Epidemiology of needlesticks and other sharps injuries and injection safety practices in the Dominican Republic.
BACKGROUND
Contaminated sharps, such as needles, lancets, scalpels, broken glass, specimen tubes, and other instruments, can transmit bloodborne pathogens such as HIV, hepatitis B (HBV), and hepatitis C viruses (HCV).


METHODS
Observation of facilities and injections and questionnaire-guided interviews were conducted in 2005 among health care workers (HCWs) in 2 public hospitals in Santo Domingo and 136 public immunization clinics (IC) in the Dominican Republic. Injection practices and sharps injuries (SIs) in health care facilities in the Dominican Republic were assessed in cross-sectional surveys to identify areas in which preventive efforts might be directed to make injection practices safer.


RESULTS
Of the 304 hospital HCWs and 136 ICs HCWs interviewed, 98 (22.3%) reported > or =1 SIs during the previous 12 months. ICs had a lower incidence (13 per 100 per person-years [p-y]) of SIs than hospitals (65 per 100 p-y) (P < .0001). Unsafe needle recapping was observed in 98% of all injections observed at hospitals but in only 12% of injections at ICs (P < .0001). Sharps were observed improperly disposed in regular waste containers in 24 (92%) of 26 areas at which injections are prepared at the hospitals but in only 11 (8%) of 136 ICs (P < .0001). Training in injection safety was received by 4% of HCWs in hospitals but by 77% in ICs (P < .001). Of 425 HCWs, 247 (58%) were fully immunized against hepatitis B. There was a higher risk of SIs among staff dentists (adjusted relative risks [aRR], 5.9; 95% confidence interval [CI]: 2.8-12.6), resident physicians (aRR, 3.5; 95% CI: 1.8-6.9), and those who gave > or =11 therapeutic injections per day (aRR, 1.6; 95% CI: 1.1-2.4).


CONCLUSIONS
Injection practices at ICs were safer than those found at public hospitals. Preventive strategies to lower SIs in public hospitals should include regular training of hospital staff to minimize needle recapping and improper disposal, among other interventions to reduce the dangers of needles.
Moro
Pedro L
PL
Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. psm9@cdc.gov
Moore
Arelis
A
Balcacer
Patricia
P
Montero
Alex
A
Diaz
Delissa
D
Gómez
Virgen
V
Garib
Zacarias
Z
Weniger
Bruce G
BG
D000554:Ambulatory Care Facilities; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004293:Dominican Republic / Q000453:epidemiology; D019538:Health Care Surveys; D006282:Health Personnel; D017325:Hepatitis B Vaccines / Q000627:therapeutic use; D006779:Hospitals, Public; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D016602:Needlestick Injuries / Q000453:epidemiology* / Q000517:prevention & control; D016273:Occupational Exposure / Q000517:prevention & control*
D017325:Hepatitis B Vaccines