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W2006602890 abstract "To the Editor:I read with interest the article by Nagao et al that describes accidental exposures to blood and body fluid in operating rooms and the issue of underreporting.1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar In their article, the authors raise some very important points regarding mucocutaneous and percutaneous exposures in Japan, as well as the critical issue of underreporting.Nagao et al utilized data from a Japanese version of the Exposure Prevention Information Network (EPINet), a surveillance system originally developed by the International Healthcare Worker Safety Centre at the University of Virginia in 1991. Between 1993 and 1994, the first Japanese hospitals began using translated versions of EPINet,2Hosomi Y. EPINet 1 (Japanese version).Infect Control. 1997; 6: 99-106Google Scholar, 3Kidouchi K. Kashiwamata M. Nakamura C. Katoh T. Mizuno Y. Watanabe S. The basics for establishing a needlestick injury prevention program in hospitals (Japanese version).Kansenshogaku Zasshi. 1997; 71: 108-115PubMed Google Scholar and, by December 1995, a Japanese-language version was ready for general use.4Hosomi Y. EPINet 2 (Japanese version).Infect Control. 1997; 6: 81-87Google Scholar The origins of Japanese exposure surveillance programs can be traced back a little further than this, however, to the early 1990s when Kiyoshi Kidouchi of the Nagoya Municipal Hospital first became concerned about hepatitis C exposures among hospital staff.5Jagger J. Parker G. Perry J. Japanese-US Collaborative Program: sharing data, learning lessons.Adv Exp Prev. 2002; 6: 3-5Google Scholar Realizing there was no system to document and track these exposures, Kidouchi translated EPINet into Japanese and introduced sharps injury surveillance to his hospital.3Kidouchi K. Kashiwamata M. Nakamura C. Katoh T. Mizuno Y. Watanabe S. The basics for establishing a needlestick injury prevention program in hospitals (Japanese version).Kansenshogaku Zasshi. 1997; 71: 108-115PubMed Google Scholar The project quickly gained wider recognition, leading the Japanese Ministry of Health, Labour and Welfare to fund an occupational infection control and prevention project coordinated at the University of Tokyo. The first national needlestick injury surveillance program in Japan was officially launched during 1996. By 2007, the national surveillance network (EPINet Japan) comprised 214 hospitals.6Yoshikawa T. Kidouchi K. Kimura S. Okubo T. Perry J. Jagger J. Needlestick injuries to the feet of Japanese healthcare workers: a culture-specific exposure risk.Infect Control Hosp Epidemiol. 2007; 28: 215-218Crossref PubMed Scopus (10) Google ScholarVarious studies utilizing Japanese EPINet data have now been published. In one of the earliest investigations,3Kidouchi K. Kashiwamata M. Nakamura C. Katoh T. Mizuno Y. Watanabe S. The basics for establishing a needlestick injury prevention program in hospitals (Japanese version).Kansenshogaku Zasshi. 1997; 71: 108-115PubMed Google Scholar 1989-1994 injury data from 5 municipal hospitals was analyzed, revealing that the overall number of needlestick injuries had been increasing each year. Regarding causative device, a study of EPINet data collected from 292 Japanese hospitals between 1996 and 1998 found that syringes and butterfly needles were most commonly to blame.5Jagger J. Parker G. Perry J. Japanese-US Collaborative Program: sharing data, learning lessons.Adv Exp Prev. 2002; 6: 3-5Google Scholar Regarding the personnel affected, an analysis of data collected from a single hospital between 1997 and 2004 revealed that almost three quarters of sharps injuries were sustained by registered nurses.7Nagao Y. Baba H. Torii K. Nagao M. Hatakeyama K. Iinuma Y. et al.A long-term study of sharps injuries among health care workers in Japan.Am J Infect Control. 2007; 35: 407-411Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Interestingly, this latter result is contrary to findings from the study by Nagao et al,1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar in which more physicians were injured than scrub nurses. Among the physicians in Nagao et al's study, suturing was the most common activity being undertaken when an injury occurred, which is similar to a recent investigation of their Chinese counterparts, in which one quarter of all physicians surveyed had experienced a suture-related injury in the previous year.8Smith D.R. Wei N. Zhang Y.J. Wang R.S. Needlestick and sharps injuries among a cross-section of physicians in Mainland China.Am J Ind Med. 2006; 49: 169-174Crossref PubMed Scopus (25) Google ScholarAnother interesting finding by the authors1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar was that many injuries sustained by scrub nurses occurred during the counting and sorting of sharps. The authors point out that this procedure is commonly performed after surgery, presumably at a time when nurses are likely to be fatigued. The issue of fatigue and its relationship with needlestick injuries has also been explored by other Japanese research, albeit with varying results. In one study,9Smith D.R. Mihashi M. Adachi Y. Nakashima Y. Ishitake T. Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital.J Hosp Infect. 2006; 64: 44-49Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar for example, excessive fatigue after work was associated with an increased risk of multiple needlestick and sharps injuries. In another Japanese study however,10Suzuki K. Ohida T. Kaneita Y. Yokoyama E. Uchiyama M. Daytime sleepiness, sleep habits and occupational accidents among hospital nurses.J Adv Nurs. 2005; 52: 445-453Crossref PubMed Scopus (99) Google Scholar needlestick injuries were correlated with excessive daytime sleepiness in a univariate statistical model, although these associations disappeared during multivariate analysis.Aside from demonstrating some epidemiologic features of mucocutaneous and percutaneous injuries in Japan, Nagao et al1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar also highlight the critical issue of underreporting. Underreporting has long been recognized as a potential confounder for injury surveillance programs because it can seriously diminish the accuracy of routinely collected data if a significant proportion of injuries are not being reported. As early as 1983, a study from the United States had revealed that three quarters of all needlestick injuries in a university hospital were not being reported.11Hamory B.H. Underreporting of needlestick injuries in a university hospital.Am J Infect Control. 1983; 11: 174-177Abstract Full Text PDF PubMed Scopus (114) Google Scholar This result is similar to the current study by Nagao et al1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar in which less than one quarter of staff who experienced exposure injuries had actually reported every incident. The Japanese authors also found major differences in reporting rates by job description, with more scrub nurses than surgeons “always” reporting any injuries they sustained. Alarmingly, however, around 1 in 5 surgeons never reported any mucocutaneous or percutaneous injury they had sustained.1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google ScholarThese results clearly suggest that the reporting of exposure incidents is not a random event. Indeed, various risk factors for the underreporting of needlestick and sharps injuries have now been elucidated. Organization factors appear to be important, with a recent Japanese study12Smith D.R. Mihashi M. Adachi Y. Shouyama Y. Mouri F. Ishibashi N. et al.Organizational climate and its relationship with needlestick and sharps injuries among Japanese nurses.Am J Infect Control. 2009; 177: 544-550Google Scholar revealing that nurses working in departments with minimal conflict were less likely to underreport any injuries they sustained. Exactly why some staff choose to report their injuries and others do not has long been a topic of debate. In the study by Nagao et al,1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar for example, 43% of surgeons and 57% of scrub nurses only reported their injuries if the source patient was seropositive. Whereas the introduction of EPINet Japan may have helped increase the reporting rate of these incidents to a certain extent,2Hosomi Y. EPINet 1 (Japanese version).Infect Control. 1997; 6: 99-106Google Scholar, 4Hosomi Y. EPINet 2 (Japanese version).Infect Control. 1997; 6: 81-87Google Scholar the overall reporting rate of sharps injuries is still believed to be insufficient.7Nagao Y. Baba H. Torii K. Nagao M. Hatakeyama K. Iinuma Y. et al.A long-term study of sharps injuries among health care workers in Japan.Am J Infect Control. 2007; 35: 407-411Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Clearly, a greater emphasis on injury reporting needs to be considered in Japanese hospitals so that health care workers from all disciplines routinely report their injuries to management, regardless of whether the device was clean or whether the patient was suffering from a potentially transmissible disease. Underreporting also has significant implications for epidemiologic research because the collection of accurate data represents an essential component for reducing needlestick injuries.13Fletcher C.E. Accurate data: an essential component in reducing needlestick injuries.Policy Polit Nurs Pract. 2000; 1: 316-324Crossref Scopus (5) Google Scholar To ensure the accuracy of exposure injury data on which Japanese preventive measures will be based, it is important to ensure that reporting rates continue to increase.Another key issue raised by the authors was that of prevention, including preventive behaviors and preventive devices.1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar It has long been known that preventive measures offer a first line of defense in infection control, and, as such, the most direct way to reduce percutaneous injuries is to simply make devices safer, wherever possible.14Jagger J.C. Are Australia's healthcare workers stuck with inadequate needle protection? The most direct way to reduce percutaneous injuries is to make devices safer.Med J Aust. 2002; 177: 405-406PubMed Google Scholar This strategy is not a panacea however, with an earlier Japanese study, for example, revealing that more than half of all injuries from a winged steel needle occurred despite the existence of protective mechanisms.7Nagao Y. Baba H. Torii K. Nagao M. Hatakeyama K. Iinuma Y. et al.A long-term study of sharps injuries among health care workers in Japan.Am J Infect Control. 2007; 35: 407-411Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar This finding suggests that more work still needs to be done to ensure that devices are safer. To further expand the scope of preventive efforts, other more broadly focused measures also need to be considered by infection control professionals. Ergonomic checklists for training in the prevention of needlestick injuries have now been trialled in Japan15Yoshikawa T. Ito A. Sakai K. Kogi K. How to design a practical action checklist for preventing needlestick injuries among health care workers.J UOEH. 2006; 28: 63-68Google Scholar and may represent a key strategy for future improvement.A shift in national priorities also needs to occur. Despite improvements in recent years, it has been noted that, whereas organized hospital infection control programs are now widely implemented in Japan, they remain frequently underresourced.16Sekimoto M. Imanaka Y. Kobayashi H. Okubo T. Kizu J. Kobuse H. et al.Impact of hospital accreditation on infection control programs in teaching hospitals in Japan.Am J Infect Control. 2008; 36: 212-219Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar A national incentive system paid to hospitals that promoted institutional infection control programs was also abolished in 2006.17Sekimoto M. Imanaka Y. Kobayashi H. Okubo T. Kizu J. Kobuse H. et al.Factors affecting performance of hospital infection control in Japan.Am J Infect Control. 2009; 37: 136-142Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar As a result, there is increasing concern that the current climate with its punitive approaches for poor performance and lack of financial incentives may simply lead to cosmetic changes by hospitals to meet accreditation standards.16Sekimoto M. Imanaka Y. Kobayashi H. Okubo T. Kizu J. Kobuse H. et al.Impact of hospital accreditation on infection control programs in teaching hospitals in Japan.Am J Infect Control. 2008; 36: 212-219Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar For these reasons, it can be seen that greater effort now needs to be focussed on protecting health care workers from needlestick and sharps injuries in Japan, particularly in the area of human resources for infection control. Additional research also needs to be undertaken at a national level to help elucidate the extent of underreporting among Japanese health care professionals. To the Editor: I read with interest the article by Nagao et al that describes accidental exposures to blood and body fluid in operating rooms and the issue of underreporting.1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar In their article, the authors raise some very important points regarding mucocutaneous and percutaneous exposures in Japan, as well as the critical issue of underreporting. Nagao et al utilized data from a Japanese version of the Exposure Prevention Information Network (EPINet), a surveillance system originally developed by the International Healthcare Worker Safety Centre at the University of Virginia in 1991. Between 1993 and 1994, the first Japanese hospitals began using translated versions of EPINet,2Hosomi Y. EPINet 1 (Japanese version).Infect Control. 1997; 6: 99-106Google Scholar, 3Kidouchi K. Kashiwamata M. Nakamura C. Katoh T. Mizuno Y. Watanabe S. The basics for establishing a needlestick injury prevention program in hospitals (Japanese version).Kansenshogaku Zasshi. 1997; 71: 108-115PubMed Google Scholar and, by December 1995, a Japanese-language version was ready for general use.4Hosomi Y. EPINet 2 (Japanese version).Infect Control. 1997; 6: 81-87Google Scholar The origins of Japanese exposure surveillance programs can be traced back a little further than this, however, to the early 1990s when Kiyoshi Kidouchi of the Nagoya Municipal Hospital first became concerned about hepatitis C exposures among hospital staff.5Jagger J. Parker G. Perry J. Japanese-US Collaborative Program: sharing data, learning lessons.Adv Exp Prev. 2002; 6: 3-5Google Scholar Realizing there was no system to document and track these exposures, Kidouchi translated EPINet into Japanese and introduced sharps injury surveillance to his hospital.3Kidouchi K. Kashiwamata M. Nakamura C. Katoh T. Mizuno Y. Watanabe S. The basics for establishing a needlestick injury prevention program in hospitals (Japanese version).Kansenshogaku Zasshi. 1997; 71: 108-115PubMed Google Scholar The project quickly gained wider recognition, leading the Japanese Ministry of Health, Labour and Welfare to fund an occupational infection control and prevention project coordinated at the University of Tokyo. The first national needlestick injury surveillance program in Japan was officially launched during 1996. By 2007, the national surveillance network (EPINet Japan) comprised 214 hospitals.6Yoshikawa T. Kidouchi K. Kimura S. Okubo T. Perry J. Jagger J. Needlestick injuries to the feet of Japanese healthcare workers: a culture-specific exposure risk.Infect Control Hosp Epidemiol. 2007; 28: 215-218Crossref PubMed Scopus (10) Google Scholar Various studies utilizing Japanese EPINet data have now been published. In one of the earliest investigations,3Kidouchi K. Kashiwamata M. Nakamura C. Katoh T. Mizuno Y. Watanabe S. The basics for establishing a needlestick injury prevention program in hospitals (Japanese version).Kansenshogaku Zasshi. 1997; 71: 108-115PubMed Google Scholar 1989-1994 injury data from 5 municipal hospitals was analyzed, revealing that the overall number of needlestick injuries had been increasing each year. Regarding causative device, a study of EPINet data collected from 292 Japanese hospitals between 1996 and 1998 found that syringes and butterfly needles were most commonly to blame.5Jagger J. Parker G. Perry J. Japanese-US Collaborative Program: sharing data, learning lessons.Adv Exp Prev. 2002; 6: 3-5Google Scholar Regarding the personnel affected, an analysis of data collected from a single hospital between 1997 and 2004 revealed that almost three quarters of sharps injuries were sustained by registered nurses.7Nagao Y. Baba H. Torii K. Nagao M. Hatakeyama K. Iinuma Y. et al.A long-term study of sharps injuries among health care workers in Japan.Am J Infect Control. 2007; 35: 407-411Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Interestingly, this latter result is contrary to findings from the study by Nagao et al,1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar in which more physicians were injured than scrub nurses. Among the physicians in Nagao et al's study, suturing was the most common activity being undertaken when an injury occurred, which is similar to a recent investigation of their Chinese counterparts, in which one quarter of all physicians surveyed had experienced a suture-related injury in the previous year.8Smith D.R. Wei N. Zhang Y.J. Wang R.S. Needlestick and sharps injuries among a cross-section of physicians in Mainland China.Am J Ind Med. 2006; 49: 169-174Crossref PubMed Scopus (25) Google Scholar Another interesting finding by the authors1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar was that many injuries sustained by scrub nurses occurred during the counting and sorting of sharps. The authors point out that this procedure is commonly performed after surgery, presumably at a time when nurses are likely to be fatigued. The issue of fatigue and its relationship with needlestick injuries has also been explored by other Japanese research, albeit with varying results. In one study,9Smith D.R. Mihashi M. Adachi Y. Nakashima Y. Ishitake T. Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital.J Hosp Infect. 2006; 64: 44-49Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar for example, excessive fatigue after work was associated with an increased risk of multiple needlestick and sharps injuries. In another Japanese study however,10Suzuki K. Ohida T. Kaneita Y. Yokoyama E. Uchiyama M. Daytime sleepiness, sleep habits and occupational accidents among hospital nurses.J Adv Nurs. 2005; 52: 445-453Crossref PubMed Scopus (99) Google Scholar needlestick injuries were correlated with excessive daytime sleepiness in a univariate statistical model, although these associations disappeared during multivariate analysis. Aside from demonstrating some epidemiologic features of mucocutaneous and percutaneous injuries in Japan, Nagao et al1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar also highlight the critical issue of underreporting. Underreporting has long been recognized as a potential confounder for injury surveillance programs because it can seriously diminish the accuracy of routinely collected data if a significant proportion of injuries are not being reported. As early as 1983, a study from the United States had revealed that three quarters of all needlestick injuries in a university hospital were not being reported.11Hamory B.H. Underreporting of needlestick injuries in a university hospital.Am J Infect Control. 1983; 11: 174-177Abstract Full Text PDF PubMed Scopus (114) Google Scholar This result is similar to the current study by Nagao et al1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar in which less than one quarter of staff who experienced exposure injuries had actually reported every incident. The Japanese authors also found major differences in reporting rates by job description, with more scrub nurses than surgeons “always” reporting any injuries they sustained. Alarmingly, however, around 1 in 5 surgeons never reported any mucocutaneous or percutaneous injury they had sustained.1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar These results clearly suggest that the reporting of exposure incidents is not a random event. Indeed, various risk factors for the underreporting of needlestick and sharps injuries have now been elucidated. Organization factors appear to be important, with a recent Japanese study12Smith D.R. Mihashi M. Adachi Y. Shouyama Y. Mouri F. Ishibashi N. et al.Organizational climate and its relationship with needlestick and sharps injuries among Japanese nurses.Am J Infect Control. 2009; 177: 544-550Google Scholar revealing that nurses working in departments with minimal conflict were less likely to underreport any injuries they sustained. Exactly why some staff choose to report their injuries and others do not has long been a topic of debate. In the study by Nagao et al,1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar for example, 43% of surgeons and 57% of scrub nurses only reported their injuries if the source patient was seropositive. Whereas the introduction of EPINet Japan may have helped increase the reporting rate of these incidents to a certain extent,2Hosomi Y. EPINet 1 (Japanese version).Infect Control. 1997; 6: 99-106Google Scholar, 4Hosomi Y. EPINet 2 (Japanese version).Infect Control. 1997; 6: 81-87Google Scholar the overall reporting rate of sharps injuries is still believed to be insufficient.7Nagao Y. Baba H. Torii K. Nagao M. Hatakeyama K. Iinuma Y. et al.A long-term study of sharps injuries among health care workers in Japan.Am J Infect Control. 2007; 35: 407-411Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Clearly, a greater emphasis on injury reporting needs to be considered in Japanese hospitals so that health care workers from all disciplines routinely report their injuries to management, regardless of whether the device was clean or whether the patient was suffering from a potentially transmissible disease. Underreporting also has significant implications for epidemiologic research because the collection of accurate data represents an essential component for reducing needlestick injuries.13Fletcher C.E. Accurate data: an essential component in reducing needlestick injuries.Policy Polit Nurs Pract. 2000; 1: 316-324Crossref Scopus (5) Google Scholar To ensure the accuracy of exposure injury data on which Japanese preventive measures will be based, it is important to ensure that reporting rates continue to increase. Another key issue raised by the authors was that of prevention, including preventive behaviors and preventive devices.1Nagao M. Iinuma Y. Igawa J. Matsumura Y. Shirano M. Matsushima A. et al.Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.Am J Infect Control. 2009; 37: 541-544Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar It has long been known that preventive measures offer a first line of defense in infection control, and, as such, the most direct way to reduce percutaneous injuries is to simply make devices safer, wherever possible.14Jagger J.C. Are Australia's healthcare workers stuck with inadequate needle protection? The most direct way to reduce percutaneous injuries is to make devices safer.Med J Aust. 2002; 177: 405-406PubMed Google Scholar This strategy is not a panacea however, with an earlier Japanese study, for example, revealing that more than half of all injuries from a winged steel needle occurred despite the existence of protective mechanisms.7Nagao Y. Baba H. Torii K. Nagao M. Hatakeyama K. Iinuma Y. et al.A long-term study of sharps injuries among health care workers in Japan.Am J Infect Control. 2007; 35: 407-411Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar This finding suggests that more work still needs to be done to ensure that devices are safer. To further expand the scope of preventive efforts, other more broadly focused measures also need to be considered by infection control professionals. Ergonomic checklists for training in the prevention of needlestick injuries have now been trialled in Japan15Yoshikawa T. Ito A. Sakai K. Kogi K. How to design a practical action checklist for preventing needlestick injuries among health care workers.J UOEH. 2006; 28: 63-68Google Scholar and may represent a key strategy for future improvement. A shift in national priorities also needs to occur. Despite improvements in recent years, it has been noted that, whereas organized hospital infection control programs are now widely implemented in Japan, they remain frequently underresourced.16Sekimoto M. Imanaka Y. Kobayashi H. Okubo T. Kizu J. Kobuse H. et al.Impact of hospital accreditation on infection control programs in teaching hospitals in Japan.Am J Infect Control. 2008; 36: 212-219Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar A national incentive system paid to hospitals that promoted institutional infection control programs was also abolished in 2006.17Sekimoto M. Imanaka Y. Kobayashi H. Okubo T. Kizu J. Kobuse H. et al.Factors affecting performance of hospital infection control in Japan.Am J Infect Control. 2009; 37: 136-142Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar As a result, there is increasing concern that the current climate with its punitive approaches for poor performance and lack of financial incentives may simply lead to cosmetic changes by hospitals to meet accreditation standards.16Sekimoto M. Imanaka Y. Kobayashi H. Okubo T. Kizu J. Kobuse H. et al.Impact of hospital accreditation on infection control programs in teaching hospitals in Japan.Am J Infect Control. 2008; 36: 212-219Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar For these reasons, it can be seen that greater effort now needs to be focussed on protecting health care workers from needlestick and sharps injuries in Japan, particularly in the area of human resources for infection control. Additional research also needs to be undertaken at a national level to help elucidate the extent of underreporting among Japanese health care professionals. Accidental exposures to blood and body fluid in the operation room and the issue of underreportingAmerican Journal of Infection ControlVol. 37Issue 7PreviewA retrospective review of all exposure injuries affecting members of the operative care line at a single university hospital between January 2000 and December 2007 was performed. A questionnaire survey on current status of adherence to barrier precautions was also completed by 164 staff members. Of 136 exposure injuries, 87 (64.0%) were in surgeons, and 49 (36.0%) were in scrub nurses. Surgeons were most commonly injured during suturing (49, 56%), followed by “handing over sharps” (7, 8%), whereas scrub nurses were most commonly injured during “counting and sorting of sharps” (15, 41%), followed by “handing over sharps,” and “splash.” The questionnaire survey revealed that compliance with goggles, face shields, and double gloving was poor, and only 9% of respondents routinely used the hands-free technique. Full-Text PDF" @default.
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