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PubMed2006

Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices.

AIMS: To review the literature on sharps injuries and occupational bloodborne virus transmission in health care in the UK and the worldwide evidence for injury prevention of sharps safety devices. METHODS: Literature review by online database and Internet resource search. RESULTS: Twenty-four relevant publications were identified regarding UK reported sharps injury rates. UK studies showed as much as a 10-fold difference between injuries reported through standard reporting systems (0.78-5.15 per 100 person-years) and rates estimated from retrospective questionnaires of clinical populations (30-284 per 100 person-years). National surveillance data from England, Wales and Northern Ireland gives a rate of 1.43 known hepatitis C virus or human immunodeficiency virus (HIV) transmissions to health care workers per annum. When extrapolated, this suggests an approximate rate of 0.009 such viral transmissions per 1000 hospital beds per annum. Risk of infection from sources with no risk factors is extremely small (less than one in one million for HIV transmission based on Scottish data). Thirty-one studies on the efficacy of sharps safety devices showed evidence of a reduction in injuries, with the greatest reductions achieved by blunt suture needles and safety cannulae. CONCLUSIONS: Although injuries remain common, confirmed viral transmission in the UK has been relatively rare. The degree of under-reporting of sharps injuries may be as much as 10-fold. Safety-engineered devices are likely to be effective at injury reduction.

HIV Infections↗
PubMed2001

Reducing needle-stick injuries with the use of 2-octyl cyanoacrylates for laceration repair.

PURPOSE: To describe the effectiveness of 2-octyl cyanoacrylates (2-OCA) for repair of lacerations, reduction of needle-stick injuries to health care providers, patient satisfaction, and overall cost reduction. DATA SOURCES: A descriptive study of typical lacerations (N = 38) presenting to a suburban urgent care center. CONCLUSIONS: Wound approximation was complete (92.1%); with no erythema, drainage, or warmth (100%) and patients were satisfied (87%) and preferred 2-OCA (91%). No needle stick injuries occurred (100%) to providers or ancillary staff. IMPLICATIONS FOR PRACTICE: 2-Octyl cyanoacrylates tissue adhesive effectively closes and heals wounds without infection, pain, or erythema. Health care providers can prevent the risk of blood and body fluid exposure from needle-stick injuries through the use of 2-OCA tissue adhesive.

Adult↗
PubMed1991

An analysis of blood and body fluid exposures sustained by house officers, medical students, and nursing personnel on acute-care general medical wards: a prospective study.

OBJECTIVE: To prospectively examine the epidemiology of blood and body fluid exposures sustained by medicine housestaff, medical school students, registered nurses (RNs), licensed practical nurses (LPNs), and nurses' aides (NAs) on general medicine wards and to define problem areas that may be amenable to change. DESIGN: Daily data collection during 9 months using a self-reporting questionnaire. SETTING: General medical wards in 2 tertiary referral hospitals. PARTICIPANTS: Medicine housestaff/students and nursing personnel. RESULTS: Physicians reported 644 exposures, of which 98 (15.2%), 296 (46.0%), and 250 (38.8%) were sustained by medicine residents, interns, and students, respectively. Blood contact occurred with 591 (91.8%) exposures. For physicians, 575 (89.3%) exposures occurred during venipuncture, intravenous catheter manipulation, and arterial punctures. Interns and students most commonly incurred exposures during venipunctures and intravenous manipulations; residents commonly were exposed during emergent intravenous catheter placements. Five-hundred-twenty-two (81%) exposures occurred between 7 A.M. and 7 P.M. During 524 (81.4%) exposures, physicians were not using barrier devices. Nurses reported 235 exposures, of which 140 (59.6%), 23 (9.8%), and 72 (30.6%) were sustained by RNs, LPNs, and NAs, respectively. RN exposures commonly occurred during intravenous manipulations and glucometer fingersticks. LPNs and NAs incurred a higher percentage of exposures during nonprocedural patient care. Blood contact and wound drainage accounted for 167 (71.1%) and 31 (13.2%) exposures, respectively. CONCLUSIONS: Exposures to blood and body fluids frequently are incurred by healthcare workers on general medical wards. Efforts to reduce these exposures should be directed not only at improving procedural skills of healthcare workers for venipunctures, intravenous catheter insertions, and glucometer fingersticks, but also in increasing barrier use during procedural and nonprocedural tasks.

Blood↗
PubMed1993

Installing needle disposal boxes closer to the bedside reduces needle-recapping rates in hospital units.

OBJECTIVE: To compare the proportion of recapped needles, an injury surrogate measure, in disposal boxes on two different types of hospital units, both before and after an intervention. DESIGN: Prospective nonrandomized intervention trial. SETTING: A major public teaching hospital. PARTICIPANTS: Specific hospital units. We selected two types of hospital units for study: the first type of hospital unit (medical-surgical ward) had existing mounted in-bathroom needle disposal boxes, and the second type of hospital unit (intensive care unit) had unmounted needle disposal boxes in the room but not necessarily near the patient's bedside. INTERVENTION: The installation, in the medical-surgical wards only, of mounted needle disposal boxes on the wall near the patient's bed. The box location in the intensive care units remained the same. In both types of unit, a new mailbox-slot disposal box (SAGE) also was substituted for the previous round-top container. RESULTS: The baseline proportion of recapped needles in the first medical-surgical unit was 32.6% (+/- 3.8%) and in the second medical-surgical unit it was 27.4% (+/- 4.0%) in the bathroom needle disposal boxes, which was similar to the observed proportion (34.7 +/- 6.4%) in the intensive care unit boxes. Following the intervention, the proportion of recapped needles was significantly reduced in the disposal containers adjacent to the bedside in medical-surgical units, to 27% (a difference of 2.9 standard errors of the baseline distribution) in the first unit and 18.2% (a difference of 4.6 standard errors) in the second. In the intensive care unit, where boxes were not moved but new mailbox-types were simply substituted, no significant change was noted (36.6%, a difference of 0.59 standard errors). A statistically significant reduction was observed in the proportion of needles recapped in both wards combined following the intervention (30.2% to 26.2%, a difference of 2.9 standard errors). CONCLUSION: Environmental changes alone are an effective means of altering the risk to healthcare workers from sharp instruments. The use of needle-box counts provides a sensitive and stable instrument to measure injury surrogates and, indirectly, behavioral change in hospital workers.

Accidents, Occupational↗
PubMed1997

Device-specific sharps injury and usage rates: an analysis by hospital department.

BACKGROUND: Whether universal precautions training has reduced percutaneous sharps injuries is questioned. Prevention programs directed to specific problem areas are required to further reduce injury. Our purpose was to identify target areas. METHODS: Device-specific sharps injury rates per 100,000 devices purchased were determined by department at Yale New Haven Hospital (1993 to 1994). Usage per full-time equivalent was calculated by department. Rates were modelled using Poisson regression. RESULTS: Three epidemiologic patterns resulted: (1) injury rates were independent of usage (butterfly needles); (2) injury rates varied directly with usage (lancets); (3) injury rates varied inversely with usage (intravenous catheters, sutures, and scalpels). Device-specific usage and injury rates varied by department. Devices used little (9/full-time equivalent) but under difficult circumstances, such as intravenous catheters in pediatric patients, were associated with high injury rates (67.7/100,000). Devices, sometimes disassembled, such as blood collecting tubes, caused significantly more injury in departments where health care professionals work under time constraints, such as in the emergency department and nursing. Unconventional use of devices (Luer-Lok syringes and scalpels) resulted in higher rates of injury (nursing and laboratories). Building services appeared to be at risk for injury. CONCLUSIONS: With device-specific injury and usage rates by department, injury prevention programs can now focus on specific devices and departments.

Accidents, Occupational↗
PubMed2000

Needle stick injuries: nurses at risk.

According to the Centers for Disease Control and Prevention (CDC), American health care workers suffer between 600,000 and 1 million needle sticks and other sharps injuries every year. Needle stick injuries are considered to be widely underreported. Eighty percent of blood contacts occur through needle sticks, making this the most common cause of health care work-related exposure to bloodborne pathogens. More than 20 pathogens can be transmitted through small amounts of blood. These include HIV, hepatitis B and C, other forms of hepatitis, syphilis, Rocky Mountain spotted fever, varicellazoster, and malaria. Hepatitis B is the most common infectious disease transmitted through work-related exposure to blood. The CDC reports that 5,100 health care workers become infected with hepatitis B each year through job-related blood contact. There have been 54 documented cases of HIV seroconversions among U.S. health care workers resulting from occupational exposures. Needle stick injuries caused by hollow-bore needles accounted for 86 percent of all reported occupational HIV exposures. Nurses make up 24 percent of the cases of HIV infection among health care workers known or thought to have been infected on the job. Research shows that 83 percent of these injuries can be prevented--most through the use of needles with safety features or needleless systems. According to the American Hospital Association, one case of serious infection by bloodborne pathogen can result in expenditures of $1 million or more for testing, follow-up, time lost from work, and disability payments. The cost of follow-up for a high-risk exposure is almost $3,000 per needle stick injury, even when no infection occurs. Safe needle devices cost about 28 cents more than standard devices.

Blood-Borne Pathogens↗
PubMed1994

[Injury to the surgeon in treatment of an HIV infected patient].

The number of HIV-infected female patients undergoing surgery is increasing. Injuries of the surgeon can never be completely excluded. The risk of HIV infection via a needle puncture lesion is estimated to be approximately 0.4%. Besides the well-known protective measures, careful wound disinfection followed by HIV tests for a period of up to six month after the lesion are indicated. It is indeed high time to consider the patient HIV test as a matter of course, not least because it is our duty to be concerned also about the health of our co-workers and staff directly engaged in patient care.

Adult↗
PubMed2004

Needle stick and other safety issues.

Percutaneous injuries such as accidental needle sticks are associated with the greatest risk for occupational transmission of blood-borne pathogens such as hepatitis B and C viruses and HIV. This article presents data on the risk of transmission of these viruses after needle sticks, offers strategies for prevention of injuries from sharp objects, and discusses postexposure prophylaxis recommendations.

Accidents, Occupational↗
PubMed1998

Minimizing the risk of penetrating injury to surgical staff in the operating theatre: towards sharp-free surgery.

Conventional surgery carries a significant risk of inadvertent injury to members of the scrub team. Although minor injury is common and usually no more than unpleasant, serious consequences may occur. Modifications in technique together with the application of modern instrumentation may reduce the risks of sharp injury substantially. The techniques and technology available in the conventional open surgery setting are reviewed.

Accidents, Occupational↗