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PubMed1999

Costs and benefits of measures to prevent needlestick injuries in a university hospital.

OBJECTIVE: To document the costs and the benefits (both in terms of costs averted and of injuries averted) of education sessions and replacement of phlebotomy devices to ensure that needle recapping did not take place. DESIGN: The percentage of recapped needles and the rate of needlestick injuries were evaluated in 1990 and 1997, from a survey of transparent rigid containers in the wards and at the bedside and from a prospective register of all injuries in the workplace. Costs were computed from the viewpoint of the hospital. Positive costs were those of education and purchase of safer phlebotomy devices; negative costs were the prophylactic treatments and follow-up averted by the reduction in injuries. SETTING: A 1,050-bed tertiary-care university hospital in the Paris region. RESULTS: Between the two periods, the proportion of needles seen in the containers that had been recapped was reduced from 10% to 2%. In 1990, 127 needlestick (12.7/100,000 needles) and 52 recapping injuries were reported versus 62 (6.4/100,000 needles) and 22 in 1996 and 1997. When the rates were related to the actual number of patients, the reduction was 76 injuries per year. The total cost of information and preventive measures was $325,927 per year. The cost-effectiveness was $4,000 per injury prevented. CONCLUSION: Although preventive measures taken to ensure reduction of needlestick injuries appear to have been effective (75% reduction in recapping and 50% reduction in injuries), the cost of the safety program was high.

Cost-Benefit Analysis↗
PubMed1993

Efficacy of gloves in reducing blood volumes transferred during simulated needlestick injury.

This study was designed to evaluate factors that affect blood volumes transferred to skin during simulated needlestick injuries in an in vitro paper prefilter model and an ex vivo porcine tissue model. The effect of needle type and size, penetration depth, and glove use on the volume of radiolabeled blood transferred was determined in each model. Blood volumes ranged from 0.47 +/- 0.26 microL (30-gauge needle, 0.5-cm depth, in vitro model) to 5.88 +/- 1.45 microL (18-gauge needle, 2.0-cm depth, in vitro model). Needle size and penetration depth were significantly associated with transfer volume. Glove material reduced the transferred blood volume by 46%-86% in both models. Transfer volumes were within the same order of magnitude for all conditions. Hence, virus titer in the source blood may be a better predictor of needlestick infectivity than is exposure volume. Regardless, gloves may exert some protective effect and should be worn whenever needles are handled.

Animals↗
PubMed1999

The effect of devices used to reduce the risk of blood spillage or needlestick injury on the flow of intravenous infusion systems.

We evaluated the effect of two devices used to reduce needlestick injury and blood spillage on the flow of saline, polygeline and blood through intravenous infusion equipment and their effects on methods of increasing flow. The devices studied all reduced flow compared with control. The reductions were less for the reflux valve (< or = 9%) and greater for the anaesthesia extension set (< or = 59%), with little further reduction in flow when both were used in series (< or = 60%). Reductions in flow increased with increasing viscosity of the fluid infused, being greatest with blood. The flow reduction produced by the reflux valve was more than compensated by increasing pressure or increasing to the next larger cannula size. The flow reduction produced by the anaesthesia extension was compensated by increasing pressure but not by increasing cannula size.

Blood↗
PubMed1989

Needlestick injuries and needle disposal in Minnesota physicians' offices.

Because little is known about needlestick injury and needle disposal in non-hospital settings, we surveyed physicians' offices in Minnesota. Recapping of needles was frequent (51.1%, 72 of 141) and injuries had occurred during the past year in 44.0% of offices. When of known cause, needlesticks were most common during blood drawing and recapping (52.0%, 13 of 25). Small offices more often recapped needles, but only metropolitan small offices reported more frequent injuries. Only 37.6% of offices used a protocol for management of injuries, and in less than half (45.4%) was physician evaluation routine. Although most offices used plastic containers and a majority (73.0%) incinerated or autoclaved needles prior to disposal, small offices more often disposed of sharps in their routine solid waste. Larger metropolitan offices more consistently followed current recommendations for handling and disposing of needles. There is a need for education efforts to address these issues for physicians and their office staff.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Preventing sharps, splash, and needlestick injuries in dentistry: a comprehensive overview.

This article presents a comprehensive collection of precautions and suggestions for preventing sharps, splash, and needlestick injuries in dentistry. The authors looked at studies of sharps and splash injuries in dentistry to determine which of these injuries are most common. They then assembled a set of precautions to prevent these injuries based on published literature, tips learned from other dentists, and their own clinical observations. Dentists must remember and apply many precautions to prevent the broad spectrum of sharps and splash injuries that could occur during the delivery of dental care.

Accidents, Occupational↗
PubMed2001

Lack of seroconversion in a health care worker after polymerase chain reaction-documented acute hepatitis C resulting from a needlestick injury.

We present a case of documented acute hepatitis C that occurred in a health care worker who sustained a needlestick injury while caring for an individual who was infected with both hepatitis C virus (HCV) and human immunodeficiency virus (HIV). According to the findings of third-generation serological assays performed during a follow-up of >1 year, the health care worker, who was treated with interferon-alpha (during weeks 2-6) and ribavirin (during weeks 5-9), did not develop antibodies against HCV, in spite of documentation of an HCV-specific T cell response.

Adult↗
PubMed2006

Role of safety-engineered devices in preventing needlestick injuries in 32 French hospitals.

OBJECTIVES: To evaluate safety-engineered devices (SEDs) with respect to their effectiveness in preventing needlestick injuries (NSIs) in healthcare settings and their importance among other preventive measures. DESIGN: Multicenter prospective survey with a 1-year follow-up period during which all incident NSIs and their circumstances were reported. Data were prospectively collected during a 12-month period from April 1999 through March 2000. The procedures for which the risk of NSI was high were also reported 1 week per quarter to estimate procedure-specific NSI rates. Device types were documented. Because SEDs were not in use when a similar survey was conducted in 1990, their impact was also evaluated by comparing findings from the recent and previous surveys. SETTING: A total of 102 medical units from 32 hospitals in France. PARTICIPANTS: A total of 1,506 nurses in medical or intensive care units. RESULTS: A total of 110 NSIs occurring during at-risk procedures performed by nurses were documented. According to data from the 2000 survey, use of SEDs during phlebotomy procedures was associated with a 74% lower risk (P<.01). The mean NSI rate for all relevant nursing procedures was estimated to be 4.72 cases per 100,000 procedures, for a 75% decrease since 1990 (P<.01); however, the decrease in NSI rates varied considerably according to procedure type. Between 1990 and 2000, decreases in the NSI rates for each procedure were strongly correlated with increases in the frequency of SED use (r=0.88; P<.02). CONCLUSION: In this French hospital network, the use of SEDs was associated with a significantly lower NSI rate and was probably the most important preventive factor.

Biomedical Engineering↗
PubMed1995

An outbreak of needlestick injuries in hospital employees due to needles piercing infectious waste containers.

OBJECTIVES: To investigate the cause of an outbreak of needlestick injuries (NSIs) in hospital employees. SETTING: A 700-bed university hospital. DESIGN: Outbreak investigation, laboratory evaluation of a medical waste disposal device, cost analysis. METHODS: Employee health department records were reviewed of workers suffering sticks from needles piercing fiberboard-contaminated material containers (CMCs). A laboratory evaluation of needle-puncture resistance properties of the CMCs was performed using a testing apparatus. The cost of a hospital waste disposal program using fiberboard CMCs was compared with the cost of a program using rigid plastic (polypropylene) boxes. RESULTS: During 40 months of surveillance in 1986 and from 1989 to 1991, only one NSI had occurred from a needle piercing a CMC. During 9 months in 1993, 13 NSIs occurred due to needles piercing CMCs (P < .001). No clinical illness resulted from the NSIs. The outbreak was halted by a temporary change to plastic (polypropylene) boxes for sharps disposal ($4.92 to $23.33/cu ft) until receipt of a box with a newly designed solid fiberboard liner ($1.25/cu ft). CMC liners used during the epidemic had a mean needle puncture resistance of 527 g, as compared with 660 g for liners used before the outbreak (P < .001). The new solid fiberboard liner has a mean puncture resistance of 1,765 g. A program of waste disposal using fiberboard CMCs was found to cost approximately one-seventh the cost of a program using plastic boxes for disposal of infectious waste. CONCLUSION: A program for infectious waste disposal using fiberboard CMCs can be safe and cost-effective if appropriate standards for puncture resistance are met.

Containment of Biohazards↗
PubMedDate not supplied

Curbing needlestick injuries. National Institute for Occupational Safety and Health.

According to NIOSH, organizational controls are vital in a prevention strategy to curb needlestick injuries to healthcare workers. These include worker training, eliminating unnecessary sharps, and placing disposal containers where sharps are used. The material presented in this article was excerpted from NIOSH's new guide, "Selecting, Evaluating, and Using Sharps Disposal Containers."

Health Personnel↗
PubMed2005

Needlestick injury in acute care nurses caring for patients with diabetes mellitus: a retrospective study.

OBJECTIVE: To quantify the incidence and assess the risk of needlestick injury (NI) in nurses caring for patients with diabetes mellitus. METHODS: A total of 400 nurses caring for patients with diabetes in 381 different hospitals throughout the United States over a period of at least 1 year voluntarily completed an Internet-based data collection instrument. The nurses self-reported comprehensive data on their experience with NI, focusing on those occurring within the past year. If respondents experienced multiple NI during this period, detailed data were collected on the most recent event. RESULTS: Of the 400 nurses, 313 (78.3%) reported experiencing at least one NI, 110 (27.5%) reported at least one NI within the last 12 months, and 44 (40% of 110) reported multiple NI. Nearly two-thirds of these injuries (n = 73/110; 66.4%) were punctures that drew blood, resulting in one case of contracted hepatitis C. The cumulative annual incidence of NI events was 448 NI per 1000 nurses. Nurses reported the injury in adherence with existing regulations and policies in only 21.8% of the cases. Disposable syringes were involved in 88 (80%) of the NI events. In half of the injuries (n = 55), the needled device was equipped with a safety feature that was ineffective, primarily because it was not fully activated (n = 47/55; 85.5%) or it malfunctioned (n = 2-5; 3.6-9.1%). NI most commonly occurred while nurses were injecting insulin (n = 33; 30%). In the 2 weeks following their NI, 60.1% of nurses noted that they were more afraid of needled devices than before the injury and 41.8% felt anxious, depressed, or stressed. As a direct result of the NI, nurses missed 77 days of work. CONCLUSIONS: This study is the first to show the relatively high risk both of NI and of NI that draws blood among nurses injecting insulin with a disposable syringe and confirms previous incidence estimates of NI among nurses. Additionally, this study reveals significant post-NI emotional distress, suggests significant under-reporting of NI to hospital officials, and demonstrates the need for a more effective needle safety device.

Accidents, Occupational↗
PubMed2002

Hollow-bore needlestick injuries in a tertiary teaching hospital: epidemiology, education and engineering.

OBJECTIVE: To describe the frequency, cause and potential cost of prevention of hollow-bore dirty needlestick injury (NSI) sustained by healthcare workers. DESIGN AND PARTICIPANTS: Ten-year prospective surveillance study, 1990-1999, with triennial anonymous questionnaire surveys of nursing staff. SETTING: 800-bed university tertiary referral hospital in Brisbane, Australia. MAIN OUTCOME MEASURES: Rates and circumstances of NSI in medical, nursing and non-clinical staff; knowledge of NSI consequences in nurses; and minimum costs of safety devices. RESULTS: Between 1990 and 1999, there was a significant increase (P < 0.001) in the trend of the reported rate of NSI. Of the 1836 "dirty" NSIs reported, most were sustained in nursing (66.2%) and medical (16.8%) staff, with 62.7% sustained before disposal. Hollow-bore injuries from hypodermic needles (83.3%) and winged butterfly needles (9.8%) were over-represented. Knowledge among nursing staff of some of the risks and outcomes of NSI improved over the decade. A trend (chi(2 )= 9.89; df = 9; P = 0.0016) with increasing rate of reported injuries in this group was detected. The estimated cost of consumables only, associated with the introduction of self-retracting safety syringes with concomitant elimination of butterfly needles, where practicable, would be about $365 000 per year. CONCLUSION: More than one NSI occurs for every two days of hospital operation. Introduction of self-retracting safety syringes and elimination of butterfly needles should reduce the current hollow-bore NSI by more than 70% and almost halve the total incidence of NSI.

Biomedical Engineering↗
PubMedDate not supplied

Avoiding the risk of needlestick injuries.

It is dangerous not to recap used needles, yet it can be equally dangerous to recap them. For each of us in the health sector, the prevention of needlestick injury (NSI) should be an everyday objective. This article discusses the risks associated with NSIs and examines whether current recommendations are being ignored.

Accidents, Occupational↗
PubMed1991

Bloody needles: the volumes of blood transferred in simulations of needlestick injuries and shared use of syringes for injection of intravenous drugs.

Residual HIV-infected blood in needles and syringes is a source of HIV infection. Using radiolabelled blood we have stimulated needlestick injuries and sharing of syringes by intravenous drug users and quantified the volumes of blood which could be transferred to recipients in these situations. Up to 0.75 microliters of blood was transferred in needlestick simulations, but there was a large variation. In simulations of needlesharing, seven to ten times more blood was transferred from the index user to the first sharer when 2 ml syringes were used compared with 1 ml syringes. Washing with water was not effective in removing 'infected' blood from a syringe.

HIV Infections↗
PubMed1990

Epidemiology of needlestick injuries in house officers.

Eighty-eight medical students, interns, and residents were surveyed to study the epidemiology of their percutaneous exposures to blood. Respondents described 159 injuries in 221 person-years (py) of exposure in hospital wards and 213 injuries in 166 py of exposure in operating rooms. Nearly all injuries (greater than 98%) were needlesticks; less than 5% were reported to occupational health services. Rates of ward-related injury were highest for students (0.97/py) and decreased during training. Most injuries were due to recapping of used needles. In contrast to ward-related injury, rates of operating room-related injury were relatively low for nonsurgical students and interns (0.3/py), higher for surgical students (1.36/py), and stable over surgical residency training (mean, 5.4/py). Virtually all surgical injuries occurred during suturing. Further research into mechanisms of needlestick injuries and product design for their prevention are needed.

Accidents, Occupational↗
PubMed1990

Risk reduction through testing, screening and infection control precautions--with special emphasis on needlestick injuries.

Transmission of the hepatitis B virus (HBV) and human immunodeficiency virus (HIV) pose substantial risks to institutional healthcare employees working with blood. While the risk of contracting hepatitis B in the hospital setting is much greater than the probability of acquiring HIV, the cost of treating the acquired immunodeficiency syndrome (AIDS)--if it develops--is much greater in both dollars and human suffering. In addition to the risks posed by the presence of HIV infection in the hospital increase daily. By the end of 1990, one of every 14 hospitalized patients will be an HIV carrier. Of all hospital-related injuries to employees, the highest percentage (35%) is caused by needlestick/"sharps" punctures. Over a 12-month period, approximately 18,000 hepatitis cases reportedly have been caused by needlestick accidents. After nurses, housekeeping personnel--victims of incorrectly disposed needles--are most at risk. Nurses incur 58% of needlesticks when needles are broken, cut or recapped. Currently, there are products on the market specifically designed to eliminate contact with needles. These cartridge-needle safety units allow for only one-time use, thus doing away with the possibility of recapping. Initial expenditures for new equipment are well worthwhile; the implementation of revised safety precautions are not only worthwhile but also required by law. The dollar costs imposed on hospitals by accidental transmission of bloodborne diseases include tests for the employee, treatment, outpatient visits and wages. One pilot study prevention program conducted in an 800-bed hospital resulted in a 53% reduction in needlestick injuries.

HIV Infections↗
PubMed1992

An examination of needlestick injury rates, hepatitis B vaccination uptake and instruction on 'sharps' technique among medical students.

A 12-question survey designed to examine venepuncture techniques and instruction and uptake of hepatitis B vaccination was completed by 172 of the 275 medical students to whom it was distributed (a response rate of 62.5%). Seventy-five injuries were reported, at an average of 0.3 per student per year. Of the respondents, 63% resheathed needles after use, a practice frequently cited as a cause of needlestick injury. However, in this sample resheathing was not significantly associated with a higher or lower injury rate (chi 2 = 2.07, P > 0.1). Of the respondents from the most recent intake, only 20 out of 57 had completed a course of hepatitis B vaccinations prior to the commencement of venepuncture duties. There was almost universal ignorance concerning the correct course of action following 'sharps' injury. Recommendations are made concerning hepatitis B vaccination and teaching strategies for medical students.

Bloodletting↗