Update of the cost of needlestick injuries in hospital healthcare personnel

OBJECTIVES: To update the mean cost of each hepatitis B, hepatitis C and HIV follow-up in health personnel accidentally exposed to blood and body fluids, to stratify the cost depending on the serological status of the source, and to identify the items that account for the main part of the cost. METHODS: A cost analysis was carried out. The postexposure program was modeled on a decision tree combining probabilities (percentage of each type of source depending on positivity for the three viruses and immunization status of the health worker against hepatitis B) and monetary costs (euros in 2002). Costs included salaries, laboratory, pharmacy (including postexposure prophylaxis), water, gas and electricity, cleaning, telephone, medical and office equipment, amortization and lost productivity. RESULTS: The mean cost was 388 euros, ranging from 1,502 euros (source positive for hepatitis C and HIV) to 172 euros (source negative for the three viruses). If the source was hepatitis B positive, the mean cost was 666 euros when the injured worker was not immunized and was 467 euros if the worker was immunized. Serologic tests and postexposure prophylaxis accounted for the main part of the cost. CONCLUSIONS: The high cost suggests the need for appropriate risk evaluation to avoid unnecessary follow-ups. The model used allows the cost of each potentially avoidable episode to be determined and could be used in any hospital to perform an economic evaluation of new preventive devices.     

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

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

Impact of safety needle devices on occupationally acquired needlestick injuries: a four-year prospective study

A four-year prospective study was undertaken at the University Hospital Birmingham National Health Service Foundation Trust to evaluate the effect of the introduction of a range of safety hypodermic needle devices on the number of reported needlestick injuries (NSIs). Data on the number of reported NSIs for four clinical areas began in 2001. Following an enhanced sharps awareness strategy in 2002, the number of NSIs reduced from 16.9/100,000 devices used in 2001 to 13.9/100,000 devices (P=0.813). In 2003, when only standard training was provided, the number of NSIs increased to 20/100,000 devices. However, the subsequent introduction of three safety needle devices with concomitant training resulted in a significant reduction in the number of reported NSIs to 6/100,000 devices in 2004 (P=0.045). User satisfaction and acceptance of the safety needles was also very favourable. These results suggest that when safety needle devices are introduced into the clinical setting and appropriate training is given, a significant reduction in the number of occupationally acquired NSIs may ensue.     

实习护士针刺伤影响因素的研究

目的 调查实习护士在实习期间发生针刺伤的情况,探讨针刺伤发生高危时间段、危险环节以及影响因素.方法 采用自行设计的问卷对2014年4月至12月和2014年7月至2015年3月期间在我院实习的350名护生进行问卷调查,调查实习期间针刺伤发生情况,回收问卷340份,有效问卷334份.结果 针刺伤发生率60.8％;其中实习前期发生率明显高于实习后期,白班多于夜班;取下注射器或输液器针头环节刺伤率最高,占24.3％;受教育程度、职业暴露是否上报、是否经常学习护理知识、定期血液学检查、是否接受相关培训对实习护士发生针刺伤有统计学意义;61.7％的护生表示担心针刺伤从而影响操作.结论 实习护生的针刺伤发生率较高,实习前期尤为突出,应前移护生职业防护教育,强化岗前培训,减少针刺伤的发生.     

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.     

Student nurses in Taiwan at high risk for needlestick injuries

PURPOSE: To describe the prevalence and characteristics of needlestick injuries (NSI) in student nurses in Taiwan. METHODS: A self-administered questionnaire was completed by 931 student nurses from 16 hospitals randomly selected from the 132 accredited hospitals. RESULTS: The questionnaire was completed by 708 of 931 students who were contacted for participation in this study. NSI during internship was reported by 61.9% (438/708) of students, of whom 14.2% (62/438) made a formal report. The majority (70.1%) of NSI occurred in the patient's room. Hollow-bored needles contributed to half (219/438) of the NSIs of which 86.8% were syringe needles. Just over half (53.2%) of those items involved in NSIs had been used on patients. Of the hollow-bored needles involved in NSIs, 21.5% had been used on a patient with an infectious disease. Vaccination against hepatitis B virus (HBV) was lacking in 47.6% of students. CONCLUSIONS: NSIs and non-reporting of NSIs were highly prevalent in nursing students. More intensive education programs should be directed at students to increase their awareness of and compliance with Universal Precautions (UP) before commencing their practical work experience. Students need to practice prompt post-exposure evaluation so that the need for early intervention can be assessed. In addition, any public health and infection control strategy should include a universal catch-up HBV vaccination program among students before commencement of internship.     

Inadequate infrastructure for follow-up after needlestick injuries in the Netherlands

OBJECTIVE: To determine how needle-stick injuries are dealt with in the Netherlands. DESIGN: Study using questionnaires. METHOD: In order to study whether victims of needle-stick injuries have access to proper treatment, we sent questionnaires to hospitals (n = 103) and Municipal Health Services (MHS) (n = 36) in the Netherlands. We enquired after the possibilities of risk-estimation and follow-up, the performance of necessary laboratory tests, direct administration of preventive medication and backup facilities. RESULTS: Questionnaires were returned by 113 (81%) institutions. 74% of the hospitals and 71% of the MHS provided follow-up for needle-stick injuries from outside their own institution. Necessary laboratory tests were not always available or sometimes could not be performed on an immediate basis. In addition, essential medication was not always directly available. MHS recognized the advantage of cooperation during followup of needle-stick injuries more than hospitals. CONCLUSION: Based on the results there is no guarantee that victims of needle-stick injuries in the Netherlands have access to appropriate care at any location in the Netherlands on a 24/7 basis. We recommend improvement of the infrastructure and cooperation between health care organizations to guarantee improved follow-up in every region.     

Occupational risk of acquiring HIV infection through needlestick injuries

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.     

临床针刺伤的相关因素及防治措施

目的了解医务人员针刺伤现状,分析致伤原因,探讨防治措施,提高防护意识。方法回顾性调查疗养院2010年1月-2017年1月医务人员针刺伤情况,统计分析发生针刺伤医务人员的科室分布和原因。结果医务人员发生针刺伤的科室中主要以外科和内科为主,分别占27.94%和26.47%;医务人员发生针刺伤的环节主要是静脉采血、输液拔针和肌肉注射,分别占19.12%、17.65%和13.24%。结论了解临床工作中针刺伤发生的相关因素,有助于医务人员加强自我保护意识及制定有针对性的防治对策,可大大降低针刺伤的危害性,防控各种传染性疾病的传播、蔓延。     

护士针刺伤综合干预效果分析

目的探讨对护士进行针刺伤综合干预的效果。方法采取规范操作流程、职业安全培训、操作演练和督查相结合的方法对护士进行针刺伤综合干预,比较干预前后护士针刺伤发生情况。结果 2012年护士针刺伤发生率为2.38%,低于2011年的11.44%,差异有统计学意义(χ2=20.022,P0.001)。2012年护士临床工作中拔针环节、注射及采血环节针刺伤发生率较2011年明显降低(均P0.01),差异均有统计学意义(均P0.05)。结论对护士实施针刺伤综合干预,可以有效减少其针刺伤的发生,值得推广应用。     

Exposure rate of needlestick and sharps injuries among Australian veterinarians

Background  

Needlestick and sharps injuries (NSI) represent an important occupational health issue in veterinary practice. Little is known about the distribution and correlates of NSI among Australian veterinarians.     

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.     

中国护士静脉采血针刺伤现状调查

目的了解护理人员静脉采血过程中针刺伤现状,探讨有效防护策略。方法采用分层整群抽样的方法对中国临床一线护士进行问卷调查。问卷内容包括护士的一般资料及护理人员静脉采血培训与管理状况、采血前戴手套依从性、近一年因静脉采血发生针刺伤的情况等。结果共发放问卷2 861份,回收有效问卷2 575份。护士定期参加静脉采血培训的占93.17%;定期进行静脉采血考核的占87.15%;仅72.74%护士在采血前了解患者是否患有血源性传染病;采血时坚持佩戴手套的仅61.01%;近一年,因采血发生针刺伤的占20.78%。使用三种不同针具静脉采血时针刺伤的发生率比较,差异无统计学意义(Pearsonχ2=1.649,P=0.438)。48.21%的静脉采血针刺伤发生在整理医疗废物时。结论中国护士静脉采血培训与管理较好,但针刺伤发生率仍较高。预防针刺伤应制定静脉采血安全操作规程,规范操作流程,明确培训内容,以改变护理人员不安全的行为。     

医务人员针刺伤现况调查分析

目的分析目前掌握的针刺伤发生特点,寻找医护人员发生针刺伤的根本原因并制定整改措施,以减少针刺伤的发生,保护医护人员的职业安全。方法收集某医院2011-2012年发生针刺伤医务人员及相应患者的资料,分析针刺伤发生特点,采用根本原因分析法寻找针刺伤的直接原因和根本原因。结果 2011-2012年共发生针刺伤58人,其中护理人员39人占67.2%,实习生22人占37.9%;针刺伤发生频率为2.4人/月,每年的8月份发生频率最高,为16人占27.6%,81.0%的锐器暴露过患者的体液;发生针刺伤的根本原因是静脉输液多、工作量大、人员配备不齐;缺乏预防针刺伤的标准操作流程,职业防护教育宣传不到位。结论针刺伤的危害不容忽视,依据针刺伤的根本原因,制定相应的整改措施,以减少类似不良事件发生。     

Effects of hospital staffing and organizational climate on needlestick injuries to nurses

OBJECTIVES: This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses. METHODS: We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units in 20 hospitals. RESULTS: Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses. CONCLUSIONS: Staffing and organizational climate influence hospital nurses' likelihood of sustaining needlestick injuries. Remedying problems with understaffing, inadequate administrative support, and poor morale could reduce needlestick injuries.     

Impact of a shielded safety syringe on needlestick injuries among healthcare workers.

OBJECTIVES: Evaluate the impact of a shielded 3 cc safety syringe on needlestick injuries among healthcare workers. DESIGN: Surveillance study. SETTING: Three medical centers. RESULTS: The total number of needlesticks from all sources rose from 134 during the baseline period to 140 during the study phase. However, the overall rate of needlesticks involving 3 cc syringes decreased from 14/100,000 inventory units to 2/100,000, and the frequency declined substantially at each of the participating medical centers. CONCLUSIONS: These results suggest that shielded syringes and related technology may offer potential for reducing the risk of needlestick injuries among hospital and other healthcare employees. This study should be viewed as a preliminary effort to assess the potential of shielded-syringe technology for reducing the risk of needlestick injuries among healthcare workers. The results are encouraging, but more clinical experience with this new device and longer follow up are essential to provide the data necessary for a definitive assessment of efficacy.