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PubMed2001

Evaluating sharps safety devices: meeting OSHA's intent. Occupational Safety and Health Administration.

The Occupational Safety and Health Administration (OSHA) revised the Bloodborne Pathogen Standard and, on July 17, 2001, began enforcing the use of appropriate and effective sharps devices with engineered sharps-injury protection. OSHA requires employers to maintain a sharps-injury log that records, among other items, the type and brand of contaminated sharps device involved in each injury. Federal OSHA does not require needlestick injury rates to be calculated by brand or type of device. A sufficient sample size to show a valid comparison of safety devices, based on injury rates, is rarely feasible in a single facility outside of a formal research trial. Thus, calculations of injury rates should not be used by employers for product evaluations to compare the effectiveness of safety devices. This article provides examples of sample-size requirements for statistically valid comparisons, ranging from 100,000 to 4.5 million of each device, depending on study design, and expected reductions in needlestick injury rates.

Blood-Borne Pathogens↗
PubMed2006

Assessment of preventive measures for accidental blood exposure in operating theaters: a survey of 20 hospitals in Northern France.

BACKGROUND: Accidental exposures to blood of body fluids (ABE) expose health care workers (HCW) to the risk of occupational infection. OBJECTIVES: Our aim was to assess the prevention equipment available in the operating theater (OT) with reference to guidelines or recommendations and its use by the staff in that OT on that day and past history of ABE. METHODS: Correspondents of the Centre de Coordination de la Lutte contre les Infections Nosocomiales (CCLIN) Paris-Nord ABE Surveillance Taskforce carried out an observational multicenter survey in 20 volunteer French hospitals. RESULTS: In total, 260 operating staff (including 151 surgeons) were investigated. Forty-nine of the 260 (18.8%) staff said they double-gloved for all patients and procedures, changing gloves hourly. Blunt-tipped suture needles were available in 49.1% of OT; 42 of 76 (55.3%) of the surgeons in these OT said they never used them. Overall, 60% and 64% of surgeons had never self-tested for HIV and hepatitis C virus (HCV), respectively. Fifty-five surgeons said they had sustained a total of 96 needlestick injuries during the month preceding the survey. Ten of these surgeons had notified of 1 needlestick injury each to the occupational health department of their hospital (notification rate, 10.4%). CONCLUSION: The occurrence of needlestick injury remained high in operating personnel in France in 2000. Although hospitals may improve access to protective devices, operating staff mindful of safety in the OT should increase their use of available devices, their knowledge of their own serostatus, and their ABE notification rate to guide well-targeted prevention efforts.

France↗
PubMed2001

Impact of introduction of sharps containers and of education programmes on the pattern of needle stick injuries in a tertiary care centre in India.

Documentation of needlestick injuries was started in the Christian Medical College Hospital, Vellore in 1993. In 1995 large sharps containers were introduced, accompanied by an intensive education programme. Details of documented injuries from 1993 to 1999 were analysed using the Epi-Info software. A total of 347 injuries occurred, mainly due to improper disposal of needles, re-capping and carelessness during use. The percentage of injuries attributed to disposal fell from 69.2% in 1995 to 38.5% in 1996 (after the education programme). A further decrease was noted after the additional introduction of small sharps containers. In 1995, 73% of injuries involved housekeeping staff, this fell to 12% in 1998. Relatively simple interventions decreased the numbers of injuries, and we recommend that all healthcare institutions should have a system of documenting needlestick injuries, and take measures to decrease their incidence.

Academic Medical Centers↗
PubMed2005

Medical students' knowledge of sharps injuries.

Healthcare workers (HCWs) including medical students are at risk of occupational exposure to blood-borne viruses following sharps incidents including needlestick injuries. The recent Department of Health guidelines recommend that all HCWs entering a career involving exposure-prone procedures should be tested for hepatitis C, making preventative strategies even more relevant. A survey of current medical students' knowledge regarding prevention of sharps injuries in Birmingham, UK was carried out to determine their awareness of these risks and to compare the findings with an earlier cohort of students. Two hundred and fifty-six medical students were enrolled into the study. Their knowledge of needlestick injury, prevention and management had significantly improved compared with the previous study. This demonstrates that intensive teaching and self-learning programmes can improve the knowledge of HCWs and reduce the number of needlestick injuries.

Awareness↗
PubMed2005

Percutaneous exposure incidents among Australian hospital staff.

We investigated all reported Percutaneous exposure incidents (PEI) among staff from a large Australian hospital in the 3-year period, 2001-2003. There were a total of 373 PEI, of which 38.9% were needlestick injuries, 32.7% were cutaneous exposures and 28.4% sharps-related injuries. Nurses were the most commonly affected staff members, accounting for 63.5% of the total, followed by doctors (18.8%) and other staff (17.7%). Needlestick injuries were responsible for the majority of nurses' PEI (44.7%). Sharps injuries constituted the major category for doctors (44.3%). Most needlestick injuries (67.6%) were caused by hollow-bore needles, while the majority of cutaneous exposures involved blood or serum (55.8%). Most sharps injures were caused by unknown devices (35.9%) or suture needles (34.9%). Overall, our investigation suggests that PEI is a considerable burden for health care workers in Australia. Further research is now required to determine the relationships, if any, between workers who suffer PEI and those who do not.

Australia↗
PubMed2003

Management of healthcare workers after occupational exposure to hepatitis C virus.

The increasing rate of hepatitis C virus (HCV) infection in the community means that there is increased risk of occupational exposure for healthcare workers. In metropolitan hospitals in Victoria, we found that 80-150 healthcare workers have occupational exposures from HCV-infected patients annually. As there is a 1.8%-3% risk of transmission of HCV from a needlestick injury, two to five healthcare workers are likely to acquire HCV each year in Victoria. These needlestick injuries pose a personal, legal and professional risk to healthcare workers and their patients. Recent information shows that early antiviral treatment of acute HCV infection has high cure rates. Current local and international protocols for management of healthcare workers exposed to HCV do not address these issues. We propose a management protocol after needlestick injury that is stratified according to the likelihood of HCV acquisition and potential risk of staff-to-patient transmission, and that is consistent with the current legal and clinical context of HCV infection in Australia.

Clinical Protocols↗
PubMed2006

Mental health of healthcare workers who experience needlestick and sharps injuries.

Healthcare workers (HCWs) are exposed daily to the risk of injury by needlesticks and other medical instruments. However, the psychiatric impacts of such injuries have not been evaluated. The aim of this study was to evaluate the mental health status of HCWs with experiences of needlestick and sharps injuries. A cross-sectional written survey was performed. The psychological symptoms before injury and current status were measured using the Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Perceived Stress Scale (PSS). The proportions of HCWs with and without needlestick and sharps injuries were 71.1% (n=263) and 28.9% (n=107), respectively. HAM-A and BDI scores were significantly higher among HCWs with injury experiences (p<0.01). HCWs with injury experiences exhibited higher PSS and BDI scores after the injury and higher levels of anxiety and depression. Particular attention should be directed towards the psychological consequences of needlestick and sharps injuries in HCWs.

Adult↗
PubMed1997

Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures--New York City, March 1993-June 1994.

Infections with bloodborne pathogens resulting from exposures to blood through percutaneous injuries (PIs) (e.g., needlestick injuries and cuts with sharp objects) are an occupational hazard for health-care workers (HCWs). PIs have been reported during 1% - 15% of surgical procedures, mostly associated with suturing. Most suturing is done using curved suture needles, although straight needles are used by some surgeons for suturing skin. Blunt suture needles (curved suture needles that have a relatively blunt tip) may be less likely to cause PIs because they do not easily penetrate skin. Based on small studies and anecdotal experience, blunt suture needles appear able to replace conventional curved suture needles for suturing many tissues, although they may require more pressure to penetrate the tissues. This report summarizes results of a study in which CDC collaborated with three teaching hospitals in New York City during 1993-1994 to evaluate a safety device (a blunt suture needle) in gynecologic surgery. The findings indicate that use of blunt needles was associated with statistically significant reductions in PI rates, minimal clinically apparent adverse effects on patient care, and general acceptance by gynecologic surgeons in these hospitals.

Accidents, Occupational↗
PubMed2006

Prevalence of percutaneous exposure incidents amongst dentists in Queensland.

BACKGROUND: Percutaneous exposure incidents (PEI) represent an important occupational health issue in dentistry, and one that can incur severe consequences from blood-borne infections. Given the importance of this topic, we considered it necessary to investigate the distribution and cause of PEI among Queensland dentists. METHODS: In 2004, a self-reporting questionnaire was mailed to a random sample of 400 dentists on the register of the Queensland Branch of the Australian Dental Association. RESULTS: A total of 285 questionnaires (73.1 per cent) were completed and returned. Of the respondents, 73.3 per cent were male and 26.7 per cent female, with a mean age of 45.2 years (SD = 11.9 years). Most were general dentists (89.1 per cent) with the remainder being specialists (10.9 per cent). More than three-quarters (78.5 per cent) reported damaging their gloves at least once during a clinical procedure in the previous 12-month period. Roughly one-quarter (27.7 per cent) had experienced at least one 'sharps' or needlestick injury in the previous 12 months, 16.1 per cent of which involved a contaminated instrument that had been previously used on a patient. The most common devices to cause 'sharps' injury in the previous 12 months were needles (14.4 per cent) and burs (10.2 per cent). CONCLUSIONS: Although PEI clearly remains a major occupational health problem for Queensland dentists, the prevalence of needlestick injuries appears to be lower than other studies from developed countries. The identification of needlestick injuries as a common cause of PEI again stresses the importance of preventive strategies with respect to potential blood-borne infections. Further research is now needed to more carefully identify effective measures for reducing PEI among dental personnel.

Adult↗
PubMed2003

Blood-borne viruses and their survival in the environment: is public concern about community needlestick exposures justified?

BACKGROUND: More than 30 million needle syringes are distributed per year in Australia as a component of harm-reduction strategies for injecting drug users (IDU). Discarded needle syringes create considerable anxiety within the community, but the extent of needlestick injuries and level of blood-borne virus transmission risk is unclear. We have undertaken a review of studies of blood-borne virus survival as the basis for advice and management of community needlestick injuries. METHODS: A Medline review of published articles on blood-borne virus survival and outcome from community injuries. RESULTS: Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) can all survive outside the human body for several weeks, with virus survival influenced by virus titer, volume of blood, ambient temperature, exposure to sunlight and humidity. HBV has the highest virus titers in untreated individuals and is viable for the most prolonged periods in needle syringes stored at room temperature. However, prevalence of HBV and HIV are only 1-2% within the Australian IDU population. In contrast, prevalence of HCV is 50-60% among Australian IDUs and virus survival in needle syringes has been documented for prolonged periods. There have been no published cases of blood-borne virus transmission following community needlestick injury in Australia. CONCLUSION: The risk of blood-borne virus transmission from syringes discarded in community settings appears to be very low. Despite this, procedures to systematically follow up individuals following significant needlestick exposures sustained in the community setting should be developed.

Attitude to Health↗
PubMed1992

Entering first-year residents' experiences and knowledge of infection control of hepatitis B and HIV, at five university-affiliated hospitals.

In 1990, the authors surveyed 149 entering first-year residents at five university-affiliated hospitals concerning the residents' experiences and knowledge of infection control. Sixty residents (40%) had experienced a needlestick injury during medical school, but only 35 of these residents (58%) had reported the mishap. One hundred thirty-nine residents (93%) had received the hepatitis B vaccine. Of those 60 who had experienced a needlestick injury, 57 (95%) had received the vaccine. Of the 149 residents, 111 (74%) reported having received instructions in universal precautions, as advocated by the Centers for Disease Control. There was a trend for residents who had received the vaccine also to have been instructed in universal precautions. Regarding the residents' knowledge of infection control, there was no statistically significant difference between the responses of those who had been instructed in universal precautions and those who had not. The authors conclude that students are at risk for needlestick injuries; however, underreporting is frequent.

Educational Measurement↗
PubMed1997

Assessing blunt cannulae as replacements for hypodermic needles during intravenous therapy: safety and utility.

OBJECTIVE: Recently, blunt 18-gauge (ga) metal cannulae have become nationally commercially available as safety products. The ability of these blunt cannulae to prevent needlestick injury and to enable direct access of all standard latex ports and vial membranes, thus eliminating hypodermic needles entirely from the intravenous (i.v.) drug administration process, is assessed. DESIGN AND SETTING: In the laboratory setting, the needlestick injury potential of small-bore blunt cannulae versus hypodermic needles was studied using blinded and randomized methods. Insertion force requirements were studied for cannulae and needles. Metal 18-ga blunt cannulae were inserted into four brands of standard Y-ports and vial stoppers to assess postpuncture integrity and force requirements. RESULTS: Needlestick injury did not occur using small-bore blunt cannulae (P < .001; n = 51). Metal 18-ga cannulae passed into prepierced standard Y-ports as easily as hypodermic needles and without loss of Y-port integrity. Insertion of metal 18-ga cannulae without prior port puncture was possible, but was associated with substantial coring and loss of integrity of the port seal, except for IVAC brand ports (P < .03). CONCLUSIONS: Metal 18-ga cannulae can be inserted through virtually all intact standard rubber vial membranes or standard Y-ports to allow safe IV access. A single prepuncture of any standard latex membrane allows economical blunt metal cannula access equally efficiently as with expensive pre-slit membranes and without loss of membrane integrity.

Equipment Design↗
PubMed2000

A randomized trial of winged Vialon cannulae and metal butterfly needles.

The purpose of this parallel randomized study was to evaluate whether subcutaneous infusion sites initiated with winged vialon cannulae would have fewer skin reactions and longer site duration than metal butterfly needles and reduce needlestick injuries to staff. Data were collected on 42 hospice inpatients from the time of insertion of the first needle or cannula to the time of the first replacement of that device. A non-parametric survival plot for time (Kaplan-Meier method) was conducted and the survival time to replacement of the Vialon cannula was found to be longer than the metal butterfly needle. During the study period there were a total of four needlestick injuries to staff from metal butterfly needles. The authors conclude that Vialon cannulae reduce the frequency of site changes and are safer for staff to use because of the reduced risk of needlestick injuries.

Accidents, Occupational↗
PubMed2002

Prescribing practices in a population-based HIV postexposure prophylaxis program.

OBJECTIVES: To characterize factors associated with being prescribed triple or double postexposure prophylaxis (PEP) against HIV in a population-based program. METHODS: Individuals potentially exposed to HIV received a 5 day starter kit of either double or triple antiretroviral PEP between April 1999 and November 2000 and did/did not receive the remaining 23 days PEP. Data were collected through dispensation of kits. Logistic regression identified characteristics independently associated with being prescribed triple therapy starter kits and with any 23 day follow-up. RESULTS: Of 2064 people receiving 5 day PEP [403 (20%) triple and 1661 (80%) double], 590 (29%) received 23 day follow-up. Independently associated with being prescribed triple therapy starter kits were being male [adjusted odds ratio (AOR) 1.38; 95% confidence interval (CI) 1.10-1.74; P = 0.006), occupational mucocutaneous injuries (AOR 1.70; 95% CI, 1.14-2.55; P = 0.010), and community needlesticks (AOR 2.04; 95% CI, 1.54-2.69; P < 0.001). Independently associated with being prescribed the 23 day follow-up were being male (AOR 1.24; 95% CI, 1.00-1.53; P = 0.04), community mucocutaneous incidents (AOR 2.83; 95% CI, 1.41-5.70; P = 0.004), community needlesticks (AOR 1.75; 95% CI, 1.33-2.29; P < 0.001), and having received triple therapy as the starter kit (AOR 2.61; 95% CI, 2.07-3.29; P < 0.001). CONCLUSIONS: Being prescribed triple therapy starter PEP was associated with being male and with experiencing an occupational mucocutaneous or community needlestick injury. Receiving the remaining 23 days PEP was associated with being male, experiencing a community mucocutaneous or needlestick injury, and triple therapy as the initial 5 day starter PEP.

Accidents↗
PubMedDate not supplied

The use of metal or plastic needles in continuous subcutaneous infusion in a hospice setting.

OBJECTIVES: Battery-driven portable syringe drivers are a convenient method for administering many drugs by continuous subcutaneous infusion (CSCI) to patients who cannot swallow medications. At the St. Clare Hospice, nurses usually use plastic needles to minimize needlestick injury but sometimes have patients transferred to metal needles. This study retrospectively examines this practice and its effectiveness. METHODS: The duration of audit was four months. During this period, there were 40 patients (23 women, 17 men), who required their medications delivered by CSCI. A total number of 74 sites were used. Metal or plastic needle CSCIs connected with one-hour release Graseby Syringe Drivers were used. The syringes were set to deliver 2 mm/hour. The maximum volume syringe used was 50 ml. The data were collected retrospectively. Analysis and results. Sixteen patients (21.6 percent) developed minor complications (13 plastic, three metal). Among them, 16 showed inflammation. Two patients (3.5 percent) showed slight bleeding. Only one patient (1.7 percent) showed local infection (metal). In 14 patients (18.9 percent), the needle was reinserted due to various reasons, including needles pulled out by patients or needles falling out due to unknown reasons. There were no needlestick injuries reported, and the staff members reported that all problems encountered were easy to identify and resolve. CONCLUSION: Plastic needle CSCI prevents needlestick injury and gives minimum distress to the patients. More research is needed to determine the local side effects of drugs used and the strategies to resolve these problems.

Adult↗
PubMed1992

Exposure to blood during various procedures: results of two surveys before and after the implementation of universal precautions.

In an attempt to define better situations involving exposure to blood, we surveyed nurses (N = 565) in a 1000-bed university hospital to determine the following for the last working shift: the rate of cutaneous exposure to blood for different procedures, the rate of needlestick injury, and the prevalence of hand lesions. Among nurses who had performed at least one of the specified procedures, 42% had been exposed to blood with unprotected skin. Direct examination of 100 pairs of hands revealed that 57% of the nurses had either acute or chronic skin lesions. Universal precautions were introduced, and a similar survey (N = 541) was carried out 1 year later to assess compliance. Exposure of unprotected skin to blood had been reduced to 27%, although 46% of nurses had not used gloves for any of the procedures they had performed. The main reason given by nurses for not wearing gloves was that they did not consider the patient to be at risk for carrying a blood-borne infection. The rate of needlestick injuries was high and had remained stable at approximately 2.8 needlesticks/nurse per year, as determined by information from the last working shifts. We conclude that compliance of nursing personnel with universal precautions was insufficient, despite an informational campaign throughout the hospital. Repeated instruction on barrier precautions and the prevention of needlestick injury (including the correct use of disposable containers) is necessary to ensure optimal protection.

Blood↗
PubMed1995

Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers--Connecticut, 1992-1993.

To determine whether the simultaneous, partial repeal of needle prescription and drug paraphernalia laws in Connecticut affected purchasing and usage of needles and syringes (syringes) by injecting-drug users (IDUs) and risk of needlestick injuries to police officers, we conducted two serial cross-sectional surveys with IDUs recruited in drug treatment centers, correctional facilities, and health department settings. Reports of needlestick injuries among Hartford police officers were reviewed before and after the new laws. Among IDUs who reported ever sharing a syringe, syringe-sharing decreased after the new laws (52% before vs. 31% after; p = 0.02). Fewer IDUs reported purchasing syringes on the street after the new laws (74% before vs. 28% after; p < 0.0001). More IDUs reported purchasing syringes from a pharmacy after the new laws (19% before vs. 78% after; p < 0.0001). Eight to eleven months after the new laws were enacted, over two thirds (91 of 134) of active IDUs interviewed were aware of both new laws. Needlestick injury rates among Hartford police officers were lower after the new laws (six injuries in 1,007 drug-related arrests for 6-month period before new laws vs. two in 1,032 arrests for 6-month period after new laws). The changes in Connecticut laws were associated with decreases in self-reported syringe-sharing and increases in purchasing by IDUs of sterile syringes from reliable sources, suggesting that the simultaneous repeal of both prescription and paraphernalia laws is an important HIV prevention strategy.

Adolescent↗