Care Providers in United Arab Emirates

Objectives Knowledge, attitudes, and practices of healthcare providers related to occupational exposure to bloodborne pathogens were assessed in a tertiary-care hospital in Middle East. Methods A cross-sectional study was undertaken using a self-administered questionnaire based on 3 paired (infectivity known vs. not known-suspected) case studies. Only 17 out of 230 respondents had an exposure in the 12 months prior to the survey and of these, only 2 had complied fully with the hospitals exposure reporting policy. Results In the paired case studies, the theoretical responses of participating health professionals showed a greater preference for initiating self-directed treatment with antivirals or immunisation rather than complying with the hospital protocol, when the patient was known to be infected. The differences in practice when exposed to a patient with suspected blood pathogens compared to patient known to be infected was statistically significant (p < 0.001) in all 3 paired cases. Failure to test an infected patients blood meant that an adequate risk assessment and appropriate secondary prevention could not be performed, and reflected the unwillingness to report the occupational exposure. Conclusion Therefore, the study demonstrated that healthcare providers opted to treat themselves when exposed to patient with infectious disease, rather than comply with the hospital reporting and assessment protocol.

Cardiovascular Investigations of Airline Pilots with Excessive Cardiovascular Risk

BACKGROUND This study examined the prevalence of airline pilots who have an excessive cardiovascular disease (CVD) risk score according to the New Zealand Guideline Group (NZGG) Framingham-based Risk Chart and describes their cardiovascular risk assessment and investigations. METHODS A cross-sectional study was performed among 856 pilots employed in an Oceania based airline. Pilots with elevated CVD risk that had been previously evaluated at various times over the previous 19 yr were reviewed retrospectively from the airlines medical records, and the subsequent cardiovascular investigations were then described. RESULTS There were 30 (3.5%) pilots who were found to have 5-yr CVD risk score of 10-15% or higher. Of the 29 pilots who had complete cardiac investigations data, 26 pilots underwent exercise electrocardiography (ECG), 2 pilots progressed directly to coronary angiograms and 1 pilot with abnormal echocardiogram was not examined further. Of the 26 pilots, 7 had positive or borderline exercise tests, all of whom subsequently had angiograms. One patient with a negative exercise test also had a coronary angiogram. Of the 9 patients who had coronary angiograms as a consequence of screening, 5 had significant disease that required treatment and 4 had either trivial disease or normal coronary arteries. CONCLUSION The current approach to investigate excessive cardiovascular risk in pilots relies heavily on exercise electrocardiograms as a diagnostic test, and may not be optimal either to detect disease or to protect pilots from unnecessary invasive procedures. A more comprehensive and accurate cardiac investigation algorithm to assess excessive CVD risk in pilots is required.

The Reporting of Blood and Body Fluid Exposure and Follow-up Practices in a Tertiary Care Hospital in United Arab Emirates

The study explored reporting and follow-up practices of blood and body fluid exposures in a tertiary care hospital in United Arab Emirates. Occupational Health clinic schedule was audited; medical files of staff members visiting the clinic to report an exposure during 2006 and 2007 were retrieved for detail review. The raw data was cleaned and original files were referred to recover any missing information. Results showed that 156 exposures were reported of which 77.6% were needle stick injuries; these were most commonly caused by handling/passing the needle, while disposing of the needle or while manipulating the needle in the patient. Wards were the most common location to report exposure (41%). Nurses reported 61% of the exposures followed by physicians 24% and laboratory staff 9%. Blood analysis was performed for 63% of patient whose blood came in contact with the staff. Post exposure blood test was performed for 91% of the staff. Treatment and follow-up was traced for 6 months at which 42.3% of the staff did not complete the follow-up. The retrospective clinical audit showed that exposures which were reported were not followed properly. The same types of preventable exposures were being reported like recapping and disposal related. We recommend a comprehensive blood and body fluid program to improve the safety and quality of work at the hospital.

Healthcare Providers' Perspectives on Occupational Exposure to HIV: A Cross-Cultural Comparison

Interviews were conducted with 24 doctors and nurses in United Arab Emirates and New Zealand to better understand factors that might influence behaviour after occupational exposure to HIV (e.g. following needlestick injury). While participants in both countries held similar beliefs regarding their primary health concerns, open reporting of HIV exposure in United Arab Emirates hospitals appeared threatened by sociocultural and political factors (particularly stigma and risk of deportation) compared to in New Zealand hospitals.