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Needlestick injuries are the most common type of occupational injury among nurses. At least 20 pathogens can be transmitted via a needlestick injury. Needlestick injuries should be reported immediately. Ongoing education of health-care staff is essential to ensure safe practice in the disposal of sharps.
Needlestick injuries to health professionals at the Hospital del Mar, Barcelona since 1987 have been prospectively studied; a total of 296 such accidents in 286 subjects have been registered. We report the first case to our knowledge of simultaneous human immunodeficiency virus (HIV) and hepatitis C (HCV) infection in a nurse who suffered a needlestick injury after a blood sampling. Forty-four days after the accident she had symptoms and laboratory findings of acute hepatitis. Subsequent laboratory tests showed elevation in the aminotransferases and antibodies against HIV. The seroconversion to HCV was not detected until 109 days after the injury. The precise sequence of clinical and biological events of this case of simultaneous HIV and HCV infection is reported.
Needlestick injuries in a 720-bed tertiary care hospital were analyzed before and after the introduction of a rigid, puncture resistant, needle disposal system. Following implementation of the system, disposal-related injuries decreased from 0.9 per 100 full-time equivalent employees/year to 0.3 per 100 full-time equivalent employees/year (p less than .005). However, needlesticks associated with procedures (2.2 vs. 4.4 per 100 full-time equivalent employees/year, p less than .0005), and those resulting from loose needles (0.5 vs. 1.9 per 100 full-time equivalent employees/year, p less than .0005), increased. Injuries occurring during needle recapping or the carrying of needles were not significantly altered. Total needlestick injuries increased from 6.0 to 8.7 per 100 full-time equivalent employees/year (p less than .0005). We concluded that a rigid, puncture resistant, needle disposal system can reduce disposal-related needlestick injuries, but must also be perceived as convenient to impact substantially upon needlesticks associated with other activities.
Needlestick accidents continue to be a hazard for healthcare workers. We report the development of acute hepatitis C infection in a physician after needlestick injury. Hepatitis C virus (HCV)-RNA, seroconversion and a raised plasma alanine aminotransferase (ALAT) level were found in plasma three months after the accident. Treatment with interferon alfa and ribavirin was started. While the physician was on treatment, HCV-RNA test results from plasma taken the day treatment was started became available. HCV-RNA was undetectable by quantitative bDNA assay, undetectable by qualitative polymerase chain reaction (PCR) and undetectable by transcription mediated amplification (TMA). A dilemma arose at this point: should the patient stop the treatment or continue the planned therapy? The physician decided to continue a 24-week course of treatment. Six months after the end of treatment, the physician was still HCV-RNA-negative and with a normal plasma ALAT level. The rationale of the decision to continue therapy is discussed. This information may be useful for clinicians confronted with a similar dilemma.
Anesthesiologists are at risk for acquiring blood-borne infections through contact with blood or body fluids. From prospective studies, the greatest risk of transmission is through a percutaneous exposure such as needlestick injury. Personal protective equipment such as gloves and gowns do not completely prevent these exposures. Although educational efforts can reduce the frequency of recapping of needles, they generally have not decreased the incidence of needlesticks. Therefore, in addition to practicing universal precautions, anesthesiologists can attempt to reduce their risk of needlestick injuries by eliminating nonessential unprotected needle use, through the use of needleless or protected needle devices (engineering controls) and by modifying anesthetic procedures requiring needles (work practice controls). Needleless or protected needle products are commercially available for use in many procedures performed by anesthesiologists. For tasks that require the use of needled devices, the practitioner should use safe techniques for handling (i.e., one-handed recapping if recapping is needed) and disposal (i.e., puncture-resistant containers) of these devices. Evaluation of the efficacy, cost, and safety of needleless or protected needle products should be continued as they are introduced into wider use. Additionally, anesthesiologists should be encouraged to report needlestick injuries so that appropriate postexposure treatment can be given and so that the incident can be studied to permit design of a work protocol or device to prevent similar accidents in the future.
Accidental needlestick exposures occur frequently among hospital personnel and account for most incidents of percutaneous injuries. Even if universal precautions were followed routinely, it is unlikely that multiple needlestick exposures could be avoided completely. Despite the likelihood of persons incurring multiple needlestick exposures, relatively little information is available on the cumulative risk of human immunodeficiency virus (HIV) infection for health care workers attending unrecognized HIV-infected patients. A quantitative method to estimate annual cumulative risk from multiple exposures is offered, and the risk of HIV infection is estimated by use of a probability model for health care workers in both hospital and emergency department settings.
Recapping is the most common cause of preventable needlestick injury. Needlestick injury can be prevented by proper handling techniques. Needlestick injury can transmit the hepatitis virus to the victim. Double-gloving protects against fluid contamination but does not add any more protection against needlesticks than does a single glove.
Recapping is the most common cause of preventable needlestick injury. Needlestick injury can be prevented by proper handling techniques. Needlestick injury can transmit the hepatitis virus to the victim. Double-gloving protects against fluid contamination but does not add any more protection against needlesticks than does a single glove.
Needlestick injury is relatively common amongst healthcare workers, particularly those, such as anaesthetists, who regularly perform invasive procedures. The risk of seroconversion following needlestick injury may be reduced by knowledge of body fluids that are high risk and knowledge of post-exposure prophylaxis following possible HIV-contaminated needlestick injury. A structured questionnaire was used to establish knowledge regarding high HIV risk body fluids and measures to be taken following needlestick injury in anaesthetists working in a large teaching hospital. Completed questionnaires were obtained from all 76 anaesthetists working in the department (39 consultant, 37 trainee/non-consultant). Only 45.2% correctly identified high-risk body fluids. Sixty-eight per cent of anaesthetists knew the appropriate first aid measures to be taken following needlestick injury. Only 15% of anaesthetists were aware that post-exposure prophylaxis (oral medication) should be administered within 1 h of injury. This study reveals a surprisingly poor knowledge of high-risk body fluids and action to be taken following needlestick injury. Timely post-exposure prophylaxis, after needlestick exposure to high-risk body fluids, is believed to reduce the risk of seroconversion to HIV. Ignorance of this may increase the risk of seroconversion to HIV for anaesthetists and other healthcare professionals.
OBJECTIVES: Needlestick injuries in healthcare workers are common. They are one of the main ways of transmitting large numbers of pathogenic micro-organisms in healthcare institutions. The aim of this study was to estimate the incidence and circumstances of needlestick injuries in a selected population of nurses from the city of Poznań and the Wielkopolskie province. MATERIALS AND METHODS: A questionnaire was filled in by 232 active nurses with secondary education, studying externally at the Medical University in Poznań. The sample was representative of nursing specialisations and workplaces of nurses in Poznań and the Wielkopolskie province. It comprised of nurses aged 22-51 years (mean, 35 years) and with work experience of 2-31 years (mean, 13 years). The workplaces of the study group were fairly diverse, but the great majority of nurses were employed in inpatient care, working in shifts (166 people). RESULTS: The probability of needlestick injuries per year equals 28.0%. Accidents of this kind were most common among nurses working in surgical wards, operating rooms, emergency medical care, GP surgeries and dialysis units. There were significant differences in the incidence of needlestick injuries between GP surgeries (statistically more common) on the one hand, and surgical wards, non-surgical wards and operating rooms on the other. Moreover, accidents in operating rooms and surgical wards were significantly more common compared to non-surgical wards. Instruments contaminated with infectious material accounted for 73.8% of the injuries in the study group of nurses. They were usually injection needles. Injuries from sterile needles, clean scalpels and contaminated scalpels were much less common. In the vast majority of cases, injuries were self-inflicted, and much less frequently caused by patients or colleagues. Most of these accidents happened during an attempt to remove a needle from a syringe, and much less while trying to place a used needle in a full medical waste container. In almost half of the cases (44.9%), the accidents occurred between the second and the fourth hour of the shift, which was probably due to a typically heavy workload during those hours, particularly on a morning shift. In the great majority of cases (84%), the nurses were wearing protective gloves at the time of accidents. CONCLUSIONS: The probability of a needlestick injury in the study group per year was 28.0%. Accidents of this kind were most common in nurses working in dialysis units, emergency medical care, GP surgeries, surgical wards, and operating rooms. Occupational sharps injuries were most often caused by a contaminated injection. The injuries were self-inflicted in the vast majority of cases. The most common cause of injuries from needles was an improper handling of syringes and needles after injections (removing a needle from a syringe or placing the needle in a full container for medical waste).
OBJECTIVE: To determine the impact of three needleless intravenous systems on needlestick injury rates. DESIGN: Randomized controlled trial. SETTING: 1,000-bed tertiary-care Midwestern hospital. PARTICIPANTS: Nursing personnel from general medical, general surgical, and intensive-care units. INTERVENTIONS: From June 1992 through March 1994, a metal blunt cannula (MBC), two-way valve (2-way), and plastic blunt cannula (PBC) were introduced into three study areas, and needlestick injury rates were compared to three control areas using traditional needled devices. RESULTS: 24 and 29 needlestick injuries were reported in study and control areas. Intravenous-therapy-related injuries comprised 45.8% and 57.1% of injuries in each area. Thirty-seven percent and 20.7% of study and control area needlestick injuries were considered to pose a high risk of bloodborne infection. The 2-way group had similar rates of total and intravenous-related needlestick injuries compared to control groups. The PBC group had lower rates of total and intravenous-related needlestick injuries per 1,000 patient-days (rate ratios [RR], 0.32 and 0.24; 95% confidence intervals [CI95], 0.12-0.81 and 0.09-0.61; P = .02 and P = .003, respectively) and per 1,000 productive hours worked (RR, 0.11 and 0.08; CI95, 0.01-0.92 and 0.01-0.69; P = .03 and P = .005, respectively) compared to controls. CONCLUSIONS: Needlestick injuries continued in study areas despite the introduction of needleless devices, and risks of bloodborne pathogen transmission were similar to control areas. The PBC device group noted lower rates of needlestick injuries compared to controls, but there were problems with product acceptance, correct product use, and continued traditional device use in study areas. Low needlestick injury rates make interpretations difficult. Further studies of safety devices are needed and should attempt greater control of worker behavior to aid interpretation.
Needlestick injuries among health care workers are a recognized health hazard, with 400,000 needlesticks occurring annually among the 4 million health care workers in the United States. Existing needlestick injury literature primarily focuses on hospital sites and may not be generalizable to other health care settings such as nursing homes, home health care sites, clinics, and emergency response units. Nurses were at high risk of needlestick injury from syringes and i.v. equipment relative to the other health care workers. Recapping, prohibited by the OSHA Bloodborne Pathogens Standard, continues to be an identified cause of injury. The literature supports comprehensive injury prevention and control strategies in conjunction with the use of safer needle devices. Health care organizations should assess their worksites to identify hazards and select products and strategies to correct the problem. Future research should clarify accurate needlestick injury rates (e.g., establish consistent denominators), address non-hospital setting risks, validate self reported data, and evaluate comprehensive interventions that employ engineering strategies to minimize the risk.
BACKGROUND: This research analyzed needlestick injuries sustained by employees working in the home health environment to determine to what extent existing infection control policies and procedures in home health care are effective in reducing the risk of transmission of blood-borne infections. METHODS: In June and July 1992, a random sample of 600 directors of home health care agencies in the United States were sent questionnaires concerning written blood-borne infection control policies and procedures of home health care agencies. Agency characteristics were also identified. RESULTS: A 46% response rate (n = 278) was obtained. Of the 226 agencies that reported needlestick injury rates, 102 agencies reported no needlestick injuries to home health care agency employees in the "last year" and 124 agencies reported from one to 134 needlestick injuries, for a cumulative total of 475. Statistical analyses revealed that agencies with "safer" sharps containers, "safer" hypodermics, or "safer" access to intravenous administration lines did not have statistically significantly rates of lower needlestick injury than agencies without these "safer" products. CONCLUSIONS: This study should be considered exploratory; causal relationships cannot be established. Although written blood-borne infection control policies and procedures do not appear to provide protection to home health care workers from the risk of needlestick injury, limitations in the data exist. Consequently, results should be viewed with caution and additional research is needed.
The Arlington Hospital Needlestick Injury (NSI) Prevention Program was created to protect healthcare workers from NSI and to assess the effectiveness of our interventions. Interventions included revising NSI policy and procedures. The average NSI rate dropped from 109 to 43 per year after the interventions, over a period of 4 years.
OBJECTIVE: To decrease the numbers of needlesticks among healthcare workers. DESIGN: All reported needlestick injuries at Santa Clara Valley Medical Center, San Jose, California, were reviewed, analyzed, and tabulated by the infection control department yearly from 1986 to 1990. SETTING: A 588-bed county teaching hospital in San Jose, California, affiliated with Stanford University. PARTICIPANTS: All employees of Santa Clara Valley Medical Center who reported needlestick injuries on injury report forms. INTERVENTIONS: From April to December 1987, more needle disposal containers were added to as many patient care areas and as close to the area of use as possible. Results of 1986, 1988, 1989, and 1990 analyses were communicated yearly to all personnel, extensive educational programs were conducted in 1987 and 1988, and educational efforts continued in 1989 and 1990. RESULTS: In 1986, there were 259 needlestick injuries at our institution, 22% (32) from recapping. After needle disposal containers were added to all patient care areas, needlestick injuries for 1988 totalled 143, a 45% decrease in the total needlestick injuries and a 53% decrease in recapping injuries. Communication of results to all areas of the hospital and educational activities were started in 1987 and continued through the next 3 years. In 1989, there were 135 needlestick injuries, a decrease of 6% from 1988; recapping injuries decreased 40% from 1988. In 1990, there were 104 needlestick injuries, a 23% decrease since 1989, and a 33% decrease in recapping injuries. The total number of needlestick injuries from 1986 to 1990 decreased by 60%, and those injuries from recapping decreased by 81% to 89%. CONCLUSIONS: We have continued to monitor needlestick injuries, communicate findings to all personnel, and include needlestick prevention in educational programs. We contend that more convenient placement of needle disposal containers, communication of findings, and education do decrease needlestick injuries in healthcare workers.
OBJECTIVES: To characterize accepted workers' compensation claims for needlestick injuries filed by healthcare workers (HCWs) in non-hospital compared with hospital settings in Washington State. DESIGN: Descriptive study of all accepted workers' compensation claims filed between 1996 and 2000 for needlestick injuries. PARTICIPANTS: All Washington State HCWs eligible to file a state fund workers' compensation claim and those who filed a workers' compensation claim for a needlestick injury. RESULTS: There were 3,303 accepted state fund HCW needlestick injury claims. The incidence of needlestick injury claims per 10,000 full-time-equivalent HCWs in hospitals was 158.6; in dental offices, 104.7; in physicians' offices, 87.0; and in skilled nursing facilities, 80.8. The most common mechanisms of needlestick injury by work location were as follows: for hospitals, suturing and other surgical procedures (16.7%), administering an injection (12.7%), and drawing blood (10%); for dentists' offices, recapping (21.3%) and cleaning trays and instruments (18.2%); for physicians' offices, disposal (22.2%) and administering an injection (10.2%); and for skilled nursing facilities, disposal (23.7%) and administering an injection (14.9%). Nurses accounted for the largest (29%) proportion of HCWs involved, followed by dental assistants (17%) and laboratory technicians and phlebotomists (12%) in non-hospital settings. Rates of needlestick injury claims increased for non-hospital settings by 7.5% annually (95% confidence interval [CI95], 4.89% to 10.22%; P < .0001). Rates decreased for hospital settings by 5.8% annually, but the decline was not statistically significant (CI95, -12.50% to 1.34%; P < .1088). HCWs were exposed to hepatitis B, hepatitis C, and human immunodeficiency viruses in non-hospital settings. CONCLUSION: There was a difference in the incidence rate and mechanisms of needlestick injuries on review of workers' compensation claim records for HCWs in non-hospital and hospital settings.
AIM: The aim of this study is to examine the connection between the health beliefs of hospital staff (doctors, nurses and auxiliary staff) and their failure to report needlestick injuries. BACKGROUND: Needlestick injury to hospital staff is quite frequent and can result in infections and disease, but staff frequently do not report the injury despite their awareness of the risk of blood-borne pathogens. METHODS: Five questionnaires were constructed based on three existing research tools and were tested for validity and reliability. Two hundred and forty questionnaires were distributed to eight randomly chosen departments of a single Israeli hospital. Seventy-six percent of the questionnaires were anonymously completed and returned. RESULTS: Nurses had the highest rate of needlestick injury, followed by auxiliary staff and doctors. Auxiliary staff showed the highest rate of compliance with the duty to report such injuries, while doctors showed the lowest. Perceived severity of contractable disease, the perceived efficacy of reporting injuries and overall motivation to maintain health were the best predictors of reporting compliance. Non-compliers emphasized the negative aspects of reporting the injuries, primarily that it took up too much time. CONCLUSIONS: The solution to non-compliance with the duty to report must be a targeted investment in training and education. Relevance to clinical practice. Finding the reasons for compliance and non-compliance with the duty to report needlestick injuries will help in designing educational programmes for hospital staff and in determining a strategy for improving health behaviour.
Medical students are at risk of acquiring infections caused by needlestick injuries, although it is unknown when needlestick injuries are most likely to occur during medical training. The aim of this study was to define high-risk periods over the course of medical training. A cross-sectional study was conducted among medical students in the first, third, fourth and fifth years of training at two medical schools in Munich. Overall, 1317 (85%) students returned a questionnaire on demographic data, vaccination status against hepatitis B, lifetime prevalence of needlestick injuries, level of knowledge about measures after such accidents, and transmission risks. Lifetime prevalence of needlestick injuries was 23%, ranging from 12% in first year students to 41% in fourth year students. These accidents happened most commonly during medical internships, especially during blood-taking practices; an activity that usually starts during the third year of training. The frequency of respondents not vaccinated against hepatitis B also varied between first (21%) and fourth (6.6%) year students. Needlestick injuries occur frequently and early on in medical training. In order to decrease the risk of preventable infections, complete coverage of vaccination against hepatitis B should be achieved early in medical training.