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Identifying, preventing and controlling needle-stick injuries in Indonesia.

机译：在印度尼西亚识别，预防和控制针刺伤害。

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摘要

The main objective of this dissertation is to develop recommendations for prevention of needle stick injuries in Indonesia, especially in healthcare settings. In order to address this objective, the following specific aims were proposed: 1) calculate incidence of needle stick injuries (NSIs), and identify individual and institutional risk factors; 2) assess the burden of sharps injuries (SIs) in free standing medical laboratories (FSLs) and describe the responses of FSLs following an SI; 3) conduct a meta-analysis to produce quantitative summary estimates of the effectiveness of NSI- interventions from the published literature; and 4) estimate the number of Indonesian HCWs infected by HBV due to NSIs.;Results of Aim 1. This research determined that the incidence rate of NSIs among HCWs on the principal Indonesian islands of Java and Bali was 0.43 per worker/year. A number of risky behaviors and practices were reported by HCWs and found to increase the risk of NSI. These included leaving used needles scattered inside the workplace and disposing used needles into public trash cans, burning or burying them. The risk of NSI was found to increase with the number of injections given per day, and there was evidence that this trend was not linear but that there was a lower risk for an intermediate workload of two to eight injections per day.;Results of Aim 2. FSLs use a variety of quality assurance procedures to control their work. Of 741 FSLs included in this analysis, 106 (14.3%) reported sharps injuries in the previous year. Of these, only 42.5% said that they "reported" the SI to the appropriate authority within their own healthcare organization. About one third (33.7%) said that they made a formal written record of the SI occurring, and nearly 40% said that they conducted an evaluation of the event to learn how to prevent future occurrences. Two factors that were significantly associated with the evaluation response following an SI were having a standard operating procedure (SOP) following an SI and routinely conducting quality audits with follow up activities.;Results of Aim 3. A systematic review of the peer reviewed medical literature revealed that introduction of safety engineered devices (SEDs) combined with training was associated with greater protection than training interventions alone. The summary random effects of the training intervention was 0.66 (95% CI = 0.50 to 0.89). The summary random effects across the five studies that assessed the efficacy of SEDs was 0.51 (95% CI --- 0.40 to 0.64). There were eight studies evaluating the effectiveness of training plus SEDs, with a summary random effects of 0.38 (95% CI = 0.28 to 0.50).;Results of Aim 4. Using a standard disease simulation model, we estimated that there were 4,899 (95% CI; 2,141-8,282) cases of HBV caused by NSIs among Indonesian HCWs in 2013. These cases were in addition to an expected annual incidence of 2,225 (95% CI; 2,089-2,357) additional cases from all other sources. Two strategies for reducing this burden are discussed: increasing HBV vaccination protection (currently only 37%) to 90% could decrease the number of NSI-acquired HBVs cases from 4,899 to about 1,000, while reducing the rate of NSIs (currently 0.43 per worker/year) through the widespread introduction of SEDs and standard precaution would reduce NSIs by 62%.
机译：本文的主要目的是在印度尼西亚，特别是在医疗机构中，提出预防针刺伤害的建议。为了实现这一目标，提出了以下具体目标：1）计算针刺伤害（NSI）的发生率，并确定个人和机构风险因素； 2）评估独立式医学实验室（FSL）中的锐器伤害（SI）负担，并描述遵循SI后FSL的反应； 3）进行荟萃分析，以根据已发表的文献对NSI干预措施的有效性进行定量总结评估； 4）估计由于NSI而被HBV感染的印度尼西亚HCW的数量。目标1的结果。该研究确定印度尼西亚主要爪哇岛和巴厘岛HCW中NSI的发生率为每名工人每年0.43。医护工作者报告了许多危险行为和做法，发现它们增加了NSI的风险。这些措施包括将用过的针头留在工作场所内，并将用过的针头放入公共垃圾桶中，进行焚烧或掩埋。发现NSI的风险随着每天注射次数的增加而增加，并且有证据表明这种趋势不是线性的，但是每天进行2至8次中等工作量的风险较低。 2. FSL使用各种质量保证程序来控制其工作。在此分析中，在741个FSL中，有106个（14.3％）报告了上一年的锋利伤害。在这些人中，只有42.5％的人表示，他们将SI“报告”给了自己的医疗机构内的适当机构。大约三分之一（33.7％）的人说他们对SI的发生进行了正式的书面记录，而近40％的人说他们对事件进行了评估以了解如何预防未来的事件。与SI后评估反应显着相关的两个因素是，在执行SI后具有标准的操作程序（SOP），并定期进行质量审计并进行后续活动。;目标3的结果。同行评审医学文献的系统评价揭示了安全工程设备（SED）与培训相结合的引入比单独的培训干预措施具有更大的保护作用。训练干预的总体随机效果为0.66（95％CI = 0.50至0.89）。评估SED疗效的五项研究的随机效应总和为0.51（95％CI --- 0.40至0.64）。有八项研究评估了训练加SED的有效性，汇总随机效应为0.38（95％CI = 0.28至0.50）。目标4的结果。使用标准的疾病模拟模型，我们估计有4,899（95在2013年的印度尼西亚HCW中，由NSI引起的％CI； 2,141-8,282）HBV病例。这些病例是所有其他来源的其他预期年发病率2,225（95％CI; 2,089-2,357）的新增病例。讨论了减轻这种负担的两种策略：将HBV疫苗接种保护（目前只有37％）提高到90％可以将NSI获得的HBV病例数从4,899减少到约1,000，同时降低NSI发生率（目前每名工人0.43 /年）通过广泛采用SED和标准预防措施将使NSI减少62％。

著录项

  • 作者

    Tarigan, Lukman Hakim.;

  • 作者单位

    University of Massachusetts Lowell.;

  • 授予单位 University of Massachusetts Lowell.;
  • 学科 Health Sciences Epidemiology.;Health Sciences Occupational Health and Safety.;Health Sciences Public Health.
  • 学位 Sc.D.
  • 年度 2014
  • 页码 144 p.
  • 总页数 144
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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