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PubMed1992

Needlestick injury in hospital personnel: a multicenter survey from central Italy. The Latium Hepatitis B Prevention Group.

OBJECTIVES: To assess the rate of needlestick injury in hospital personnel in an Italian region. To identify risk factors potentially amendable to correction. DESIGN: Hospital workers undergoing hepatitis B prevaccination testing in 1985 through 1986 were interviewed regarding needlestick injury in the previous year, job category, area of work, years of employment, and other pertinent information. SETTING: Of the 98 public hospitals of the Latium region, 68 participated in the survey: 32 of 55 with less than 200 beds, 20 of 25 with 200 to 300 beds, 11 of 13 with 400 to 900 beds, and all of the 5 with more than 1,000 beds. PARTICIPANTS: All healthcare workers providing direct patient care or environmental services as well as student nurses were invited by the hospital directors to undergo hepatitis B prevaccination testing and vaccination, if eligible. RESULTS: Of 30,226 hospital workers of the 68 participating hospitals, 20,055 were interviewed (66.3%): 47.7% of the 7,172 doctors, 71% of the 14,157 nurses, 55.9% of the 2,513 technicians, and 71.9% of the 6,384 ancillary workers. Needlestick injury was recalled by 29.3%; the rates were 54.9%, 35.3%, 33.8%, 26.5%, 18.7%, and 14.7% in surgeons, registered and unskilled nurses, physicians, ancillary workers, and technicians, respectively. The recalled injury rate was 39.7% and 34.0% in surgical and intensive care areas; in infectious diseases, it was 16.7%. Rates were lower in hospitals with 200 to 300 beds (25.6%). The needlestick injury rate declined from 32% in those with less than 5 years of employment to 28% in those with more than 20 years (p less than .01). Prevalence of HBV infection was higher in student nurses and young workers recalling a needlestick exposure (14.3% and 15.8%, respectively), versus 10.1% and 12.8% in those not exposed (p less than .01 and less than .05, respectively). CONCLUSIONS: Parenteral exposure to blood-borne infectious agents is a relevant risk among healthcare workers in our region, particularly in defined job categories and hospital areas (surgeons, nurses, surgical, and intensive care areas). Immunization and educational efforts should be made along with better designs of devices to reduce the risk of infection.

Hepatitis B↗

PubMed1992

Impact of a shielded safety syringe on needlestick injuries among healthcare workers.

OBJECTIVES: Evaluate the impact of a shielded 3 cc safety syringe on needlestick injuries among healthcare workers. DESIGN: Surveillance study. SETTING: Three medical centers. RESULTS: The total number of needlesticks from all sources rose from 134 during the baseline period to 140 during the study phase. However, the overall rate of needlesticks involving 3 cc syringes decreased from 14/100,000 inventory units to 2/100,000, and the frequency declined substantially at each of the participating medical centers. CONCLUSIONS: These results suggest that shielded syringes and related technology may offer potential for reducing the risk of needlestick injuries among hospital and other healthcare employees. This study should be viewed as a preliminary effort to assess the potential of shielded-syringe technology for reducing the risk of needlestick injuries among healthcare workers. The results are encouraging, but more clinical experience with this new device and longer follow up are essential to provide the data necessary for a definitive assessment of efficacy.

Humans↗

PubMed2004

Safety syringes can reduce the risk of needlestick injury in venous thromboembolism prophylaxis.

Patients undergoing major orthopaedic surgery of the lower extremities are at high risk of developing venous thromboembolism (VTE). Pharmacologic thromboprophylaxis has greatly reduced the likelihood of VTE. The most effective medications are administered once or twice daily by subcutaneous injection, a drug delivery route associated with an increased risk of needlestick injury. Awareness of the potential lethality of needlestick injuries has increased during the past decade, resulting in the development of national safety guidelines from the Occupational Safety and Health Administration on the handling and management of needles and other sharps. This article reviews the potential risks and costs associated with needlestick injury during the administration of VTE prophylaxis in patients undergoing major orthopaedic surgery. The development of novel anticoagulants and accompanying devices to prevent needlestick injury is also discussed.

Anticoagulants↗

PubMedDate not supplied

An overview of litigation concerning needlestick injuries in defective design and negligent use of equipment cases.

Needlestick injury litigation has occurred in several settings, but in recent years, the primary basis for lawsuits involves the transmission of deadly diseases or the fear of acquiring those diseases. These cases may be divided into situations that concern defective product designs and situations where there has been negligent use of or disposal of the needles. This article provides exemplary cases that discuss both the law and factual issues surrounding needlestick injuries.

Equipment Design↗

PubMed2003

Occupational exposure to needlestick injuries and hepatitis B vaccination coverage among health care workers in Egypt.

BACKGROUND: The health care worker (HCW) is at substantial risk of acquiring bloodborne pathogen infections through exposure to blood or infectious body fluids. Hepatitis B vaccination of HCWs and optimal HCW practices regarding management of sharps can minimize these risks. This study explores the frequency of exposure to needlestick injuries and the hepatitis B vaccination coverage among HCWs in Egypt. METHODS: All HCWs available in a 25% random sample of different types of health care facilities from 2 governorates in Egypt (Nile Delta and Upper Egypt) were included in the study. A total of 1485 HCWs were interviewed. History of exposure to needlestick injuries, vaccination status, and socioeconomic data were collected. RESULTS: Of the 1485 HCWs interviewed, 529 (35.6%) were exposed to at least 1 needlestick injury during the past 3 months with an estimated annual number of 4.9 needlesticks per worker. The most common behavior associated with needlestick injuries was 2-handed recapping. Overall, 64% of HCWs disposed of needles unsafely in nonpuncture-proof containers. Overall 15.8% of HCWs reported receiving 3 doses of hepatitis B vaccine. Vaccination coverage was highest among professional staff (38%) and lowest among housekeeping staff (3.5%). Using Kane's model to predict infections after needlestick exposures, we estimate 24,004 hepatitis C virus and 8617 hepatitis B virus infections occur each year in Egypt as a result of occupational exposure in the health care environment. CONCLUSION: High rates of needlestick injuries and low vaccination coverage contribute highly to the rates of viral hepatitis infections among HCWs. Prevention of occupational infection with bloodborne pathogens should be a priority to the national program for promotion of infection control. Training of HCWs on safe handling and collection of needles and sharps, and hepatitis B vaccination of all HCWs is required to reduce transmission.

Accidents, Occupational↗

PubMed1994

Needlestick injury in medical students.

OBJECTIVE: To determine the incidence of needlestick injuries and the prevalence of hepatitis B vaccination among medical students, dentistry students, and hospital staff. DESIGN AND SUBJECTS: Anonymous survey of final year medical students and dentistry students enrolled at Sydney University in 1992, and nursing staff and doctors employed in the wards and emergency department of Royal Prince Alfred Hospital, Sydney. RESULTS: During their clinical training, 22% of medical students and 72% of dentistry students had received one or more contaminated, penetrating "sharps" injuries. Of hospital staff, 50% of ward nurses, 71% of ward doctors, and 50% of emergency staff had received this type of injury during the previous two years. Students were significantly more likely to be vaccinated against hepatitis B than hospital staff (P < 0.001)--98% of medical students and 95% of dentistry students had received a full course of vaccination. The rate of vaccination among hospital staff ranged from 79% in emergency staff to 85% in ward nurses. CONCLUSIONS: Clinical students sustain needlestick injuries at a rate comparable with hospital personnel and therefore face a significant risk of exposure to transmissible pathogens, including hepatitis B virus, HIV, and hepatitis C virus. The rate of hepatitis B vaccination is high among clinical hospital staff and almost universal among medical and dentistry students.

Adult↗

PubMed1991

Needlestick injuries and hepatitis B immunization in Florida paramedics: a statewide survey.

STUDY OBJECTIVES: To determine the incidence of needlestick injury among paramedics working in Florida during 1987, to describe the circumstances surrounding such injuries, and to assess the hepatitis B vaccination status of this group. DESIGN: Survey of a systematic random sample of paramedics using a self-administered questionnaire. SETTING: Florida. TYPE OF PARTICIPANTS: Paramedics. MAIN RESULTS: A completed questionnaire was returned by 300 of 500 paramedics (60%) who received the mailed questionnaire. Sixty-nine paramedics (23%) reported a total of 110 needlestick injuries. More than one third of injuries occurred in conjunction with recapping needles. Almost 62% of reported injuries could have been prevented had proper needle disposal technique been used. Sixty-two percent of paramedics reported having had at least one dose of the hepatitis B vaccine. Sixty-five percent of the unvaccinated paramedics said they would take the hepatitis B vaccine if it was offered free. CONCLUSION: The majority of needlestick injuries among paramedics in Florida could be prevented with proper needle disposal. Offering the hepatitis B vaccine at no charge to paramedics in Florida could increase the vaccination rate substantially.

Adult↗

PubMed2002

Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses.

BACKGROUND: Recently passed federal legislation requires institutions to adopt safety equipment to prevent needlesticks, but there is little empirical evidence of the effectiveness of specific types of safety devices or the contribution of safety devices to reducing needlesticks relative to the contributions of staffing, organizational climate, and clinicians' experience. METHOD: In 1998, 2287 medical-surgical unit nurses in 22 US hospitals were surveyed in regard to staffing and organizational climate in their hospitals and about patient and nurse outcomes, including needlestick injuries. Hospitals provided information about available protective devices at the time of the survey. Relationships between nurse and hospital characteristics and protective equipment and the likelihood of needlestick injuries and near-miss incidents were examined. RESULTS: Poor organizational climate and high workloads were associated with 50% to 2-fold increases in the likelihood of needlestick injuries and near-misses to hospital nurses. Capless-valve secondary intravenous set systems and use of any type of protective equipment for IV starts or blood draws were associated with 20% to 30% lowered risks of both event types. CONCLUSIONS: Nurse staffing and organizational climate are key determinants of needlestick risk and must be considered with the adoption of safety equipment to effectively reduce sharps injuries.

Accidents, Occupational↗

PubMed1997

Childhood needlestick injuries in the Dublin metropolitan area.

Childhood needlestick injuries and other risk exposures outside of hospital are becoming increasingly common. A retrospective review of casenotes to ascertain the incidence, epidemiology and adequacy of management and follow-up of exposures in the Dublin metropolitan area revealed 52 cases between July 1995 and October 1996. Median age of children was 7.4 years. Most occurred in inner city areas with a recognised high prevalence of i.v. drug use. Only 2 high-risk exposures were identified. On presentation all cases received Hepatitis B vaccination and 56% received Hepatitis B immunoglobulin. Following Hepatitis B virus, Hepatitis C virus and Human immunodeficiency virus testing, no seroconversions have been identified to date in 9 children with completed tests. General follow-up and Hepatitis B immunisation when initiated were not always complete. Standardised management protocols and wider availability of counselling are recommended.

Adolescent↗

PubMed2003

Needlestick injuries among medical students.

BACKGROUND: Concern about occupational exposure to bloodborne pathogens exists, and medical students, who lack in experience in patient care and surgical technique, may be at an increased exposure risk. METHODS: This prospective cohort study evaluated needlestick injuries and practices regarding the use of protective strategies against bloodborne pathogens in medical students. A questionnaire was developed and sent to 224 medical students. RESULTS: Of 224 students, 146 students (64%) returned questionnaires. Forty-three students (30%) reported needlestick injuries that most commonly occurred in the operating room; 86% of students reported always using double gloves in the operating room; 90% reported always wearing eye protection, and all but one student had been vaccinated against hepatitis B. A concern about contracting a bloodborne pathogen through work was noted in 125 students, although they usually reported that this concern only slightly influenced their decision regarding a career subspecialty. CONCLUSION: Medical students have a high risk for needlestick injuries, and attention should be directed to protection strategies against bloodborne pathogens.

Adult↗

PubMed1990

Needlestick injuries in anaesthetists.

A survey of needlestick injuries among 42 anaesthetists at this university hospital was carried out over a 3-month period to ascertain the rate of occurrence and the extent to which a revised protocol for the management of such injuries was followed. There were nine reported incidents, of which six were with contaminated needles. Three were reported. Eight anaesthetists had not taken up immunisation against hepatitis B. The rationale behind the revised protocol, and possible reasons for poor compliance are discussed.

Accidents, Occupational↗

PubMedDate not supplied

[Needlestick injuries among nursing workers at a university hospital in the interior of the Sao Paulo state].

The risk presented by health care workers of acquiring bloodborne pathogens is well documented by the literature, which shows that Aids and Hepatitis acquired in the work setting is a real fact. This descriptive retrospective study was conducted in a university hospital in 1998 and aimed at analyzing needlestick injuries in nursing workers. Results showed that of the 398 officially reported occupational accidents, 125 (30.40%) were needlestick injuries and that 89 (71.20%) occurred among nursing workers. The most frequent occurrences took place during medication administration (25.78%). Authors concluded that nursing workers were the most frequently victimized workers by occupational accidents involving needlestick injuries.

Accidents, Occupational↗

PubMed1992

Needlestick injury: blood, mononuclear cells, and acquired immunodeficiency syndrome.

INTRODUCTION: Because transmission of HIV to health care workers after needlestick injury has occurred mainly a result of deep insertion of large gauge needles, blood and viable mononuclear cells transferred after needlestick injury were measured. METHODS: Needles of 20 to 27 gauge were filled with HIV-1 seropositive blood and inserted through extracorporeal human skin or parafilm covering physiologic saline solution modified Drabkin's solution, or culture medium, or inserted directly into one of these fluids, to a depth of one third of the needle length (0.5 inch) for 1 second. Volume of blood transferred was measured by both modified Drabkin's method and by chromium 51 labeling of red blood cells. Transfer of viable mononuclear cells was measured by growth in culture medium containing autologous feeder cells. RESULTS: The volume of blood transferred from a needle passed through skin varied from 312 +/- 69 nl from a 20-gauge needle to 14 +/- 4 nl from a 27-gauge needle, as measured by modified Drabkin's technique, and from 404 +/- 80 nl to 12 +/- 3.1 nl, as measured by chromium 51 labeling of red blood cells. The volume of blood transferred from a needle passed through parafilm was twice that transferred through skin. The volume of blood transferred through skin was 40% that transferred directly into fluid not covered by any barrier; blood transferred through parafilm was 80% of that transferred directly. When needles containing blood were inserted into culture medium for 1 second in the absence of a barrier, at least one viable mononuclear cell was almost always transferred to fluid from all gauges of needle tested. Insertion of needles through skin prevented transfer of all viable mononuclear cells from only 3% to 5% of 20- to 23-gauge needles, and from 12% to 32% of 26- and 27-gauge needles. Parafilm was an even less effective barrier than skin. Insertion of needles through parafilm completely prevented transfer of viable mononuclear cells from no 20- to 23-gauge needles and from only 5% to 10% of 26- and 27-gauge needles. CONCLUSION: The volume of blood transferred after needle insertion through skin for 1 second varied with the gauge of the needle and was 30-fold higher from a 20-gauge than from a 27-gauge needle. Variable mononuclear cells were transmitted after insertion through skin from more than 95% of 20- to 23-gauge needles and from 68% to 88% of 26- and 27-gauge needles. Parafilm was less effective than skin in reducing transmission of blood and viable mononuclear cells.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Occupational needlestick injuries: educational program and mechanical opening needle disposal boxes.

1. Needle recapping injuries, which individual employees have considerable ability to prevent, declined significantly following inservice education. 2. The problem of needles protruding into the opening of mechanical lids in needle disposal boxes persisted even after the inservice sessions. When clearlid, nonmechanical opening boxes were used, disposal injuries related to protruding needles declined significantly. 3. An educational program coupled with the appropriate placement of disposal boxes had a beneficial impact on some categories of needlestick injuries, although the total number of needlestick injuries did not decline.

Humans↗

PubMed1991

Needlestick injury in surgeons: what is the incidence?

A prospective study by questionnaire was carried out to investigate the incidence of needlestick injury in the operating theatre staff of a teaching hospital and to calculate the individual risk of acquiring blood-borne virus infection in the UK from this source. The individual rate of needlestick injury in operating theatre staff was 1.55% per surgeon per operation (confidence interval (Cl) 0.6-2.5%). The calculated rate of clinical hepatitis B in surgeons compared with the observed rate suggests that needlestick in theatre is the main mode of transmission.

Accidents, Occupational↗

PubMed1988

Effect of bedside needle disposal units on needle recapping frequency and needlestick injury.

Needle recapping has been shown to be one of the leading causes of needlestick injuries. Frequency of recapping has not been reported. This study was designed to determine the frequency of needle recapping by nursing personnel and the effect of bedside needle disposal units on the frequency of recapping and needlesticks. Seventy-four nurses carrying out 312 activities involving use of needles were observed. The subjects were not aware of the nature of the study. The recapping frequency was 93.9%. The study was repeated after educational programs and following installation of a hospital-wide bedside needle disposal system. Fifty-three nurses performing 151 activities with needles were observed. Frequency of recapping was 94%. There was no significant difference in the rate of recapping or needlestick injuries after installation of the new needle disposal system. Educational programs regarding recapping, a very common practice, may be ineffective. Alternate methods for preventing needlesticks may be necessary.

Accidents, Occupational↗

PubMed1995

Needlestick injuries. A multidisciplinary concern.

This article outlines a variety of steps implemented by the medical center in an effort to reduce the number of needlestick injuries among nurses within our institution. Overall, we have seen a decline in needlestick injuries with the greatest decline among the nursing staff. We attribute this decline to staff education, improved needle-disposal containers, and the addition of needleless products for IV infusions. More important, a rigorous quality-management approach, including employee involvement, the sharing of data throughout the institution, and management commitment to the issue, has enabled continuous improvement. We are in the process of refining our methods so that future decisions regarding neddlestick injury reduction-activities will more specifically address problem areas.

Academic Medical Centers↗

PubMed1989

Needlestick injuries in blood collection staff. A retrospective analysis.

Health care workers, including blood collection staff, are increasingly concerned about occupational hazards, particularly infection with human immunodeficiency virus (HIV) and hepatitis B virus. For individuals involved with volunteer blood donors, the most frequent route of parenteral exposure is needlestick injury with the phlebotomy needle. To assess the level of risk and possible avenues for prevention, 117 needlestick injury reports involving 72 employees were reviewed over a 2-year period (March 1983-March 1985) at a large blood center. Some 708,824 units of blood were collected over this period by more than 200 collection staff members. The incidence of needlestick injury for the study period was 0.0165 percent (1 in approximately 6000 collections). The activities most frequently associated with injury were the filling of the pilot tubes, removal of the needle from the pilot tubes, and performance of the hemoglobin fingerstick. As needlestick is a rare event and as the prevalence of infection is low among volunteer donors, the risk of acquiring HIV or hepatitis B is extremely small among blood collection staff. This information should serve to reassure employees who perform venipuncture.

Accidents, Occupational↗