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.     

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.     

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.     

Effect of bedside needle disposal units on needle recapping frequency and needlestick injury

Needle recapping has been shown to be one of the leading causes of needlestick injuries. Frequency of recapping has not been reported. This study was designed to determine the frequency of needle recapping by nursing personnel and the effect of bedside needle disposal units on the frequency of recapping and needlesticks. Seventy-four nurses carrying out 312 activities involving use of needles were observed. The subjects were not aware of the nature of the study. The recapping frequency was 93.9%. The study was repeated after educational programs and following installation of a hospital-wide bedside needle disposal system. Fifty-three nurses performing 151 activities with needles were observed. Frequency of recapping was 94%. There was no significant difference in the rate of recapping or needlestick injuries after installation of the new needle disposal system. Educational programs regarding recapping, a very common practice, may be ineffective. Alternate methods for preventing needlesticks may be necessary.     

Needlestick and sharps injuries among health-care workers in Taiwan.

Sharps injuries are a major cause of transmission of hepatitis B and C viruses and human immunodeficiency virus in health-care workers. To determine the yearly incidence and causes of sharps injuries in health-care workers in Taiwan, we conducted a questionnaire survey in a total of 8645 health care workers, including physicians, nurses, laboratory technicians, and cleaners, from teaching hospitals of various sizes. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 per person in the past 12 months, respectively. Of most recent episodes of needlestick/sharps injury, 52.0% were caused by ordinary syringe needles, usually in the patient units. The most frequently reported circumstances of needlestick were recapping of needles, and those of sharps injuries were opening of ampoules/vials. Of needles which stuck the health-care workers, 54.8% had been used in patients, 8.2% of whom were known to have hepatitis B or C, syphilis, or human immunodeficiency virus infection. Sharps injuries in health-care workers in Taiwan occur more frequently than generally thought and risks of contracting blood-borne infectious diseases as a result are very high.     

Needlestick injury: impact of a recapping device and an associated education program

OBJECTIVE: To determine the impact of the introduction of a plastic shield-shaped device (Needleguard, Biosafe, Auckland, New Zealand) and education program designed to allow safer recapping, on recorded rates of needlestick injury. DESIGN: A before-after trial with a two-year duration of follow-up. SETTING: Tertiary referral hospital. PARTICIPANTS: Nursing and other hospital personnel. RESULTS: Prospectively collected baseline data, together with the results of an anonymous questionnaire of 25% of the hospital nursing staff, defined a reported needlestick injury rate of 6.9 per hundred full-time nursing staff per year. In the pre-intervention period, there were 6.7 needlestick injuries per 100 nursing staff members per year reported. This increased to 15.4 (p less than .0001) needlestick injuries per 100 nursing staff members per year after the intervention. An anonymous survey undertaken at both time periods suggests that the apparent increase in officially reported needlestick injuries is due to an increase in the willingness of nurses to now report previously unreported needlestick injuries. CONCLUSIONS: The impact of the safety device and education program was the more accurate reporting of needlestick injuries; many nursing staff continued to resheath needles contrary to hospital policy. Many staff simply did not use the newly designed safety device. Approaches to improving compliance with such safety devices are considered.     

Sharps disposal containers

Sharps disposal containers are specially designed containers into which used needles and other medical-waste sharps are discarded. They are intended to protect hospital employees--including sharps users and other workers downstream--from sharps injuries that result from contact with needles and other sharp devices. Since our last Evaluation of sharps containers in August-September 1993, manufacturers have introduced various new designs that may further reduce the risk of needlesticks and other sharp-object injuries (SOIs). These designs are intended to prevent users from overfilling the sharps container; they are also easier to use and better constructed. In this study, we evaluated eight models of sharps containers from four suppliers. None of the evaluated devices meet all our criteria; they all have disadvantages that could result in a needlestick. However, the devices that we rate Preferred or Acceptable meet our basic requirements for preventing SOIs and perform satisfactorily against most of our criteria. The eight evaluated models run the gamut: one is Preferred, four are Acceptable, two are Not Recommended, and one is Unacceptable.     

Impact of introduction of sharps containers and of education programmes on the pattern of needle stick injuries in a tertiary care centre in India

Documentation of needlestick injuries was started in the Christian Medical College Hospital, Vellore in 1993. In 1995 large sharps containers were introduced, accompanied by an intensive education programme. Details of documented injuries from 1993 to 1999 were analysed using the Epi-Info software. A total of 347 injuries occurred, mainly due to improper disposal of needles, re-capping and carelessness during use. The percentage of injuries attributed to disposal fell from 69.2% in 1995 to 38.5% in 1996 (after the education programme). A further decrease was noted after the additional introduction of small sharps containers. In 1995, 73% of injuries involved housekeeping staff, this fell to 12% in 1998. Relatively simple interventions decreased the numbers of injuries, and we recommend that all healthcare institutions should have a system of documenting needlestick injuries, and take measures to decrease their incidence.     

An effective educational program to reduce the frequency of needle recapping

We developed an educational program that reported the rate of needle recapping to healthcare workers, in conjunction with emphasis on appropriate disposal procedures. Over 12 months, the rate of recapping needles used for venipuncture and for percutaneous medication injections fell from 61% to 16% (p less than .0001). Over the same period, the recapping of needles used primarily for intravenous (IV) administration fell from 44% to 33% (p = .03). Re-evaluation of the rate of recapping eight months later showed a continuation of these lowered rates. Needlestick injuries were too few in number during the study period to detect any change accompanying the decreased recapping rate. We conclude that programs that report back to employees their rate of recapping can significantly reduce this activity in the disposal of needles used for venipuncture and for percutaneous medication injections. While such reporting may reduce the rate of recapping of needles used for IV administration, the effect is not nearly so marked. Modifications in design remain the most promising approach to preventing needlestick injuries from recapping needles used for IV administration.     

Occupational injuries and exposures among Canadian dentists: the results of a national survey.

OBJECTIVES: To measure the frequency of occupational exposures reported by dentists in Canada and to identify factors associated with occupational exposure. DESIGN: A national mailed survey of a stratified random sample of 6,444 dentists with three follow-up attempts. Weighted data were analyzed using t tests, analysis of variance, and multiple logistic regression. RESULTS: The response rate was approximately 66%. Occupational exposures, percutaneous injuries, and mucous membrane exposures in the last year were reported by 67%, 62%, and 29% of respondents, respectively. Fewer than 1% reported exposure to human immunodeficiency virus or hepatitis B virus (HBV). Respondents reported means of 1.5 mucous membrane and 3.0 percutaneous exposures per year. HBV immunization was reported by 91% of dentists, but of these 28% reported no post-immunization serology. Other reports of suboptimal compliance included use of a postexposure protocol by only 41% and HBV vaccination of all assistants or of hygienists by 74% and 77% of respondents, respectively. Factors associated with percutaneous exposure included non-use of postexposure protocol or puncture-proof containers for sharps disposal, treating > or =20 patients per day, and male gender. Risk factors for mucous membrane exposure included non-use of eye protection or masks. CONCLUSION: This study provides evidence of the protective effect of puncture-proof containers, eye protection, and masks and raises concerns related to HBV post-immunization serology and postexposure protocols. To reduce risk of infection, educational interventions are required to improve compliance with Universal Precautions, with emphasis on comprehensive HBV immunization and post-immunization serology, the use of barriers, puncture-proof containers for sharps disposal, and postexposure protocols.     

Needlestick and sharps injuries among nurses in the healthcare sector in a city of western Turkey

The aims of this study were to determine the rate of bloodborne infections after needlestick and sharps injuries in nurses at work, to estimate the number of vaccinations administered, and to assess whether universal precautions were being followed. The study involved 289 nurses working in five hospitals and six primary healthcare centres. Between 1 April 2002 and 31 June 2002, a total of 139 practising nurses were included in the study following a needlestick or sharps injury. The results of completed questionnaires were collated, and Chi-squared test was used for analysis. The rate of hollow-bored needle-related injuries was 76.2% (106/139). Most nurses (69.1%) did not report any details of their injuries and 32.4% (45/139) of nurses had not been vaccinated against hepatitis B virus (HBV). Only 5.3% of the nurses who responded to the compliance question indicated that they always complied with universal precautions. Of 139 nurses, 1.4% and 7.9% showed evidence of HBV infection and hepatitis C virus (HCV) infection, respectively. All those who had hepatitis B were aged 30 years or under, whereas most of those who were anti-HCV positive (81.8%) were over 30 years old (P < 0.05). Nurses working in the Turkish healthcare sector are frequently exposed to bloodborne infections. Precautions and protection from needlestick and sharps injuries are important in preventing infection of nurses. Education about the transmission of bloodborne infections, vaccination and post-exposure prophylaxis must be implemented. Further investigations are warranted to elucidate the risk to nurses of contracting these potentially serious infections.     

Analysis of needle stick injuries at a university hospital: situations of occurrence and trends

Needlestick injuries remain the major source of risk of acquiring bloodborne diseases (AIDS, hepatitis B and C). Therefore, it is a priority discussing strategies of intervention based in sources of risk. The purpose of this study was to analyze needlestick injuries occurred at a university hospital. A data base construction made possible to identify the situations in which those accidents occur and standards of tendencies along the years. The data pointed out that the majority of needlestick injuries occurred while performing or assisting procedures. The introduction of the first prevention measures (universal precautions) reduced the total number of needlestick injuries. However, changes in needlestick-injury rates related to the recapping were not observed. Authors discussed the use of different prevention strategies: introduction of safety devices, changing the training focus, and the reorganization of the work environment and work practices.     

Impact of a needleless intravenous system in a university hospital

Needlestick injuries are a serious, but preventable problem in the healthcare industry. Industry has developed better devices to protect the healthcare worker. This study evaluates the impact of a "needleless" intravenous system on needlestick exposures and whether the increased cost of this new system could be justified. Exposures were defined and injury reports analyzed retrospectively and following introduction of the needleless IV system. This study indicates that the introduction of a needleless IV system can significantly reduce the number of IV-related injuries that occur in an institution, and is economically feasible. Other categories of exposure (needle-related, related to other sharps, and trash-related) also showed a drop, whereas exposure from the disposal of sharp devices into needle boxes showed a significant increase. This seems to support other findings that in-room needle-box containers have not thus far reduced the number of injuries related to sharps disposal.     

Occupational exposures to bloodborne pathogens among healthcare workers in Rio de Janeiro, Brazil

Healthcare workers (HCWs) frequently face the risk of occupational infection from bloodborne pathogens following exposure to blood and body fluids. This study describes the results of a surveillance system of occupational exposure to bloodborne pathogens among HCWs in Rio de Janeiro, Brazil, during an eight-year period. A total of 15 035 exposures reported from 537 health units were reviewed. Six circumstances comprised nearly 70% of the reported exposures: recapping needles (14%), performing surgical procedures or handling surgical equipment (14%), handling trash (13%), during disposal into sharps containers (13%), performing percutaneous venepuncture (10%) and during blood drawing (5%). Easily preventable exposures, such as incidents related to recapping needles, handling trash, and sharps left in an inappropriate place, represented 30% of the exposures reported. Post-exposure prophylaxis (PEP) for human immunodeficiency virus (HIV) was initiated for 46% of exposed HCWs. Although Brazilian guidelines indicate that PEP is usually not recommended for exposures with insignificant or very low risk of HIV infection, PEP was prescribed to a large proportion of exposed HCWs under these circumstances. The prevention of occupational exposure to bloodborne pathogens among HCWs and their safety must be considered as a public health issue. Although infection-preventative measures such as antiretroviral drugs and rapid tests are available, this study shows that there are still a high number of easily preventable exposures. The implementation of more effective prevention strategies is urgently required in this country.     

基层医疗机构安全注射现状调查

目的了解基层医疗机构安全注射现状。方法随机抽取湖北省55所基层医疗机构,采用问卷调查基层医疗机构安全注射工作现状。结果共发放问卷55份,收回有效问卷50份,有效回收率为90.91%。50所有效问卷的回答单位均为湖北省各市区一级及以下的医疗机构,其中社区卫生服务中心16所、乡镇卫生院和村卫生室各17所。50所基层医疗机构均未重复使用注射器、采血器,全部采用一次性无菌注射器,仅7所(14.00%)医疗机构使用了回缩自毁型安全注射器。所有手卫生设施和锐器盒均配置的医疗机构仅5所(10.00%),32所(64.00%)医院机构治疗车上未配备锐器盒,21所(42.00%)注射室未配备干手设施,18所(36.00%)治疗车上未配备速干手消毒剂和治疗室未配备干手设施。2015年医护人员上报的锐器伤中,有114人发生了117次锐器伤,其中由安瓿引起的锐器伤74人次(63.25%)。医疗废物处置中,仍存锐器盒渗漏、重复使用、满3/4未及时封闭和未做到每个可能产生锐器的场所均配备锐器盒的现象。结论基层医疗机构中仍存在设施设备不足、医疗废物处置监管不规范等安全注射隐患。     

Implementing standard precautions in the operating theatre: the role of the infection control liaison nurse

The appointment of an infection control liaison nurse (ICLN), particularly in specialised areas such as the operating theatre (OT), can make a significant contribution to the infection control program. That nurse's value can be demonstrated when specific changes to infection control practices are proposed. Following the introduction of standard precautions in a 560-bed adult teaching hospital, the OT ICLN identified that some nursing staff were not complying with the guidelines on standard precautions. A specific policy for OT staff was therefore formulated, and focused on OT procedures in relation to the appropriate use of protective clothing and prevention of sharps injuries. This paper describes the role of the ICLN in the implementation of standard precautions in the OT. A variety of strategies were used, including educational sessions, an infection control questionnaire and a role play. [AIC Aust Infect Control 1999; 4(1):7-11]     

医务人员职业损伤的研究分析

目的：研究分析医务人员因针头或其他尖锐器具造成损伤的发生率及其原因。方法：对610名医务人员进行问卷调查，被调查人员包括医生，护士，技师和实验工作人员。被调查者通过回顾的方式，如实填写过去一年内皮肤损伤的原因，次数及所采取的预防措施，回收有效问卷581份（95％），结果：在581名被调查者中，共发生1811例次皮肤务污染事件，其中54％是被污染血液后的内孔针头引起的，医务人员清楚地了解，有13％的病人患有乙肝，丙肝，梅毒，艾滋病等可以通过血液传播的疾病，每名医师（技师）每年有2．85次皮肤损伤几率，每名护士每年有3．4次皮肤损伤几率,所有的损伤事故发生后，均采用强力碘等消毒伤口，并有针对性地采取大量盐水冲洗，注射乙肝疫苗，高效免疫球蛋白等措施，结论：医务人员的这种损伤与他们的特殊职业有密切的关联，54％的损伤是在内孔针头充满血液的情况下造成的，具有很高的传播疾病的危险性，因此，应采取针对性的防护安全教育，预防事故发生。     

The impact of multifocused interventions on sharps injury rates at an acute-care hospital.

OBJECTIVE: To determine the impact of a multifocused interventional program on sharps injury rates. DESIGN: Sharps injury data were collected prospectively over a 9-year period (1990-1998). Pre- and postinterventional rates were compared after the implementation of sharps injury prevention interventions, which consisted of administrative, work-practice, and engineering controls (ie, the introduction of an anti-needlestick intravenous catheter and a new sharps disposal system). SETTING: Sharps injury data were collected from healthcare workers employed by a mid-sized, acute-care community hospital. RESULTS: Preinterventional annual sharps injury incidence rates decreased significantly from 82 sharps injuries/1,000 worked full-time-equivalent employees (WFTE) to 24 sharps injuries/1,000 WFTE employees postintervention (P<.0001), representing a 70% decline in incidence rate overall. Over the course of the study, the incidence rate for sharps injuries related to intravenous lines declined by 93%, hollow-bore needlesticks decreased by 75%, and non-hollow-bore injuries decreased by 25%. CONCLUSION: The implementation of a multifocused interventional program led to a significant and sustained decrease in the overall rate of sharps injuries in hospital-based healthcare workers.