Estimated cost of needlestick injuries for six major needled devices

A major factor in the introduction of new products designed to decrease the risk of needlesticks to healthcare workers (HCWs) is whether the increased expense of a safer device is offset by the savings of preventing needlesticks. The itemized costs of needlestick injuries associated with six major needled devices were estimated and compared to the cost of the devices causing the injuries, based on 1988 dollars. Included was the cost of treatment, prophylaxis and employee health department personnel time. The average cost of needlestick injury was $405, with a narrow range of $390 to $456 for different devices. As a percent of the cost of the devices, needlesticks cost as little as 10% of the cost of the device, for the intravenous (IV) catheter, to as much as 457%, for needles used to connect IV lines. On the average, needlesticks cost 36% of the devices' cost. These data may be used to weigh the potential economic benefits of safer needle technology or other strategies intended to reduce the incidence of needlesticks.     

Verbesserter Schutz vor blutübertragbaren Erregern – Umsetzung der europäischen Nadelstichrichtlinie in deutsches Recht abgeschlossen

Needlestick injuries are common in healthcare workers. Due to European directive 32/2010/EU all member states had to implement new rules on the prevention of needlestick injuries. Setting into law the new technical rule on biohazards in the healthcare sector (TRBA 250) end of march based on the German order on biosafety (Biostoffverordnung) the implementation in Germany is complete: Today the use of safety devices is mandatory for nearly all risky procedures, healthcare workers are sheltered best from the risk of needlesticks now.     

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.     

A five-year study of needlestick injuries: significant reduction associated with communication, education, and convenient placement of sharps containers.

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.     

Mental health of healthcare workers who experience needlestick and sharps injuries

Healthcare workers (HCWs) are exposed daily to the risk of injury by needlesticks and other medical instruments. However, the psychiatric impacts of such injuries have not been evaluated. The aim of this study was to evaluate the mental health status of HCWs with experiences of needlestick and sharps injuries. A cross-sectional written survey was performed. The psychological symptoms before injury and current status were measured using the Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Perceived Stress Scale (PSS). The proportions of HCWs with and without needlestick and sharps injuries were 71.1% (n=263) and 28.9% (n=107), respectively. HAM-A and BDI scores were significantly higher among HCWs with injury experiences (p<0.01). HCWs with injury experiences exhibited higher PSS and BDI scores after the injury and higher levels of anxiety and depression. Particular attention should be directed towards the psychological consequences of needlestick and sharps injuries in HCWs.     

某大型综合医院医护人员针刺及其他锐器损伤情况

目的 了解医院医护人员针刺及其他锐器损伤情况,为进一步开展干预研究提供线索,并为干预措施效果评价提供基线数据.方法 采用白填式调查问卷对某大型综合医院1201名临床一线医护人员在2009年1月1日至2009年12月31日期间所发生的针刺及其他锐器损伤状况进行回顾性调查.结果 医护人员在过去1年中发生针刺及其他锐器损伤共4302人次,针刺及其他锐器损伤年人均发生次数为3.58人次,损伤发生率为78.85％.发生针刺及其他锐器损伤的高风险人群为妇产科、外科、重症监护室和急诊科医护人员,其接触发生率和年人均发生次数分别为94.67％和4.51人次、93.09％和4.46人次、85.44％和3.08人次、76.62％和4.55人次,引起医护人员针刺及其他锐器损伤的主要医疗操作是掰安瓿、输液结束拔针、整理用毕的锐器和手术中(缝合或切开),其接触发生率分别为46.96％ 、30.97％ 、25.73％和14.49％.医护人员针刺及其他锐器损伤主要是由安瓿瓶、头皮针、皮下注射针、缝合针和手术刀片引起,其损伤发生率分别为47.04％、37.22％、31.31％ 、17.65％和7.08％.结论 医护人员仍然面临较大的针刺及其他锐器损伤风险,不同工种、不同科室医护人员在不同医疗操作及医疗操作的不同阶段、使用不同医疗锐器、使用锐器的用途不同发生职业接触的风险不同,应积极采取有针对性的综合性预防控制措施,全面贯彻落实GBZ/T 213-2008《血源性病原体职业接触防护导则》.     

Fatigue increases the risk of injury from sharp devices in medical trainees: results from a case-crossover study.

BACKGROUND: Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers. DESIGN: Case-crossover study. SETTING: Five academic medical centers in the United States and Canada. PARTICIPANTS: Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue. RESULTS: Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week (P<.001) and slept less the night before an injury (P<.001) than did other healthcare workers. Fatigue increased injury risk in the study population as a whole (incidence rate ratio [IRR], 1.40 [95% confidence interval {CI}, 1.03-1.90]), but this effect was limited to medical trainees (IRR, 2.94 [95% CI, 1.71-5.07]) and was absent for other healthcare workers (IRR, 0.97 [95% CI, 0.66-1.42]) (P=.001).Conclusions. Long work hours and sleep deprivation among medical trainees result in fatigue, which is associated with a 3-fold increase in the risk of sharps injury. Efforts to reduce trainee work hours may result in reduced risk of sharps-related injuries among this group.     

Implication of the prevalence of needlestick injuries in a general hospital in Malaysia and its risk in clinical practice

Objectives  To determine the prevalence of cases and episodes of needlestick injury among three groups of health care workers in the past one-year, the level of knowledge on blood-borne diseases and universal precautions and the practice of universal precautions. Other factors associated with the occurrence of needlestick injuries and the reporting of needlestick injuries were also analysed. Methods  A cross-sectional study was conducted in May 2003 to study the needlestick injuries among 285 health care workers (doctors, nurses, medical students) in a public teaching hospital in Negeri Sembilan, Malaysia. Results  The prevalence of needlestick injuries among the respondents was 24.6% involving 71 cases i.e. 48.0% among doctors, 22.4% among medical students, and 18.7% among nurses and the difference was statistically significant (p<0.001). There were a total of 174 episodes of needlestick injury. Prevalence of episode of needlestick injuries was highest among doctors (146%), followed by nurses (50.7%) and medical students (29.4%). Cases of needlestick injuries attained lower scores on practice of universal precautions compared to non-cases (p<0.001). About 59% of cases of needlestick injury did not report their injuries. Conclusions  The study showed that needlestick injuries pose a high risk to health care workers and it is underreported most of the time. Many needlestick injuries can be prevented by strictly following the practice of universal precautions.     

基层医务人员锐器刺伤与血源性疾病感染风险定量评估

目的定量评估医务人员血源性疾病感染风险。方法调查乡镇卫生院基层医务人员锐器刺伤情况以及乙肝疫苗免疫率,采用Kane模型计算个人年感染概率。结果429名医务人员平均年锐器刺伤率50．82％,每人年刺伤频数为1．05,乙肝疫苗免疫率72．03％。HBV、HCV、HIV每万人年风险感染例数分别为239、99和0．08。结论通过锐器刺伤以及乙肝疫苗免疫率调查可以定量评估医务人员HBV等血源性疾病感染风险。     

Blood‐borne viruses and their survival in the environment: is public concern about community needlestick exposures justified?

BACKGROUND: More than 30 million needle syringes are distributed per year in Australia as a component of harm-reduction strategies for injecting drug users (IDU). Discarded needle syringes create considerable anxiety within the community, but the extent of needlestick injuries and level of blood-borne virus transmission risk is unclear. We have undertaken a review of studies of blood-borne virus survival as the basis for advice and management of community needlestick injuries. METHODS: A Medline review of published articles on blood-borne virus survival and outcome from community injuries. RESULTS: Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) can all survive outside the human body for several weeks, with virus survival influenced by virus titer, volume of blood, ambient temperature, exposure to sunlight and humidity. HBV has the highest virus titers in untreated individuals and is viable for the most prolonged periods in needle syringes stored at room temperature. However, prevalence of HBV and HIV are only 1-2% within the Australian IDU population. In contrast, prevalence of HCV is 50-60% among Australian IDUs and virus survival in needle syringes has been documented for prolonged periods. There have been no published cases of blood-borne virus transmission following community needlestick injury in Australia. CONCLUSION: The risk of blood-borne virus transmission from syringes discarded in community settings appears to be very low. Despite this, procedures to systematically follow up individuals following significant needlestick exposures sustained in the community setting should be developed.     

Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers.

OBJECTIVE: To evaluate the effect of introducing an engineered device for preventing injuries from sharp instruments (engineered sharps injury prevention device [ESIPD]) on the percutaneous injury rate in healthcare workers (HCWs). METHODS: We undertook a controlled, interventional, before-after study during a period of 3 years (from January 1998 through December 2000) at a major medical center. The study population was HCWs with potential exposure to bloodborne pathogens. HCWs who sustain a needlestick injury are required by hospital policy to report the exposure. A confidential log of these injuries is maintained that includes information on the date and time of the incident, the type and brand of sharp device involved, and whether an ESIPD was used. INTERVENTION: Introduction of an intravenous (IV) catheter stylet with a safety-engineered feature (a retractable protection shield), which was placed in clinics and hospital wards in lieu of other IV catheter devices that did not have safety features. No protective devices were present on suture needles during any of the periods. The incidence of percutaneous needlestick injury by IV catheter and suture needles was evaluated for 18 months before and 18 months after the intervention. RESULTS: After the intervention, the incidence of percutaneous injuries resulting from IV catheters decreased significantly (P<.01), whereas the incidence of injuries resulting from suture needle injuries increased significantly (P<.008). CONCLUSION: ESIPDs lead to a reduction in percutaneous injuries in HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens.     

Prevalence of hepatitis C antibodies in a large sample of Belgian healthcare workers.

OBJECTIVE: To assess the risk of hepatitis C virus (HCV) infection among Belgian (Flemish) healthcare workers. DESIGN: A seroprevalence survey of HCV IgG antibodies. SETTING AND PARTICIPANTS: A systematic sample of 5,064 employees from 22 general hospitals in Flanders and Brussels, Belgium, was tested at the annual occupational medical examination. Together with demographic and occupational data, information was collected on the frequency of blood contact, needlestick injuries, and medical and surgical history. The blood samples were tested using the third-generation Abbott Screen Kit test, with confirmation by Matrix, LIA, and an in-house polymerase chain reaction and the Quantiplex-HCV b-DNA test. RESULTS: 21 persons were found to be positive for HCV markers. The overall prevalence was 0.41% (95% confidence interval [CI95], 0.24-0.59). A statistically significant association was found with a history of blood transfusion (odds ratio [OR], 4.14; CI95, 1.67-10.31) and with history of a clinically apparent hepatitis (OR, 3.98; CI95, 1.60-9.90). Although the ORs for the frequency of blood contact were slightly elevated (between 1.17 and 2.73), this association was not significant. Moreover, a history of needlestick injuries showed a nonsignificant OR of 1.28 (CI95, 0.53-3.09), and no statistically significant difference was found with a variety of duties and tasks. The ORs for potential occupational risk factors were adjusted according to age, gender, antecedents, and other confounders using a logistic regression analysis. Based on this procedure, the ORs decreased slightly. CONCLUSIONS: Flemish healthcare workers showed a lower HCV seropositivity than is seen in the general population; a history of blood transfusion and of clinically apparent hepatitis was most strongly associated with the presence of HCV markers. We concluded that employees in Flemish regional general hospitals are not at an overall increased risk for HCV infection, although occasional transmission through percutaneous injuries is possible, and prevention therefore remains imperative.     

Prevalence and prevention of needlestick injuries among health care workers in a German university hospital

Objective Health care workers (HCWs) are exposed to bloodborne pathogens, especially hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) through job-related risk factors like needlestick, stab, scratch, cut, or other bloody injuries. Needlestick injuries can be prevented by safer devices. Methods The purpose of this study was to investigate the frequency and causes of needlestick injuries in a German university hospital. Data were obtained by an anonymous, self-reporting questionnaire. We calculated the share of reported needlestick injuries, which could have been prevented by using safety devices. Results 31.4% (n = 226) of participant HCWs had sustained at least one needlestick injury in the last 12 months. A wide variation in the number of reported needlestick injuries was evident across disciplines, ranging from 46.9% (n = 91/194) among medical staff in surgery and 18.7% (n = 53/283) among HCWs in pediatrics. Of all occupational groups, physicians have the highest risk to experience needlestick injuries (55.1%—n = 129/234). Evaluating the kind of activity under which the needlestick injury occurred, on average 34% (n = 191/561) of all needlestick injuries could have been avoided by the use of safety devices. Taking all medical disciplines and procedures into consideration, safety devices are available for 35.1% (n = 197/561) of needlestick injuries sustained. However, there was a significant difference across various medical disciplines in the share of needlestick injuries which might have been avoidable: Pediatrics (83.7%), gynecology (83.7%), anesthesia (59.3%), dermatology (33.3%), and surgery (11.9%). In our study, only 13.2% (n = 74/561) of needlestick injuries could have been prevented by organizational measures. Conclusion There is a high rate of needlestick injuries in the daily routine of a hospital. The rate of such injuries depends on the medical discipline. Implementation of safety devices will lead to an improvement in medical staff’s health and safety.     

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.     

Needlestick injuries during medical training

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.     

Risk factors for physical assault. State-managed workers' compensation experience

BACKGROUND: The estimation of incidence and evaluation of risk factors associated with nonfatal occupational assault injuries have rarely been documented in a statewide population context. A state-managed workers' compensation system can provide estimates of incidence of such injuries and allow evaluation of risk factors. METHODS: Using claims data from the state-managed West Virginia Workers' Compensation, the incidence rates of workplace injuries resulting from physical assault were estimated for the period 1997-1999. Data on potential risk factors were obtained from the claim-related electronic data files, and the risk associated with each factor was assessed using proportional injury ratios (PIRs). RESULTS: During the study period, 2122 compensated injuries were associated with workplace violence. The incidence of assault injuries was 108.2 cases per 100,000 employee years. Women sustained a higher incidence than men. Healthcare workers, public safety workers, and teachers accounted for almost 75% of all assault injuries. Workers in these occupations also differed from each other with regard to seasonality and timing of assault, perpetrator-victim relationship, and types of injury. Evidence of gender-occupation interaction indicated higher risk of assault injury in men compared to women across the three leading occupations. Nighttime work shifts were associated with greater risk of assault for female healthcare workers (PIR=1.8; 95% confidence interval, 1.09-2.87). CONCLUSIONS: The healthcare sector sustained the bulk of assault injuries in West Virginia. Although the majority of healthcare-sector employees were women, the risk of assault injuries was higher in male employees. Risk factors and injury characteristics identified in this study, particularly for three high-risk occupations, should help develop strategies for preventing workplace violence. Protecting female healthcare workers on night-shift duty, especially in nursing home settings, appears to be an important target for intervention.     

Preventing needlesticks in emergency medical system workers.

Emergency medical system (EMS) workers frequently use sharp devices in injury-prone circumstances that involve limited visibility, confined spaces, rapidly moving vehicles, and uncooperative victims. This study examined the efficacy of an automatic self-retracting lancet in reducing needlestick injuries and related direct and indirect costs. Subjects were 477 active-duty EMS workers. Counseling, laboratory testing (hepatitis B and C, hepatic function enzymes, and human immunodeficiency virus), antiviral prophylaxis, and immunizations were provided according to US Public Health Service guidelines. Baseline and biennial laboratory testing for hepatitis B and C and liver function enzymes were conducted. After the introduction of a spring-loaded automatic-retracting type glucometer lancet device, needlestick injuries decreased from 16 per 954 EMS worker-years to 2 per 477 EMS worker-years. The annualized cost of treatment declined from $8276 to $2068. The change to a self-retracting device decreased the number of needlestick injuries and was cost-effective with a minimal increase in device cost (annualized $366 per year).