Needlestick Injury Rate Research Articles

Infection control practices in the home: a survey of households of HIV-infected persons with hemophilia.

To assess infection control practices and risk for human immunodeficiency virus (HIV) transmission in households where home infusion for hemophilia is used. Cross-sectional prospective survey from 1992 through 1994. Hemophilia treatment centers. Human immunodeficiency virus (HIV)-infected persons with hemophilia who receive home infusions of clotting factor concentrate and their household members. Frequency of specific infection control practices in the home and the risk of HIV transmission to household members. We surveyed 235 persons from 75 families (79 HIV-infected persons with hemophilia and 156 household members) about infection control practices in the home. Forty-eight percent of household members surveyed helped with the infusion process. Of 74 members who assisted with infusion, 13 (18%) had sustained a needlestick injury, 11 of whom were injured during the past year. One hundred fifty household members tested for antibody to HIV were antibody negative. These household members had a total of 903 person-years of contact after HIV was diagnosed in the index case. Household members' adherence to recommended infection control measures was highest for washing hands after cleaning up infusion equipment and waste, and for using sharps disposal containers. Adherence was lowest for wearing gloves when helping with infusions and proper disposal of bloody waste from the infusion. No HIV transmission was found among persons living with HIV-infected persons with hemophilia, although there was a high rate of needlestick injuries during home infusion. Because persons who assisted with infusions often did not wear gloves and many households did not dispose of bloody waste properly, hemophilia treatment center personnel should emphasize these areas when training for home infusion. Adherence to appropriate infection control practices should help to keep the risk of HIV transmission in households extremely low.

Do protective devices prevent needlestick injuries among health care workers?

Objectives: To determine the effectiveness and direct cost of two protective devices—a shielded 3 ml safety syringe (Safety-Lok; Becton Dickinson and Co., Becton Dickinson Division, Franklin Lakes, N.J.) and the components of a needleless IV system (InterLink; Baxter Healthcare Corp., Deerfield, Ill.)-in preventing needlestick injuries to health care workers. Design: Twelve-month prospective, controlled, before-and-after trial with a standardized questionnaire to monitor needlestick injury rates. Setting: Six hospital inpatient units, consisting of three medical units, two surgical units (all of which were similar in patient census, acuity, and frequency of needlesticks), and a surgical-trauma intensive care unit, at a 900-bed urban university medical center. Participants: All nursing personnel, including registered nurses, licensed practical nurses, nursing aides, and students, as well as medical teams consisting of an attending physician, resident physician, interns, and medical students on the study units. Intervention: After a 6-month prospective surveillance period, the protective devices were randomly introduced to four of the chosen study units and to the surgical-trauma intensive care unit. Results: Forty-seven needlesticks were reported throughout the entire study period, 33 in the 6 months before and 14 in the 6 months after the introduction of the protective devices. Nursing staff members who were using hollow-bore needles and manipulating intravenous lines accounted for the greatest number of needlestick injuries in the pre-intervention period. The overall rate of needlestick injury was reduced by 61%, from 0.785 to 0.303 needlestick injuries per 1000 health care worker—days after the introduction of the protective devices (relative risk = 1.958; 95% confidence interval, 1.012 to 3.790; p = 0.046). Needlestick injury rates associated with intravenous line manipulation, procedures with 3 ml syringes, and sharps disposal were reduced by 50%; however, reductions in these subcategories were not statistically significant. No seroconversions to HIV-1 or hepatitis B virus seropositivity occurred among those with needlestick injuries. The direct cost for each needlestick prevented was $789. Conclusions: Despite an overall reduction in needlestick injury rates, no statistically significant reductions could be directly attributed to the protective devices. These devices are associated with a significant increase in cost compared with conventional devices. Further studies must be concurrently controlled to establish the effectiveness of these devices.

Impact of Increased Legal Access to Needles and Syringes on Practices of Injecting-Drug Users and Police Officers???Connecticut, 1992???1993

To determine whether the simultaneous, partial repeal of needle prescription and drug paraphernalia laws in Connecticut affected purchasing and usage of needles and syringes (syringes) by injecting-drug users (IDUs) and risk of needlestick injuries to police officers, we conducted two serial cross-sectional surveys with IDUs recruited in drug treatment centers, correctional facilities, and health department settings. Reports of needlestick injuries among Hartford police officers were reviewed before and after the new laws. Among IDUs who reported ever sharing a syringe, syringe-sharing decreased after the new laws (52% before vs. 31% after; p = 0.02). Fewer IDUs reported purchasing syringes on the street after the new laws (74% before vs. 28% after; p < 0.0001). More IDUs reported purchasing syringes from a pharmacy after the new laws (19% before vs. 78% after; p < 0.0001). Eight to eleven months after the new laws were enacted, over two thirds (91 of 134) of active IDUs interviewed were aware of both new laws. Needlestick injury rates among Hartford police officers were lower after the new laws (six injuries in 1,007 drug-related arrests for 6-month period before new laws vs. two in 1,032 arrests for 6-month period after new laws). The changes in Connecticut laws were associated with decreases in self-reported syringe-sharing and increases in purchasing by IDUs of sterile syringes from reliable sources, suggesting that the simultaneous repeal of both prescription and paraphernalia laws is an important HIV prevention strategy.

Risks to surgeons: A comparison of blunt and sharp tipped suture needles

SummaryBlunt taper-point suture needles have been designed to reduce the risks to surgeons from blood borne infections. The use of ordinary sharp pointed suture needles was compared in this study with that of blunt taper-point needles during emergency and elective obstetric and gynaecological surgery. Data from 341 operations performed by 12 senior and middle grade staff were collected. Risk of infection was assessed by recording the incidence of needle stick injury, gross blood contamination and glove puncture. The rates of needle stick injury and glove puncture were lower with taper-point needles and their use may be expected to reduce the risk of acquiring hepatitis B or HIV infection from patients.

Device-Specific Risk of Needlestick Injury in Italian Health Care Workers

Objectives. —To identify the types of medical devices causing needlestick injuries among Italian health care workers, to document the device-specific injury rates and time trends for different hollow-bore needles, and to compare injury rates from these devices with those reported in the United States. Design. —Longitudinal survey. Settings. —Twelve Italian acute care public hospitals. Methods. —Data were obtained from a multihospital surveillance database on the number of total injuries reported in each device category. Hospitals provided the corresponding number of devices used annually for each needle type. Main Outcome Measure. —Number of needlestick injuries by type of hollow-bore needle per 100000 devices used per year. Results. —A total of 2524 injuries from hollow-bore needles were reported. Disposable syringes/hypodermic needles accounted for 59.3% of injuries, followed by winged steel needles (33.1%), intravenous catheter stylets (5.4%), and vacuum-tube phlebotomy needles (2.2%). Intravenous catheter stylets had the highest needlestick injury rate (15.7/100 000 devices used), and disposable syringes had the lowest needlestick injury rate (3.8/100 000). In contrast to the other devices, the injury rate from winged steel needles increased from 6.2 per 100 000 in 1990 to 13.9 per 100000 in 1992. Conclusions. —The device-specific needlestick injury rates in Italy are similar to those reported in the United States, suggesting similar exposure experience in two countries. However, in contrast to the United States, needleless intravenous access is standard practice in Italy and thus eliminates one potential risk to Italian health workers. Implementation of safer equipment, such as shielded or retracting needles, and continuing training programs are needed to further reduce the hazards that health care workers face. ( JAMA . 1994;272:607-610)

Analysis of needlestick injuries to health care workers prhome care

Background:This research analyzed needlestick injuries sustained by employees working in the home health environment to determine to what extent existing infection control policies and procedures in home health care are effective in reducing the risk of transmission of blood-borne infections. Methods: In June and July 1992, a random sample of 600 directors of home health care agencies in the United States were sent questionnaires concerning written blood-borne infection control policies and procedures of home health care agencies. Agency characteristics were also identified. Results: A 46% response rate ( n = 278) was obtained. Of the 226 agencies that reported needlestick injury rates, 102 agencies reported no needlestick injuries to home health care agency employees in the “last year” and 124 agencies reported from one to 134 needlestick injuries, for a cumulative total of 475. Statistical analyses revealed that agencies with “safer” sharps containers, “safer” hypodermics, or “safer” access to intravenous administration lines did not have statistically significantly rates of lower needlestick injury than agencies without these “safer” products. Conclusions: This study should be considered exploratory; causal relationships cannot be established. Although written blood-borne infection control policies and procedures do not appear to provide protection to home health care workers from the risk of needlestick injury, limitations in the data exist. Consequently, results should be viewed with caution and additional research is needed.

Device-Specific Risk of Needlestick Injury in Italian Health Care Workers

To identify the types of medical devices causing needlestick injuries among Italian health care workers, to document the device-specific injury rates and time trends for different hollow-bore needles, and to compare injury rates from these devices with those reported in the United States. Longitudinal survey. Twelve Italian acute care public hospitals. Data were obtained from a multihospital surveillance database on the number of total injuries reported in each device category. Hospitals provided the corresponding number of devices used annually for each needle type. Number of needlestick injuries by type of hollow-bore needle per 100,000 devices used per year. A total of 2524 injuries from hollow-bore needles were reported. Disposable syringes/hypodermic needles accounted for 59.3% of injuries, followed by winged steel needles (33.1%), intravenous catheter stylets (5.4%), and vacuum-tube phlebotomy needles (2.2%). Intravenous catheter stylets had the highest needlestick injury rate (15.7/100,000 devices used), and disposable syringes had the lowest needlestick injury rate (3.8/100,000). In contrast to the other devices, the injury rate from winged steel needles increased from 6.2 per 100,000 in 1990 to 13.9 per 100,000 in 1992. The device-specific needlestick injury rates in Italy are similar to those reported in the United States, suggesting similar exposure experience in two countries. However, in contrast to the United States, needleless intravenous access is standard practice in Italy and thus eliminates one potential risk to Italian health workers. Implementation of safer equipment, such as shielded or retracting needles, and continuing training programs are needed to further reduce the hazards that health care workers face.

Device-specific risk of needlestick injury in Italian health care workers

<h3>Objectives.</h3> —To identify the types of medical devices causing needlestick injuries among Italian health care workers, to document the device-specific injury rates and time trends for different hollow-bore needles, and to compare injury rates from these devices with those reported in the United States. <h3>Design.</h3> —Longitudinal survey. <h3>Settings.</h3> —Twelve Italian acute care public hospitals. <h3>Methods.</h3> —Data were obtained from a multihospital surveillance database on the number of total injuries reported in each device category. Hospitals provided the corresponding number of devices used annually for each needle type. <h3>Main Outcome Measure.</h3> —Number of needlestick injuries by type of hollow-bore needle per 100000 devices used per year. <h3>Results.</h3> —A total of 2524 injuries from hollow-bore needles were reported. Disposable syringes/hypodermic needles accounted for 59.3% of injuries, followed by winged steel needles (33.1%), intravenous catheter stylets (5.4%), and vacuum-tube phlebotomy needles (2.2%). Intravenous catheter stylets had the highest needlestick injury rate (15.7/100 000 devices used), and disposable syringes had the lowest needlestick injury rate (3.8/100 000). In contrast to the other devices, the injury rate from winged steel needles increased from 6.2 per 100 000 in 1990 to 13.9 per 100000 in 1992. <h3>Conclusions.</h3> —The device-specific needlestick injury rates in Italy are similar to those reported in the United States, suggesting similar exposure experience in two countries. However, in contrast to the United States, needleless intravenous access is standard practice in Italy and thus eliminates one potential risk to Italian health workers. Implementation of safer equipment, such as shielded or retracting needles, and continuing training programs are needed to further reduce the hazards that health care workers face. (<i>JAMA</i>. 1994;272:607-610)

The Epidemiology of Needlestick and Sharp Instrument Accidents in a Nigerian Hospital

To characterize the epidemiology of percutaneous injuries of healthcare workers (HCWs) in Ile-Ife, Nigeria. A cross-sectional survey of a random sample of HCWs regarding details of needlestick and sharp instrument injuries within the previous year. University hospital and clinics in Ile-Ife, Nigeria. Hospital personnel with potential occupational exposure to patients' blood. Needlestick accidents during the previous year were reported by 27% of 474 HCWs, including 100% of dentists, 81% of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff. The rate of needlestick injuries was 0.6 per person-year overall: 2.3 for dentists, 2.3 for surgeons, 0.4 for nonsurgical physicians, and 0.6 for nursing staff. Circumstances associated with needlestick injuries included unexpected patient movement in 29%, handling or disposal of used needles in 23%, needle recapping in 18%, accidental stick by a colleague in 18%, and needle disassembly in 10%. Sharp instrument injuries were reported by 15% of HCWs and most commonly involved broken glass patient specimen containers (39%). Almost all HCWs were aware of the potential risk of HIV transmission through percutaneous injuries, and 91% considered themselves very concerned about their occupational risk of HIV acquisition. The high frequency of percutaneous exposure to blood among HCWs in this Nigerian hospital potentially could be reduced by simple interventions at modest cost.

Needle covers reduce needlestick injury

The objective of the study, conducted in the general wards of Flinders Medical Center in South Australia, was to determine whether the risk of needlestick injuries from hypodermic needles could be reduced by the use of needle covers that are applied with a one-handed technique immediately after use of the needle. Baseline rates of needlestick injury were collected for a year prior to the use of needle covers, and incident cases of needlestick injury were collected after needle covers were introduced. The odds ratio, derived from pre- and postintervention data, for injuries over which the use of needle covers could have had no influence, was used to show that the net effect of other influences on needlestick rates was not significant. The use of needle covers was associated with a significant reduction in needlestick injuries to nurses. The odds ratio for needlestick injury for nurse injuries that needle covers could not have prevented was 0.92. (95% CI 0.40-2.03). The odds ratio for needlestick injury for nurse injuries that needle covers could have prevented was 0.40 (95% CI 0.18–0.82). Although the odds ratio for needlestick injury to cleaners was 0.19, the 95% exact confidence interval was 0.00–1.64.

An examination of needlestick injury rates, hepatitis B vaccination uptake and instruction on ‘sharps’ technique among medical students

A 12-question survey designed to examine venepuncture techniques and instruction and uptake of hepatitis B vaccination was completed by 172 of the 275 medical students to whom it was distributed (a response rate of 62·5%). Seventy-five injuries were reported, at an average of 0·3 per student per year. Of the respondents, 63% resheathed needles after use, a practice frequently cited as a cause of needlestick injury. However, in this sample resheathing was not significantly associated with a higher or lower injury rate ( χ 2 = 2·07, P > 0·1). Of the respondents from the most recent intake, only 20 out of 57 had completed a course of hepatitis B vaccinations prior to the commencement of venepuncture duties. There was almost universal ignorance concerning the correct course of action following ‘sharps’ injury. Recommendations are made concerning hepatitis B vaccination and teaching strategies for medical students.

Needlestick Injury in Hospital Personnel: A Multicenter Survey from Central Italy

Objectives:To assess the rate of needlestick injury in hospital personnel in an Italian region. To identify risk factors potentially amenable to correction.Design:Hospital workers undergoing hepatitis B prevaccination testing in 1985 through 1986 were interviewed regarding needlestick injury in the previous year, job category, area of work, years of employment, and other pertinent information.Setting:Of the 98 public hospitals of the Latium region, 68 participated in the survey: 32 of 55 with less than 200 beds, 20 of 25 with 200 to 300 beds, 11 of 13 with 400 to 900 beds, and all of the 5 with more than 1,000 beds.Participants:All healthcare workers providing direct patient care or environmental services as well as student nurses were invited by the hospital directors to undergo hepatitis B prevaccination testing and vaccination, if eligible.Results:Of 30,226 hospital workers of the 68 participating hospitals, 20,055 were interviewed (66.3%): 47.7% of the 7,172 doctors, 71% of the 14,157 nurses, 55.9% of the 2,513 technicians, and 71.9% of the 6,384 ancillary workers. Needlestick injury was recalled by 29.3%; the rates were 54.9%, 35.3%, 33.8%, 26.5%, 18.7%, and 14.7% in surgeons, registered and unskilled nurses, physicians, ancillary workers, and technicians, respectively. The recalled injury rate was 39.7% and 34.0% in surgical and intensive care areas; in infectious diseases, it was 16.7%. Bates were lower in hospitals with 200 to 300 beds (25.6%). The needlestick injury rate declined from 32% in those with less than 5 years of employment to 28% in those with more than 20 years (p<.01). Prevalence of HBV infection was higher in student nurses and young workers recalling a needlestick exposure (14.3% and 15.8%, respectively), versus 10.1% and 12.8% in those not exposed (p<.01 and <.05, respectively).Conclusions:Parenteral exposure to bloodborne infectious agents is a relevant risk among healthcare workers in our region, particularly in defined job categories and hospital areas (surgeons, nurses, surgical, and intensive care areas). Immunization and educational efforts should be made along with better designs of devices to reduce the risk of infection.

Exposure to blood during various procedures: Results of two surveys before and after the implementation of universal precautions

In an attempt to define better situations involving exposure to blood, we surveyed nurses (N = 565) in a 1000-bed university hospital to determine the following for the last working shift: the rate of cutaneous exposure to blood for different procedures, the rate of needlestick injury, and the prevalence of hand lesions. Among nurses who had performed at least one of the specified procedures, 42% had been exposed to blood with unprotected skin. Direct examination of 100 pairs of hands revealed that 57% of the nurses had either acute or chronic skin lesions. Universal precautions were introduced, and a similar survey (N = 541) was carried out 1 year later to assess compliance. Exposure of unprotected skin to blood had been reduced to 27%, although 46% of nurses had not used gloves for any of the procedures they had performed. The main reason given by nurses for not wearing gloves was that they did not consider the patient to be at risk for carrying a blood-borne infection. The rate of needlestick injuries was high and had remained stable at approximately 2.8 needlesticks/nurse per year, as determined by information from the last working shifts. We conclude that compliance of nursing personnel with universal precautions was insufficient, despite an informational campaign throughout the hospital. Repeated instruction on barrier precautions and the prevention of needlestick injury (including the correct use of disposable containers) is necessary to ensure optimal protection.

Needlestick Injury: Impact of a Recapping Device and an Associated Education Program

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. A before-after trial with a two-year duration of follow-up. Tertiary referral hospital. Nursing and other hospital personnel. 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. 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.

Needlestick Injury: Impact of a Recapping Device and an Associated Education Program

AbstractObjective: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&lt;.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.

Needlestick Injury Rate Reduction During Phlebotomy: A Comparative Study of Two Safety Devices

Vanderbilt University Medical Center's Lab Liaison Services evaluated two phlebotomy devices designed to reduce needlestick injuries in phlebotomy. Analysis during the 17- month evaluation period showed the rate of needlestick injuries using a standard phlebotomy device was 28 injuries per 100 employees, use of a recapping device decreased the rate to 26 injuries per 100 employees, and use of a needle-sheathing device that eliminates recapping and disassembly reduced the rate to only five injuries per 100 employees. This represents an 82% reduction in the needlestick injury rate. The use of a needlesheathing device eliminated all recapping, disassembly, and disposal injuries. The dramatic reduction of needlestick injuries has led to a safer working environment for laboratory employees.

Needlestick Injuries in Ophthalmology

Because serious nosocomial diseases can be transmitted by needlestick injuries, a retrospective review of needlestick injuries was conducted for a period of 2.5 years at a major university teaching hospital. The objective was to determine the needlestick injury rate among employees of the Department of Ophthalmology versus the other departments. Ophthalmologists had the highest incidence per person of needle injuries among physicians. Retina and strabismus surgeons were at higher risk than anterior segment surgeons.

AIDS and the Minority Health Care Worker

1. Large groups of health care workers, many of whom are among ethnic minorities with potential for occupational exposure to HIV/HBV, are generally underserved in training on prevention of occupational transmission of the viruses. 2. The inadequacy of training for indirect client care personnel appears to be one of the primary reasons for high rates of needlestick injuries and exposure to blood. 3. Training in appropriate infection control techniques can help reduce the uneasiness and fear among health care workers over occupationally-related HIV/HBV transmission.

Impact of a recapping device on venepuncture-related needlestick injury.

In a 33-month prospective analysis of needlestick injuries, venepuncturists working under Centers for Disease Control (CDC) guidelines for handling used needles were shown to incur a needlestick injury for every 3,175 to 4,006 needle-handling procedures. On the other hand, users of a simple device designed to reduce the risk of injury when recapping used needles were shown to incur a needlestick only once in every 16,100 venepunctures performed (P less than 0.001). This represents a fourfold reduction in the rate of needlestick injuries. We thus question the effectiveness of the CDC nonrecapping policy.

Impact of a Recapping Device on Venepuncture-Related Needlestick Injury

In a 33-month prospective analysis of needlestick injuries, venepuncturists working under Centers for Disease Control (CDC) guidelines for handling used needles were shown to incur a needlestick injury for every 3,175 to 4,006 needle-handling procedures. On the other hand, users of a simple device designed to reduce the risk of injury when recapping used needles were shown to incur a needlestick only once in every 16,100 venepunctures performed (P less than 0.001). This represents a fourfold reduction in the rate of needlestick injuries. We thus question the effectiveness of the CDC nonrecapping policy.