Needlestick Injury Rate Research Articles

Should blood-borne virus testing be part of operative consent? When the doctor becomes the patient

Point-of-care testing (POCT) is a sensitive, specific and rapid form of testing for the presence of HIV antibodies. Post-exposure prophylaxis for HIV infection can reduce seroconversion rates by up to...

A survey of sharps including needlestick injuries in nurses in New South Wales, Australia

ObjectivesThis cross-sectional study sought to determine the prevalence rate of sharps including needlestick injuries (NSI) in a 12-month periodamong nurses and midwives, factors associated with NSI injuries and to compare data across workplace categories and geographic regions. MethodsThe study surveyed a randomly selected representative sample of nurses (n=7423) from the NSW Nurses’ Association membership representing members from five major workplace categories and four major geographic regions. ResultsAtotal of 1301 eligible contactable nurses participated (response rate 18.5%). The 12-month self-reported prevalence rate of injury was 6.5% (n=84). NSI rates of injury were higher in the clinical areas of emergency room, operating theatres, medical and surgical wards, mental health and aged care. Bygeographic region the rate of injury was highest in remote areas (16.4%). Logistic regression modelling was used to identify factors which increase the risk of a NSI injury; only working in a remote region was statistically significant. The odds of sustaining a NSI injury for nurses and midwives working in remote areas was 2.9 times the odds for nurses working in city/inner regional areas when controlling for other risk factors. ConclusionsThe NSI rates of injury reported in this study are similar to those reported in other recent state and national studies in Australia and the UK. Nosignificant differences were identified when clinical areas were compared. This study suggests that the risk is significantly higher in remote areas.

Needlestick Injury Rates According to Different Types of Safety-Engineered Devices: Results of a French Multicenter Study

To evaluate the incidence of needlestick injuries (NSIs) among different models of safety-engineered devices (SEDs) (automatic, semiautomatic, and manually activated safety) in healthcare settings. This multicenter survey, conducted from January 2005 through December 2006, examined all prospectively documented SED-related NSIs reported by healthcare workers to their occupational medicine departments. Participating hospitals were asked retrospectively to report the types, brands, and number of SEDs purchased, in order to estimate SED-specific rates of NSI. Setting. Sixty-one hospitals in France. More than 22 million SEDs were purchased during the study period, and a total of 453 SED-related NSIs were documented. The mean overall frequency of NSIs was 2.05 injuries per 100,000 SEDs purchased. Device-specific NSI rates were compared using Poisson approximation. The 95% confidence interval was used to define statistical significance. Passive (fully automatic) devices were associated with the lowest NSI incidence rate. Among active devices, those with a semiautomatic safety feature were significantly more effective than those with a manually activated toppling shield, which in turn were significantly more effective than those with a manually activated sliding shield (P < .001, chi(2) test). The same gradient of SED efficacy was observed when the type of healthcare procedure was taken into account. Passive SEDs are most effective for NSI prevention. Further studies are needed to determine whether their higher cost may be offset by savings related to fewer NSIs and to a reduced need for user training.

Using an intravenous catheter system to prevent needlestick injury

To identify the effect of a sharps awareness campaign and the introduction of a safety catheter device on the annual incidence of needlestick injuries between 2003 and 2007. In 2003, a sharps awareness campaign began in San Martino Hospital in Genoa, Italy. In 2005, a safety catheter was introduced and healthcare workers were trained in its use. Data for all occupational accidents from 2003 to 2007 were collected and analysed. After introduction of the sharps awareness campaign and use of safety catheters, reported incidents of sharps injuries involving catheters fell from 19 in 2004 to two in 2007 and in neither of those two cases were needlestick prevention devices used. Overall, the rate of needlestick injuries was 24.1 per 100,000 cases when conventional catheters were used and 0.4 per 100,000 cases with safety catheters. The sharps awareness campaign and newly adopted needlestick prevention device may have contributed to the prevention of percutaneous injuries caused by catheters. Until the onset of the campaign, the reported annual incidence of needlestick injuries was six. This increased to a peak of 19 reported injuries in 2004, which could be attributed to improved reporting effected by the campaign.

Assessment of health care workers occupational exposure to HIV and post-exposure prophylaxis (PEP) in health centers and hospitals of Addis Ababa, Ethiopia

Background: Occupational exposure that places a worker at risk of HIV infection is a percutaneous injury, contact of mucous membrane or skin with blood or other body fluids. Exploring the extent of exposures, knowledge and practices of health care workers on occupational HIV risks is important. The study was done to assess occurrence of occupational exposures and knowledge and practice regarding HIV post-exposure prophylaxis among health care workers in health centers and hospitals of Addis Ababa. Methods: A facility based cross-sectional study, involving 372 health care workers, was conducted in Addis Ababa from March to April 2008. A pre-tested, interviewer administered, structured questionnaire was applied for data collection. Odds ratio with 95% confidence interval and logistic regression analysis were employed to measure the degree of association between factors and identify the predictors for occurrence of needle stick injuries. Results: The study revealed that 38.2% of health care workers experienced at least one needle stick injury in their life time and 19% of respondents experienced injury within the last one year. Rate of needle stick injury in the previous one year was estimated at 1.34 injuries per person. Factors associated with occurrence of injuries were being a nurse (AOR = 15.39, 95%CI = 3.70–18.05), having work experience for more than 10 years (AOR = 2.68, 95%CI = 1.30–5.54), working long hours (AOR = 1.90, 95%CI = 1.10–3.31), attending fewer patients per day (AOR = 2.21, 95%CI = 1.32–3.58), self perception of high risk HIV (AOR = 2.05, 95%CI = 1.10–3.82) and non-consistent use of personal protective equipments (AOR = 1.67, 95%CI = 1.01–2.76). Two hundred sixty four (71.0%) respondents had knowledge about HIV post-exposure prophylaxis. Conclusion: The findings of this study indicated that occupational exposures were common among health care workers. Health facilities should make available to their system that includes a standardized written protocol and reporting unit for management of occupational exposures. Improvement of work environment and appropriate management of exposed cases, including addressing the psychosocial burden health workers face after exposure is also imperative. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

Needlestick injuries among nursing students in China

To describe and characterize the rates and the nature of needlestick injuries among nursing students in China. A questionnaire was delivered to 248 randomly selected nursing students from seven training hospitals to obtain information relevant occupational needlestick injuries. A total of 1144 incidents of needlestick injuries were reported among the 246 nurses during the time period of internship. The overall rate of needlestick injuries among these nurses was 100%, according to this survey. Insufficient awareness of occupational safety and limited work experience with handling needlestick injuries in these nurse students were significantly reported. In addition, when stratified by departments, the highest rate of needlestick injuries was seen in the surgery department. The occurrence of needlestick injuries is significantly related to clinical practice behaviors. Needlestick injuries are commonly reported in nursing students in China. Enhanced awareness of occupational safety in nursing students is expected to reduce the risk of needlestick injuries.

Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study

BackgroundAccidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan.MethodsAt Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated; surveillance data from 2002 to 2007 was analyzed and compared with various risk factors.ResultsDuring study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394; 28.5%) followed by registered nurses (n = 283; 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002–04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including; hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and patients visits in clinics (p = 0.01).ConclusionWe report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project.

The Incidence and Reporting Rates of Needle-Stick Injury Amongst UK Surgeons

Needle-stick injuries are common. Such accidents are associated with a small, but significant, risk to our career, health, families and not least our patients. National guidelines steer institution-specific strategies to provide a consistent and safe method of dealing with such incidents. Surgeon-specific guidelines are not currently available. We have observed that hospital sharps policy is often considered cumbersome to the surgeon, resulting in on-the-spot decision making with potential long-term implications. By their essence, these decisions are inconsistent, not reproducible and, thus, we believe them to be unsafe. The under-reporting to occupational health departments is well documented. Current surgical practice has the potential to expose the surgeon to unnecessary risk. The aims of this study were to establish the true incidence of contaminations caused by needle-stick injury in our hospital and to assess how well current protocols are really implemented. We identified all surgeons of consultant, non-career staff grade (NCSG) and registrar grade working in a large 687-bed district general hospital serving a population of 550,000, in the UK. We designed a retrospective, anonymous 30-second survey. Surgeons' awareness and opinion of local policy was sought in a free-text section. Of the 98 surgeons in the hospital, 77% responded to the questionnaire and 44% anonymously admitted to having a needle-stick injury. Only 3 of the 33 (9%) who sustained an needle-stick injury said that they followed the agreed local policy. Twenty-three surgeons (70%) performed first aid type procedures such as informing scrub nurse, changing needle and gloves. Seven surgeons (21%) simply ignored the incident and continued. Forty-three surgeons commented on the policy's nature with only 9 who regarded it as 'user friendly'. Needle-stick injury is still a common problem, particularly in the surgical cohort and remains significantly under-reported. The disparity between hospital sharps policy and actual surgical practice is considered and an explanation for the difference sought. Without this awareness of 'real-life' surgical practice, the occupational health figures for sharps injury will always tell a rosy story under-estimating a real problem. We strongly advocate universal precautions in the operating theatre. However, we acknowledge that sharps injuries will occur. We should remain vigilant and act upon contaminations without surgical bravado but with mater-of-fact professionalism. This includes regular review of policy and, particularly, promotion of surgical awareness.

Device-specific rates of needlestick injury at a large military teaching hospital

The device-specific needlestick injury (NSI) rate provides a means of comparing rates of injury between work sites and institutions over time. We performed a retrospective study of intravenous and percutaneous injection NSI at a large military teaching hospital using electronic purchase records and occupational NSI exposure forms to define action levels for process improvements. A rate of 2.25 NSI per 100,000 intravenous needles and 2.21 NSI per 100,000 percutaneous needles was found.

The reporting of needlestick injuries sustained in theatre by surgeons: are we under-reporting?

Surgeons frequently sustain needlestick injuries when operating. The aim of this study was to evaluate the incidence and reporting rate of needlestick injuries at one institution. A questionnaire was distributed anonymously to 69 surgeons of all grades and specialties in a district general hospital in the UK. The questionnaire was returned by 42 surgeons (60.9%). There were 840 needlestick injuries over two years, of which 126 caused bleeding. Senior surgeons who spent more hours operating per week had a higher rate of needlestick injuries compared with junior surgeons (29.1 vs 6.59 injuries per surgeon over two years). Of the total number of injuries, 19 (2.26%) were reported to Occupational Health according to the surgeons questioned, but only six reported incidents were found in the Occupational Health records. Junior surgeons were significantly more likely to report needlestick injuries than senior surgeons (9.82% vs 1.10% of injuries reported, P=0.0000045). The main reasons for failure to report needlestick injuries were due to the lack of time and excessive paperwork. Seventy-three percent of surgeons did not routinely use double gloves when operating, mainly because of decreased hand sensation. The rate of needlestick injury reporting by surgeons at this institution is extremely low. Previous studies have shown a higher reporting rate suggesting that, despite awareness of blood-borne infections, surgeons are still not following recommended protocols.

Needlestick injuries in a major teaching hospital: The worthwhile effect of hospital-wide replacement of conventional hollow-bore needles

Needlestick injury (NSI) with hollow-bore needles remains a significant risk of bloodborne virus acquisition in health care workers. The impact on NSI rates after substantial replacement of conventional hollow-bore needles with the simultaneous introduction of safety-engineered devices (SEDs) including retractable syringes, needle-free intravenous (IV) systems, and safety winged butterfly needles was examined in an 800-bed Australian university hospital. NSIs were prospectively monitored for 2 years (2005-2006) after the introduction of SEDs and compared with prospectively collected preintervention NSI data (2000-2004). Preintervention hollow-bore NSI rates over 10 years persisted at a constant rate between 3.01 and 3.77 per 100 full-time equivalent employees (FTE) (P = .31). Rates for 2005 (1.93; 95% CI: 1.48-2.47 per 100 FTE) and 2006 (1.50; 95% CI: 1.11-1.97 per 100 FTE) were significantly lower than the average rate for the preintervention years (3.39; 95% CI: 2.7-4.24 per 100 FTE, P = .00004). This represents a fall of 49% (43.1%-55.7%) in hollow-bore NSI, contributed to by the virtual elimination of NSI related to accessing IV lines. More importantly, high-risk injuries were also reduced 57% by retractable syringe use with an overall budgetary increase of approximately US $90,000 per annum. Introduction of SEDs results in an impressive fall in NSI with minimal cost outlay.

Preventing Needlestick Injuries in Obstetrics and Gynecology

Surgical needlestick injuries are common in obstetrics and gynecology and can cause transmission of viral diseases including hepatitis and acquired immunodeficiency syndrome (AIDS). Strategies to reduce the rate of needlestick injuries include using instruments rather than fingers to retract tissue and grasp needles, double gloving, using surgical staplers for skin closure, and substituting blunt tip surgical needles for sharp tip needles where applicable. Studies have shown the use of blunt tip surgical needles to be remarkably effective in reducing needlestick injuries. Despite recommendations by the American College of Surgeons that blunt tip surgical needles be used routinely, at least for fascial closure, and by the Occupational Safety and Health Administration and the National Institute for Occupational Health and Safety that these devices be used whenever medically appropriate, use in obstetrics and gynecology appears to be limited. Potential barriers to use include availability, the "feel" of the needle as it penetrates tissue, and habit. We suggest that blunt tip surgical needles have the potential to replace traditional needles for many obstetric and gynecologic applications. If their use is to become more widespread, we must focus on availability, evaluation for specific applications, and physician education.

Prevalence and prevention of needlestick injuries among health care workers in a German university hospital

Health care workers (HCWs) are exposed to bloodborne pathogens, especially hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) through job-related risk factors like needlestick, stab, scratch, cut, or other bloody injuries. Needlestick injuries can be prevented by safer devices. The purpose of this study was to investigate the frequency and causes of needlestick injuries in a German university hospital. Data were obtained by an anonymous, self-reporting questionnaire. We calculated the share of reported needlestick injuries, which could have been prevented by using safety devices. 31.4% (n = 226) of participant HCWs had sustained at least one needlestick injury in the last 12 months. A wide variation in the number of reported needlestick injuries was evident across disciplines, ranging from 46.9% (n = 91/194) among medical staff in surgery and 18.7% (n = 53/283) among HCWs in pediatrics. Of all occupational groups, physicians have the highest risk to experience needlestick injuries (55.1%-n = 129/234). Evaluating the kind of activity under which the needlestick injury occurred, on average 34% (n = 191/561) of all needlestick injuries could have been avoided by the use of safety devices. Taking all medical disciplines and procedures into consideration, safety devices are available for 35.1% (n = 197/561) of needlestick injuries sustained. However, there was a significant difference across various medical disciplines in the share of needlestick injuries which might have been avoidable: Pediatrics (83.7%), gynecology (83.7%), anesthesia (59.3%), dermatology (33.3%), and surgery (11.9%). In our study, only 13.2% (n = 74/561) of needlestick injuries could have been prevented by organizational measures. There is a high rate of needlestick injuries in the daily routine of a hospital. The rate of such injuries depends on the medical discipline. Implementation of safety devices will lead to an improvement in medical staff's health and safety.

Sharp-Device Injuries to Hospital Staff Nurses in 4 Countries

To compare sharp-device injury rates among hospital staff nurses in 4 Western countries. Cross-sectional survey. Acute-care hospital nurses in the United States (Pennsylvania), Canada (Alberta, British Columbia, and Ontario), the United Kingdom (England and Scotland), and Germany. A total of 34,318 acute-care hospital staff nurses in 1998-1999. Survey-based rates of retrospectively-reported needlestick injuries in the previous year for medical-surgical unit nurses ranged from 146 injuries per 1,000 full-time equivalent positions (FTEs) in the US sample to 488 injuries per 1,000 FTEs in Germany. In the United States and Canada, very high rates of sharp-device injury among nurses working in the operating room and/or perioperative care were observed (255 and 569 injuries per 1,000 FTEs per year, respectively). Reported use of safety-engineered sharp devices was considerably lower in Germany and Canada than it was in the United States. Some variation in injury rates was seen across nursing specialties among North American nurses, mostly in line with the frequency of risky procedures in the nurses' work. Studies conducted in the United States over the past 15 years suggest that the rates of sharp-device injuries to front-line nurses have fallen over the past decade, probably at least in part because of increased awareness and adoption of safer technologies, suggesting that regulatory strategies have improved nurse safety. The much higher injury rate in Germany may be due to slow adoption of safety devices. Wider diffusion of safer technologies, as well as introduction and stronger enforcement of occupational safety and health regulations, are likely to decrease sharp-device injury rates in various countries even further.

The usability and acceptability of a needleless connector system

Needleless connectors were introduced into clinical practice to reduce the rate of needlestick injuries to healthcare workers (HCWs). There have, however, been limited reports of user acceptability of these devices. The usability and acceptability of the Clearlink needleless connector (Baxter Healthcare, UK) was therefore completed by HCWs at University Hospital Birmingham NHS Foundation Trust following a 12-month clinical evaluation. Seventy percent (28/40) of HCWs reported that they would prefer to use Clearlink needleless connectors rather than conventional luers caps, 15% (6/40) would use either, and only 15% (6/40) preferred to use luer caps. In total, 85% of HCWs reported that Clearlink was acceptable to use in the clinical situation. The results demonstrate that comprehensive training and technical support both before and after new device implementation were essential to ensure a smooth transition.

Role of Safety-Engineered Devices in Preventing Needlestick Injuries in 32 French Hospitals

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. 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. A total of 102 medical units from 32 hospitals in France. A total of 1,506 nurses in medical or intensive care units. 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). 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.

Long working hours increase the risk of sharp and needlestick injury in nurses: the need for new policy implication

This paper reports a study to determine the sharp and needlestick injury incidence in nurses working at a university hospital and the contributing factors. Although it is generally felt that working in the healthcare sector is clean and without risk, healthcare staff and especially physicians and nurses who generally work very long hours are actually exposed to various occupational risks. Sharps and needlestick injuries are important problems for healthcare workers as they increase the risk of spread of infection. A self-administered questionnaire was completed in October 2005 by 449 of the 516 nurses working at a Turkish hospital (response rate 87.0%). The percentage of nurses experiencing a sharp or needlestick injury during their professional life was 79.7%. The incidence of exposure to sharp or needlestick injury in the last year was 68.4%. The factors increasing the rate of sharp and needlestick injury were: age 24 years and less, <or=4 years of nursing experience, working in surgical or intensive care units and working for more than 8 hours per day (P < 0.05). The findings indicate which groups of staff should be targeted for educational programmes. Consideration also needs to be given to the unwanted effects of working long shifts, where tiredness may contribute to the number of needlestick injuries.

The health beliefs of hospital staff and the reporting of needlestick injury

The aim of this study is to examine the connection between the health beliefs of hospital staff (doctors, nurses and auxiliary staff) and their failure to report needlestick injuries. Needlestick injury to hospital staff is quite frequent and can result in infections and disease, but staff frequently do not report the injury despite their awareness of the risk of blood-borne pathogens. Five questionnaires were constructed based on three existing research tools and were tested for validity and reliability. Two hundred and forty questionnaires were distributed to eight randomly chosen departments of a single Israeli hospital. Seventy-six percent of the questionnaires were anonymously completed and returned. Nurses had the highest rate of needlestick injury, followed by auxiliary staff and doctors. Auxiliary staff showed the highest rate of compliance with the duty to report such injuries, while doctors showed the lowest. Perceived severity of contractable disease, the perceived efficacy of reporting injuries and overall motivation to maintain health were the best predictors of reporting compliance. Non-compliers emphasized the negative aspects of reporting the injuries, primarily that it took up too much time. The solution to non-compliance with the duty to report must be a targeted investment in training and education. Relevance to clinical practice. Finding the reasons for compliance and non-compliance with the duty to report needlestick injuries will help in designing educational programmes for hospital staff and in determining a strategy for improving health behaviour.

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.

Short-term economic impact associated with occupational needlestick injuries among acute care nurses

ABSTRACTPurpose: Recent survey data have reported the incidence rate of needlestick injuries (NIs) and NIs which draw blood sustained by nurses caring for patients with diabetes in an in-patient hospital setting. The purpose of this study was to deduce the potential short-term annual economic impact resulting from such NI, and to project the potential national economic burden of NI among this population of health care workers (HCWs).Methods: Data were obtained from a recently published, IRB-approved, Internet-based survey in which nurses routinely treating patients with diabetes self-reported outcomes of their experience with NI (N = 400). A micro-costing approach was adopted. Direct costs comprised post-exposure testing (PET) for infection, post-exposure health care services utilization, and NI-induced post-exposure prophylactic (PEP) drug utilization. Indirect costs were derived from missed workdays and associated lost productivity. These data were combined with data related to the national epidemiology and total incidence of NIs among HCWs and risk-associated populations to project the national burden.Results: Among 400 nurses, 110 sustained at least one NI in the past year, with 73 punctures drawing blood. The ensuing total short-term costs of these NIs were calculated to range from $25 896 to $36 066. Indirect costs accounted for 44–62% of this total cost. Average short-term costs per NI ranged from $145 to $201, and average short-term costs of NI per injured nurse ranged from $235 to $328. Assuming mean values from published literature on the incidence and distribution of NI among nursing populations, an annual national burden of $65 million was calculated for costs in the immediate period following NI.Conclusions: These data suggest substantial economic burden immediately following NI on a national and individual hospital level occurring among acute-care nurses treating patients with diabetes. Long-term treatment costs would add to the overall economic burden.