A questionnaire study was carried out of all orthopedic surgical procedures in the operating rooms of a teaching hospital over an 8-week period to describe the frequency and circumstances of accidental blood contact. Blood exposure occurred in 11% of the procedures. Contamination of intact skin was the most common incident (79%); percutaneous injury occurred in 13%. The majority of the incidents were believed to be preventable.
Although stainless steel has been produced for more than a hundred years, exposure-related mortality data for production workers are limited.
To describe cause-specific mortality in Finnish ferrochromium and stainless steel workers.
We studied Finnish stainless steel production chain workers employed between 1967 and 2004, from chromite mining to cold rolling of stainless steel, divided into sub-cohorts by production units with specific exposure patterns. We obtained causes of death for the years 1971-2012 from Statistics Finland. We calculated standardized mortality ratios (SMRs) as ratios of observed and expected numbers of deaths based on population mortality rates of the same region.
Among 8088 workers studied, overall mortality was significantly decreased (SMR 0.77; 95% confidence interval [CI] 0.70-0.84), largely due to low mortality from diseases of the circulatory system (SMR 0.71; 95% CI 0.61-0.81). In chromite mine, stainless steel melting shop and metallurgical laboratory workers, the SMR for circulatory disease was below 0.4 (SMR 0.33; 95% CI 0.07-0.95, SMR 0.22; 95% CI 0.05-0.65 and SMR 0.16; 95% CI 0.00-0.90, respectively). Mortality from accidents (SMR 0.84; 95% CI 0.67-1.04) and suicides (SMR 0.72; 95% CI 0.56-0.91) was also lower than in the reference population.
Working in the Finnish ferrochromium and stainless steel industry appears not to be associated with increased mortality.
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Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers The aim of this study was to implement and evaluate a practical intervention programme designed to help staff in health care work-places to deal with patient violence towards staff. The programme was part of a controlled, prospective study that ran for 1 year. The study population was comprised of staff at 47 health care work-places, randomly assigned to either the intervention or control group. The Violent Incident Form (VIF), a checklist designed to simplify the registration of violent events, was introduced at all 47 work sites, where staff were instructed to register all types of violent and threatening incidents directed towards them during the 1-year study period. The intervention work-places also followed a structured feedback programme, where the circumstances concerning registered incidents were discussed on a regular basis with work-place staff. Baseline examination of the study groups revealed no statistically significant difference with regard to self-reported violence in the past year. At the conclusion of the 1-year period, the difference between groups was statistically significant (P
The objective of this study was to describe the mechanisms of percutaneous blood exposure (PCE) among doctors and discuss rational strategies for prevention. Data were obtained as part of a nation-wide questionnaire survey of occupational blood exposure among hospital employed doctors in Denmark. The doctors were asked to describe their most recent PCE, if any, within the previous 3 months. Detailed information on the instruments, procedures, circumstances and mechanisms that caused the PCE was obtained. Of 9375 doctors, 6256 (67%) responded, and 6005 questionnaires were eligible for analysis. Of 971 described PCE the majority were caused by suture needles (n = 483), i.v.-catheter-stylets (n = 94), injection needles (n = 75), phlebotomy needles (n = 53), scalpels (n = 45), arterial blood sample needles (n = 41) and bone fragments (n = 23). Inattentiveness was the most common cause, contributing to 30.5% of all PCE. Use of fingers rather than instruments was a major cause of injury in surgical specialities and was a contributing cause of 36.9% PCE on suture needles. Common contributing causes when fingers were used (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. It was often argued that instruments were not practical to use or might harm the tissue. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines like recapping only, but other mechanisms like sudden patient movements and 'acute situation' were common, especially in the case of PCE on i.v.-catheter-stylets. It is concluded that the exposure mechanisms of PCE reflect both unsafe routines, difficult working conditions and unsafe devices. Education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.
Surgical team members constantly are exposed to blood during procedures. Inadvertent injuries (e.g., needle sticks, cuts) and contaminations expose team members and patients to the risk of transmission of bloodborne pathogens. Injuries and contaminations can be decreased significantly for scrub people and first assistants, however, by introducing new working methods (i.e., no-touch instrument passing technique, instrument neutral zone).
Much has been written about client violence against social workers; however, little attention has been given to reporting behavior of social workers who have been the target of such violence. The study discussed in this article documents the prevalence of client violence among a sample of social workers from a broad range of social work settings. It examines respondents' reasons for not reporting or for reporting client violence to management. A random sample of 300 social workers was mailed a questionnaire that examined these issues. A total of 171 questionnaires were returned, for a response rate of 57 percent. The majority of respondents had experienced some form of violence from clients. Approximately one-quarter of respondents indicated that they did not report an incident of violence perpetrated against them by a client.
To describe the process through which Ireland changed its policies towards smoking in work-places and distil lessons for others implementing or extending smoke-free laws. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: This analysis is informed by a review of secondary sources including a commissioned media analysis, documentary analysis and key informant interviews with policy actors who provide insight into the process of smoke-free policy development. The policy analysis techniques used include the development of a time-line for policy reform, stakeholder analysis, policy mapping techniques, impact analysis through use of secondary data and a review process. The policy analysis triangle, which highlights the importance of examining policy content, context, actors and processes, will be used as an analytical framework.
The importance of the political, economic, social and cultural context emerged clearly. The interaction of the context with the policy process both in identification of need for policy and its formulation demonstrated the opportunity for advocates to exert influence at all points of the process. The campaign to support the legislation had the following characteristics: a sustained consistent simple health message, sustained political leadership/commitment, a strong coalition between the Health Alliance, the Office of Tobacco Control and the Department of Health and Children, with cross-party political support and trade union support. The public and the media support clearly defined the benefit of deliberate and consistent planning and organization of a communication strategy.
The Irish smoke-free legislation was a success as a policy initiative because of timing, dedication, planning, implementation and the existence of strong leadership and a powerful convinced credible political champion.
Although acts of threats and violence are problems that have received increased attention in recent years within Swedish pre-hospital care, only a handful of scientific studies have been carried out in this field. Threats and violence have a negative influence on the well-being of ambulance personnel. The aim in this study was both to investigate the incidents of threats and violence within the Swedish ambulance service and to describe these situations. Data was collected with questionnaires answered by 134 registered nurses and paramedics from 11 ambulance stations located in four counties. The respondents' experiences of pre-hospital care varied from 3 months to 41 years (mean=12 years, median=8 years). The results showed that 66% of the ambulance personnel experienced threats and/or violence during their work while 26% experienced threats and 16% faced physical violence during the last year. The most common kind of threat was threats of physical violence with 27% of the respondents experiencing threats involving weapons. Commonly occurring physical violence was in the form of pushes, punches, kicks and bites. In most cases, the perpetrator was the patient himself often under the influence of alcohol or drugs. The most serious situations occurred when the reason for raising the ambulance alarm was intoxication or a decreased level of consciousness.
The aim of this study was to quantitatively estimate the long-term trends of occupational exposure to chemical agents in Finland for surveillance, prevention, and risk assessment purposes.
We studied trends by utilizing the Finnish job-exposure matrix (FINJEM), which includes occupation-specific estimates of the prevalence P (percent of employed) and average level L (agent-specific units) of inhalation exposure to chemical agents at different time periods. We used FINJEM data to calculate national estimates of the numbers of exposed workers (N exp), and the prevalence of and level of exposure to 41 chemical agents in 1950, 1970, 1990, and 2008. We also estimated the prevalence of employees exposed to levels exceeding 50% of the Finnish occupational exposure limit (OEL) (P high) and national occupational inhalation exposure (NOIE = N exp × L). Future exposures in 2020 were estimated according to the predicted change of the occupational structure of the labor force and the observed agent-specific exposure trends in 1990-2008. We estimated dermal exposure indirectly from the statistics of occupational skin diseases in 1975-2009.
Inhalation exposure to most chemical agents had decreased. Using 1990 as the reference (100), the median values of P for 1950, 1970, 1990, 2008, and 2020 were 91, 149, 100, 58, and 41, respectively. The corresponding values were 218, 224, 100, 30, and 14 for P high, 151, 121, 100, 78, and 66 for L, and 119, 176, 100, 38, and 20 for NOIE. The trends varied considerably according to the agent. Exposure of, for example, asbestos, benzene, and benzo(a)pyrene substantially decreased. The annual incidence of occupational skin diseases due to chemical factors decreased from 6.9 per 10 000 employed in 1975-1979 to 4.6 per 10 000 in 2000-2009, suggesting a decrease in dermal exposure.
Inhalation exposure to most chemical agents has decreased in Finland since 1970. High exposures and the average level of exposure started to decrease already in the 1950s. The declining incidence of occupational skin diseases suggests that dermal exposure has also diminished. However, high exposures still exist and cause a substantial amount of occupational diseases and symptoms. Chemical exposures and the related disease burden are expected to continue decreasing in the future. These results cannot be generalized to other countries, particularly if the development phase of technology and the occupational structure of the labor force differ significantly from those in Finland.