Risk Of Needlestick Injury Research Articles

Prevalence Of Needle Stick Injuries And Their Underreporting Among Healthcare Workers In The Department Of Obstetrics And Gynaecology

Introduction: Needle stick and sharp injuries (NSSIs) are hazardous and are frequently reported injuries among health care workers (HCW). These injuries expose them to infectious disease pathogens such as Hepatitis B, Hepatitis C and HIV that can be lethal. The physicians, nurses, medical students and other healthcare workers are highly susceptible to needle stick injuries. Standard precautions are available for all the workers and students’ safety purposes. Every incident is compulsory to be reported but some are under-reported. This represents a missed opportunity for initiating post exposrure prophylaxis, early detection of seroconversion and implementation of prevention strategies.Objectives: Obstetrics and Gynaecology Department is one of the department estimated as high risk of sharp injuries. The objective of the study is to identify the prevalence of needle stick and sharps injuries (NSSIs) and the rate of under-reporting to occupational health services. It also aims to explore the reasons for under-reporting and the knowledge, awareness and perception of risk of needle stick injuries in Obstetrics and Gynaecology Department of two teaching hospitals in Malaysia.Methods: A cross-sectional study of 194 respondents involving all the healthcare workers and students (Specialists, Medical Offiers, House offiers, Nurses, Medical assistants, Medical students and nursing students) from Obstertrics and Gynaecology wards in two teaching hospitals who are willing to participate were included. A structured questionnaire was used as the survey instrument. By using statistical analysis, we compared the data of sociodemographics of health workers, injury information, knowledge on risk of needle stick injury and risk perception on needle stick injury.Results: Out of 194 respondents, a total of 19(9.8%) respondents sustained needle stick injury. The prevalence was highest among medical student, 42.1%(n=8). Among the 19 cases, 36.8% did not report the incident due to perceived low risk of Hepatitis B/Human Immuno defiiency virus infection (42.9%), and that it was not important to report the incident (28.6%).Conclusion: There is a fair understanding of Universal Work Precaution among the HWCs in the Department of Obstetrics and Gynaecology in both the hospitals. However, there still exist a large gap between their knowledge, attitude and practice of the universal work precaution. As noted in the study, the highest prevalence of needle stick injury and its’ under-reporting is among medical students. Therefore, exposure prevention among the students must be an institutionalconcern, although every student must be aware of their responsibility for this prevention. Completion of three doses of Hepatitis B must be reiterated and HWCs must also be aware of their antibody status.

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.

Prevalence and Associated Factors of Needle Stick Injury among Nursing and Midwifery Students an Haramaya and Jigjiga University, Eastern Ethiopia

Background: In developing countries including Ethiopia, the risk of having work-related injury is 10 to 20 times higher than that of developed countries. In their everyday clinical practice, nurse students are at a great risk of occupational hazards, especially risk of exposure to blood borne pathogens potentially resulting to infections. High levels of occupational hazards are believed to affect students’ health and academic performance. Objectives: To assess prevalence of needle stick injury and associated factors among nurse and midwife students during their clinical practice. Methods: Cross-sectional study design was employed to assess needle stick injuries among randomly selected 600 nurse and midwife students in December 2013. Self-administered questionnaire was used to collect the data. Logistic regression with OR and 95% CI were computed. Results: One year self-reported prevalence of one or more needle sticks/sharp injury was 62.8%. The life time risk of needle stick injury was 64.8%. The results of the multivariate analysis indicated that exposure to needle stick/ sharp injury was significantly associated with being male (AOR 1.56, 95% CI1.07-2.275), Urban family Residence (AOR 2, 95% CI 1.18 – 2.422), Learning about infection prevention (AOR 0.44, 95% CI 0.17 – 1.17) and Disassembling used needles before disposal (AOR 1.55, 95% CI 1.09-2.204). Conclusion: The prevalence of needle sticks/sharp injury was very high in the study population. In order to improve the situation, creating awareness about infection prevention before deploying of students to clinical practice is important.

OUTCOMES OF ACCIDENTS AT WORK WITH EXPOSURE

Introduction: In the labour process there are several occupational hazard risks that present themselves invisibly to workers. Occupational exposure to biological material via sharps is high among health workers. Biosafety is an integral part of safety and occupational hygiene. The risk of contamination by biological material is inherent in anything exposed to it, but it varies according to the activities undertaken by workers. Objective: To characterise the outcomes of accidents at work involving the exposure of workers to biological agents, in the ABC Paulista region. Methods: This was a descriptive study using a convenience sample from three municipalities in the Grande ABC region: Santo André, São Bernardo do Campo and São Caetano do Sul. The data was sourced from 47 records of reported accidents with biological material in the Greater ABC region in the year 2012. The data was processed and tabulated in the statistical program SPSS 19. We used notification records and obtained the profiles of the injured workers and characteristics of the accident, according to gender, age, county of residence, profession, occupation, type of exposure, material involved, the situation of the agent causing the accident, use of personal protective equipment (PPE) equipment, and communication about the work accident (CAT). Results: The incidence of accidents with sharps was related to the frequent handling of these objects and the behaviour of professionals who use practices that pose the risk of needlestick injuries, such as the improper disposal of sharps. Conclusion: The main cause of biological accidents was sharps. Females (70.2 %) and nursing staff (63.8 %) were more likely to be involved in accidents.

OUTCOMES OF ACCIDENTS AT WORK WITH EXPOSURE

Introduction: In the labour process there are several occupational hazard risks that present themselves invisibly to workers. Occupational exposure to biological material via sharps is high among health workers. Biosafety is an integral part of safety and occupational hygiene. The risk of contamination by biological material is inherent in anything exposed to it, but it varies according to the activities undertaken by workers. Objective: To characterise the outcomes of accidents at work involving the exposure of workers to biological agents, in the ABC Paulista region. Methods: This was a descriptive study using a convenience sample from three municipalities in the Grande ABC region: Santo Andre, Sao Bernardo do Campo and Sao Caetano do Sul. The data was sourced from 47 records of reported accidents with biological material in the Greater ABC region in the year 2012. The data was processed and tabulated in the statistical program SPSS 19. We used notification records and obtained the profiles of the injured workers and characteristics of the accident, according to gender, age, county of residence, profession, occupation, type of exposure, material involved, the situation of the agent causing the accident, use of personal protective equipment (PPE) equipment, and communication about the work accident (CAT). Results : The incidence of accidents with sharps was related to the frequent handling of these objects and the behaviour of professionals who use practices that pose the risk of needlestick injuries, such as the improper disposal of sharps. Conclusion: The main cause of biological accidents was sharps. Females (70.2 %) and nursing staff (63.8 %) were more likely to be involved in accidents.

Intranasal naloxone administration for treatment of opioid overdose.

The pharmacology, pharmaco-kinetic properties, and clinical efficacy of naloxone injection administered intranasally for the reversal of opioid overdose are reviewed. Naloxone is an opioid-receptor antagonist that is used in the treatment of opioid overdose to reverse the respiratory and central nervous system-depressant effects of the opioid. Naloxone injection is traditionally given by intravenous, intramuscular, and subcutaneous routes. Paramedics also administer naloxone injection intranasally in the prehospital setting to treat suspected opioid overdose. The nasal mucosa has a rich blood supply that allows for efficient drug absorption and the avoidance of first-pass hepatic metabolism that would be seen with oral administration. Obtaining vascular access can be difficult in known drug users, prolonging the time required to administer the antidote. Patients awakening from an overdose may be agitated, confused, and even combative, thus increasing the risk of needle-stick injury to first responders. The intranasal route avoids the need for establishing vascular access and can be associated with speedier patient recovery. In two randomized controlled trials, intranasal naloxone alone was shown to be sufficient for reversing opioid-induced respiratory depression in 74% and 72% of the respective study populations of patients experiencing opioid overdose. In addition, the safety profile of intranasal naloxone appears to be no different than that of naloxone injection in the treatment of opioid overdose in the prehospital setting. Intranasal administration of naloxone appears to be effective in treatment of opioid overdose when i.v. administration is impossible or undesirable.

Tissue adhesives for closure of surgical incisions.

Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later. Initially, tissue adhesives were used primarily in emergency room settings, but this review looks at the use of tissue adhesives in the operating room/theatre where surgeons are using them increasingly for the closure of surgical skin incisions. To determine the effects of various tissue adhesives compared with conventional skin closure techniques for the closure of surgical wounds. In March 2014 for this second update we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We did not restrict the search and study selection with respect to language, date of publication or study setting. Only randomised controlled trials were eligible for inclusion. We conducted screening of eligible studies, data extraction and risk of bias assessment independently and in duplicate. We expressed results as random-effects models using mean difference for continuous outcomes and risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes. We investigated heterogeneity, including both clinical and methodological factors. This second update of the review identified 19 additional eligible trials resulting in a total of 33 studies (2793 participants) that met the inclusion criteria. There was low quality evidence that sutures were significantly better than tissue adhesives for reducing the risk of wound breakdown (dehiscence; RR 3.35; 95% CI 1.53 to 7.33; 10 trials, 736 participants that contributed data to the meta-analysis). The number needed to treat for an additional harmful outcome was calculated as 43. For all other outcomes - infection, patient and operator satisfaction and cost - there was no evidence of a difference for either sutures or tissue adhesives. No evidence of differences was found between tissue adhesives and tapes for minimising dehiscence, infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However there was evidence in favour of using tape for surgeons' assessment of cosmetic appearance (mean difference (VAS 0 to 100) 9.56 (95% CI 4.74 to 14.37; 2 trials, 139 participants). One trial compared tissue adhesives with a variety of methods of wound closure and found both patients and clinicians were significantly more satisfied with the alternative closure methods than the adhesives. There appeared to be little difference in outcome for different types of tissue adhesives. One study that compared high viscosity with low viscosity adhesives found that high viscosity adhesives were less time-consuming to use than low viscosity tissue adhesives, but the time difference was small. Sutures are significantly better than tissue adhesives for minimising dehiscence. In some cases tissue adhesives may be quicker to apply than sutures. Although surgeons may consider the use of tissue adhesives as an alternative to other methods of surgical site closure in the operating theatre, they need to be aware that sutures minimise dehiscence. There is a need for more well designed randomised controlled trials comparing tissue adhesives with alternative methods of closure. These trials should include people whose health may interfere with wound healing and surgical sites of high tension.

Anesthesia Personnel's Knowledge of, Attitudes Toward, and Practice to Prevent Needlestick Injuries

Anesthesia personnel are at risk for needlestick injuries (NSIs). This study evaluated the knowledge of, attitudes toward, and practice of preventing NSIs among anesthesia personnel in four Iranian university hospitals. A self-administered anonymous questionnaire was distributed to 104 anesthesia personnel. In addition, hospital infection control center records were reviewed. The prevalence of NSI among anesthesia personnel was 56.8%. Only 32.2% reported their NSI. Men were more knowledgeable about the risks associated with NSI and the application of standard precautions than women, but were also more likely to experience NSI. Standard precautions were often not followed. In contrast with other hospital staff, most reported NSIs among anesthesia personnel produced high-risk exposures. The knowledge and prevention practices of anesthesia personnel related to needles and other sharps were not satisfactory. These health care providers need appropriate training on standard precautions and administrative oversight to improve their practices. Anesthesia personnel's gender and position should also be considered to improve compliance.

Needle-free jet injection for administration of influenza vaccine: a randomised non-inferiority trial

Administration of vaccines by needle-free technology such as jet injection might offer an alternative to needles and syringes that avoids the issue of needle phobia and the risk of needle-stick injury. We aimed to assess the immunogenicity and safety of trivalent influenza vaccine given by needle-free jet injector compared with needle and syringe. For this randomised, comparator-controlled trial, we randomly assigned (1:1) healthy adults (aged 18-64 years) who attended one of four employee health clinics in the University of Colorado health system, with stratification by site, to receive one dose of the trivalent inactivated influenza vaccine Afluria given either intramuscularly with a needle-free jet injector (Stratis; PharmaJet, Golden, CO, USA) or with needle and syringe. Randomisation was done with a computer-generated randomisation schedule with a block size of 100. Because of the nature of the study, masking of participants was not possible. Immunogenicity was assessed by measurement of the hemagglutination inhibition antibody titres in serum for the three viral strains included in the vaccine. We included six coprimary endpoints: three strain-specific geometric mean titre ratios and the absolute differences in three strain-specific seroconversion rates. The immune response of the jet injector group was regarded as non-inferior to that of the needle and syringe group if both the upper bound of each of the three 95% CIs for the strain-specific geometric mean titre ratios was 1.5 or less, and the upper bound of the three 95% CIs for the strain-specific seroconversion rate differences was less than 10 percentage points. We used t test for group comparison. This study is registered with ClinicalTrials.gov, number NCT01688921. During the 2012-13 influenza season of the northern hemisphere, we allocated 1250 participants to receive vaccination by needle-free jet injector (n=627) or needle and syringe (n=623). In the intention-to-treat immunogenicity population, all participants with two serum samples were included (575 in the jet injector group and 574 in the needle and syringe group). The immune response to Afluria when given by needle-free jet injector met the criteria for non-inferiority for all six coprimary endpoints. The jet injector group met the geometric mean titre criterion for non-inferiority for the A/H1N1, A/H3N2, and B strains (upper bound of the 95% CI for the geometric mean titre ratios were 1·10 for A/H1N1, 1·17 for A/H3N2, and 1·04 for B strains). The jet injector group met the seroconversion rate criterion for non-inferiority for the A/H1N1, A/H3N2, and B strains (upper bound of the 95% CI of the seroconversion rate differences were 6·0% for A/H1N1, 7·0% for A/H3N2, and 5·7% for B strains). We recorded serious adverse events in three participants, none of which were study related. The immune response to influenza vaccine given with the jet injector device was non-inferior to the immune response to influenza vaccine given with needle and syringe. The device had a clinically acceptable safety profile, but was associated with a higher frequency of local injection site reactions than was the use of needle and syringe. The Stratis needle-free jet injector device could be used as an alternative method of administration of Afluria trivalent influenza vaccine. Biomedical Advanced Research and Development Authority (BARDA), PATH, bioCSL, and PharmaJet.

Sharps Usage Patterns and Hazards Among Firefighters and Emergency Services Personnel at a Suburban Fire Department

Needlestick injuries (NSIs) are a recognized risk for healthcare workers (HCWs). NSIs have been extensively studied in traditional HCWs, but not in emergency responders. Practices that increase the risk of NSI for emergency responders have not been examed. The objectives of the study were to: 1) identify and define the types of unsafe sharps techniques present in this fire department; 2) determine the frequency of unsafe sharps techniques.

A novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer.

The aim of this randomized controlled study was to investigate the effects of a novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer.Patients diagnosed with cervical cancer were randomly divided into a control group (n = 32) and a treatment group (n = 33). Patients in the control group underwent a traditional fixation method using a haemostat, elastic band and abdominal bandage. Patients in the treatment group underwent an improved fixation method using an indwelling needle and membrane cover. We used a visual analogue scale (VAS) to evaluate each patient's comfort score and also recorded the incidence of needlestick injury and the length of injection time in each group. The VAS scores measured before and after chemotherapy in the treatment group were lower than in the control group. The incidence of needlestick injury in the treatment group was significantly lower than in the control group. The length of injection time in treatment group was significantly lower than in the control group. Compared with the traditional fixation method, the improved fixation method not only increased patient comfort but also reduced both the risk of needlestick injury and the length of injection time. This improved technique deserves increased clinical use.

ASSESSMENT OF THE RISK OF NEEDLESTICK INJURIES ASSOCIATED WITH INTRAVITREAL INJECTIONS

To assess the overall risk of needlestick injuries (NSIs) associated with intravitreal injection, and more specifically related to the practice of compounding pharmacies of applying informational adhesive stickers to repackaged bevacizumab injection syringes. This cross-sectional study involved an online survey of retina specialists in the United States. Of the 717 invited retina specialists, 158 (22%) responded to the online survey. The respondents reported using 1 pair of gloves (51%), no gloves (46%), or 2 pairs of gloves (3%) during intravitreal injection. Repackaged bevacizumab syringes distributed by compounding pharmacy were used by 89% of the respondents, and 63% reported that the adhesive sticker was applied directly to the syringe. Unintentional adhesion between the sticker and hand or glove was experienced by 9% of respondents. At least 1 NSI during intravitreal injection was experienced by 8% of respondents, and sticker-related injury was reported by 3%. The sticker was perceived to increase risk for NSI by 33% of respondents. This survey showed that 8% of the responding physicians surveyed have experienced at least one NSI during intravitreal injections, of which approximately one third was attributed to the adhesive sticker. Direct application of misfitting stickers to repackaged syringes by compounding pharmacies may be a practice that can aggravate the risk of NSI.

A previously unidentified risk of needlestick injury in the emergency medical services setting

A previously unidentified risk of needlestick injury in the emergency medical services setting

Comparison of skin closure methods in Abdominal Surgeries: Adhesive 2 – Octylcyanoacrylate/Staples/Suture Materials

The most important and necessary step in any surgical procedure is Closure of skin. Sutures and staples are the traditional methods of wound closure, while tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but they may show tissue reactivity and can require removal. Closure of wounds with staples offers the advantage of faster closure, less tissue reactivity but post-operative site pain and cost are major factors of its low acceptance. Tissue adhesives offer the advantages of no risk of needle stick injury and no requirement to remove sutures later. Tissue adhesives have better cosmetic outcome, some brands offer adhesives even with anti-bacterial (especially against Gram +ve bacilli) and anti-fungal properties so post-operative infection rate is the least with

Risk of Needle-Stick Injuries Associated With the Use of Subdermal Needle Electrodes During Intraoperative Neurophysiologic Monitoring

Subdermal needle electrodes are commonly used during intraoperative neurophysiologic monitoring (IONM). However, there is an associated risk of needle-stick exposure to the IONM technologist as well as other operating room personnel. We performed a retrospective study to investigate the incidence and circumstances of needle sticks related to the use of subdermal needle electrodes. IONM was performed on 50,665 consecutive surgeries with an estimated use of approximately 2,000,000 needle electrodes. Incident reports of needle exposures were analyzed for personnel, location, and circumstances. Associated Worker's Compensation expenses for the technologists were analyzed. There were 174 reported needle-stick exposures (0.34% incidence) occurring during 173 surgeries, which included 75 IONM technologists (43.1%), 38 anesthesia personnel (21.8%), 34 nurses (19.5%), 16 surgeons (9.2%), and 11 other staff (6.3%). No infectious disease transmission was reported. Fifty-seven technologists incurred expenses totaling $24,174 (average $424 per exposure). The cost for non-IONM personnel was not available. Most needle sticks for technologists occurred during the removal of needles (52.0%) and during patient positioning (67.7%) for non-IONM personnel. Needle-stick exposure from subdermal needle electrodes during IONM is an infrequent but distressing event occurring in 0.34% of our study group and was not limited to the IONM technologist. Although no infections occurred as a result of needle-stick exposure in this study, steps to minimize needle sticks should be taken during IONM.

Sharps legislation and assessment of needle protection systems

Needlestick injuries (NSIs) carry the potential for transmission of serious blood-borne infections and pose a significant risk to patients and healthcare staff. These infections come with an estimated cost of £300 million per year in the UK (Saia et al, 2010). An EU directive mandated in May of 2013 has sought to minimise the risk of NSI though the introduction of needle-protection systems. The authors of this article set out to assess nursing knowledge of this legislation and ascertain which needle-protection systems for low-molecular weight heparin/anti Xa (for subcutaneous administration) were preferred in a large teaching trust. Approximately half of the nurses questioned had some knowledge of the legislation and almost all agreed that there is a need for needle protection systems. All four devices tested meet requirements for the legislation but the preferred devices were the needle protection system for enoxaparin and fondaparinux with a self-sheathing style device after activation.

Innovative Solution to Sharp Waste Management in a Tertiary Care Hospital in Karachi, Pakistan

Prevalence of hepatitis B and C in Pakistan is 2.5% and 4.5%, respectively. Major cause of these infections is reuse of syringes. To determine a cost-effective, innovative solution to prevent syringe reuse and break the transmission cycle of blood-borne infections. STUDY DESIGN, SETTINGS, AND DURATION: Analytical study in a tertiary care hospital, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, July 2011 to June 2012. Healthcare workers from 30 wards included in the study were trained on injection safety, use of needle remover and needle pit, and management of needlestick injuries. Each ward was provided with 2 needle-removing devices, and a pit was constructed for disposal of needles. Usage of the device in wards and pit use were monitored regularly. In 28 (93.3%) wards, sharp containers were accessible by public and were slack. Syringes were recapped using both hands in 27 (90%) cases; needlestick injury was reported by 30% of paramedics, while 25 (83.3%) of the interviewed staff had not received any formal training in injection safety. Vigilant monitoring and information sharing led to healthcare workers in 28 (96.5%) wards using the device. Needle containers were emptied in 27 (93.1%) wards, and needle pits were used in 26 (96.3%) wards. Needlestick injury was nil in follow-up. Needle removers permanently disable syringes. The needle pit served as a cost-effective, innovative method for disposal of needles. The intervention resulted in reducing the risk of needlestick injury.

Needlestick Injuries among Nurses in a Tertiary Care Hospital: A Work Hazard or Lack of Awareness?

Objectives: The present study addresses this important issue of NSI and aims at determining their occurrence among the nursing staff in Dr Rajendra Prasad Government Medical College (RPGMC) and hospital, Kangra at Tanda (H.P). Methods: A cross sectional study undertaken amongst the nursing staff of Dr RPGMC and hospital, Kangra at Tanda. Results: Out of the 164 respondents, 35(21.3%) reported to having one or more NSIs in their career and the maximum of these were amongst the nurses whose work experience was less than five years (13.4%). Conclusions: The results of this study confirm the importance of the need for an increased awareness of the risk of needlestick injury, the need to provide for the training and education of health-care workers DOI: http://dx.doi.org/10.3126/ajms.v5i1.4971 Asian Journal of Medical Science Vol.5(1) 2014 pp.58-62

Minimizing Nurses' Risks for Needlestick Injuries in the Hospital Setting

Despite advances in safety mechanisms for sharps, nurses continue to be at high risk for needlestick injuries, with more than half of all nurses experiencing at least one needlestick injury during their careers. Needlestick injury risk appears to be the result of three incident factors: nurses' sense of urgency, variable shift work, and lower skill level related to years of experience, academic degree, and younger age. This article synthesizes the evidence related to these risk factors among nurses in the hospital setting. Evidence linking needlestick injury risk with both variable shift work and lower skill level is demonstrated. The evidence supporting a relationship between needlestick injury risk and nurses' sense of urgency is conflicting. It is the authors' goal to reduce needlestick injury risk for nurses; therefore, specific changes to hospital nursing practice are recommended based on the evidence identified.

Reduce needlestick injury risk

Reduce needlestick injury risk