SlideShare a Scribd company logo
Curbing Sharps associated Infections in ED Dr. Rashidi Ahmad Medical lecturer/Emergentist School of Medical Sciences USM Health Campus [email_address] Occupational Hazard Workshop 4 th  September 2007
“ We need to create a culture of safety in the work environment  to make sure that health care organizations promote and support sharps injury prevention.” ,[object Object]
Outline ,[object Object],[object Object],[object Object],[object Object]
Sharps associated infections (SAI) ,[object Object],[object Object],[object Object],[object Object],Perry, J., Parker, G., & Jagger, J. (2003). EPINet report: 2002 percutaneous injury rates. Advances in Exposure Prevention, 6(3), 32– 36 .
Fraction of HCV, HBV, HIV infections in HCWs  attributable to contaminated sharps World Health Report. Geneva. WHO. 2001
Nagao et al. A long-term study of sharps injuries among health care workers in Japan. Am J Infec Control 2007;35:407-11 .
Devices involved in percutaneous injuries (n: 13,731)
Nagao et al. A long-term study of sharps injuries among health care workers in Japan. Am J Infec Control 2007;35:407-11.
* Recapping accounted for up to 30% of reported needle stick injuries Julian Gold, et al. Guidance note on Health Care Worker Safety from HIV and other  Blood Borne Infections. World Bank, Washington, DC, USA, May 2004
What is the risk of transmission following a NSI to a  positive source?   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Julian Gold, et al. Guidance note on Health Care Worker Safety from HIV and other Blood Borne Infections. Paper prepared for the East Asia and Pacific Region of the World Bank. World Bank, Washington, DC, USA, May 2004
Impact of SRIs ,[object Object],[object Object],[object Object],[object Object]
Work locations where blood & fluid exposures  occurred (n: 16,855)
Hazards among EDHCWs  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why EDHCWs are at risk of sharp-associated infections? ,[object Object],[object Object],[object Object],GD Kelen, GB Green and RH Purcell  et al. , Hepatitis B and hepatitis C in emergency department patients,  N Engl J Med   326  (1992), pp. 1399–1404
Cont… ,[object Object],[object Object],J Jui, P Stevens and K Hedberg  et al. , HIV seroprevalence in ED patients: Portland, Oregon, 1988-1991,  Acad Emerg Med   2  (1995), pp. 773–783. GD Kelen, GB Green and RH Purcell  et al. , Hepatitis B and hepatitis C in  ED patients,  N Engl J Med   326  (1992), pp. 1399–1404
Risk of HIV infection among  EDHCWs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
9,793 procedures Blood contact  379 (3.9%) Skin 362 (95%)  Mucus membrane 11 (3%)  Percutaneous 6 (2%)
[object Object],[object Object],[object Object],[object Object],Results
*All significant at  P <0.01.  Adapted from Centers for Disease Control and Prevention (30).   0.1-0.6  0.2  Postexposure zidovudine use  2.2-18.9  6.4  End-stage disease in patient  1.9-14.8  5.1  Needle placed directly in artery or vein  1.8-17.7  5.2  Visible blood on device  6.1-44.6  16.1  Deep injury  95% confidence interval  Adjusted odds ratio*  Risk factor  Risk factors for HIV infection in healthcare workers after percutaneous exposure
Prevalence of HBV markers in  emergency physicians. ,[object Object],[object Object],[object Object],[object Object]
Results & conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object]
The management of sharps in the    Emergency Department:  Is it safe? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Excess risk to the user,  another person, or both [28% of 418] Excess risk to the user [27%]  Excess risk to another person [12%] * Of the 418 observed  sharp utilizations, none resulted in a puncture wound
[object Object],[object Object],[object Object],[object Object],[object Object],Results
EDHCWs and compliance to universal precautions ,[object Object],[object Object],[object Object]
169 HCWs IV catheter placement (35)  Phlebotomy (66). ETI (98)  PE (8)  Use of needles  (22) Patient handling (17) Foley catheter placement (3)  101 HCWs (Non critical) 68 HCWs (Critical)
101 HCWs (Non critical) Wearing Glove (52.5%) Wearing Glove Needle use (64%) PE (72%) ETI (88%) Physical handling of patients (76%) Foley catheter placement (100%). 68 HCWs (Critical)
[object Object],[object Object],[object Object],[object Object],[object Object],LJ Baraff and DA Talan, Compliance with universal precautions in a university hospital emergency department,  Ann Emerg Med   18  (1989), pp. 654–657   Results and conclusion
Summary on SAIs in ED ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Injury Prevention:  The Three E’s ,[object Object],[object Object],[object Object],Christoffel T., and Gallagher S.,  Injury Prevention and Public Health , Gaithers,  Gaithersburg, Maryland: Aspen Publishers, 1999, 30-32,139-200
The Three E’s:  Education ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rushing, distracted, angry & multiple passes are  significant risk behavior to SRIs Behavior Modification
The Three E’s:  Enforcement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mandating compliance with UP is more effective than just a guideline ,[object Object],[object Object],[object Object],Kelen P, et al. Substantial improvement in compliance with universal precautions in an emergency department following institution of policy.(1991)  Archives of Internal Medicine , 151 (10), pp. 2051-2056
[object Object],[object Object],[object Object],Kelen P, et al. Substantial improvement in compliance with universal precautions in an emergency department following institution of policy.(1991)  Archives of Internal Medicine , 151 (10), pp. 2051-2056 Results
 
The Three E’s:  Engineering ,[object Object],Blunt needle
Needleless intravenous -line access  Needless access system It has been well demonstrated that these devices can reduce intravenous-connection-related percutaneous injuries by 50% to 60% while maintaining user satisfaction  Lawrence LW, Delclos GL, Felknor SA, et al. The effectiveness  of a needleless intravenous connection system:  an assessment by injury rate and user satisfaction.  Infect Control Hosp Epidemiol 1997;18(3):175-82
Conclusions Preventive measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General factors for SAIs prevention ,[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you Q ?

More Related Content

What's hot

Strategies to reduce CIED infection, PADIT Trial by Haseeb Raza
Strategies to reduce CIED infection, PADIT Trial by Haseeb RazaStrategies to reduce CIED infection, PADIT Trial by Haseeb Raza
Strategies to reduce CIED infection, PADIT Trial by Haseeb Raza
Haseeb Raza
 
Necessity of COVID-19 vaccination in previously infected individuals
Necessity of COVID-19 vaccination in previously infected individualsNecessity of COVID-19 vaccination in previously infected individuals
Necessity of COVID-19 vaccination in previously infected individuals
MattisHallsteinVolla
 
Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...
Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...
Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...
hivlifeinfo
 
Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020
Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020
Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020
hivlifeinfo
 
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Me...
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Me...Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Me...
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Me...
CLOVE Dental OMNI Hospitals Andhra Hospital
 
KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...
KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...
KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...
Anil Haripriya
 
Guideline for the Prevention of Surgical Site Infection, 2017
Guideline for the Prevention of Surgical Site Infection, 2017Guideline for the Prevention of Surgical Site Infection, 2017
Guideline for the Prevention of Surgical Site Infection, 2017
RubenMariscal3
 
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...
hivlifeinfo
 
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014
Hivlife Info
 
Evaluation of Physical &; Mental Status of COVID Recovered Patients Underwent...
Evaluation of Physical &; Mental Status of COVID Recovered Patients Underwent...Evaluation of Physical &; Mental Status of COVID Recovered Patients Underwent...
Evaluation of Physical &; Mental Status of COVID Recovered Patients Underwent...
DrHeena tiwari
 
Knowledge and Attitude of Oral and Maxillofacial Post Graduate on COVID 19: A...
Knowledge and Attitude of Oral and Maxillofacial Post Graduate on COVID 19: A...Knowledge and Attitude of Oral and Maxillofacial Post Graduate on COVID 19: A...
Knowledge and Attitude of Oral and Maxillofacial Post Graduate on COVID 19: A...
DrHeena tiwari
 
Слайдсет о новом в лечении ВИЧ.Key Slides on What’s Hot in HIV Treatment.2020
Слайдсет о новом в лечении ВИЧ.Key Slides on What’s Hot in HIV Treatment.2020 Слайдсет о новом в лечении ВИЧ.Key Slides on What’s Hot in HIV Treatment.2020
Слайдсет о новом в лечении ВИЧ.Key Slides on What’s Hot in HIV Treatment.2020
hivlifeinfo
 
10.1016@j.ijid.2020.06.099
10.1016@j.ijid.2020.06.09910.1016@j.ijid.2020.06.099
10.1016@j.ijid.2020.06.099
MattisHallsteinVolla
 
Slide deck cancer care during covid 19 pandemic
Slide deck cancer care during covid 19 pandemicSlide deck cancer care during covid 19 pandemic
Slide deck cancer care during covid 19 pandemic
madurai
 
Современное лечение ВИЧ: когда начинать, чем начинать. Contemporary Managemen...
Современное лечение ВИЧ: когда начинать, чем начинать. Contemporary Managemen...Современное лечение ВИЧ: когда начинать, чем начинать. Contemporary Managemen...
Современное лечение ВИЧ: когда начинать, чем начинать. Contemporary Managemen...
hivlifeinfo
 
Highlights of IAS 2013.CCO Official Conference Coverage of the 7th IAS Confer...
Highlights of IAS 2013.CCO Official Conference Coverage of the 7th IAS Confer...Highlights of IAS 2013.CCO Official Conference Coverage of the 7th IAS Confer...
Highlights of IAS 2013.CCO Official Conference Coverage of the 7th IAS Confer...Hivlife Info
 
Predictors and Outcomes of Pediatric COVID 19 Cases in Recent Scenario: Syst...
 Predictors and Outcomes of Pediatric COVID 19 Cases in Recent Scenario: Syst... Predictors and Outcomes of Pediatric COVID 19 Cases in Recent Scenario: Syst...
Predictors and Outcomes of Pediatric COVID 19 Cases in Recent Scenario: Syst...
DrHeena tiwari
 
Современное лечение ВИЧ: индивидуализация стартовой АРТ /Contemporary Manage...
Современное лечение ВИЧ:  индивидуализация стартовой АРТ /Contemporary Manage...Современное лечение ВИЧ:  индивидуализация стартовой АРТ /Contemporary Manage...
Современное лечение ВИЧ: индивидуализация стартовой АРТ /Contemporary Manage...
hivlifeinfo
 
doi: 10.1101/2021.05.28.21258012
doi: 10.1101/2021.05.28.21258012doi: 10.1101/2021.05.28.21258012
doi: 10.1101/2021.05.28.21258012
MattisHallsteinVolla
 
Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015
Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015
Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015
Hivlife Info
 

What's hot (20)

Strategies to reduce CIED infection, PADIT Trial by Haseeb Raza
Strategies to reduce CIED infection, PADIT Trial by Haseeb RazaStrategies to reduce CIED infection, PADIT Trial by Haseeb Raza
Strategies to reduce CIED infection, PADIT Trial by Haseeb Raza
 
Necessity of COVID-19 vaccination in previously infected individuals
Necessity of COVID-19 vaccination in previously infected individualsNecessity of COVID-19 vaccination in previously infected individuals
Necessity of COVID-19 vaccination in previously infected individuals
 
Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...
Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...
Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...
 
Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020
Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020
Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020
 
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Me...
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Me...Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Me...
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Me...
 
KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...
KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...
KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...
 
Guideline for the Prevention of Surgical Site Infection, 2017
Guideline for the Prevention of Surgical Site Infection, 2017Guideline for the Prevention of Surgical Site Infection, 2017
Guideline for the Prevention of Surgical Site Infection, 2017
 
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...
 
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014
 
Evaluation of Physical &; Mental Status of COVID Recovered Patients Underwent...
Evaluation of Physical &; Mental Status of COVID Recovered Patients Underwent...Evaluation of Physical &; Mental Status of COVID Recovered Patients Underwent...
Evaluation of Physical &; Mental Status of COVID Recovered Patients Underwent...
 
Knowledge and Attitude of Oral and Maxillofacial Post Graduate on COVID 19: A...
Knowledge and Attitude of Oral and Maxillofacial Post Graduate on COVID 19: A...Knowledge and Attitude of Oral and Maxillofacial Post Graduate on COVID 19: A...
Knowledge and Attitude of Oral and Maxillofacial Post Graduate on COVID 19: A...
 
Слайдсет о новом в лечении ВИЧ.Key Slides on What’s Hot in HIV Treatment.2020
Слайдсет о новом в лечении ВИЧ.Key Slides on What’s Hot in HIV Treatment.2020 Слайдсет о новом в лечении ВИЧ.Key Slides on What’s Hot in HIV Treatment.2020
Слайдсет о новом в лечении ВИЧ.Key Slides on What’s Hot in HIV Treatment.2020
 
10.1016@j.ijid.2020.06.099
10.1016@j.ijid.2020.06.09910.1016@j.ijid.2020.06.099
10.1016@j.ijid.2020.06.099
 
Slide deck cancer care during covid 19 pandemic
Slide deck cancer care during covid 19 pandemicSlide deck cancer care during covid 19 pandemic
Slide deck cancer care during covid 19 pandemic
 
Современное лечение ВИЧ: когда начинать, чем начинать. Contemporary Managemen...
Современное лечение ВИЧ: когда начинать, чем начинать. Contemporary Managemen...Современное лечение ВИЧ: когда начинать, чем начинать. Contemporary Managemen...
Современное лечение ВИЧ: когда начинать, чем начинать. Contemporary Managemen...
 
Highlights of IAS 2013.CCO Official Conference Coverage of the 7th IAS Confer...
Highlights of IAS 2013.CCO Official Conference Coverage of the 7th IAS Confer...Highlights of IAS 2013.CCO Official Conference Coverage of the 7th IAS Confer...
Highlights of IAS 2013.CCO Official Conference Coverage of the 7th IAS Confer...
 
Predictors and Outcomes of Pediatric COVID 19 Cases in Recent Scenario: Syst...
 Predictors and Outcomes of Pediatric COVID 19 Cases in Recent Scenario: Syst... Predictors and Outcomes of Pediatric COVID 19 Cases in Recent Scenario: Syst...
Predictors and Outcomes of Pediatric COVID 19 Cases in Recent Scenario: Syst...
 
Современное лечение ВИЧ: индивидуализация стартовой АРТ /Contemporary Manage...
Современное лечение ВИЧ:  индивидуализация стартовой АРТ /Contemporary Manage...Современное лечение ВИЧ:  индивидуализация стартовой АРТ /Contemporary Manage...
Современное лечение ВИЧ: индивидуализация стартовой АРТ /Contemporary Manage...
 
doi: 10.1101/2021.05.28.21258012
doi: 10.1101/2021.05.28.21258012doi: 10.1101/2021.05.28.21258012
doi: 10.1101/2021.05.28.21258012
 
Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015
Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015
Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015
 

Similar to Sai In Ed

Prevention mrsa.ppt.shirlhooper
Prevention mrsa.ppt.shirlhooperPrevention mrsa.ppt.shirlhooper
Prevention mrsa.ppt.shirlhooper
Shirl Hooper
 
Intensive care nurses’ knowledge & practices regarding
Intensive care nurses’ knowledge & practices regardingIntensive care nurses’ knowledge & practices regarding
Intensive care nurses’ knowledge & practices regarding
Alexander Decker
 
Importance and implication of starting HIV treatment early
Importance and implication of starting HIV treatment earlyImportance and implication of starting HIV treatment early
Importance and implication of starting HIV treatment early
European Centre for Disease Prevention and Control
 
A Study on Awareness of Needle sticks injury in students undergoing paramedic...
A Study on Awareness of Needle sticks injury in students undergoing paramedic...A Study on Awareness of Needle sticks injury in students undergoing paramedic...
A Study on Awareness of Needle sticks injury in students undergoing paramedic...
iosrjce
 
knowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdf
knowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdfknowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdf
knowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdf
Dr. Gawad Alwabr
 
Age and Number of Surgeries Increase Risk for Complication in Polytrauma Pati...
Age and Number of Surgeries Increase Risk for Complication in Polytrauma Pati...Age and Number of Surgeries Increase Risk for Complication in Polytrauma Pati...
Age and Number of Surgeries Increase Risk for Complication in Polytrauma Pati...
Crimsonpublisherssmoaj
 
Race and Variations in Operative Treatment 10.22.09
Race and Variations in Operative Treatment 10.22.09Race and Variations in Operative Treatment 10.22.09
Race and Variations in Operative Treatment 10.22.09
Leonard Davis Institute of Health Economics
 
Final FRD
Final FRDFinal FRD
Final FRD
Nina Shedd
 
Knowledge-and-Practice-of-Hepatitis-B-Prevention-among-Health-Care-Workers-in...
Knowledge-and-Practice-of-Hepatitis-B-Prevention-among-Health-Care-Workers-in...Knowledge-and-Practice-of-Hepatitis-B-Prevention-among-Health-Care-Workers-in...
Knowledge-and-Practice-of-Hepatitis-B-Prevention-among-Health-Care-Workers-in...
FrancisOpwonya1
 
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...
dbpublications
 
Risk factors of chronic liver disease amongst patients receiving care in a Ga...
Risk factors of chronic liver disease amongst patients receiving care in a Ga...Risk factors of chronic liver disease amongst patients receiving care in a Ga...
Risk factors of chronic liver disease amongst patients receiving care in a Ga...
iosrjce
 
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
Jacob Amofa
 
Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiat...
Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiat...Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiat...
Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiat...
ijtsrd
 
Awareness And Practice Of Infection Control Protocol Amidst Covid-19 Pandemic...
Awareness And Practice Of Infection Control Protocol Amidst Covid-19 Pandemic...Awareness And Practice Of Infection Control Protocol Amidst Covid-19 Pandemic...
Awareness And Practice Of Infection Control Protocol Amidst Covid-19 Pandemic...
DrHeena tiwari
 
Observacional de ivermectina
Observacional de ivermectinaObservacional de ivermectina
Observacional de ivermectina
Freddy Flores Malpartida
 
Contemporary Management of HIV. New Data From AIDS 2018
Contemporary Management of HIV. New Data From AIDS 2018Contemporary Management of HIV. New Data From AIDS 2018
Contemporary Management of HIV. New Data From AIDS 2018
hivlifeinfo
 
The art of the possible ideas
The art of the possible   ideasThe art of the possible   ideas
The art of the possible ideas
howardcooper
 
Patient safety
Patient safety Patient safety
Patient safety
Mathew Varghese V
 

Similar to Sai In Ed (20)

Prevention mrsa.ppt.shirlhooper
Prevention mrsa.ppt.shirlhooperPrevention mrsa.ppt.shirlhooper
Prevention mrsa.ppt.shirlhooper
 
Intensive care nurses’ knowledge & practices regarding
Intensive care nurses’ knowledge & practices regardingIntensive care nurses’ knowledge & practices regarding
Intensive care nurses’ knowledge & practices regarding
 
Importance and implication of starting HIV treatment early
Importance and implication of starting HIV treatment earlyImportance and implication of starting HIV treatment early
Importance and implication of starting HIV treatment early
 
A Study on Awareness of Needle sticks injury in students undergoing paramedic...
A Study on Awareness of Needle sticks injury in students undergoing paramedic...A Study on Awareness of Needle sticks injury in students undergoing paramedic...
A Study on Awareness of Needle sticks injury in students undergoing paramedic...
 
knowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdf
knowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdfknowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdf
knowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdf
 
Age and Number of Surgeries Increase Risk for Complication in Polytrauma Pati...
Age and Number of Surgeries Increase Risk for Complication in Polytrauma Pati...Age and Number of Surgeries Increase Risk for Complication in Polytrauma Pati...
Age and Number of Surgeries Increase Risk for Complication in Polytrauma Pati...
 
Race and Variations in Operative Treatment 10.22.09
Race and Variations in Operative Treatment 10.22.09Race and Variations in Operative Treatment 10.22.09
Race and Variations in Operative Treatment 10.22.09
 
Final FRD
Final FRDFinal FRD
Final FRD
 
Wesat2003
Wesat2003Wesat2003
Wesat2003
 
Knowledge-and-Practice-of-Hepatitis-B-Prevention-among-Health-Care-Workers-in...
Knowledge-and-Practice-of-Hepatitis-B-Prevention-among-Health-Care-Workers-in...Knowledge-and-Practice-of-Hepatitis-B-Prevention-among-Health-Care-Workers-in...
Knowledge-and-Practice-of-Hepatitis-B-Prevention-among-Health-Care-Workers-in...
 
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...
 
Risk factors of chronic liver disease amongst patients receiving care in a Ga...
Risk factors of chronic liver disease amongst patients receiving care in a Ga...Risk factors of chronic liver disease amongst patients receiving care in a Ga...
Risk factors of chronic liver disease amongst patients receiving care in a Ga...
 
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
 
2015-42-4_6
2015-42-4_62015-42-4_6
2015-42-4_6
 
Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiat...
Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiat...Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiat...
Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiat...
 
Awareness And Practice Of Infection Control Protocol Amidst Covid-19 Pandemic...
Awareness And Practice Of Infection Control Protocol Amidst Covid-19 Pandemic...Awareness And Practice Of Infection Control Protocol Amidst Covid-19 Pandemic...
Awareness And Practice Of Infection Control Protocol Amidst Covid-19 Pandemic...
 
Observacional de ivermectina
Observacional de ivermectinaObservacional de ivermectina
Observacional de ivermectina
 
Contemporary Management of HIV. New Data From AIDS 2018
Contemporary Management of HIV. New Data From AIDS 2018Contemporary Management of HIV. New Data From AIDS 2018
Contemporary Management of HIV. New Data From AIDS 2018
 
The art of the possible ideas
The art of the possible   ideasThe art of the possible   ideas
The art of the possible ideas
 
Patient safety
Patient safety Patient safety
Patient safety
 

More from Rashidi Ahmad

Humanitarian charter
Humanitarian charterHumanitarian charter
Humanitarian charterRashidi Ahmad
 
Kenali ular (snake)
Kenali ular (snake) Kenali ular (snake)
Kenali ular (snake) Rashidi Ahmad
 
Soft tissue ultrasound
Soft tissue ultrasoundSoft tissue ultrasound
Soft tissue ultrasoundRashidi Ahmad
 
Post resuscitation care
Post resuscitation carePost resuscitation care
Post resuscitation careRashidi Ahmad
 
Mild traumatic brain injury
Mild traumatic brain injuryMild traumatic brain injury
Mild traumatic brain injuryRashidi Ahmad
 
Mannitol Vs Hypertonic Saline
Mannitol Vs Hypertonic SalineMannitol Vs Hypertonic Saline
Mannitol Vs Hypertonic SalineRashidi Ahmad
 
Sedation With Ketamine
Sedation With KetamineSedation With Ketamine
Sedation With KetamineRashidi Ahmad
 
Is The Mediastinum Wide
Is The Mediastinum WideIs The Mediastinum Wide
Is The Mediastinum WideRashidi Ahmad
 
Emergency Fluid Therapy
Emergency Fluid TherapyEmergency Fluid Therapy
Emergency Fluid TherapyRashidi Ahmad
 
Humanitarian Mercy Conference
Humanitarian Mercy ConferenceHumanitarian Mercy Conference
Humanitarian Mercy ConferenceRashidi Ahmad
 

More from Rashidi Ahmad (20)

Humanitarian charter
Humanitarian charterHumanitarian charter
Humanitarian charter
 
Terrorism in msia
Terrorism in msiaTerrorism in msia
Terrorism in msia
 
Fracture care
Fracture careFracture care
Fracture care
 
Kenali ular (snake)
Kenali ular (snake) Kenali ular (snake)
Kenali ular (snake)
 
Acute poisoning
Acute poisoningAcute poisoning
Acute poisoning
 
Soft tissue ultrasound
Soft tissue ultrasoundSoft tissue ultrasound
Soft tissue ultrasound
 
Pain score in ed
Pain score in edPain score in ed
Pain score in ed
 
Pseudotumour
PseudotumourPseudotumour
Pseudotumour
 
Nasal fb
Nasal fbNasal fb
Nasal fb
 
Post resuscitation care
Post resuscitation carePost resuscitation care
Post resuscitation care
 
Trauma scan
Trauma scanTrauma scan
Trauma scan
 
Mild traumatic brain injury
Mild traumatic brain injuryMild traumatic brain injury
Mild traumatic brain injury
 
Mannitol Vs Hypertonic Saline
Mannitol Vs Hypertonic SalineMannitol Vs Hypertonic Saline
Mannitol Vs Hypertonic Saline
 
Sedation With Ketamine
Sedation With KetamineSedation With Ketamine
Sedation With Ketamine
 
Shock Trial
Shock TrialShock Trial
Shock Trial
 
Is The Mediastinum Wide
Is The Mediastinum WideIs The Mediastinum Wide
Is The Mediastinum Wide
 
Emergency Fluid Therapy
Emergency Fluid TherapyEmergency Fluid Therapy
Emergency Fluid Therapy
 
Humanitarian Mercy Conference
Humanitarian Mercy ConferenceHumanitarian Mercy Conference
Humanitarian Mercy Conference
 
Burr Hole
Burr HoleBurr Hole
Burr Hole
 
Burr Hole
Burr HoleBurr Hole
Burr Hole
 

Recently uploaded

THOA 2.ppt Human Organ Transplantation Act
THOA 2.ppt Human Organ Transplantation ActTHOA 2.ppt Human Organ Transplantation Act
THOA 2.ppt Human Organ Transplantation Act
DrSathishMS1
 
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdfAlcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Dr Jeenal Mistry
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
MedicoseAcademics
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in StockFactory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
rebeccabio
 
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdfARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
Anujkumaranit
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
LanceCatedral
 
Surgical Site Infections, pathophysiology, and prevention.pptx
Surgical Site Infections, pathophysiology, and prevention.pptxSurgical Site Infections, pathophysiology, and prevention.pptx
Surgical Site Infections, pathophysiology, and prevention.pptx
jval Landero
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
Dr. Rabia Inam Gandapore
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Savita Shen $i11
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists  Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Saeid Safari
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
VarunMahajani
 
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
Catherine Liao
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
MedicoseAcademics
 
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfMANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
Jim Jacob Roy
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
kevinkariuki227
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
Levi Shapiro
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
MedicoseAcademics
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
addon Scans
 

Recently uploaded (20)

THOA 2.ppt Human Organ Transplantation Act
THOA 2.ppt Human Organ Transplantation ActTHOA 2.ppt Human Organ Transplantation Act
THOA 2.ppt Human Organ Transplantation Act
 
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdfAlcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
 
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in StockFactory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
 
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdfARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
 
Surgical Site Infections, pathophysiology, and prevention.pptx
Surgical Site Infections, pathophysiology, and prevention.pptxSurgical Site Infections, pathophysiology, and prevention.pptx
Surgical Site Infections, pathophysiology, and prevention.pptx
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists  Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
 
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
 
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfMANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
 

Sai In Ed

  • 1. Curbing Sharps associated Infections in ED Dr. Rashidi Ahmad Medical lecturer/Emergentist School of Medical Sciences USM Health Campus [email_address] Occupational Hazard Workshop 4 th September 2007
  • 2.
  • 3.
  • 4.
  • 5. Fraction of HCV, HBV, HIV infections in HCWs attributable to contaminated sharps World Health Report. Geneva. WHO. 2001
  • 6. Nagao et al. A long-term study of sharps injuries among health care workers in Japan. Am J Infec Control 2007;35:407-11 .
  • 7. Devices involved in percutaneous injuries (n: 13,731)
  • 8. Nagao et al. A long-term study of sharps injuries among health care workers in Japan. Am J Infec Control 2007;35:407-11.
  • 9. * Recapping accounted for up to 30% of reported needle stick injuries Julian Gold, et al. Guidance note on Health Care Worker Safety from HIV and other Blood Borne Infections. World Bank, Washington, DC, USA, May 2004
  • 10.
  • 11.
  • 12. Work locations where blood & fluid exposures occurred (n: 16,855)
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. 9,793 procedures Blood contact 379 (3.9%) Skin 362 (95%) Mucus membrane 11 (3%) Percutaneous 6 (2%)
  • 18.
  • 19. *All significant at P <0.01. Adapted from Centers for Disease Control and Prevention (30). 0.1-0.6 0.2 Postexposure zidovudine use 2.2-18.9 6.4 End-stage disease in patient 1.9-14.8 5.1 Needle placed directly in artery or vein 1.8-17.7 5.2 Visible blood on device 6.1-44.6 16.1 Deep injury 95% confidence interval Adjusted odds ratio* Risk factor Risk factors for HIV infection in healthcare workers after percutaneous exposure
  • 20.
  • 21.
  • 22.
  • 23. Excess risk to the user, another person, or both [28% of 418] Excess risk to the user [27%] Excess risk to another person [12%] * Of the 418 observed sharp utilizations, none resulted in a puncture wound
  • 24.
  • 25.
  • 26. 169 HCWs IV catheter placement (35) Phlebotomy (66). ETI (98) PE (8) Use of needles (22) Patient handling (17) Foley catheter placement (3) 101 HCWs (Non critical) 68 HCWs (Critical)
  • 27. 101 HCWs (Non critical) Wearing Glove (52.5%) Wearing Glove Needle use (64%) PE (72%) ETI (88%) Physical handling of patients (76%) Foley catheter placement (100%). 68 HCWs (Critical)
  • 28.
  • 29.
  • 30.
  • 31.
  • 32. Rushing, distracted, angry & multiple passes are significant risk behavior to SRIs Behavior Modification
  • 33.
  • 34.
  • 35.
  • 36.  
  • 37.
  • 38. Needleless intravenous -line access Needless access system It has been well demonstrated that these devices can reduce intravenous-connection-related percutaneous injuries by 50% to 60% while maintaining user satisfaction Lawrence LW, Delclos GL, Felknor SA, et al. The effectiveness of a needleless intravenous connection system: an assessment by injury rate and user satisfaction. Infect Control Hosp Epidemiol 1997;18(3):175-82
  • 39.
  • 40.
  • 41.

Editor's Notes

  1. The three E’s of injury prevention address the three conceptual approaches to injury prevention. The three are complimentary to each other and can be applied synergistically to the same injury problem. Christoffel T., and Gallagher S., Injury Prevention and Public Health , Gaithers, Gaithersburg, Maryland: Aspen Publishers, 1999, 30-32,139-200.
  2. The educational approach can be simplified to that if people are given information about the risk of injuries they will avoid those behaviors that will lead to injury. This assumes there is a lack of information about the risk of injuries. This approach is founded on the the rational-empirical strategy (Benne &amp; Chin) that assumes that people are rational and when given information will act to optimize their health. Many public health programs utilize this approach. Examples: “Buckle up”, “Practice Safe Sex” Chin, R and Benne, K. “general strategies for effective change in human systems” In: Warren Bennis et al.(eds.) The Planning of Change , New York: Holt, Rinehart and Winston, Inc. 32-59, 1969.
  3. Enforcement strategies can be applies at varying levels. They can regulate the environment to make it less risky or they can regulate behavior. This can be done through statue law or tort law. Both have been used successfully.
  4. The environment can be reengineered (or changed) to reduce the risk of injuries. Some of the greatest successes in injury have been because of engineering a change in the environment. These have not only been limited to motor vehicle safety but diverse applications such as child resistant caps, and safety straps on changing tables.