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PubMed2001

Report of the Council on Scientific Affairs: preventing needlestick injuries in health care settings.

Needlestick injuries continue to pose a significant risk to health care workers; however, appropriate use of needlestick prevention devices, especially in comprehensive prevention programs, can significantly reduce the incidence of such injuries. Cost analyses indicate that use of these devices will be cost-effective in the long term. To provide more scientific and cost data on the efficacy of needlestick prevention devices, recording of needlestick injuries must be improved. Federal law now requires the use of safety-engineered sharps devises to protect health care workers, and state-level legislation on the use and evaluation of needlestick prevention devices is under consideration. Health care employers should evaluate the implementation of needlestick prevention devices with the participation of employees who will use such devices and, where appropriate, introduce such devices accompanied by the necessary education and training, as part of a comprehensive sharps injury prevention and control program.

American Medical Association↗

PubMed1991

Effect of educational programs, rigid sharps containers, and universal precautions on reported needlestick injuries in healthcare workers.

OBJECTIVE: To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital. DESIGN: Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially. SETTING: A 700-bed general hospital that serves as the main teaching hospital of the University of Cincinnati. PARTICIPANTS: All employees of University Hospital who reported to personnel health for management of needlestick injuries. INTERVENTIONS: In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice. RESULTS: Surveillance identified 1,602 needlestick injuries (320/year) or 104/1,000/year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers. CONCLUSIONS: The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.

Accidents, Occupational↗

PubMedDate not supplied

Needlestick injuries among resident physicians.

OBJECTIVE: To assess the frequency and causes of needlestick injuries in medical and surgical housestaff. DESIGN: A retrospective survey. SETTING: Urban university teaching hospital. PARTICIPANTS: 386 housestaff; 221 responded. INTERVENTION: Survey questionnaire. MAIN RESULTS: 1) Frequency of needlestick: Of 221 respondents, 57 (26%) reported never having had a needlestick, while 164 (74%) reported at least one needlestick injury with a suture or hollow-bore needle. The average frequencies were 0.63 per resident-year among 149 non-surgical residents and 3.8 per resident-year among 72 surgical residents. Among residents in internal medicine, 12 of 78 needlestick injuries (15%) sustained were from patients documented to be HIV-positive. 2) Causes of needlestick: The causes of injury were assessed in detail in a sample of the 157 most recent needlestick injuries. Suturing was the cause in 35 of 61 (57%) surgical residents, while recapping needles was the cause in 36 of 96 (38%) non-surgical residents. Inexperience was not the cause of injury; in 94% of cases the residents felt comfortable performing the procedure, and in 74% of cases the residents had performed the procedure more than 50 times before. 3) Reporting of injury: Only 30 (19%) of 157 injuries were reported to the personnel health service, thus compromising documentation for potential workmen's compensation. CONCLUSIONS: Needlestick injuries are common among medical and surgical housestaff. Efforts should be made to prevent needlestick injuries and to report those that occur.

Academic Medical Centers↗

PubMed1998

Glove usage and reporting of needlestick injuries by junior hospital medical staff.

The use of gloves when conducting invasive procedures and the reporting of needlestick injuries have been strongly encouraged. Despite this, neither practice appears to be universal. In order to determine the rates of glove usage and needlestick injury reporting, we conducted a survey of junior doctors in three hospitals in the UK. Of the 190 respondents, the majority rarely wore gloves for venesection, insertion of intravenous cannulas or arterial blood gas sampling. For more major procedures (insertion of central venous lines, insertion of thoracostomy tubes, suturing) gloves were invariably worn. Only 17.5% of needlestick injuries were reported. The rates of glove usage and needlestick injury reporting were lower than previous studies have demonstrated in North America. Surgeons suffered the most needlestick injuries and were the least likely to report them. The low reporting rate may have serious implications, particularly in view of the new Government guidelines on needlestick injuries which involve HIV-infected blood. By failing to use gloves and report needlestick injuries, junior doctors, in particular surgeons, are placing themselves and patients at increased risk of blood-borne transmissible diseases.

Gloves, Surgical↗

PubMed1993

Hand dexterity in hospital personnel with multiple needlestick injuries.

OBJECTIVE: To test the hypothesis that multiple needlestick injuries in hospital employees may be due to intrinsic deficits in hand dexterity. DESIGN: A case-control study comparing employees with multiple reported needlestick injuries to those with none. Hand dexterity was tested using the Purdue Pegboard Test, a standardized validated test of hand dexterity. SETTING: A 300-bed, acute care teaching hospital. PARTICIPANTS: Fifteen hospital employees who sustained four or more injuries were compared to 19 controls. RESULTS: No differences were detected in hand dexterity between the case and control groups. CONCLUSIONS: While employees with multiple needlestick injuries accounted for 85% of reported injuries, underlying factors responsible for injuries in this high-risk subgroup do not include measurable deficits in hand dexterity.

Case-Control Studies↗

PubMed2000

Occupational needlestick injuries in a metropolitan police force.

OBJECTIVES: Police officers are at risk of bloodborne diseases through needlestick injuries but few studies have addressed this problem. The purpose of this study was to assess the risk of needlestick injuries in law enforcement officers and to determine predictors of injuries and reporting rates. DESIGN: An anonymous, voluntary questionnaire was distributed to 1738 active-duty, metropolitan police officers. The survey included the number of needlestick injuries ever experienced, how often these were reported, activities at the time of injury and attitudes toward injuries. RESULTS: Of the 803 respondents (46.2% of survey population), 29.7% had at least one needlestick injury, and 27.7% of this group had two or more. Risk factors included evening shifts, pat-down searches, patrol duties, male gender and less experience. Only 39.2% sought medical attention for these injuries. CONCLUSIONS: Needlestick injuries occur with considerable frequency in this group of law enforcement personnel, suggesting an increased risk of becoming infected with bloodborne pathogens, including hepatitis B, hepatitis C and HIV.

Adult↗

PubMed1991

Influence of an educational program and mechanical opening needle disposal boxes on occupational needlestick injuries.

OBJECTIVES: To determine whether an educational program had a beneficial impact on healthcare worker needlestick injuries, particularly those caused by recapping. Secondary goals were to evaluate the efficacy of in-room needle-boxes and to determine whether surveillance data were useful when evaluating new products. DESIGN: Survey of employee health department reports. SETTING: Tertiary care teaching hospital. PARTICIPANTS: Healthcare workers who reported needlestick injuries and other blood and body fluid exposures to the employee health department. INTERVENTIONS: Exposure data from the 10 months prior to institution of the educational program and installation of disposal boxes were compared with data from the following 27 months. Additionally, the type of disposal box was changed for the last 9 months of the survey. RESULTS: Needlestick injuries caused by recapping fell significantly following the educational program (p = .005). However, injuries caused by previously disposed needles protruding into the mechanical opening of the needleboxes increased significantly (p = .002). Following a change of needleboxes to a nonmechanical opening design, the latter type of injury declined (p = .052). Total needlestick injuries, most other categories of needlestick injury, and other exposures did not change significantly during the 37 months of the study. CONCLUSIONS: The educational programs appeared to have positive impact on reducing recapping injuries, but many other needlestick categories did not change significantly. Mechanical opening needle disposal boxes appear to present a hazard when compared with fixed opening boxes. Surveillance data appear to be useful in monitoring injuries as well as evaluating products.

Accidents, Occupational↗

PubMed1983

Underreporting of needlestick injuries in a university hospital.

A survey of 1429 university hospital employees was conducted to estimate the extent of unreported needlestick injuries. Data based on 726 responses show that 40% of needlestick injuries within the past 3 months and 75% of needlestick injuries in the previous year had not been reported. Employees who did not report needlestick injuries were more likely to be new employees (less than 2 years). In addition to nursing, laboratory, and housekeeping employees, inhalation therapists and pharmacists are also at high risk for needlestick injuries. Studies attempting to show a reduction in needlestick injury rate should not use employee health records to assess efficacy.

Accidents, Occupational↗

PubMed1989

Impact of a recapping device on venepuncture-related needlestick injury.

In a 33-month prospective analysis of needlestick injuries, venepuncturists working under Centers for Disease Control (CDC) guidelines for handling used needles were shown to incur a needlestick injury for every 3,175 to 4,006 needle-handling procedures. On the other hand, users of a simple device designed to reduce the risk of injury when recapping used needles were shown to incur a needlestick only once in every 16,100 venepunctures performed (P less than 0.001). This represents a fourfold reduction in the rate of needlestick injuries. We thus question the effectiveness of the CDC nonrecapping policy.

Accidents, Occupational↗

PubMedDate not supplied

Epidemiology of needlestick injuries among health care workers in a secondary care hospital in Saudi Arabia.

BACKGROUND: Accidental needlestick injuries sustained by health care workers are a common occupational hazard in health care settings. The aim of this study was to review the epidemiology of needlestick injuries in Buraidah Central Hospital, a 212-bed secondary care hospital in Buraidah, Saudi Arabia. METHODS: We conducted a retrospective survey of all self-reported documents related to needlestick injuries, for the period January 2002 through December 2003. The data was analyzed to determine the age, sex and job category of the health care worker suffering the injury as well as the risk factors responsible for needlestick injuries. RESULTS: During the 2-year period, employees reported 73 injuries from needles and other sharp objects. Nurses were involved in 66% of instances, physicians in 19%, technicians in 10%, and nonclinical support staff in 5.5%. The majority (53.4%) of the injuries occurred after use and before disposal of the objects. Syringe needles were responsible for 63% of all injuries. Most injuries occurred during recapping of used needles (29%), during surgery (19%), and by collision with sharps (14%). Disposal-related (11%) causes as well as injuries by concealed sharps (5%) occurred while handling linens or trash containing improperly disposed needles. CONCLUSION: This data emphasizes the importance of increased awareness, training and education of health care workers for reporting and prevention of needlestick injuries.

Adult↗

PubMedDate not supplied

Device-specific risk of needlestick injury in Italian health care workers.

OBJECTIVES: To identify the types of medical devices causing needlestick injuries among Italian health care workers, to document the device-specific injury rates and time trends for different hollow-bore needles, and to compare injury rates from these devices with those reported in the United States. DESIGN: Longitudinal survey. SETTINGS: Twelve Italian acute care public hospitals. METHODS: Data were obtained from a multihospital surveillance database on the number of total injuries reported in each device category. Hospitals provided the corresponding number of devices used annually for each needle type. MAIN OUTCOME MEASURE: Number of needlestick injuries by type of hollow-bore needle per 100,000 devices used per year. RESULTS: A total of 2524 injuries from hollow-bore needles were reported. Disposable syringes/hypodermic needles accounted for 59.3% of injuries, followed by winged steel needles (33.1%), intravenous catheter stylets (5.4%), and vacuum-tube phlebotomy needles (2.2%). Intravenous catheter stylets had the highest needlestick injury rate (15.7/100,000 devices used), and disposable syringes had the lowest needlestick injury rate (3.8/100,000). In contrast to the other devices, the injury rate from winged steel needles increased from 6.2 per 100,000 in 1990 to 13.9 per 100,000 in 1992. CONCLUSIONS: The device-specific needlestick injury rates in Italy are similar to those reported in the United States, suggesting similar exposure experience in two countries. However, in contrast to the United States, needleless intravenous access is standard practice in Italy and thus eliminates one potential risk to Italian health workers. Implementation of safer equipment, such as shielded or retracting needles, and continuing training programs are needed to further reduce the hazards that health care workers face.

Accidents, Occupational↗

PubMed1993

Needle covers reduce needlestick injury.

The objective of the study, conducted in the general wards of Flinders Medical Center in South Australia, was to determine whether the risk of needlestick injuries from hypodermic needles could be reduced by the use of needle covers that are applied with a one-handed technique immediately after use of the needle. Baseline rates of needlestick injury were collected for a year prior to the use of needle covers, and incident cases of needlestick injury were collected after needle covers were introduced. The odds ratio, derived from pre- and post-intervention data, for injuries over which the use of needle covers could have had no influence, was used to show that the net effect of other influences on needlestick rates was not significant. The use of needle covers was associated with a significant reduction in needlestick injuries to nurses. The odds ratio for needlestick injury for nurse injuries that needle covers could not have prevented was 0.92. (95% CI 0.40-2.03). The odds ratio for needlestick injury for nurse injuries that needle covers could have prevented was 0.40 (95% CI 0.18-0.82). Although the odds of ratio for needlestick injury to cleaners was 0.19, the 95% exact confidence interval was 0.00-1.64.

Accidents, Occupational↗

PubMed2006

Risk of needlestick injuries by injection pens.

Injection pens are used by patients when auto-administering medication (insulin, interferon, apokinon etc.) by the subcutaneous route. The objective of this study was to evaluate the rate of injection pen use by healthcare workers (HCWs) and the associated risk of needlestick injuries to document and compare injury rates between injection pens and subcutaneous syringes. A one-year retrospective study was conducted in 24 sentinel French public hospitals. All needlestick injuries linked to subcutaneous injection procedures, which were voluntarily reported to occupational medicine departments by HCWs between October 1999 and September 2000, were documented using a standardized questionnaire. Additional data (total number of needlestick injuries reported, number of subcutaneous injection devices purchased) were collected over the same period. A total of 144 needlestick injuries associated with subcutaneous injection were reported. The needlestick injury rate for injection pens was six times the rate for disposable syringes. Needlestick injuries with injection pens accounted for 39% of needlestick injuries linked with subcutaneous injection. In all, 60% of needlestick injuries with injection pens were related to disassembly. Injection pens are associated with needlestick injuries six times more often than syringes. Nevertheless, injection pens have been shown to improve the quality of treatment for patients and may improve treatment observance. This study points to the need for safety-engineered injection pens.

Disposable Equipment↗

PubMed2005

Brief report: needlestick injury and inadequate post-exposure practice in medical students.

BACKGROUND: Medical students are at a particularly high risk for needlestick injury and its consequences because of their relative inexperience and lack of disability insurance. OBJECTIVE: To determine the risk of needlestick injury and the use of post-exposure prophylaxis among medical students. DESIGN: Internet-based survey. PARTICIPANTS: The 2003 graduating medical school class at the University of Toronto. MEASUREMENTS: Number of needlestick injuries, circumstances surrounding those incidents, and post-exposure actions. RESULTS: The response rate was 88% (157/178). Over one third (55/157) of respondents suffered at least 1 needlestick injury. In more than half the high-risk injuries, the students continued working and did not seek medical advice. Six students who suffered a needlestick injury began prophylactic human immunodeficiency virus medications. Of those students who suffered an injury, 15% had purchased disability insurance prior to the incident. CONCLUSIONS: Poor use of post-exposure procedures and a lack of disability insurance leave medical students at high risk for career and life-altering consequences from a needlestick injury.

Humans↗

PubMed1989

Needlestick injuries in ophthalmology.

Because serious nosocomial diseases can be transmitted by needlestick injuries, a retrospective review of needlestick injuries was conducted for a period of 2.5 years at a major university teaching hospital. The objective was to determine the needlestick injury rate among employees of the Department of Ophthalmology versus the other departments. Ophthalmologists had the highest incidence per person of needle injuries among physicians. Retina and strabismus surgeons were at higher risk than anterior segment surgeons.

Hospitals, Teaching↗

PubMed1991

Evaluating needlestick injuries in nursing personnel. Development of a questionnaire.

1. Needlestick injuries are the most common type of occupational injury experienced by nursing personnel. Sixty percent to 90% of needlestick injuries in medical centers are incurred by nurses. 2. Future increases in patient acuity and more advanced technology are likely to increase the risk of nurses experiencing accidental needlesticks. 3. Needle devices that require disassembly of equipment, especially those related to intravenous piggybacks and prefilled cartridge syringes, are placing nurses at an increased risk for injury. 4. Needle-less devices or devices which keep the needle recessed except during intended use have been designed. The assessment instrument can identify needlestick injury incidence and trends and can be used to evaluate and justify the increased costs of purchasing new safety equipment.

Accidents, Occupational↗

PubMed2006

Long working hours increase the risk of sharp and needlestick injury in nurses: the need for new policy implication.

AIM: This paper reports a study to determine the sharp and needlestick injury incidence in nurses working at a university hospital and the contributing factors. BACKGROUND: Although it is generally felt that working in the healthcare sector is clean and without risk, healthcare staff and especially physicians and nurses who generally work very long hours are actually exposed to various occupational risks. Sharps and needlestick injuries are important problems for healthcare workers as they increase the risk of spread of infection. METHOD: A self-administered questionnaire was completed in October 2005 by 449 of the 516 nurses working at a Turkish hospital (response rate 87.0%). RESULTS: The percentage of nurses experiencing a sharp or needlestick injury during their professional life was 79.7%. The incidence of exposure to sharp or needlestick injury in the last year was 68.4%. The factors increasing the rate of sharp and needlestick injury were: age 24 years and less, <or=4 years of nursing experience, working in surgical or intensive care units and working for more than 8 hours per day (P < 0.05). CONCLUSION: The findings indicate which groups of staff should be targeted for educational programmes. Consideration also needs to be given to the unwanted effects of working long shifts, where tiredness may contribute to the number of needlestick injuries.

Adult↗

PubMed1995

Do protective devices prevent needlestick injuries among health care workers?

OBJECTIVES: To determine the effectiveness and direct of two protective devices-a shielded 3 ml safety syringe (Safety-Lok; Becton Dickinson and Co., Becton Dickinson Division, Franklin Lakes, N.J.) and the components of a needleless IV system (InterLink; Baxter Healthcare Corp., Deerfield, Ill.)--in preventing needlestick injuries to health care workers. DESIGN: Twelve-month prospective, controlled, before-and-after trial with a standardized questionnaire to monitor needlestick injury rates. SETTING: Six hospital inpatient units, consisting of three medical units, two surgical units (all of which were similar in patient census, acuity, and frequency of needlesticks), and a surgical-trauma intensive care unit, at a 900-bed urban university medical center. PARTICIPANTS: All nursing personnel, including registered nurses, licensed practical nurses, nursing aides, and students, as well as medical teams consisting of an attending physician, resident physician, interns, and medical students on the study units. INTERVENTION: After a 6-month prospective surveillance period, the protective devices were randomly introduced to four of the chosen study units and to the surgical-trauma intensive care unit. RESULTS: Forty-seven needlesticks were reported throughout the entire study period, 33 in the 6 months before and 14 in the 6 months after the introduction of the protective devices. Nursing staff members who were using hollow-bore needles and manipulating intravenous lines accounted for the greatest number of needlestick injuries in the pre-intervention period. The overall rate of needlestick injury was reduced by 61%, from 0.785 to 0.303 needlestick injuries per 1000 health care worker-days after the introduction of the protective devices (relative risk = 1.958; 95% confidence interval, 1.012 to 3.790; p = 0.046). Needlestick injury rates associated with intravenous line manipulation, procedures with 3 ml syringes, and sharps disposal were reduced by 50%; however, reductions in these subcategories were not statistically significant. No seroconversions to HIV-1 or hepatitis B virus seropositivity occurred among those with needlestick injuries. The direct cost for each needlestick prevented was $789. CONCLUSIONS: Despite an overall reduction in needlestick injury rates, no statistically significant reductions could be directly attributed to the protective devices. These devices are associated with a significant increase in cost compared with conventional devices. Further studies must be concurrently controlled to establish the effectiveness of these devices.

Direct Service Costs↗