Graduation Year

2012

Document Type

Thesis

Degree

M.S.P.H.

Degree Granting Department

Public Health

Major Professor

Hamisu Salihu, M.D., Ph.D.

Committee Member

Donna Haiduven, Ph.D., R.N., C.I.C.

Committee Member

Thomas Truncale, D.O., M.P.H.

Keywords

activation chamber, antecubital fossa pad, bloodborne pathogen, retraction mechanism, scientific filter

Abstract

Intravascular devices with engineered sharps injury protection (ESIP) are designed to reduce sharps injuries, but have not been investigated for blood splatter potential. In this laboratory-based experiment, which did not use human subjects, 100 intravenous catheters of the same type with a retraction mechanism, were tested for blood splatter. Once blood was obtained from a simulated brachial vein containing mock venous blood, the devices were placed in a testing chamber and scientific filters labeled A, B & C were used to capture blood splatter after activation. The blood splatter was examined visually and microscopically, and the filters were weighed pre- and post-activation on an analytical scale. The research questions in this study were: 1) do retractable intravenous devices produce blood splatter, and 2) does blood splatter frequency differ between visual methods vs. microscopy?

The differences in filter mass, visual inspection, and microscopic analysis for presence of blood on filters were the units of analysis. Descriptive statistics, paired t-tests to determine pre and post activation filter weights and kappa statistics to assess degree of agreement between methods were used to analyze the data. For filters B and C, the proportions with blood detected by the naked eye were 12 and 13% respectively. However, for filter A, both visual and microscopic methods detected blood splatter on 70% and 71% of the time respectively. In addition, a statistically significant difference was observed in the mean mass of filter A between pre- and post-activation confirmed by the naked eye (t= - 0.0013, p= 0.01400) and confirmed microscopically (t= - 0.00014, p=0.0092). Substantial agreement between methods was observed for filter A (kappa=0.78; 95% CI: 0.64-0.92), filter B (kappa= 0.73; 95% CI: 0.51-0.95) and filter C (kappa= 0.75; 95% CI: 0.55-0.96). However, in 7 instances (7%), blood was detected by microscopy but not by the naked eye on filters A (5 %), B (1%), and C (1%), respectively. Also, in 6 instances (6%), blood was detected by the naked eye but now by microscopy on filter B (3%), and filter C (3%). Consequently, there is potential for a total of 13 % blood splatter.

The findings indicate potential for bloodborne pathogen exposure with use of a specific retractable intravascular catheter. The finding that blood splatter was detected by microscopy in 7% of the instances has important occupational health implications. Healthcare workers (HCWs) may not be able to detect this blood splatter when it occurs and may not report a splash to mucous membranes or non-intact skin. This study therefore reinforces the need for HCWs to wear personal protective equipment, such as masks, face shields, goggles, when using intravascular catheters with retractable mechanisms. It is recommended that the research protocol used in this study be replicated by other investigators and tested on all brands of retractable intravascular devices.

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