Safety-engineered Devices Research Articles

Impact of Safety-Engineered Devices on the Incidence of Occupational Blood and Body Fluid Exposures Among Healthcare Personnel in an Academic Facility, 2000-2014.

Legislative actions and advanced technologies, particularly dissemination of safety-engineered devices, have aided in protecting healthcare personnel from occupational blood and body fluid exposures (BBFE). To investigate the trends in BBFE among healthcare personnel over 15 years and the impact of safety-engineered devices on the incidence of percutaneous injuries as well as features of injuries associated with these devices. Retrospective cohort study at University of North Carolina Hospitals, a tertiary care academic facility. Data on BBFE in healthcare personnel were extracted from Occupational Health Service records (2000-2014). Exposures associated with safety-engineered and conventional devices were compared. Generalized linear models were applied to measure the annual incidence rate difference by exposure type over time. A total of 4,300 BBFE, including 3,318 percutaneous injuries (77%), were reported. The incidence rate for overall BBFE was significantly reduced during 2000-2014 (incidence rate difference, 1.72; P=.0003). The incidence rate for percutaneous injuries was also dramatically reduced during 2001-2006 (incidence rate difference, 1.37; P=.0079) but was less changed during 2006-2014. Percutaneous injuries associated with safety-engineered devices accounted for 27% of all BBFE. BBFE was most commonly due to injecting through skin, placing intravenous catheters, and blood drawing. Our study revealed significant overall reduction in BBFE and percutaneous injuries likely due in part to the impact of safety-engineered devices but also identified that a considerable proportion of percutaneous injuries is now associated with these devices. Additional prevention strategies are needed to further reduce percutaneous injuries and improve design of safety-engineered devices.

Occupational exposure to hepatitis infection among Egyptian healthcare workers and hepatitis B vaccination

Background/aim Healthcare workers (HCWs) are at a high risk for blood-borne pathogens due to their contact with patients and contaminated instruments. The present study aimed to determine the risk of exposure to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among Egyptian HCWs in relation to the level of infection control education, the number of hepatitis B vaccine doses received, and the resulting immunity. Participants and methods This cross-sectional study was conducted on 228 HCWs. Hepatitis B surface antigen, hepatitis B core antibody, hepatitis B surface antibody titer, and hepatitis C virus antibody (HCV-Ab) were tested by using the enzyme-linked immunosorbent assay technique. Real-time PCR for both HBV-DNA and HCV-RNA in serum was done with positive hepatitis B surface antigen and HCV-Ab, respectively. Results During the study period, 78% of the HCWs received full HBV vaccination; 73.6% of them were vaccinated in the last 5 years. Lack of protective hepatitis B surface antibody (HBs-Ab) titer was found in 27.2% of the participants. HCV-Ab was positive in 6.14% HCWs, being significantly higher in individuals 40 years of age or older when compared with those under 40. Half of those with positive HCV-Ab had HCV-RNA below the detection limit. Conclusion Implementation of infection control guidelines played a role in reducing the prevalence of HCV infection among HCWs and in vaccinating HCWs in the last 5 years. Adopting safety-engineered devices is required to help in the reduction of needle stick and sharp medical devices injuries and risk for blood-borne infections.

Impact of safety-engineered devices on the incidence of occupational blood and body fluid exposures among healthcare personnel in an Academic Facility, 2000-2014

Impact of safety-engineered devices on the incidence of occupational blood and body fluid exposures among healthcare personnel in an Academic Facility, 2000-2014

Reducing needlestick injuries through safety-engineered devices: results of a Japanese multi-centre study

Quantitative information on the effectiveness of safety-engineered devices (SEDs) is needed to support decisions regarding their implementation. To elucidate the effects of SED use in winged steel needles, intravenous (IV) catheter stylets and suture needles on needlestick injury (NSI) incidence rates in Japan. Japan EPINet survey data and device utilization data for conventional devices and SEDs were collected from 26 participating hospitals between 1 April 2009 and 31 March 2014. The NSI incidence rate for every 100,000 devices was calculated according to hospital, year and SED use for winged steel needles, IV catheter stylets and suture needles. Weighted means and 95% confidence intervals (CI) were used to calculate overall NSI incidence rates. In total, there were 236 NSIs for winged steel needles, 152 NSIs for IV catheter stylets and 180 NSIs for suture needles. The weighted NSI incidence rates per 100,000 devices for SEDs and non-SEDs were as follows: winged steel needles, 2.10 (95% CI 1.66-2.54) and 14.95 (95% CI 2.46-27.43), respectively; IV catheter stylets, 0.95 (95% CI 0.60-1.29) and 6.39 (95% CI 3.56-9.23), respectively; and suture needles, 1.47 (95% CI-1.14-4.09) and 16.50 (95% CI 4.15-28.86), respectively. All devices showed a significant reduction in the NSI incidence rate with SED use (P<0.001 for winged steel needles, P=0.035 for IV catheter stylets and P=0.044 for suture needles). SED use substantially reduces the incidence of NSIs, and is therefore recommended as a means to prevent occupational infections in healthcare workers and improve healthcare safety.

Sharps injury reduction: Safety, training and manufacturer support

Despite the legislation EU Directive 2010/32/EU on prevention of sharps injuries being in force for two years now, research shows that not all NHS trusts have revised and published their sharps policy—only 84% have. Furthermore, 33% of trusts have not instructed staff to use safety devices, and out of the staff who require sharps safety training, only just over half have received it. This article emphasises the importance placed on training by the directive, and explains how partnering with a manufacture who offers ongoing support can help with an effective conversion to safety-engineered devices (SEDs). It is important for trusts to select a manufacturer who not only offers high-quality SEDs but also provides a full support package, offering appropriate bespoke training, as well as ongoing advice, robust safety policies/procedures and help with risk assessments. These points are supported by comments from various trusts who have already converted to SEDs from their experiences.

Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in French Hospitals, 2003-2012: Results of the French National Network Survey, AES-RAISIN.

To assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities. Retrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008-12). Reported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012. Of the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.

Adopting a Global Safety Standard for the Prevention of Ebola Needle-Stick Exposures

Adopting a Global Safety Standard for the Prevention of Ebola Needle-Stick Exposures

Prevention of needle-stick injuries in healthcare facilities: a meta-analysis.

OBJECTIVE To estimate the summary effectiveness of different needle-stick injury (NSI)-prevention interventions. DESIGN We conducted a meta-analysis of English-language articles evaluating methods for reducing needle stick, sharp, or percutaneous injuries published from 2002 to 2012 identified using PubMed and Medline EBSCO databases. Data were extracted using a standardized instrument. Random effects models were used to estimate the summary effectiveness of 3 interventions: training alone, safety-engineered devices (SEDs) alone, and the combination of training and SEDs. SETTING Healthcare facilities, mainly hospitals PARTICIPANTS Healthcare workers including physicians, midwives, and nurses RESULTS From an initial pool of 250 potentially relevant studies, 17 studies met our inclusion criteria. Six eligible studies evaluated the effectiveness of training interventions, and the summary effect of the training intervention was 0.66 (95% CI, 0.50-0.89). The summary effect across the 5 studies that assessed the efficacy of SEDs was 0.51 (95% CI, 0.40-0.64). A total of 8 studies evaluated the effectiveness of training plus SEDs, with a summary effect of 0.38 (95% CI, 0.28-0.50). CONCLUSION Training combined with SEDs can substantially reduce the risk of NSIs.

Sharp truth: health care workers remain at risk of bloodborne infection.

In 2013, new regulations for the prevention of sharps injuries were introduced in the UK. All health care employers are required to provide the safest possible working environment by preventing or controlling the risk of sharps injuries. To analyse data on significant occupational sharps injuries among health care workers in England, Wales and Northern Ireland before the introduction of the 2013 regulations and to assess bloodborne virus seroconversions among health care workers sustaining a blood or body fluid exposure. Analysis of 10 years of information on percutaneous and mucocutaneous exposures to blood or other body fluids from source patients infected with a bloodborne virus, collected in England, Wales and Northern Ireland through routine surveillance of health care workers reported for the period 2002-11. A total of 2947 sharps injuries involving a source patient infected with a bloodborne virus were reported by health care workers. Significant sharps injuries were 67% higher in 2011 compared with 2002. Sharps injuries involving an HIV-, hepatitis B virus- or hepatitis C virus (HCV)-infected source patient increased by 107, 69 and 60%, respectively, between 2002 and 2011. During the study period, 14 health care workers acquired HCV following a sharps injury. Our data show that during a 10-year period prior to the introduction of new regulations in 2013, health care workers were at risk of occupationally acquired bloodborne virus infection. To prevent sharps injuries, health care service employers should adopt safety-engineered devices, institute safe systems of work and promote adherence to standard infection control procedures.

Implementation of an enhanced safety-engineered sharp device oversight and bloodborne pathogen protection program at a large academic medical center.

Exposure of healthcare personnel to bloodborne pathogens (BBPs) can be prevented in part by using safety-engineered sharp devices (SESDs) and other safe practices, such as double gloving. In some instances, however, safer devices and practices cannot be utilized because of procedural factors or the lack of a manufactured safety device for the specific clinical use. In these situations, a standardized system to examine requests for waiver from expected practices is necessary. Before-after program analysis. Large academic medical center. Vanderbilt University Medical Center developed a formalized system for an improved waiver process, including an online submission and tracking site, and standards surrounding implementation of core safe practices. The program's impact on sharp device injuries and utilization of double gloving and blunt sutures was examined. Following implementation of the enhanced program, there was an increase in the amount of undergloves and blunt sutures purchased for surgical procedures, suggesting larger utilization of these practices. The rate of sharp device injuries of all at-risk employees decreased from 2.32% to 2.12%, but this decline was not statistically significant (P = .14). The proportion of reported injuries that were deemed preventable significantly decreased from 72.7% (386/531) before implementation to 63.9% (334/523; P = .002) after implementation of the enhanced program. An enhanced BBP protection program was successful at providing guidance to increase safe practices and at improving the management of SESD waiver requests and was associated with a reduction in preventable sharp device injuries.

Effectiveness of safety-engineered devices in reducing sharp object injuries.

Sharps injuries remain a common factor in occupational exposure of healthcare workers to blood-borne viruses. The extent to which the introduction of safety-engineered devices has been effective in reducing such injuries among healthcare workers is unclear. To investigate the incidence of sharp object injury among healthcare workers in the Capital Health Region of Alberta, Canada and to determine the effectiveness of the introduction of safety- engineered devices in preventing these. All reports of sharp object injuries to Capital Region Workplace Health and Safety offices from healthcare workers 2003-10 were analysed. Rates of sharp object injury were compared before (2006), during (2007-08) and after (2009-10) the introduction of safety-engineered devices, adjusting for other potential risk factors using Poisson regression and log-linear models. Between 2003 and 2010, a total of 4707 sharp object injuries were reported from 15 healthcare facilities. The sharp object injury rate per 1000 full-time equivalent employees per year declined from 35 before the introduction period to 30 during the introduction period (rate ratio [RR]: 0.88, 95% confidence interval [CI]: 0.78, 0.99) among most healthcare workers, but then rebounded again slightly after the intervention. Physician risks showed little change during the period of introduction (odds ratio [OR]: 0.99, 95% CI: 0.85, 1.14) but decreased significantly after the intervention (OR: 0.83, 95% CI: 0.71, 0.97). The introduction of safety-engineered devices was associated with a modest reduction in reported sharp object injuries but this appeared to be relatively short-lived for most workers.

Frequency of use and activation of safety-engineered sharps devices: a sharps container audit in five Australian capital cities

Sharps injuries (SI) among healthcare personnel (HCP) in Australia are of such concern the matter was brought before Parliament in 2013. Many SI from safety-engineered devices (SED) are due to nonactivation. Monitoring of activation is recommended. This paper outlines a sharps container (SC) contents audit conducted in Australian capital cities. Reusable, 22 L SC (Sharpsmart, Daniels Corporation, Melbourne) were randomly selected from random healthcare facilities (HCF) in five cities. Wearing protective apparel, the operator opened and decanted SC and sorted hollow-bore needles (HBN) into: capped v. uncapped non-SED, and activated or non-fully activated SED. Volumes and weights were recorded for inter-study comparisons. WinPepi v2.78 was used to calculate probability (significance set at ≤ 0.05), relative-risk and 95% confidence limits. 1212 L of sharps (167.9 kg) from 102 SC from 27 hospitals were audited. Many devices were bloodcontaminated. Of the 9651 HBN, 30.4% were SED and 19.4% of the SED were not, or partially, activated. Of the 6718 non-SED, 30.6% were capped needles or capped needle-syringes. City averages for capped or naked sharps ranged from 64.2% (Sydney) to 97.8% (Adelaide) while hospital averages ranged from 32.6 to 100%. Overall, 54.2% of devices were discarded ‘sharp’. It is disturbing that 75.5% of hollow-bore needles were capped or naked, indicating a high proportion of Australian HCP are unnecessarily at risk of SI while handling sharps. The high non-use of SED and non-activation of SED needs researching.Widespread SED evaluation and adoption (automatic and semi-automatic SED where feasible), repetitive competency training and safety-ownership are needed. Legislation may be indicated.

The Importance of Needlestick and Sharps Safety for Nurses and Staff in the Interventional Radiology Setting

Needlestick injuries continue to be one of the most serious health and safety threats in our health care workplaces. Because of the invasive nature and unique procedural circumstances of interventional radiology (e.g., dark environment, sterile drapes, etc.), nurses and radiologists are at a high risk of accidental needlestick and sharps injuries. As a natural result of these procedural circumstances, the focus of the staff is on the patient and his or her well-being, and it is likely not on the safety of the staff during or after the procedure, when the risk of injury is greatest. Despite the fact that the majority of US acute care facilities have now largely converted to the use of safety-engineered medical devices, after the first decade of the Needlestick Safety and Prevention Act of 2000, a large number of nurses and other personnel still remain at serious risk of injury. By combining proactive measures—such as training staff on the correct use of medical safety devices, establishing injury prevention teams, and evaluating all medical safety devices thoroughly—with reactive measures like maintaining an accurate injury log, nurses will be able to come to work with a lessened risk of needlestick and sharps injuries and be able to educate one another on how to make these types of injuries a “never event” in the health care setting.

Nurses’ sharps, including needlestick, injuries in public and private healthcare facilities in New South Wales, Australia

Abstract Background The aim of this paper is to determine factors associated with sharps-related injury rates in nurses by analysing the combined data from two state-wide cross-sectional studies of nurses and comparing rates between public and private sectors and between different nurse practice areas in NSW. Methods The data from two studies conducted in 2006 and 2007 were combined for 44 similar data items and for similar nurse participants (registered nurses, registered midwives and enrolled nurses). Both studies had recruited nurses from membership of the NSW Nurses' Association. Data for 256 and 1100 participants respectively were combined for this comparative analysis. Results The sharps-related annual injury rate was 7.2% (95% CI: 5.9, 8.7). It was significantly higher in operating theatres, renal, mental health and paediatric practice areas in private compared with public facilities (17.9% versus 5.2%). Positive aspects of sharps safety practices included: 90% of nurses reported their injuries, were aware of processes required for dealing with sharps injuries and found their managers to be approachable. Areas for improvement included the provision of information about persons responsible for follow-up (21% unsure), increased provision of safety-engineered medical devices (SEMDs) (50% not available), decreased provision of non-SEMDs (75% available) and a focus on the highly-resistant practice of recapping needles (35% report recapping non-SEMDs). Conclusions There are significant differences in sharps-related injuries between public and private facilities. Opportunities exist to improve safety practices across various nursing practice environments.

The importance of implementing safe sharps practices in the laboratory setting in Europe

Healthcare workers are at risk of sharps injuries and subsequent infection from more than 40 bloodborne pathogens or species. Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) together account for the vast majority of cases. The Directive 2010/32/EU “Prevention from sharp injuries in the hospital and healthcare sector”, issued to protect workers from these risks, requires an integrated approach to prevention including awareness-raising, education, training, elimination of unnecessary needles, safe procedures for sharps use and disposal, banning of recapping, vaccination, use of personal protective equipment, provision of safety-engineered devices, and appropriate surveillance, monitoring, response and follow-up.As laboratories represent a high-risk setting both in the preanalytical and analytical phase, we reviewed accidents and prevention in this setting in the light of the new legislation.Phlebotomy is the procedure carrying the highest risk of exposure and infection, involved in 30–50% of HIV and HCV cases detected in nationwide systems following accidental blood exposures implemented since the 1990s in Italy and France. In laboratories, problems in the management of sharps containers, recapping, needle disassembly by hand and blood transfer from syringes into tubes were observed and accounted for two-thirds of injuries. These accidents could be reduced through education and monitoring of behaviours, and introduction of medical devices incorporating safety-engineered protection mechanisms with appropriate training. Laboratory staff should be immunized against HBV, and know policies and procedures for the post-exposure management and prophylaxis. The management commitment to safety is crucial to ensure the necessary support to these changes.

Impact of a single safety-engineered device on the occurrence of percutaneous injuries in a general hospital in Brazil

Health care workers are exposed to bloodborne pathogens through occupational injuries, and the replacement of sharps by safety-engineered devices has been recommended as a key preventive measure. This recommendation has been difficult to implement in Brazil. We conducted a retrospective study of selected data from a database of blood and body fluid exposures reported from January 2007 through December 2011 in a public general hospital in Rio de Janeiro where, from the end of 2009, a safety lancet for blood glucose testing (BGT) was introduced. A log-binomial model was used to evaluate the effect of the introduction of the safety lancet on the proportion of percutaneous injuries (PIs) during BGT in the nursing staff. Nursing staff had a significant reduction in rate of PIs per 100 full-time equivalents from 2007 to 2011 (P < .001), and medical residents had the highest rate throughout the same period. A reduction of PIs by small-gauge needles was observed since 2009, and injuries during BGT fell abruptly in 2010 and 2011 paralleling the number of purchased safety lancets (P < .001). The adoption of a single safety device, which required no training, significantly reduced PIs among the nursing team.

Economic benefits of safety-engineered sharp devices in Belgium - a budget impact model

BackgroundMeasures to protect healthcare workers where there is risk of injury or infection from medical sharps became mandatory in the European Union (EU) from May 2013. Our research objective was to estimate the net budget impact of introducing safety-engineered devices (SEDs) for prevention of needlestick injuries (NSIs) in a Belgian hospital.MethodsA 5-year incidence-based budget impact model was developed from the hospital inpatient perspective, comparing costs and outcomes with SEDs and prior-used conventional (non-safety) devices. The model accounts for device acquisition costs and costs of NSI management in 4 areas of application where SEDs are currently used: blood collection, infusion, injection and diabetes insulin administration. Model input data were sourced from the Institut National d’Assurance Maladie-Invalidité, published studies, clinical guidelines and market research. Costs are discounted at 3%.ResultsFor a 420-bed hospital, 100% substitution of conventional devices by SEDs is estimated to decrease the cumulative 5-year incidence of NSIs from 310 to 75, and those associated with exposure to blood-borne viral diseases from 60 to 15. Cost savings from managing fewer NSIs more than offset increased device acquisition costs, yielding estimated 5-year overall savings of €51,710. The direction of these results is robust to a range of sensitivity and model scenario analyses. The model was most sensitive to variation in the acquisition costs of SEDs, rates of NSI associated with conventional devices, and the acquisition costs of conventional devices.ConclusionsNSIs are a significant potential risk with the use of sharp devices. The incidence of NSIs and the costs associated with their management can be reduced through the adoption of safer work practices, including investment in SEDs. For a Belgian hospital, the budget impact model reports that the incremental acquisition costs of SEDs are offset by the savings from fewer NSIs. The availability of more robust data for NSI reduction rates, and broadening the scope of the model to include ancillary measures for hospital conversion to SED usage, outpatient and paramedic device use, and transmission of other blood-borne diseases, would strengthen the model.

PHP10 - Economic Analysis of the Prevention of Medical Sharps Injuries with Safety-Engineered Devices: A Systematic Review

PHP10 - Economic Analysis of the Prevention of Medical Sharps Injuries with Safety-Engineered Devices: A Systematic Review

Issues in Understanding the Impact of the Needlestick Safety and Prevention Act on Hospital Sharps Injuries

Measuring the effect of the Needlestick Safety and Prevention Act (NSPA) is challenging. No agreement exists on a common denominator for calculating injury rates. Does it make a difference? How are the law and safety-engineered devices related? What is the effect on injuries and costs? This study examines those issues in assessing the impact of the legislation on hospital worker percutaneous injuries. Using a historic prospective design, we analyzed injury data from 85 hospitals. Injury rates were calculated per 100 full-time equivalents, 100 staffed beds, and 100 admissions each year from 1995 to 2005. We compared changes for each denominator. We measured the proportion of the injury rate attributed to safety-engineered devices. Finally, we estimated a national change in injuries and associated costs. For all denominators, a precipitous drop in injury rates of greater than one-third ([Formula: see text]) occurred in 2001, immediately following the legislation. The decrease was sustained through 2005. Concomitant with the decrease in rates, the proportion of injuries from safety-engineered devices nearly tripled ([Formula: see text]) across all denominators. We estimated annual reductions of more than 100,000 sharps injuries at a cost savings of $69-$415 million. While the data cannot demonstrate cause and effect, the evidence suggests a reduction in hospital worker injury rates related to the NSPA, regardless of denominator. It also suggests an association between the increase in safety-engineered devices and the reduction in overall injury rates. The decreases observed translate into significant reductions in injuries and associated costs.

Safety-Engineered Devices in 2012: The Critical Role of Healthcare Workers in Device Selection

Affiliation: 1. International Healthcare Worker Safety Center, Division of Infectious Diseases, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia. Received October 17, 2012; accepted January 22, 2013; electronically published April 18, 2013. 2013 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2013/3406-0011$15.00. DOI: 10.1086/670638 Over the past 2 decades in the United States, a dramatic transformation of policies, procedures, and technologies for protecting healthcare workers from the risk of occupational bloodborne pathogen transmission has occurred. In the United States, we have an abundance of safety device choices and a regulatory framework to support continued improvement in reducing this occupational risk. Whether we achieve this objective depends directly on informed product choices as healthcare employers make their purchasing decisions.