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In recognition of the safety risks involved in caring for patients requiring any level of sedation, the Joint Commission, in the USA, has set specific standards around credentialing, competency assessment, and education. The six general competencies identified by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties are cited by the Joint Commission as a framework for credentialing and ongoing competency assessment. The intent of procedural sedation education is to develop and validate knowledge, skills, and behavioral competency in the management of patients requiring pharmacologic intervention during procedures. Significant advances in technology over the past few decades have created opportunity for organizations to meet the challenges of competency development and validation for healthcare practitioners. Simulation-based education is an emerging learning and assessment modality that educates, provides practice experience, and validates the competencies required to manage procedural sedation.
Two healthcare workers developed disabling chronic posttraumatic stress disorder after needlestick exposures to blood from a patient infected with human immunodeficiency virus (HIV), even though both continue to test negative for HIV antibody more than 22 months after their exposures. We describe these 2 cases and review the relevant literature. Prospective studies of psychological morbidity after occupational needlestick injuries are required to determine the role of long-term psychological follow-up, counseling, and support.
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