Causes Of Needlestick Injuries Research Articles

EVALUATION OF NEEDLE STICK INJURY AND ASSOCIATED FACTORS AMONG HEALTHCARE WORKERS IN AL NAJAF CITY/ IRAQ

Introduction:In healthcare-related situations, needle sticks represent a substantial work-related health risk. Healthcare professionals face the danger of contracting blood-borne infections as well as the psychological impact of these wounds. The study aimedtoevaluate the prevalence of needle stick injuries and the associated socio-demographic determinants among healthcare workers.Methods: The research employed a cross-sectional design, with data collection occurring from February 1st, 2023 to February 1st, 2024. 380participants were conveniently selected from different Al-Najaf City/Iraq healthcare institutions. The study sample included a variety of specialists, including anesthetics, surgeons, dentists, surgeon assistants, anesthetics assistants, nurses, physicians, and laboratory workers. A self-administered questionnaire from previously published articles was used for data collection. It covers socio-demographic information, a history of previous exposure to, and the reasons for needle stick injuries.Quantitative variables were summarized with means and standard deviations; descriptive statistics for categorical variables included frequencies and percentages. P ≤ 0.05 indicated statistical significance.Results: Most healthcare workers (85%) were previously exposed to needle sticks. Job category was significantly associated with a history of needle stick exposure (p < 0.001). The anesthetics represent the highest job class exposed to needle sticks (100%). More than one-fifth of participants (21.85%) reported recapping needles followed by bending needles in 16.84% of them as a cause of needle stick injuries. Conclusion: Most healthcare workers are exposed to needle stick injuries; job category is an important risk factor

Frequency of Needle Wound Injury (Needle-stick) and Its Related Factors in Nursing Staff in Sirjan in 2020

Background: Nurses are exposed to blood-borne infections such as hepatitis B (HB), hepatitis C (HC), and human immunodeficiency virus (HIV) through needle-stick injuries (NSIs). Objectives: This study aimed to determine the prevalence of needle sticks and their related factors among nurses in the hospitals of Sirjan. Methods: In this cross-sectional study, 312 nurses were enrolled by census. Data were collected using demographic characteristics and a needle-stick information questionnaire. Descriptive and analytical tests (chi-square or Fisher’s exact test and logistic regression model) were used to analyze data. Results: Out of 312 nurses participating in the study, 189 (60.6%) had experienced NSIs during the last year. The most common objects for NSIs were syringes and needles (35.4%), and the most common cause of NSIs was recapping (45.4%). In this study, 82% of needle-stick nurses were forced to work overtime. Ages of 20 - 29 years (odds ratio (OR) = 3.94, 95%CI: 1.12 - 13.84; P = 0.032), work experience between 5 - 10 years (OR = 2.50, CI: 1.12 - 5.57; P = 0.02), HB vaccination (OR = 0.26, CI: 0.07 - 0.98; P = 0.04) were significantly associated with rates of needle-sticks. Conclusions: Due to the high frequency of NSIs among the nursing staff and to reduce these injuries, using safety devices, especially in the emergency ward, providing a calm and stress-free environment for staff, reducing the number of night shifts and workload, teaching safety principles and standards to young nurses and supporting nurses who experience NSIs were advised.

Needlestick Injuries With Insulin Injections: Risk Factors, Concerns, and Implications of the Use of Safety Pen Needles in the Asia-Pacific Region.

Globally, health care workers (HCWs) are at a high risk of occupational exposure to needlestick injuries (NSIs). Needlestick injuries not only are associated with an increased risk of infections caused by bloodborne pathogens but are also a primary source of emotional distress and job burnout for HCWs and patients. Insulin injection-related NSIs are common among HCWs working in hospitals in the Asia-Pacific (APAC) region and impose a significant burden. Insulin pen needles have a high risk of transmitting infections (at both the patient-end and cartridge end of the sharp) after use. Recapping a needle after administering an insulin injection poses a major risk to HCWs. Currently, several safety-engineered needle devices (SENDs) are available with active or passive safety mechanisms. Passive insulin safety pen needles with dual-ended protection and automatic recapping capabilities have resulted in a significant drop in accidental punctures to HCWs while administering insulin to patients with diabetes. In this article, we have reviewed the burden and common causes of NSIs with insulin injections among HCWs in the APAC region. We have discussed current approaches to address the issues associated with NSIs and the benefits of introducing SENDs in health care settings, including long-term care facilities, nursing homes, and home care settings where patients may require assisted insulin injections. This review also summarizes key strategies/recommendations to prevent NSIs in HCWs and patients with diabetes in the APAC region.

The Incidence of Needlestick and Sharps Injuries Among Healthcare Workers in a Tertiary Care Hospital: A Cross-Sectional Study.

Background Needlestickinjuries (NSIs) and sharps injuries (SIs) remain significant hazards in most healthcare facilities that expose healthcare workers (HCWs) to blood-borne pathogens (e.g., HIV, hepatitis B, and hepatitis C). This study aims to review the incidence of NSIs and SIs in King Fahad Medical City (KFMC) and correlate this incidence with several parameters related to the event, including age, sex, length of work experience,type of injury, type of instrument causing the injury, type of activity during which the injury happened, nature of the job of the HCWs, and location within the hospital where the injury happened. Methodology This cross-sectional study involves all self-reported documents related to needlestick and sharp injuries among HCWs at King Fahad Medical City (KFMC) in Riyadh, Kingdom of Saudi Arabia, from January 2017 to December 2020. The data of 389reports of needlestick and sharp injuries detailingincidence and site, shift, type, and instrument related to the incidents were reported to the infection control department for coding and analysis using the Statistical Package for the Social Sciences (SPSS)version 22 (IBM SPSS Statistics, Armonk, NY, USA). Results Our data showed that NSIs/SIs could be caused by a wide range of objects used by healthcare workers, including needles, suture needles, scalpels, and sharp devices. Remarkably, the most common cause of NSIs was handling the sharp object (38.8%), followed by disposing of the sharp object (19.3%).Furthermore, nurses were found to be the highest at-risk category of HCWs experiencing NSIs (49.9%), while medical waste handlers (1.5%) and dentists (1.3%) were least likely to incur injuries. Conclusion This study sheds some light on the incidence rates of NCIs and SIs at KFMCand correlates these rates with several demographical, occupational, and experiential parameters related to these events.

The study of prevalence of needle stick and sharp injuries among healthcare workes in tertiary care hospital, Navi Mumbai

Needlestick injuries (NSIs) as defined by accidentally puncture the skin by needles. The occupational exposures to NSIs are considered to be much higher in the developing world and multiple risk factors eg. improper use of protective equipment (like failure to use suitable-sized gloves), working in surgical or intensive care units, insufficient work experience, young age, needle recapping, unsuitable needle disposal, intravenous cannulation may contribute to NSIs. To determine the occurrence/ prevalence of needle stick and sharp injuries (NSIs) among healthcare workers working in a tertiary care hospital and the factors responsible for NSIs. A cross-sectional study was conducted in a tertiary care hospital among HCws in the hospital over a period of one year Jan 2020-December 2020. Nursing staffs are most frequently reported NSI. Among the groups, most common cause of NSIs was found to be recapping of needle followed by cleaning, HGT and procedure. The most common cause of NSI among housekeeping staffs found to be needle lying on the floor and accidental mixing of sharp biomedical waste with other waste. The HCWs from critical care unit eg. ICUs are the most commonly reported NSIs HCWs are always at high risk of attaining NSIs. The nursing staffs followed are the most vulnerable group who gets the sharp/NSI and require extra attention. As a preventive measures regular training and education of nursing staffs and all other categories of health care workers to be ensured in healthcare settings.

English

BACKGROUND Health care workers are more prone to occupational hazards, like needlestick injuries, blood, and body fluid exposures. Needlestick injuries (NSI) are responsible for the transmission of serious infections like HIV, HBV and HCV. The occurrence of needlestick injuries is highest among the nurses. The objective of the study was to assess the knowledge, attitude and practice regarding needlestick injuries among nursing faculty in Justice K. S. Hegde Charitable Hospital, Mangalore. METHODS A cross-sectional survey was conducted among the nursing faculty working in a tertiary care hospital based on a structured questionnaire, and the obtained data were further analysed statistically. RESULTS The percentage of needle stick injury was 13.3 % among 75 nursing faculty. 94.7 % of the nurses were aware of the universal precaution guidelines and 84 % knew about post-exposure prophylaxis (PEP). 36 % of nurses knew the preventive guidelines' full details, but 50.7 % of the nurses were unaware of it. Many participants were aware that NSI transmits HIV (92 %) and Hepatitis B (68 %). The leading cause of NSI might be heavy work (54.7 %) followed by hurried procedures (41.3 %). 29.3 % of the nurses were still inclined to recapping the needle after use. 68 % of the nurses were mindful of washing hands with only water post exposure. 28 % were not willing to report a NSI. 80 % of nurses were fully immunised against Hepatitis B. CONCLUSIONS The best way to reduce NSI is to impart knowledge and awareness to the faculty. Our study showed that the knowledge, attitude, and practice among the nursing faculty were promising but requires to be further strengthened. KEY WORDS Needlestick Injury, Nursing Staff, Knowledge, Attitude, Practice

Prevalence of needle stick injuries among health care workers of various hospitals: a cross sectional study in an urban district of North India

Background: Needle stick injuries (NSI) are one of the dreaded but preventable occupational hazard posed to health care worker in various clinical settings. The causes of NSI includes injuries caused by use of hypodermic needles, blood collection needles, needles in intravenous delivery systems, needles in diagnostic aspiration procedures and needle in interventional or surgical procedures. In developing countries, needle stick injuries prevalence is also related to lack of standard operating protocol in various institution.Methods: A cross sectional observational study was carried out in 384 paramedical, technical, auxiliary and sanitary staff of three government and three private hospitals of Meerut from November 2015 to October 2016.Results: In our study, Overall prevalence of NSI was 77/384 (20.1%). Among sub-groups, needle stick injury was 26.6% and 31.3% in nurses, 37.5% and 16.7% in technicians, 15% and 12.5% in wardboys/aaya and 15.6% and 9.4% in sweepers of public and private hospitals respectively.Conclusions: Standard operating protocol is the need of the hour at every medical institution and hospitals for NSI. Regular training regarding NSI, promoting early reporting and availability of immediate Post exposure prophylaxis should be ensured.

Prevalence of Needlestick Injuries among Healthcare Workers in Rizgary Teaching Hospital

Needlestick injury in healthcare settings is a global issue. Despite being recognized for many years, needlestick and sharps injuries (NSIs) continue to present a risk of occupational exposure to blood-borne pathogens for health care works (HCWs). The objectives of the study were to determine the prevalence of needlestick injuries among HCWs in Rizgary Teaching Hospital and to identify the causes of needlestick injuries. A cross-sectional study was conducted on 76 healthcare workers in Rizgary Teaching hospital; there were a total of 45 males, 31 females. The data collections were administrated using face-to-face interviews to ensure a good response rate and to ensure all questions were answered. Most (52.6%) needlestick injuries occurred in wards with syringe needles being the most common causative tool; surgery ward was the most prevalent site of needlestick injuries occurrence (42.1%). The percentage of acupuncture was high and needles were the most common cause, and most injuries occurred during the re-use of the needles. The study recommends several measures to prevent and reduce acute injuries among HCWs; these measures include health education, behavior change, safer devices, and an educational program to educate these HCWs.

Global Prevalence and Device Related Causes of Needle Stick Injuries among Health Care Workers: A Systematic Review and Meta-Analysis.

Background:Healthcare workers (HCWs) suffer more than 2 million occupational needle-stick injuries (NSIs) annually.Goal:To determine the global prevalence and causes of NSIs among HCWs.Methods:In this systematic review and meta-analysis, three databases (PubMed, Web of science, and Scopus) were searched for reports from January 1, 2000 to December 31, 2018. The random effects model was used to determine the prevalence of NSIs among HCWs. Hoy et al.’s instrument was employed to evaluate the quality of the included studies.Findings:A total of 87 studies performed on 50,916 HCWs in 31 countries worldwide were included in the study. The one-year global pooled prevalence of NSIs among HCWs was 44.5% (95% CI: 35.7, 53.2). Highest prevalence of NSIs occurred in the South East Asia region at 58.2% (95%, CI: 36.7, 79.8). By job category, prevalence of NSIs was highest among dentists at 59.1% (95% CI: 38.8, 79.4), Hypodermic needles were the most common cause of NSIs at 55.1% (95% CI: 41.4, 68.9).Conclusion:The current high prevalence of NSIs among HCWs suggests need to improve occupational health services and needle-stick education programs globally.

A study on PEI among private dentists in Mashhad, Iran.

Aim:We aimed to identify the percutaneous exposure incident (PEI) by private dentists in Mashhad, Iran.Methods:Subjects included 199 dentists enrolled in this study. A questionnaire consisting of 11 questions was sent to the dentists for data collection. Information was collected on knowledge about dangers of PEI, a history of needlestick or sharps injuries over the past 12 months, types of devices causing the needlestick or sharps injuries, HBV vaccination, knowledge about PEI protective and therapeutic protocol, and reporting PEI to the specialist. The first ten questions were corrected and each sheet received a score ranging from 0 to 10.Result:95 women (47.7%) and 104 men (52.3%) participated in this study aged between 27–72 years old. The findings showed that a total of 132 dentists (66.3%) had experiences with PEI. 45 (22.6%) of them had experiences with PEI in the past year. Files and needles were found to be the most frequent tools causing PEI, each with 29.7% of frequency. 16.6%, 8.6, 5.7, and 9.7% were obtained for dental burs, band, and surgical baled, respectively as other tools responsible for injuries. Results of the question about causes of needlestick injuries showed that personal carelessness is the most frequent reason (53.8%) followed by inappropriate disposal of the needles (7.6%).Conclusion:The personal carelessness and inappropriate disposal of needles were reported as the most common reasons for PEI injuries. It is suggested to educational programs for dentists should focus on preventing the PEI.

Awareness and Occupational Exposures to Needlestick Injuries among Healthcare Workers: A Quantitative Assessment in a Ghanaian Metropolis

Abstract Background: This study determined awareness and occupational exposures to needlestick injuries (NSIs) and its associated risk factors among healthcare workers (HCWs) in the Kumasi Metropolis, Ghana. Materials and Methods: A descriptive cross-sectional study was conducted among a total of 540 HCWs from three selected tertiary hospitals in the Kumasi Metropolis, Ghana. Data were collected using a structured questionnaire and analyzed. Results: All the study participants were aware of NSI and NSI-associated hepatitis B virus (HBV), hepatitis C virus, or human immunodeficiency virus (HIV) acquisition. Most of them (63.6%) were trained on the safety use of sharps devices and the majority of them preferred safety-engineered devices (79.8%). A greater proportion of the participants has had HBV vaccination (85.9%). The prevalence of NSIs was approximately 47%. NSIs were highly ranked to occur at patient's bedside (28.5%) and clinical laboratories (24.6%). Handling of needles/sharp objects before usage (27.7%) and during usage (34.0%) ranked the second and first cause of NSIs among health workers, respectively. Compared with those with less than 5 years working experience, having worked at the health facility between 5 and 10 years (prevalence rate ration [PRR] = 2.07 [1.39–3.11], p = 0.0004), 11–15 years (PRR = 4.32 [2.14–8.73], p < 0.0001), and >15 years (PRR = 5.73 [2.40–13.70], p < 0.0001) were associated with increased events of NSI. Conclusion: Despite the high awareness of NSIs and its perceived risk of infection acquisition, the prevalence of NSIs was high among HCWs. There is, therefore, the need for employers to enforce the universal precaution practices, provide regular training and education, and ensure adherence of HCWs to safety precaution of needle usage disease.

Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers

IntroductionNeedlestick injuries (NSIs) from a contaminated needle put healthcare workers (HCWs) at risk of becoming infected with a blood-borne virus and suffering serious short- and long-term medical consequences. Hypodermic injections using disposable syringes and needles are the most frequent cause of NSIs.ObjectiveTo perform a systematic literature review on NSI and active safety-engineered devices for hypodermic injection.MethodsMEDLINE, EMBASE, and COCHRANE databases were searched for studies that evaluated the clinical, economic, or humanistic outcomes of NSI or active safety-engineered devices.ResultsNSIs have been reported by 14.9%–69.4% of HCWs with the wide range due to differences in countries, settings, and methodologies used to determine rates. Exposure to contaminated sharps is responsible for 37%–39% of the worldwide cases of hepatitis B and C infections in HCWs. HCWs may experience serious emotional effects and mental health disorders after a NSI, resulting in work loss and post-traumatic stress disorder. In 2015 International US$ (IntUS$), the average cost of a NSI was IntUS$747 (range IntUS$199–1,691). Hypodermic injections, the most frequent cause of NSI, are responsible for 32%–36% of NSIs. The use of safety devices that cover the needle-tip after hypodermic injection lowers the risk of NSI per HCW by 43.4%–100% compared to conventional devices. The economic value of converting to safety injective devices shows net savings, favorable budget impact, and overall cost-effectiveness.ConclusionThe clinical, economic, and humanistic burden is substantial for HCWs who experience a NSI. Safety-engineered devices for hypodermic injection demonstrate value by reducing NSI risk, and the associated direct and indirect costs, psychological stress on HCWs, and occupational blood-borne viral infection risk.

Workers' Compensation Claims for Needlestick Injuries Among Healthcare Personnel in Hospitals, Doctors' Surgeries and Nursing Institutions

The "Technical rules for biological agents in healthcare and welfare facilities" (TRBA 250) came into force in March 2014 in Germany and deals with protective measures to prevent needlestick injuries (NSI). The present study covers the period of 6 months after TRBA 250 came into force. The study had 2 objectives: to investigate whether hospitals, doctors' surgeries and care facilities differ with respect to the causes of needlestick injuries (NSI) and to collect data on availability and implementation of safety-engineered devices (SED) in these healthcare settings workplaces. This study analyses workers' compensation claims for NSI, as received by the Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, BGW) (n=1602). During a telephone interview (response rate 33.3%), the subjects were asked about the course of the accident and the handling of SED at the workplace. Descriptive analyses were performed for hospitals, doctors' surgeries and care facilities (including inpatient care for the elderly and outpatient care). In all 3 settings, about half of the NSI did not occur during the invasive procedure, but during the subsequent disposal of the instruments. 30% of all NSI were caused by needles for subcutaneous injections; in care facilities, the proportion was above 50%. SED were involved in 20% of the NSI in hospitals and doctors' surgeries and in 10% of NSI in care facilities. Lack of experience in activating the safety mechanism was the most important cause of failure for NSI with SED. SED were available at the workplace in 80% of hospitals and doctors' surgeries and in 50% of care facilities. Training on the safe disposal of sharp instruments should be provided to all professional groups who come into contact with such instruments. It is currently not possible to provide a reliable estimate of the risk of infection from subcutaneous needles. As a high proportion of NSI in nursing homes and outpatient care services were caused by subcutaneous needles, training on safe handling practices for disposal of needles is needed in these settings.

Occupational exposure to blood and body fluids among primary health-care workers in Kaduna State, Nigeria

Background: Primary Health-Care Workers (PHCWs) are at a high risk of contracting blood-borne infections due to their occupational exposure to blood and body fluids (BBFs). The aim of this study is to determine the frequency of occupational exposures and associated factors contributing to the exposure to BBFs. We also evaluated the post-exposure practices among PHCWs in Kaduna State. Materials and Methods: A cross-sectional study was carried out from September 26 to October 7, 2011. One hundred and seventy-two PHCWs were included in the study using a multistage sampling technique. A structured questionnaire was used to obtain the data on sociodemographic characteristics, occupational exposures to BBFs and post-exposure practices of PHCWs. Data were analyzed using SPSS version 20.0 statistical software, and descriptive, bivariate, and multiple logistic regression analyses were performed. The level of significance was set at P ≤ 0.05. Results: One hundred and seventeen (68%) PHCWs had been exposed to BBF during their professional practice, of which 53.5% and 38.4% were needlestick and blood splash exposures, respectively. Needlestick and blood splash exposures 3 months prior to the survey occurred in 27.2% and 53.0% of them, respectively. The most common causes of needlestick injuries were during disposal of needles (44.0%) and administration of injections (28.0%). The majority of the respondents (79.8%) failed to report the exposure incidents. Only 8% of the respondents preformed the desirable post-exposure action of washing the exposure site immediately with soap and water. Primary health care workers Conclusion: The high rate of occupational exposure to BBFs among health-care workers reveals an urgent need to raise awareness and to provide periodic training in infection prevention.

The Frequency, Causes and Prevention of Needlestick Injuries in Nurses of Kerman: A Cross-Sectional Study.

The needlestick injuries can cause the transmission of infectious diseases. Compared to other members of the community of health care nurses are at great risk of needle stick injury because of their frequent performance with vein punctures and taking care of patients suffering from different infectious diseases. The main aim of this study was to assess Prevalence, causes and preventive of Needle Sticks injuries among nurses in Kerman (south of Iran). This cross-sectional study was conducted from December 2014 to March 2015 on 240 nurses employed in two hospitals of Kerman. Sampling was performed through simple random sampling. Data gathered through a researcher made questioner. Data analysed by use descriptive analytical testes. From the nurses' perspective the main physical and human causes of needlestick injuries were syringe needles (82) and crowded wards (74). The majority of the nurses believed the most effective method to prevent needlestick were training (82). Due to the high prevalence of injuries caused by sharp objects in nurses, needlestick injuries are suggested to be recorded in special forms and their causes to be checked by the Infection Control Committee. Since syringe needle heads and angiocatheter are the main causes of needlestick injuries, providing safe medical equipment should also be emphasized.

Behavior, perception and compliance related to adoption of safety measures in response to needle stick injuries among nursing personnel at a tertiary care institute of North India

Background: Needle stick injuries (NSIs) caused by sharp instruments such as hypodermic needles, blood collection needles; intravenous (IV) cannula or needles used to connect parts of IV delivery system are common in clinical practice. A potential risk of transmission of various fatal diseases such as acquired immunodeficiency syndrome, hepatitis and others have been a matter of serious concern in busy clinical settings. Aim and Objectives: The present survey study was carried out to evaluate the prevalence of NSIs among nursing personnel of our institute so as to identify the potential risk factors responsible for possibly acquiring NSIs. The study also aims to reinforce uniformly the recommended preventive measures by the nursing personnel in our institute with the formulation and implementation of newer preventive strategies by hospital authorities. Materials and Methods: A cross-sectional survey was carried out from July 2012 to November 2012 in the nursing department of our hospital. Informed verbal consent was taken from nursing personnel prior to distribution of the self-reporting questionnaire. Questions related to awareness such as cause of NSIs, number of NSIs, procedures that caused NSIs, clinical response of personnel after injury, preventive measures like hepatitis B immunization, use of personal protective equipment (PPE) and reasons for not using the PPE and training regarding prevention of NSIs were also included. A total of 179 staff nurses from all clinical areas of the hospital participated in this study excluding those who were on any kind of long leave. Statistical analysis was performed by using the Statistical Package for the Social Sciences version 15 for windows and value of P < 0.05 was considered as significant and P < 0.001 as highly significant. Results: Almost more than half of the nursing personnel (57.5%) had NSIs at one occasion or the other. Nearly 58% nursing personnel had NSIs for 3-times and few had even more than 10 times. NSIs during bedside care of the patient (57.2%) were reported as one of the significant potentially vulnerable location to get the NSIs as compared with the operation theater and emergency (5%) areas (P < 0.001). About 92% of the nursing personnel reported that needles used in routine injection practices were the main instrument that caused NSIs as compared with the hypodermic needle and surgical blades. Recapping of needles (66%) was the main procedure that caused NSIs as compared to IV line (20.4%) and others (P < 0.001). Around 81% nurses were already vaccinated against hepatitis B before the survey study. Conclusion: NSIs are highly prevalent among nurses. Injection practices have to be improved with reinforcing and modification of existing preventive measures. Procedures associated with higher risks of NSIs such as recapping of needles, non-wearing of gloves, improper disposal of sharps and others should be strongly discouraged so as to decrease the incidence of NSIs and morbidity and mortality associated with it.

Needlestick Injuries in Nursing Homes: The Prominent Role of Insulin Pens

Causes and circumstances related to 162 needlestick injuries in nursing homes were analyzed. In addition to nurses, geriatrics helpers were found to be an important occupational group at risk. Insulin pens were the most frequent cause of needlestick injuries among nursing personnel. Insulin pens are a major instrument involved with unsafe needle-handling practices.

Using a Systems Approach in Developing a Survey to Assess the Contributing Factors to Needlestick Injuries

Needlestick injuries (NSIs) are the result of multiple factors which interact in a complex manner. In an attempt to understand the causes of NSIs, a systems approach was adopted. An extensive literature review identified behaviors, equipment, safety and interpersonal environments, and administrative policies and procedures as potential contributors to NSIs. Two phases in the development of an instrument that measures the contributions of the individual, organization, and environment are reported. In phase one, a questionnaire was developed using the critical incident technique and tested on nursing and paramedic students and nursing professors. In phase two, a revised survey was administered to 205 nurses. The following factors representing different levels of a health care system emerged: safety environment, stressors, conflicting or conflicting procedures, critical behaviors, and knowledge. The discussion addresses how the questionnaire can be used to test the relative influences of these factors on the occurrence of NSIs and generate recommendations for system-wide interventions.

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.