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Bakgrund: Blodburen smitta sprids genom blod, blodtillblandade kroppsvätskor eller via blodprodukter. De mest framträdande blodburna smittorna är hiv, hepatit B och C och dessa klassas som allmänfarliga sjukdomar. Miljontals människor lever med hiv, hepatit B och C världen över. Inom vården är stick- och skärskador samt återanvänt engångsmaterial de som utgör de vanligaste smittoriskerna. Bland vårdpersonal råder det delade meningar om hur de upplever att det är att vårda patienter med blodburen smitta. Syfte: Att beskriva hur patienter med blodburen smitta (hiv, hepatit B och C) upplever bemötandet inom vården. Metod: En litteraturstudie med deskriptiv design baserad på tio vetenskapliga artiklar med kvalitativ ansats och en artikel med mixad ansats. Samtliga artiklar söktes i sökmotorn PubMed via databasen Medline. Huvudresultat: Resultaten från artiklarna visade att vårdpersonalens bemötande hade bidragit till att deltagarna känt sig stigmatiserade och stämplad i mötet med vården. Deltagarna hade upplevt vårdpersonalens rädsla för att själva bli smittad, vilket påverkade bemötandet negativt. Resultatet påvisade att känslig information hade avslöjats för obehöriga personer och deltagarna upplevde bemötandet som respektlöst då sekretessen inte upprätthölls. Okunskap om blodsmittor, bristande information, dålig respons på deltagarnas frågor samt att diagnoser hade överlämnats på fel sätt framkom även i resultatet. Av resultatet uppenbarade sig också att en del deltagarna i studierna hade känt sig jämlik behandlad av vårdpersonalens goda bemötande. Slutsats: Det har visat sig att deltagarna upplever stigmatiserande attityder, bristande kunskap samt att vårdpersonalen i deras bemötande uppvisar en rädsla för att själva bli smittad. Rädsla kan uppstå till följd av okunskap. Genom att förbättra vårdpersonalens kunskap om blodburna smittor skulle detta kunna bidra till att vårdpersonal blir mer säkra i vårdandet av patienter med blodsmitta. Detta skulle kunna främja att patienterna får en bättre upplevelse av bemötandet inom vården och att omvårdnaden skulle kunna bli bättre. / Background: Blood-borne infection is spread through blood, blood-mixed body fluids or through blood products. The most prominent blood-borne infections are HIV, hepatitis B and C and these are classified as general dangerous diseases. Millions of people live with HIV, hepatitis B and C worldwide. In healthcare, sharps injuries and recycled disposable materials are the most common risks of infection. There are divided opinions among healthcare professionals about how they feel about caring for patients with blood-borne infections. Aim: To describe how patients with bloodborne pathogens (HIV, hepatitis B and C) experience the treatment in healthcare. Method: A literature study with descriptive design based on ten scientific articles with a qualitative approach and one article with mixed methods. All articles were searched in the search engine PubMed through the database Medline. Results: The results from the articles showed that the healthcare personnel attitudes in treatment of the participants contributed to feeling stigmatized and stamped in the meeting with care. The participants had experienced the healthcare personnel fear of themselves being infected, which affected the treatment negatively. The results showed that sensitive information had been revealed to unauthorized persons and the participants experienced the treatment as disrespectful because confidentiality was not maintained. Ignorance about blood infections, shortage of information, poor response to the participants' questions and that diagnoses had been submitted incorrectly also appeared in the results. The result appeared that some participants in the studies had felt equal treatment from health professionals with a good attitude. Conclusion: It has been shown that participants feel stigmatizing attitudes, lack of knowledge and the caregivers in their treatment have a fear of becoming infected themselves. Fear can arise as a result of ignorance. By improving the caregivers' knowledge of blood-borne infections, this could contribute to healthcare professionals becoming more secure in the care of patients with bloodborne infections. This could promote that the patients get a better experience of the treatment in the care and that the nursing could be better.

Om storleken på utrymmen i spels levlar påverkar stämningen har diskuterats av leveldesignförfattare, bland andra Totten (2019) som nämner i sin bok, An Architectural Approach to Level Design, att olika storlekar på utrymmen i spel främjar olika känslor. Denna bakgrund för studien har sedan applicerats på den data som samlats in för att svara på problemformuleringen Hur påverkas upplevd stämning av områdets storlek i Bloodbornes Forbidden Woods och Upper Cathedral Ward? Datan består av storleksmätningar av utrymmen i två av spelets områden samt kommentarer från internet. Kommentarerna granskades efter ord och uttryck kopplade till upplevd stämning och områdets storlek. Efter att ha sammanställt kommentarerna om områdena analyserades de utefter storleksmätningarna och Tottens (2019) teori. Vi fann indikation till att storlek påverkar upplevd stämning, men att mer forskning krävs för att säkerställa resultatet. Denna kunskap kan potentiellt användas av level designers för att skapa en bättre spelupplevelse. För framtida arbete föreslår författarna att skapa en egen artefakt för att bättre kunna kontrollera beroende och oberoende variabler.

A research project submitted in partial fulfilment of the requirements for the degree of Master’s (Industrial/Organisational Psychology) in the Faculty of Humanities, University of the Witwatersrand, Johannesburg, March 2017 / A South African study, based on a sample of 208 medical personnel working in public and private institutions, was conducted in order to determine whether job demands and job resources led to differences in the propensity to comply with Needlestick Injury (NSI) intervention scores. Three self-report questionnaires were completed by the participants, namely the self-developed demographic questionnaire, the Job Demands-Resources Scale (JDRS) which measured job demands and resources, and thirdly the self-developed Propensity to Comply with Interventions for Needlestick Injuries Scale (PCINS) which measured the propensity to comply with interventions for NSIs. Accidental needle stick, as well as sharp, injuries occur frequently within the medical context and are associated with high risks for blood-borne infections (Adefolalu, 2014). Specifically within South Africa blood-borne infections such as HIV carry heavy significance. Needlestick injuries often go unreported by healthcare professionals, and these injuries are widely prevalent. The researcher aimed to explore the job demands and resources that contribute to and mitigate against these injuries. Therefore support for the analysis of job demands and resources and the propensity to comply with NSI interventions exists. The results of the study suggested that there were mostly no significant differences between Job Demands and Resources and the propensity to comply with NSI Interventions scores. However significant relationships were found between length of shift and the propensity to comply with NSI interventions and growth opportunities and the propensity to comply with NSI interventions. The findings did not follow the proposed hypotheses that job demands would lead to a decrease in the propensity to comply with NSI interventions and job resources would lead to an increase in the propensity to comply with NSI interventions as longer length of shift (job demand) led to an increase in propensity to comply with NSI interventions and an association between high levels of growth opportunity (job resource), and low levels of propensity to comply with NSI interventions, was found. / GR2018

Because of their relative inexperience in performing procedures and handling sharps devices, medical students and resident physicians are considered to be at high risk for sharps injuries. A higher rate of sharps injuries for medical trainees implies a higher risk for occupationally-acquired infection with bloodborne pathogens and may have financial and legal implications for training institutions. This study examines the prevalence of sharps injuries among US medical students and resident physicians. A systematic review of the literature yielded 10 studies that gave data on sharps injuries for US medical students or residents, and those data were combined with data from our institution to produce pooled prevalences. Results from our institution showed that residents had a significantly higher risk of sharps injuries than medical students. While sharps injuries increased with students' years of training, residents' rates decreased with increasing level of training. Resident rates were highest in the department of Surgery and lowest for Pediatrics. Comparing pooled prevalences of US trainees revealed that residents were 6 times more likely than medical students to have a sharps injury. This information can be used by training programs to inform changes in residency training curricula and infection control policies, as well as to forecast Worker's Compensation and long-term disability insurance coverage requirements. Medical training institutions must continue to provide opportunities for students and residents to perfect their procedural skills, but at the same time, trainees must be protected from the risk of sharps injuries and exposure to bloodborne pathogens.

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.

Thesis (MPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The research focused on the knowledge of occupational safety by hospital managers towards HIV and other blood borne pathogens transmission in Abakaliki region in eastern Nigeria. These pathogens are easily transmissible by needle sticks and other occupational accidents. It is important to identify factors that pre-expose hospital cleaners to occupational risk exposure that can lead to the transmission of HIV, HBV and HCV. The research was conducted in 10 different hospitals. A total of 90 questionnaires were administered to the hospital cleaners that volunteered to participate in the research and 68 questionnaires were returned representing 75.6% of the total questionnaires. The mean age and standard deviation of the respondents in this study was 38.6 + or – 5.4 years. The researcher conducted a semi-structured interview with all the 10 hospital managers involved with the study and the interviews showed there was a need for an organised training on hospital work and occupational hazards, risk exposures and precautions. The questionnaires showed the knowledge of hospital cleaners on occupational safety and it was observed the majority of the hospital cleaners were not aware of post exposure prophylaxis for HIV. The workers relatively had good practices put in place to prevent HIV, HBV and HCV transmission but majority of them had not received HBV vaccine due to lack of awareness and availability. There was a significant positive correlation between the knowledge of the health workers and HIV transmission and the practice put in place by health workers to prevent HIV transmission (P<0.05). This implies as the knowledge of the health workers about HIV transmission increases, the practice put in place by health workers to prevent HIV transmission and Hepatitis B&C increases. Therefore there is need for continuous training on blood borne pathogens transmission such as HIV transmission in the hospitals and its routes of transmission. There is need for awareness creation for HBV vaccine and Post exposure prophylaxis for HIV exposure. / AFRIKAANSE OPSOMMING: Nie beskikbaar / jfl201601

Standard precautions are a set of guidelines that aim to protect health care workers from infections from blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes while providing care to patients. However, compliance to the standard precautions is often low in low-income countries in spite of the greater risk of infection. This study examined the knowledge and practice of standard precautions among health care workers in public secondary health facilities in Abuja, the Federal Capital Territory of Nigeria. A quantitative descriptive survey was conducted with 83 doctors and 194 nurses using a structured questionnaire. Findings show suboptimal knowledge and practice of the standard precautions among the health care workers. Knowledge of post-exposure prophylaxis for HIV was low as well as hepatitis B immunization among the respondents. A lack or irregular supply of essential materials, such as personal protective equipment, was the main reason the respondents did not comply to the precautions. This report recommends the development and implementation of a comprehensive infection prevention and control program in health facilities in order to ensure compliance to the standard precautions by health care workers. / Public Health / M.A. (Public Health)

Thesis (MMed (Occupational Medicine))--Stellenbosch University, 2013. / Introduction Exposure incidents involving blood and body fluids represent a major hazard for medical undergraduates. Every medical teaching university experiences the problem of undergraduate medical students sustaining such incidents. Although Post Exposure Prophylaxis (PEP) is readily available and accessible to medical undergraduates following an incident, continuity and quality of care extends beyond the provision of PEP. This includes follow up consultations after receiving PEP according to protocol. Study Design This study was performed at the Tygerberg Campus of Stellenbosch University in Cape Town, South Africa to assess compliance with follow up consultations following an exposure incident. The study base consisted of all the medical undergraduates who reported an exposure incident at the Campus Health clinic. Cases were defined as medical undergraduate students of Stellenbosch University who had reported an exposure incident between January 2007 and December 2011. They were identified using the clinic database and records. Influential factors associated with the exposure incident, including compliance regarding follow up consultations were obtained from standardised reporting forms and medical records. The data was analysed in 2 sections, a cross sectional component (descriptive and analytical) and a retrospective cohort component. Two student cohorts were retrospectively followed from the beginning of their 3rd year to the end of their medical curriculum (6th year). Results There were 280 exposure incidents reported in the study period, of which 174 were low risk and were 106 high risk incidents for which PEP was prescribed (37.86% used PEP). For those who had high risk exposures, 90.57% (n=96) attended the 6-week follow up consultation, 48.11% (n=51) attended the 3 month visit and 34.91% (n=37) attended the 6 month follow up visit. There was an increase in the number of exposure incidents from 2010 (n=43) to 2011 (n=76). Internal medicine accounted for the most number of incidents (n=68), followed by Surgery (n=51), Obstetrics and Gynaecology (n=44), and Paediatrics (n=42). Drawing blood was the most common reported activity associated with exposures. Of notable importance was recapping, disposing of needles and insertion of blood into sample tubes. These activities accounted for 63 of the 280 exposure incidents. The 4th year students were the least at risk for exposure incidents compared to 3rd, 5th, 6th years. The annual average cumulative risk of having an exposure incident was found to be 5.7% (95%CI=4%-8%) and 6.8% (95%CI=5%-9%) amongst the 2 student cohorts over the duration of 4 years (clinical exposure time). Recommendations There is an urgent need for the number of exposure incidents to be reduced, e.g. needle recapping and disposal, and insertion of blood in sample tubes cause numerous preventable incidents. Various other strategies can be implemented in order to reduce the number of incidents across all undergraduate years of study. It is envisaged that by reducing the number of exposure incidents, there will be a subsequent decrease in the number of individuals requiring PEP. The importance of ensuring compliance with regard to follow up consultations needs to be emphasized. Factors that lead to noncompliance need to be investigated in a separate study.

Standard precautions are a set of guidelines that aim to protect health care workers from infections from blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes while providing care to patients. However, compliance to the standard precautions is often low in low-income countries in spite of the greater risk of infection. This study examined the knowledge and practice of standard precautions among health care workers in public secondary health facilities in Abuja, the Federal Capital Territory of Nigeria. A quantitative descriptive survey was conducted with 83 doctors and 194 nurses using a structured questionnaire. Findings show suboptimal knowledge and practice of the standard precautions among the health care workers. Knowledge of post-exposure prophylaxis for HIV was low as well as hepatitis B immunization among the respondents. A lack or irregular supply of essential materials, such as personal protective equipment, was the main reason the respondents did not comply to the precautions. This report recommends the development and implementation of a comprehensive infection prevention and control program in health facilities in order to ensure compliance to the standard precautions by health care workers. / Public Health / M.A. (Public Health)