Challenges and Adherence to Standard Precautions for Prevention of Percutaneous Injuries and Exposure to Blood Borne Pathogens in Clinical Practice: A Review

Background: Standard Precautions (SP) was introduced by Centre for Disease Control to minimise the risks of disease transmission in the process of healthcare. Many factors are thought to influence the knowledge and the practice of these measures. Objective: To review challenges and adherence to SP for the prevention of percutaneous injuries and exposure to patients’ blood in clinical practice. Methods: The World Wide Web sites such as, Pub Med central, Google scholar were searched using key words such as percutaneous, needle stick injuries, standard precautions, adherence. Relevant articles were reviewed and included based on defined criteria. Results: The prevalence of needle stick injuries (NSI) varies among health care workers (HCWs) and across countries and is as high as 73% among some groups. The knowledge of SP varied among HCWs in different nations;however the practice of SP was noted to be lower than knowledge across most studies. Majority of HCWs in developing countries that sustained NSI failed to report the incident to appropriate authorities. Adherence to Standard Precautions is influenced by lack of proper training, poor supplies, low commitment of HCWs and health facility managers etc. Conclusion: Needle stick injuries and exposure to patients’ blood remain a risk for disease transmission among HCWs. Despite appreciable knowledge of standard precautions, the practice has remained low across the globe. Factors that had positive influence on practice of SP such as use of devices with safety features, adherence to infection control guideline, comfortable working environment, repeated and intense training etc. should be adopted and promoted.

Effect of low-frequency pulse percutaneous electric stimulation on peripheral nerve injuries at different sites

BACKGROUND： The postoperative recovery of nerve function in patients with peripheral nerve injury is always an important problem to solve after treatment. The electric stimulation induced electromagnetic field can nourish nerve, postpone muscular atrophy, and help the postoperative neuromuscular function. OBJECTIVE： To observe the effects of low-frequency pulse percutaneous electric stimulation on the functional recovery of postoperative patients with peripheral nerve injury, and quantitatively evaluate the results of electromyogram （EMG） examination before and after treatment. DESIGN ： A retrospective case analysis SETTING： The Sixth People＇s Hospital affiliated to Shanghai Jiaotong University PARTICIPANTS： Nineteen postoperative inpatients with peripheral nerve injury were selected from the De- partment of Orthopaedics, the Sixth People＇s Hospital affiliated to Shanghai Jiaotong University from June 2005 to January 2006, including 13 males and 6 females aged 24-62 years with an average of 36 years old. There were 3 cases of brachial plexus nerve injury, 3 of median nerve injury, 7 of radial nerve injury, 3 of ul- nar nerve injury and 3 of common peroneal nerve injury, and all the patients received probing nerve fiber restoration. Their main preoperative manifestations were dennervation, pain in limbs, motor and sensory disturbances. All the 19 patients were informed with the therapeutic program and items for evaluation. METHODS： ① Low-frequency pulse percutaneous electric stimulation apparatus： The patients were given electric stimulation with the TERESA cantata instrument （TERESA-0, Shanghai Teresa Health Technology, Co., Ltd.）. The patients were stimulated with symmetric square waves of 1-111 Hz, and the intensity was 1.2-5.0 mA, and it was gradually adjusted according to the recovered conditions of neural regeneration following the principle that the intensity was strong enough and the patients felt no obvious upset. They were treated for 4- 24 weeks, 10-30 minutes for each time, 1-3 times a day, and 6 weeks as a course. ② EMG examination was applied to evaluate the recoveries of recruitment, motor conduction velocity （MCV） and sensory conduction velocity （SCV） before and after treatment. The patients were examined with the EMG apparatus （DIS- A2000C, Danmark） before and after the treatment of percutaneous electric stimulation. ③Standards for evaluating the effects included cured （complete recovery of motor functions, muscle strength of grade 5, no abnormality in EMG examination）, obviously effective [general recovery of motor function, muscle strength of grade 4, no or a few denervation potentials, motor conduction velocity （MCV） and sensory conduction velocity （SCV）], improved （partial recovery of motor function, muscle strength of grade 3, denervation potentials and reinneration potentials, slowed MCV and SCV, invalid （no obvious changes of motor function）. MAIN OUTCOME MEASURES： ① Ameliorated degree of the nerve function of the postoperative patients with peripheral nerve injury treated with percutaneous electric stimulation; ② Changes of EMG examination before and after treatment. RESULTS： All the 19 postoperative patients with peripheral nerve injury were involved in the analysis of results. ① Comparison of nerve function before and after treatment in 19 patients with peripheral nerve injury of different sites： For the patients with radial nerve injury （n=7）, the nerve functions all completely recovered after 8-week treatment, and the cured and obvious rate was 100% （7/7）; For the patients with brachial plexus nerve injury （n=3）, 1 case had no obvious improvement, and the cured and obvious rate was 67% （2/3）; For the patients with common peroneal nerve injury （n=3）, the extension of foot dorsum generally recovered in 1 case of nerve contusion after 4-week treatment, and the cured and obvious rate was 67% （2/3）; For the patients with median nerve injury （n=3）, muscle strength was obviously recovered, and the cured and obvious rate was 100% （3/3）; For the patients with ulnar nerve injury （n=3）, 1 case only had recovery of partial senses, and the cured and obvious rate was 67% （2/3）. Totally 9 cases were cured, 7 were obviously effective, 1 was improved, and only 2 were invalid. After 4 courses, the cured rate of damaged nerve function after four courses was 47% （9/19）, and effective rate was 89% （17/19）.② Comparison of EMG examination before and after treatment： Before and after percutaneous electric stimulation, he effective rates of recruitment, MCV and SCV were 89% （17/19）, 58% （11/19）, 47% （9/19） respectively, and there were extremely obvious differences （P〈 0.01）. CONCLUSION： ①Low-frequency pulse percutaneous electric stimulation can improve the nerve function of postoperative patients with peripheral nerve injury of different sites, especially that the injuries of radial nerve and median nerve recover more obviously. ②Percutaneous electric stimulation can ameliorate the indexes of EMG examination, especially the recruitment, in postoperative patients with peripheral nerve injury.

Effects of Qishen Yiqi Dripping Pills(芪参益气滴丸) in Reducing Myocardial Injury and Preserving Microvascular Function in Patients Undergoing Elective Percutaneous Coronary Intervention:A Pilot Randomized Study

Objectives：To evaluate the effect of treatment with Qishen Yiqi Dripping Pills（芪参益气滴丸,QSYQ） on myocardial injury and myocardial microvascular function in patients undergoing elective percutaneous coronary intervention（PCI）.Methods：Eighty patients undergoing elective PCI were randomly assigned to QSYQ and control groups.The QSYQ group received QSYQ at a dosage of 0.5 g 3 times daily（3–7 days before PCI and then daily for 1 month） and regular medication,which comprised of aspirin,clopidogrel,statin,β-blocker,and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in the absence of contradiction.The control group received only the regular medication.The index of microcirculatory resistance（IMR） was measured at maximal hyperemia after PCI.The fractional flow reserve was measured before and after the procedure.Troponin Ⅰ levels were obtained at baseline and 20–24 h after the procedure.Results：Pre-PCI troponin Ⅰ levels between the two groups were similar（0.028±0.05 vs.0.022±0.04 ng/m L,P=0.55）.However,postPCI troponin Ⅰ levels in the QSYQ group were significantly lower than that in the control group（0.11±0.02 vs.0.16±0.09 ng/m L,P〈0.01）.IMR values were significantly lower in the QSYQ group as compared to the control group（16.5±6.1 vs.31.2±16.0,P〈0.01）.Multivariate analysis identified QSYQ treatment as the only independent protective factor against IMR 〉32（odds ratio=0.29,95% confidence interval：0.11–0.74,P=0.01）.Conclusion：The present study demonstrated the benefit of QSYQ in reducing myocardial injury and preserving microvascular function during elective PCI.