Time Trends of Percutaneous Injuries in Hospital Nurses: Evidence of the Interference between Effects of Adoption of Safety Devices and Organizational Factors.

Marco M Ferrario,Daniela Dalla Gasperina,Francesco Gianfagna,Giovanna Martinelli,Rossana Borchini,Giovanni Veronesi,Oriana Dashi,Marco Cavicchiolo

doi:10.3390/ijerph18084371

Abstract

Few studies have focused on the combined effects of devices and work organization on needlestick injuries trends. The aim of the study was to estimate trends of percutaneous injury rates (IR) in nurses (N) and nurse assistants (NA) over a 10 year period, in which passive safety devices were progressively adopted. Percutaneous and mucocutaneous injuries registered in a University Hospital in Northern Italy in Ns and NAs in 2007–2016 were analyzed. Organizational data were also available on shift schedules, turnover, downsizing and age- and skill-mix. We estimated IRs per 100 full-time equivalent workers from Poisson models and their average annual percent changes (APC) from joinpoint regression model. In the entire period, monotonic decreases in percutaneous IRs occurred among day-shift Ns (APC = −20.9%; 95% CI: −29.8%, −12%) and NAs (APC = −15.4%; −32.9%, 2.2%). Joinpoint modeling revealed a turning point in 2012 for night-shift Ns, with a steady decline in 2007–2012 (APC = −19.4%; −27.9%, −10.9%), and an increase thereafter (APC = +13.5%; 1.5%, 25.5%). In comparison to 2008 and 2012, in 2016 night-shift Ns were 5.9 and 2.5 times more likely to be younger and less qualified or experienced than day-shift Ns. The observed declines in percutaneous injury rates occurred in a time period when safety devices were progressively implemented. The causal nature of multiple exposures and organizational procedures in affecting injury time trends should be further addressed by quasi-experimental studies.

Highlights

The aim of this study was first to analyze the temporal trend of Needlestick injury (NSI) rate among ward nurses and nurse assistants who worked for a period of ten years in a Northern Italian hospital during the progressive introduction into the healthcare setting of safety devices to replace conventional devices
Percutaneous injuries (PI) rates for Ns and nurse assistants (NA) (Table 1, panel b), only for the latter group, a monotonic decreasing trend was evident over the entire period, with rates starting from 3.9 per 100 full-time equivalent (FTE) in 2007 and reaching 1.5 per 100 FTE in 2015 and 2016
Our results show that it might not be shift work per se, but rather shift-level organizational factors and staffing models that influence NSIs trends and that they may even interfere with the effectiveness of passive safety devices in hospital ward nurses

Summary

Introduction

Occupational exposures to blood-borne infections are one of the most frequent accidents occurring in healthcare settings. Percutaneous injuries (PI), occurring mainly while using or disposing of needles and in smaller proportions of scalpels or other sharp devices, occur far more frequently than accidental contacts with blood or other body fluids through bare skin or mucous membranes (mucocutaneous exposures) [1,2]. Needlestick injury (NSI) rates in nurses are reported to vary between 2.1 and 5.5 per 100 full-time equivalent (FTE) in different studies [3,4,5,6,7,8]. The introduction of safety devices has been shown to lower NSI rates [9,10,11,12], recent meta-analyses support evidence of the effectiveness in prevention of NSI events of passive intravenous systems only, i.e., safety containers

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