Occupational Exposures in Latin America (including the Caribbean, Central America, and South America)

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INTERNATIONAL HEALTHCARE WORKER SAFETY CENTER, UNIVERSITY OF VIRGINIA Occupational Exposures in Latin America (including the Caribbean, Central America, and South America) Bibliography of Country-Specific
INTERNATIONAL HEALTHCARE WORKER SAFETY CENTER, UNIVERSITY OF VIRGINIA Occupational Exposures in Latin America (including the Caribbean, Central America, and South America) Bibliography of Country-Specific & Regional Needlestick, Surveillance, and Exposure Risk Studies ARGENTINA Miceli M, Herrera F, Temporiti E, Li D, Vila A, Bonvehí P. Adherence to an occupational blood borne pathogens exposure management program among healthcare workers and other groups at risk in Argentina. Brazilian Journal of Infectious Diseases 2005;9: ABSTRACT- We conducted a retrospective review of 130 occupational blood borne pathogens exposure (BBP-OE) records at Centro de Estudios Médicos e Investigaciones Clínicas, a university hospital with an ongoing educational program and a postexposure management program for healthcare workers (HCWs) since 1995, in order to evaluate adherence to a hospital BBP-OE management program. We compared HCWs from our institution (Group 1) and HCWs from independent institutions that contract our postexposure management program (Group 2). Compliance with standard precautions in Group 1 was inadequate in 77%, 23%, and 16% of nurses, physicians, and others, respectively. A greater proportion of HCWs in Group 1 (74% vs. 40%) reported occupational accidents within two hours after exposure (p = ). No difference was observed regarding compliance with adherence to schedule, partial adherence, and loss at follow-up (14%, 33%, and 53%; p 0.05). Adherence to the standard of care for BBP- OE, including postexposure prophylaxis, was low (HIV: 53% and HBV: 63%). Knowledge of the seropositive status of the source patient did not improve adherence. We conclude that postexposure programs do not guarantee appropriate behavior by HCWs. General interventions and ongoing personnel education to modify individual attitudes are needed, as are continued efforts to assess HCWs' experiences with these programs, as well as the identification of strategies to improve adherence. BRAZIL Balsamo AC, Felli VE. Study of work accidents related to human body fluids exposure among health workers at a university hospital. [in Portuguese] Revista Latino-Americana de Enfermagem 2006;14: ABSTRACT- This descriptive and exploratory study from a quantitative approach aimed to characterize workers who were victims of work accidents related to human body fluids exposure and to evaluate the accident victim care protocol. The population consisted of 48 workers who were victims of work accidents involving exposure to human body fluids, from July 2000 to June Data were collected through a form and interviews. Results showed that nursing workers presented higher accident risk levels and that 87.50% involved piercing and cutting material, such as needles and butterflies (70%). As to the accident-related situation/activity, the workers indicated that 25% were due to an inadequate act during the procedure ; 19.64% mentioned that it happened and 29.17% answered that they did not have any suggestion. This study provided important tools to review and elaborate strategies to prevent accidents involving exposure to human body fluids. Brandi S, Benatti MC, Alexandre NM. [Accidents with sharp instruments in nurses in a university hospital in Campinas, Sao Paolo] [Portuguese] Revista da Escola de Enfermagem - USP 1998;32: Bredt CS, Monteiro AL, Ramalho M, Orrico G, Santos NJ, Ruiz EA, Felipo E, Caminada S. Rate of underreporting needle stick exposures in a referral center for treatment of patients infected with HIV Int Conf AIDS (Jul 9-14);13: abstract no. ThPpC1456. ABSTRACT- Background: After the official CDC recommendation to use chemoprophylaxis for post exposures injures with needle sticks, there is no data referring rates of underreported exposures. In the last year, only 18 exposures were reported in our institution, but the underreporting rate is not known. Objective: To evaluate the rate of underreporting exposures with needle stick injuries, possible factors related to this rate and the characteristics of the exposures. Methods: The Center for Referral and Training STD/ AIDS is a public health care facility for treatment of patients with AIDS. Data were collected within a month (10/1/99-10/31/99). Anonymous and voluntary questionnaires were answered by health care workers (HCW) ( physicians, registered nurses, nursing auxiliaries, dentists, lab technicians and housekeepers) Results: 164 HCW answered the questionnaire (67.5%, N = 243). 24 exposures were reported in the last year (14.6%); 79% of the exposures occurred in HCW admitted more than 1 year before; 91% of the exposures occurred during daytime and only 54% of the exposures were reported on the same day. 3/6 HCW didn't report their exposures because they judged that there was no risk. From the exposures reported, 58.3% occurred among nurses, 17% among housekeepers, 12.5% among lab technicians and 12.5% among physicians and dentists. Conclusions: Others authors report rates of underreporting between 70 and 90% among HCW. We found 21% of underreporting exposures. We believe that this rate is very high in an institution where 100% of the patients are infected with HIV. Educational efforts also must be carried out to reduce the time of reporting after the exposure. Brevidelli MM, Cianciarullo TI. Analysis of needlestick injuries at a university hospital: occurrence situations and tendencies. [in Portuguese] Revista Latino-Americana de Enfermagem 2002;10: ABSTRACT- Needlestick injuries remain the major source of risk of acquiring bloodborne diseases (AIDS, hepatitis B and C). Therefore, it is a priority discussing strategies of intervention based in sources of risk. The purpose of this study was to analyze needlestick injuries occurred at a university hospital. A data base construction made possible to identify the situations in which those accidents occur and standards of tendencies along the years. The data pointed out that the majority of needlestick injuries occurred while performing or assisting procedures. The introduction of the first prevention measures (universal precautions) reduced the total number of needlestick injuries. However, changes in needlestick-injury rates related to the recapping were not observed. Authors discussed the use of different prevention strategies: introduction of safety devices, changing the training focus, and the reorganization of the work environment and work practices. Brevidelli MM, Cianciarullo TI. Application of the health belief model to the prevention of occupational needlestick injuries. [in Portuguese] Revista de Saúde Pública 2001;35: ABSTRACT- Objective: To prevent health care professionals from acquiring bloodborne diseases (AIDS, hepatitis B and C), it is recommended that needles should not be recapped. However, these professionals frequently do not comply with this recommendation. The main purpose of this study was to assess this problem by using the Health Belief Model (HBM) to correlate the compliance with the recommendation of not recapping needles with: (1) these professionals' perceptions regarding one's susceptibility and severity to blood-borne infections; (2) their perceptions regarding the benefits and barriers to comply with this recommendation; and (3) the cues received to comply with this recommendation. Methods: Nursing staff at a hospital were asked: (1) how frequently they have recapped needles in the previous month; and (2) their HBM beliefs. To quantify and measure these beliefs, Likert scales were created and went through a validation regarding their content (referees) and construct (exploratory factorial analysis) and their reliability analysis (correlation of two halves and Cronbach's alpha coefficients). The relationship of beliefs and compliance with the recommendation of not recapping needles was obtained through regression analysis. Results: A nursing staff sample was obtained through voluntary cooperation (n=319). In this group, 75% admitted recapping needles at least once. Nursing professionals who most frequently follow the recommendation of not recapping needles have less than two years of professional experience and they are the group who perceive less barriers and more benefits to follow the recommendation. These results initiated a discussion on restructuring the professional training provided by the hospital. Canini SR, Gir E, Hayashida M, Machado AA. Needlestick injuries among nursing staff members at a university hospital in the interior of São Paulo State. [In Portuguese] Revista Latino-Americana de Enfermagem 2002;10: ABSTRACT- The risk presented by health care workers of acquiring bloodborne pathogens is well documented by the literature, which shows that Aids and Hepatitis acquired in the work setting is a real fact. This descriptive retrospective study was conducted in a university hospital in 1998 and aimed at analyzing needlestick injuries in nursing workers. Results showed that of the 398 officially reported occupational accidents, 125 (30.40%) were needlestick injuries and that 89 (71.20%) occurred among nursing workers. The most frequent occurrences took place during medication administration (25.78%). Authors concluded that nursing workers were the most frequently victimized workers by occupational accidents involving needlestick injuries. Canini SR, Gir E, Machado AA. Accidents with potentially hazardous biological material among workers in hospital supporting services. Revista Latino-Americana de Enfermagem 2005;13: ABSTRACT- Descriptive study was carried out to characterize the occupational accidents involving potentially contaminated material among workers of hospital supporting services. The study reviewed records of workers involved in these accidents and attended at a specialized outpatient clinic of a large tertiary care hospital between January 1997 and October A total of 2814 workers from different professional categories were attended during this period. Of these, 147 (5.2%) belonged to the hospital supporting services and were the victims of 156 accidents, auxiliary cleaning personnel (80.2%), and over a third of the workers had not received any dose of hepatitis B vaccine (35.4%). Most accidents were due to sharp injuries (96.8%) caused by inadequately discarded hollow needles. Chemoprophylaxis for HIV was not indicated in only 23.1% of cases. We conclude that these workers are also exposed to the possibility of acquiring blood-borne pathogens and that periodical education programs are needed. Chiodi MB, Marziale MH, Robazzi ML. Occupational accidents involving biological material among public health workers. Revista Latino-Americana de Enfermagem 2007;15: ABSTRACT: This descriptive research aimed to recognize the occurrence of work accidents (WA) involving exposure to biological material among health workers at Public Health Units in Ribeirão Preto-SP, Brazil. A quantitative approach was adopted. In 2004, 155 accidents were notified by means of the Work Accident Communication (WAC). Sixty-two accidents (40%) involved exposure to biological material that could cause infections like Hepatitis and Aids. The highest number of victims (42 accidents) came from the category of nursing aids and technicians. Needles were responsible for 80.6% of accidents and blood was the biological material involved in a majority of occupational exposure cases. This subject needs greater attention, so that prevention measures can be implemented, which consider the peculiarities of the activities carried out by the different professional categories. de Almeida CAF, Benatti MCC. Occupational exposure of health care workers to organic fluids and adhesion to chemorprophilaxis. [in Portuguese] Revista da Escola de Enfermagem da USP 2007;41: ABSTRACT- This study was aimed at investigating the characteristics of occupational accidents and of the workers that suffered them, and at evaluating the adhesion to chemoprophylaxis and to control and follow up tests after occu-pational accidents with risk of contamination by the human immunodeficiency virus and of the hepatitis B and C virus. This is a descriptive epidemiological study whose data was collected from the notifications of one of the administrative regions of the State of São Paulo's Secretary of Health between 2000 and It was observed 7.3% of refusals for chemoprophylaxis against human immunodeficiency virus by antiretrovirals, and that 40.6% of the care workers who accepted the chemoprophylaxis did not complete the treatment in the four weeks estimated for it. This diagnosis highlights the need for the institutions involved to establish strategies that make possible an increase in the adherence of health workers to these care procedures. de Almeida CB, Pagliuca LM, Leite AL. Labor accidents involving the eyes: assessment of occupational risks involving nursing workers. [in Portuguese] Revista Latino- Americana de Enfermagem 2005;13: ABSTRACT- The study aimed at identifying nursing workers who were victims of eye accidents and the type of accident; describing the measures taken and proposing Health Education methods. A descriptive and exploratory study was carried out at a public maternity hospital from September 2002 to January Data were collected through direct observation of the environment and interviews with workers. Subjects were ten professionals (one nurse, two technicians and seven nursing auxiliaries) who were victims of work accidents involving the eye. The accidents were grouped according to the type of material that caused the trauma: chemical substances (4), medication (3), mechanical trauma (1), scalp (1) and urine (1). The results reveal that hospital workers are vulnerable to labor accidents because the environment presents biological, chemical and physical risks. An important step to prevent the occurrence of new accidents would be the prevention of human mistakes through permanent training and the use of protection glasses. Garcia LP, Blank VLG. Management of occupational exposures to potentially infectious materials in dentistry. [in Portuguese] Revista de Saúde Pública 2008;42: ABSTRACT- Objective: To evaluate whether post-exposure measures referred by dentists and dental assistants are in line with those recommended by Brazilian health authorities. Methods: An epidemiological survey was carried out in a city of Southern Brazil, in Subjects (289 dentists and 104 dental assistants) were selected through random systematic sampling. Data were collected through self-reported questionnaires. Results: Washing the exposure site was the most common measure taken by dentists (98.5%) and assistants (89.2%) after sustaining a percutaneous injury. More dentists asked the patients if they carried blood-borne viruses after sustaining a percutaneous injury (44.6%) than a splash to a mucous membrane (14.3%). Taking post-exposure prophylaxis, notifying the accident and requesting blood tests to patients were the least remembered and taken measures by dentists and assistants. After sustaining an occupational exposure to potentially infectious materials, 10.8% of dentists and 2.7% of dental assistants sought medical care. Conclusions: Based on the Brazilian Ministry of Health recommendations, post-exposure management among the study population was considered, in general, inadequate, especially among dental assistants. Garcia LP, Blank VLG, Blank N. Adherence to personal protection against hepatitis B among dentists and dental assistants. [in Portuguese] Revista Brasileira de Epidemiologia 2007;10: ABSTRACT- Objective: The Hepatitis B virus poses arecognized occupational risk to dental careworkers. All dental care workers must beprotected through immunization, withcompletion of vaccine series, and monitoring of vaccine response. This study examined the adherence to personal protectionagainst hepatitis B, including vaccinationand use of personal protective equipment,among dentists and dental assistants in the city of Florianopolis, South of Brazil. Methods: In this cross-sectional study, datawere collected through self-reported questionnaires. Responses were obtained from 289 dentists and 104 dental assistants. Results: The prevalence of complete hepati-tis B series vaccination was 73.4% amongdentists and 39.4% among dental assistants. Only 32.1% and 21.9% of them, respectively, monitored vaccine response. Acomplete vaccine series was associatedwith year of graduation as of 1997 (PR =1.16; IC95% = ) and working mainlyin a surgical specialty (PR = 1.24; IC95% = ) among dentists, and with attending a training program among assistants (PR = 1.96; IC95% = ). The proportion of always wearing gloves, masks,and protective eyewear was higher amongdentists than assistants. Conclusion: Campaigns are necessary to vaccinate thosewho neither have been vaccinated norhave completed vaccine series and to inform about the need of vaccine responsemonitoring. Educational training is recom-mended to improve adherence to personalprotection, specially focused on dental assistants. Grande Gimenez Marino C, El-Far F, Barsanti Wey S, Servolo Medeiros EA; Hospital Epidemiology Committee, Federal University at Sao Paulo, SP, Brazil. Cut and puncture accidents involving health care workers exposed to biological materials. Brazilian Journal of Infectious Diseases 2001;5: ABSTRACT- The first report of occupational acquisition of HIV appeared in 1984, and, by June, 1997, the Centers for Disease Control and Prevention (CDC) had reported 52 documented cases of sero conversion following occupational exposure to HIV 1 by health care workers of those cases. 47 (90.3%) were exposed to blood. The most frequent type of accident reported was percutaneous needlestick injury. Prospective studies have estimated that the risk of HIV transmission following percutaneous exposure to infected blood is 0.3% (Confidence Interval 95% = 0.2% to 0.5%). Following a mucous membrane exposure, the risk is 0.09% (CI 95% = 0.006% to 0.5%). The risk of hepatitis B acquisition ranges from 6% to 30%, and hepatitis C acquisition, 3% to 10%. Since 1992, the São Paulo Hospital's Hospital Infection Prevention and Control Service (SPCIH) has notified and treated all workers exposed to accidents involving biological materials. In the last six years, we have handled approximately 1,300 cases of reported accidents, of which 90% were percutaneous, most involving needlesticks. Such cases were frequently caused by the inadequate disposal and recapping of needles. In these accidents, 20% of the source patients were HIV positive, 10% were hepatitis C positive, and 7.6% were hepatitis B positive. This review summarizes the guidelines for a standardized response when dealing with accidents involving health care workers. Transmission of hepatitis B and HIV can be reduced if adequate preventive measures are taken in advance. If proper prophylaxis is not being done, it should be initiated immediately. Machado AA, da Costa JC, Gir E, Moriya TM, Figueiredo FC. [Risk of infection by the human immune deficiency virus (HIV) among health professionals.] [in Portuguese] Revista de Saúde Pública 1992;26:54-6. ABSTRACT- To investigate the occupational risk of infection by HIV among health professionals, 36 cases of occupational accidents involving exposure to material potentially infected with HIV, reported at a Brazilian General Hospital (HCFMRP), were studied. Of the injured workers 75% were female and 25% male (ranging from 23 to 49 years old) and just one of them had high-risk behavior of HIV infection. Of these health professionals, 52.8% were nursing auxiliaries, 19.4%, nurses, 13.9%, nursing attendants, 5.5%, laboratory technicians, 2.8% surgery instrumentalist, 2.8% accountants and 2.8% nursing technicians. In 47.2% of cases the workers had a parenteral exposure to blood (needlestick injuries). The right hand and fingers were the body areas most effected. The serologic test to detect HIV antibodies by the ELISA method was required of all the workers
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