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PubMed2002

Effects of hospital staffing and organizational climate on needlestick injuries to nurses.

OBJECTIVES: This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses. METHODS: We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units in 20 hospitals. RESULTS: Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses. CONCLUSIONS: Staffing and organizational climate influence hospital nurses' likelihood of sustaining needlestick injuries. Remedying problems with understaffing, inadequate administrative support, and poor morale could reduce needlestick injuries.

Blood-Borne Pathogens↗
PubMed1995

Application of CQI tools to the reduction in risk of needlestick injury.

OBJECTIVE: To reduce the risk of needlestick injuries to laboratory workers. DESIGN: Continuous Quality Improvement (CQI) tools were applied to data collected on the number of blood gas syringes that arrived in the laboratory with needles still attached and to the reasons for these occurrences. SETTING: A clinical chemistry department within a 900-bed tertiary referral university teaching hospital. PARTICIPANTS: Clinical chemistry laboratory staff and medical staff responsible for sending syringes with needles still attached. INTERVENTIONS: Changing to a preheparinized blood gas syringe that included a syringe cap within the packaging. RESULTS: Fivefold reduction in the number of syringes arriving in the laboratory with needles still attached. CONCLUSION: The risk of needlestick injury to laboratory workers can be reduced by provision to clinical staff of preheparinized blood gas syringes that include a syringe cap within the packaging. The techniques to CQI provide powerful tools for the identification, solving, and monitoring of safety-related issues within the healthcare environment.

Accidents, Occupational↗
PubMed2004

Raising awareness and reducing the risk of needlestick injuries.

More than 100,000 needlestick injuries occur in the UK each year. Preventive strategies include training, education, modification of practice, hepatitis B vaccination and the use of needle-protective devices. This paper examines the literature to investigate why injuries occur, why staff do not always report them and what can be done about these problems.

Health Knowledge, Attitudes, Practice↗
PubMed1986

Perceptions and beliefs of nursing and medical personnel about needle-handling practices and needlestick injuries.

A survey of 1473 nursing and medical personnel employed in two hospitals in a large metropolitan area was conducted to determine perceptions and beliefs about needle-handling practices and needlestick injuries. Additional questions in the survey focused on responsibility for discarding needles and syringes and the correct practice for disposal of needles and syringes in various situations presented. Analyses were based on 488 responses (33%). Nurses at the 437-bed University Hospital handled more needles and experienced more needlestick injuries than did nurses at the 300-bed Community Hospital. Needle-handling and needlestick injuries among medical personnel at the two hospitals were similar, although University Hospital interns and residents and University Hospital fourth-year medical students handled more needles than did the medical staff at either hospital. A total of 164 (33.6%) respondents reported receiving one or more needlestick injuries during 1983. A large proportion of respondents in each group reported that they did nothing about the needlestick injuries they experienced. Carelessness was perceived by all groups to be the most common reason for needlestick injuries. Most respondents reported some knowledge of proper needle disposal techniques and perceived lack of knowledge as the least important reason for needlestick injuries.

Attitude of Health Personnel↗
PubMed1992

Reported hospital needlestick injuries in relation to knowledge/skill, design, and management problems.

OBJECTIVES: To investigate reported needlestick injuries in hospital workers from an adult learner theory perspective: identifying safe needle device knowledge and practice, and flaws in needle designs and management practices surrounding such problems. DESIGN: Exploratory descriptive study of reported needlestick injuries from hollow needled devices in a hospital. Injured healthcare workers were counseled via hospital protocol, then a survey was filled out containing no identifiers of individual or institution. SETTING: Seventeen Metropolitan Washington, DC, area hospitals. PARTICIPANTS: All workers reporting needlestick injuries during February 1-28, 1990. RESULTS: Seventy-two injuries were reported; there were no multiple injuries to any individual. Thirty-three (45.8%) were to registered nurses (RNs)-more than any other group of workers. Recapping accounted for a higher percentage than any other activity (10 sticks, 14.1%). Of workers incurring recapping injuries, 3 identified a knowledge of a one-handed spearing technique and did not practice it; 4 neither knew nor practiced it. Eighteen (25.0%) were to "down-stream" housekeepers and aides who did not use such devices in their practice. Disposable needle/syringes caused 49.3% of injuries; hypodermic needles on intravenous lines caused 16.9%. Of the needlesticks, 60.6% were after use and before disposal, 4.2% occurred as the worker was putting an item into a needlebox, and 9.9% occurred from needles protruding from inappropriate bags. Many injuries occurred in the first 2 hours of work after being off the previous day, on Sunday, and on Monday. CONCLUSIONS: Of nurses and medical technologists reporting knowledge of a spearing recapping technique, 97.3% suffered injury via other methods. This strongly suggests that knowledge leads to different action. Safer needled devices and needle-free systems would make a safer workplace. Further study is indicated to identify if and why the first two hours after returning to work on Sunday or Monday are risky for needlestick injuries. Management practices must ensure compliance to safe practice both by employees and related medical staff.

Clinical Competence↗
PubMed2005

Needlestick injuries, management and education: a role for emergency medicine?

INTRODUCTION: The objectives of the study were to study the pattern of needlestick injuries presenting to an inner city emergency department, and to highlight areas where greater training is required. The emergency department is involved in the management of injuries both in the hospital setting and in the community. The setting was an inner city area with a high incidence of intravenous drug abuse, HIV, hepatitis B and C. METHODS: A retrospective review of all emergency notes triaged as needlestick injury for a 12-month period from July 2001 to July 2002. Information studied included times from incident, arrival at department, to be seen by doctor and to get post-exposure prophylaxis (PEP) if indicated; also the number of tetanus toxoid, hepatitis B immunoglobulin/vaccine, HIV PEP given as well the number indicated. The risk of injury and exposure were assessed and follow-up was checked. RESULTS: There were 73 needlestick injuries, 35 (48%) presented during normal working hours (09.00-17.00 h) and 38 (52%) presented outside these hours. Twenty-six (34%) were in healthcare workers, 51 (66%) were in non-healthcare workers. The average time from the incident to arrival was 1.4 h for healthcare workers and 22.6 h for non-healthcare workers. The median time from arrival in the department to be seen by a doctor was 90 min. Ten injuries (13.7%) were high risk. Antiretroviral agents were given to 15 patients (20.1%) and the median time from door to HIV PEP was 90 min (average 141 min). CONCLUSIONS: There is a delay and lack of urgency in the presentation of needlestick injuries for assessment and treatment. Education of emergency staff, other healthcare workers and the general public is needed to reduce the needle-to-door and needle-to-PEP time for the effective management of needlestick injuries and prevention of hepatitis and HIV seroconversion.

Emergency Medicine↗
PubMed2005

Prospective study of community needlestick injuries.

Fifty three children were referred following community needlestick injuries, August 1995 to September 2003. Twenty five attended for serology six months later. None were positive for HIV, or hepatitis B or C. Routine follow up after community needlestick injury is unnecessary. HIV post-exposure prophylaxis should only be considered in high risk children.

Adolescent↗
PubMed1991

Needlestick injury: impact of a recapping device and an associated education program.

OBJECTIVE: To determine the impact of the introduction of a plastic shield-shaped device (Needleguard, Biosafe, Auckland, New Zealand) and education program designed to allow safer recapping, on recorded rates of needlestick injury. DESIGN: A before-after trial with a two-year duration of follow-up. SETTING: Tertiary referral hospital. PARTICIPANTS: Nursing and other hospital personnel. RESULTS: Prospectively collected baseline data, together with the results of an anonymous questionnaire of 25% of the hospital nursing staff, defined a reported needlestick injury rate of 6.9 per hundred full-time nursing staff per year. In the pre-intervention period, there were 6.7 needlestick injuries per 100 nursing staff members per year reported. This increased to 15.4 (p less than .0001) needlestick injuries per 100 nursing staff members per year after the intervention. An anonymous survey undertaken at both time periods suggests that the apparent increase in officially reported needlestick injuries is due to an increase in the willingness of nurses to now report previously unreported needlestick injuries. CONCLUSIONS: The impact of the safety device and education program was the more accurate reporting of needlestick injuries; many nursing staff continued to resheath needles contrary to hospital policy. Many staff simply did not use the newly designed safety device. Approaches to improving compliance with such safety devices are considered.

Accidents, Occupational↗
PubMed1999

Risk of transmission and features of hepatitis C after needlestick injuries.

The rate of transmission and management of needlestick injuries from hepatitis C virus (HCV) patients to healthcare workers is still a matter of debate. We used a stringent protocol using monthly transaminase levels and polymerase chain reaction for HCV RNA to monitor 53 healthcare workers prospectively for up to 6 months following needle injuries from HCV-positive patients. Evidence of transmission of HCV was found in only 2 workers (4%) with mild asymptomatic infection, one of which resolved spontaneously. Based on our experience, we now use a less-intensive follow-up protocol. Further investigation is required to determine the most cost-effective method to monitor individuals who suffer a needlestick injury from an HCV-positive patient.

Adult↗
PubMed1990

Needlestick injuries and needle disposal in Minnesota nursing homes.

We examined needle use and disposal, needlestick injuries and their management, and employee education regarding the acquired immunodeficiency syndrome and needle use by means of a questionnaire sent to all long-term care facilities certified for skilled care in Minnesota. Responses were received from 297 of 349 (85.1%) homes. Nearly all homes (271 of 293; 92.5%) provided education for new nursing employees about use and disposal of needles. Disposal of needles and sharps was generally consistent with current recommendations for short-term care hospitals. Needlestick injuries were usually related to recapping and were most common in registered and licensed practical nurses but were infrequent (i.e., less than 1 injury per home per employee-year) probably because parenteral therapy is infrequently used in long-term care settings. Only slightly over half (166 of 286; 58%) of the homes had protocols for management of needlestick injuries. Although Minnesota nursing homes properly dispose of needles and sharps, many of these institutions need to develop policies for management of needlestick injuries that are consistent with current recommendations.

Accidents, Occupational↗
PubMed2000

Evaluation of interventions to prevent needlestick injuries in health care occupations.

OBJECTIVE: The objective of this study was to evaluate interventions that reduce or prevent needlestick injuries in health care occupations. METHODS: Cochrane Collaboration search strategies to locate studies that evaluated interventions to reduce needlestick injuries in health care occupations were used. Studies were selected if they met the following criteria: (1) interventions were evaluated in the defined population; (2) interventions were randomized, with a comparison group(s); (3) outcomes were objectively measured and had interpretable data. Eleven studies met inclusion criteria. The main outcomes of interest were changes in the number of glove or skin perforations and changes in amount of skin contamination. RESULTS: Three studies found a decrease in glove or skin perforations when double gloves or combinations of gloves were used by surgeons and their assistants. One study found an increase in glove perforations but a decrease in hand contamination. Three studies evaluated the effectiveness of specialized needles in reducing needlestick injuries during surgical wound closure with decreases in glove or skin perforations reported. Protective devices were evaluated in three studies and significant reductions in glove perforations were found with the use of a needleless intravenous system and surgical assist device. One study evaluated a "no-touch" technique used by surgeons during wound closure and found a significant decrease in the number of glove perforations compared to the traditional "hand-in" method of closure. CONCLUSIONS: Few randomized controlled trials have been employed to evaluate the effectiveness of interventions to reduce needlestick injuries in health care occupations. The majority of the studies evaluated interventions during surgical procedures, rather than during patient care on nursing units, probably because the latter is more difficult to observe.

Evaluation Studies as Topic↗
PubMed1993

Transmission of HIV via a needlestick injury: practice recommendations and research implications.

1. The majority of occupational exposures to potentially infectious blood and body fluids occur via needlestick injury. The morbidity and mortality from these exposures is significant. 2. Models from Haddon and White can help identify strategies to decrease the probability of needlestick injury. 3. A review of research examining work practices mandated by the Bloodborne Pathogens Standard challenges their effectiveness. Principles identified by Robertson provide insight into why work practices may not prevent needlestick injuries. 4. Engineering controls may be more effective in preventing needlestick injuries. Analysis of type and potential impact of needlestick preventive devices, cost, training requirements, and acceptance is essential in product selection.

Accidents, Occupational↗
PubMed1984

Incidence of needlestick injuries in hospital personnel: implications for prevention.

A retrospective review of needlestick injuries was conducted for the period January 1979 through May 1981 at a major university teaching hospital. The objective of this review was to determine the needlestick injury rate among employees according to department, occupation, activity, shift, and full- or part-time status. Two hundred eighty-six incidents of needlestick injuries were recorded. Almost 90% of injuries occurred in nursing, housekeeping, and clinical laboratory personnel. Direct handling of needles primarily involved nursing and laboratory personnel. Housekeeping personnel were injured primarily as "innocent victims" hauling trash. Significantly elevated incidence rates were observed in part-time and night-shift personnel. Incidence rates in registered nurses significantly exceeded rates in licensed practical nurses. On the basis of these findings, it is suggested that prevention of such incidents should be focused on such high-risk groups.

Female↗
PubMed2000

Sharps and needlestick injuries: the impact of hepatitis B vaccination as an intervention measure.

INTRODUCTION: This paper studies the epidemiology of sharps and needlestick injuries amongst health care workers and the effectiveness of intervention measures implemented at a regional hospital, Singapore. MATERIALS AND METHODS: A retrospective review of sharps and needlestick injuries among healthcare workers of a regional hospital at Singapore between 1992 and 1997. Various interventions namely education, policy changes and a hospital-wide hepatitis B immunisation programme were reviewed for effectiveness of programmes implementation. RESULTS: Of the 347 reported sharps and needlestick injuries, 45.7% occurred in the nursing staff, 25.1% medical staff, 7.5% health attendants, 5.2% hospital cleaners and 3.7% laboratory technicians. A steady rise in reporting was noted amongst the doctors from 1994 and this correlated with the implementation of educational talks given to new medical staff in May 1993. The number of healthcare workers with no previous history of hepatitis B immunisation decreased significantly from 17 in 1996 to 9 in 1997 (P < 0.001, odds ratio = 1.806 with 95% CI 1.443 to 2.261) after the implementation of the hospital-wide hepatitis B immunisation programme. CONCLUSIONS: Levels of awareness may contribute towards changes seen in the number of reporting of injuries. In our experience, we contend that education and appropriate policy changes towards easier reporting help to decrease sharps and needlestick injuries in healthcare workers. The hospital-wide hepatitis B immunisation programme helped to raise the immune status of the staff so as to reduce the costly prophylactic usage of hepatitis B immunoglobulin.

Allied Health Personnel↗
PubMed1997

[The basics for establishing a needlestick injury prevention program in hospitals].

Although the risk of occupationally acquired infection is a matter of considerable concern for health care workers, the problem of needlestick injuries has yet to be fully understood in Japan. We investigated 257 cases of needlestick injuries in five Nagoya Municipal Hospitals from 1989 to 1994 using the Japan EPInet. The number of needlestick injuries increased each year of the study. In one of these hospitals, the Higashi Municipal Hospital, a specialist committee began activities in April, 1993, and protective equipment and devices were also introduced during 1994. HCV contamination injuries accounted for 70%-80% of the total number of injuries reported during the 1991-1994 period at the four hospitals and during 1991-1992 period at the Higashi Municipal Hospital. At the Higashi Municipal Hospital, HCV contamination injuries decreased from 22 cases (48%) in 1993, to 15 cases (25%) in 1994. The use of the Japanese EPINet for analytical purposes enabled us to clearly identify the causes and status of needlestick injuries, resulting in the establishment of an effective prevention program.

Female↗
PubMed2005

Needlestick injuries in a tertiary care centre in Mumbai, India.

Accidental exposure from blood/body fluid of patients is a risk to healthcare workers (HCWs). Percutaneous injury is the most common method of exposure to blood-borne pathogens. A policy was formulated at our institute, a tertiary care centre in central Mumbai, and we report a six-year (1998--2003) ongoing surveillance of needlestick injuries. Of the 380 HCWs who reported needlestick injuries, 45% were nurses, 33% were attendants, 11% were doctors and 11% were technicians. On source analysis, 23, 15 and 12 were positive for Hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV) and hepatitis C virus (HCV), respectively. Immediate action following potential exposure included washing the wound with soap and water, encouraging bleeding and reporting the incident to the emergency room. Analysis of the source of injuries revealed that known sources accounted for 254 injuries, and unknown sources from garbage bags and Operating Theatre instruments accounted for 126 injuries. Most needlestick injuries occurred during intravenous line insertion (N=112), followed by blood collection (N=69), surgical blade injury (N=36) and recapping needles (N=36). Immediate postexposure prophylaxis (PEP) for HCWs who sustained injuries with hepatitis-B-virus-positive patients included booster hepatitis B immunization for those positive for antiHBs. A full course of immunization with hepatitis B immunoglobulin was given to those who were antiHBs negative. All staff who sustained injury with HIV were given immediate antiretroviral therapy (AZT 600 mg/day) for six weeks. Subsequent six-month follow-up showed zero seroconversion.

Accidents, Occupational↗
PubMed2005

Needlestick injuries in the United States. Epidemiologic, economic, and quality of life issues.

Best evidence from prospective studies with aggressive monitoring suggests that the incidence of needlestick injuries is significantly higher than reported through passive surveillance, ranging from 14 to 839 needlestick injuries per 1,000 health care workers per year. The economic cost of managing these injuries is substantial, ranging from dollars 51 to dollars 3,766 (2002 U.S. dollars). This amount excludes the cost of treating the long-term complications of needlestick injuries, such as HIV and hepatitis B and C infections, each of which can cost several hundreds of thousands of dollars to manage. In addition, health care workers experience significant fear, anxiety, and emotional distress following a needlestick injury, sometimes resulting in occupational and behavior changes. Despite the availability of engineered injury prevention devices, the implementation of these new technologies has been mixed in part because of the perception that these devices are costly and cost ineffective. However, widespread use of safety devices might be more easily justified on economic grounds when the full clinical and economic benefits of these new technologies are considered, especially within the context of injury prevention.

Accidents, Occupational↗
PubMed2001

Management of needlestick injuries in general dental practice.

The objective of this paper is to advise on the development of practical policies for needlestick injuries in general dental practice. Policies for dealing with occupational exposure to chronic blood borne viruses, namely, hepatitis B, C and HIV are evolving. This article was particularly prompted by recent changes in post exposure prophylaxis for HIV infection. A flow chart is also included which should be of possible use in general dental practice. Needlestick injuries are of increasing concern to healthcare workers. Successful prophylaxis requires careful planning in advance. Whilst all practices should have a policy for sharps injuries, prevention of needlestick injuries remains the best policy.

Blood-Borne Pathogens↗