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PubMedDate not supplied

Cost-effectiveness of prophylactic AZT following needlestick injury in health care workers.

In response to health care workers' concerns about contracting infection with the human immunodeficiency virus (HIV) in the workplace, several institutions now offer prophylactic azido-deoxythymidine (AZT) for needlesticks sustained while exposed to HIV-infected patients. The authors designed a model to evaluate the cost-effectiveness of AZT prophylaxis. If AZT were 100% effective, prophylaxis would cost $2,388 per life-year gained and $66,876 per life saved using a societal perspective. For each $100 increase in the cost of AZT, the cost per life-year saved increased $1,190. Reducing the efficacy of AZT to 75, 50, and 25% raised the costs per life-year gained to $3,184, $4,775, and $9,551, respectively. If AZT were given for all needlesticks without regard to the HIV status of the source, the costs of prophylaxis would rise substantially. It is concluded that AZT, if moderately effective, can be cost-effective as a prophylactic agent but only if used in instances where the source is known to have an HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Under-reporting of contaminated needlestick injuries in emergency health care workers.

STUDY HYPOTHESIS: There is considerable under-reporting of contaminated occupational needlestick and other sharp object injuries among emergency health care workers. POPULATION: A convenience sample of emergency physicians, emergency nurses, and emergency medical technicians (EMTs). METHODS: A survey instrument eliciting demographic and work-related factors was developed and administered; survey items included age, sex, occupation, years in occupation, number of procedures performed per week, number of contaminated needlestick (and other "sharps") injuries recalled, and number of these injuries formally reported during the previous five years. Nonsegmented visual analog scales were used to assess eight attitudes possibly associated with nonreporting. Analysis was by analysis of variance and multiple linear regression with stepwise variable election. RESULTS: Two hundred fifty-nine subjects recalled 643 contaminated exposures during the five-year study period, but only 228 (35%) were formally reported. One or more injuries occurred in 55% of EMTs compared with 72% of nurses and 80% of physicians (P less than .05). Physicians recalled a mean of 3.8 contaminated exposures, whereas nurses recalled 2.8 and EMTs recalled only 1.8 (P less than .05). Physicians formally reported a mean of 0.26 exposures, whereas EMTs reported 0.85 and nurses reported 1.25 (P less than .05). Physicians formally reported only one eighth of their injuries compared with EMTs and nurses, who each reported two thirds of these events (P less than .05). Perception of risk, occupation, years in occupation, and concern about excessive paperwork were the most powerful predictors of low reporting rate (P less than .05). CONCLUSIONS: Work-related contaminated sharp object injuries are under-reported by emergency health care workers, especially emergency physicians.

Accidents, Occupational↗
PubMed2002

Use of polymerase chain reaction for early detection and management of hepatitis C virus infection after needlestick injury.

Infection with hepatitis C virus (HCV) is a matter of great concern because of its potentially grave consequences. Instead of relying on the conventional anti-HCV antibody test to detect HCV infection after needlestick incidents, we used the polymerase chain reaction (PCR) to achieve earlier detection, to manage a patient more effectively, and to exclude possible infection more quickly. Fourteen incidents were studied in which the source patients were positive for both the anti-HCV antibody and HCV RNA, and the exposed subjects were negative for anti-HCV antibody at the time of the incidents. In one of the exposed subjects, a nurse, the result of the PCR test for HCV RNA was positive at 2 wk after the needlestick incident; the nurse's viral load was very low (800 copies/ml) and she responded well to immediate medical treatment. She never developed acute hepatitis C; her serum anti-HCV antibody level and alanine aminotransferase (ALT) activity did not become elevated, and results of her PCR test for HCV RNA were negative following treatment. In the other 13 needlestick incidents, the results of PCR tests of the exposed subjects were negative for HCV RNA throughout the study and possible infections were quickly ruled out.

Female↗