Sharps Injuries In Healthcare Workers Research Articles

An Assessment of Sharps Injuries in Healthcare Workers

An Assessment of Sharps Injuries in Healthcare Workers

Costs of postexposure management of occupational sharps injuries in health care workers in the Republic of Korea

Costs of postexposure treatment of sharps injuries (SIs) in health care workers (HCWs) are an economic burden in many countries. This study analyzed the costs associated with SIs in HCWs in the Republic of Korea. Between October 1, 2005, and February 28, 2006, general information on SIs among HCWs and the direct costs (eg, laboratory, pharmacy, medical and surgical treatments) and indirect costs eg, (loss of working days) were collected prospectively from 34 hospitals nationwide. A total of 700 SIs were documented, 505 of which (72.1%) generated costs. The average costs per SI were pharmacy, 123,091 won (US$129); laboratory tests, 66,958 won ($70); medical services, 26,332 won ($28); and medical treatments, 9,377 won ($10). The average costs of preventive measures were 160,274 won ($168) for hepatitis B virus (HBV), 127,858 won ($134) for hepatitis C virus (HCV), and 139,552 won ($146) for HIV. Of the laboratory tests, 32.9% were HBV-related, 29.4% were HCV-related, and 19.8% were HIV-related. Of postexposure prophylaxes, 34.9% were HB immunoglobulin and 31.4% were HBV vaccines. We estimated that 7,057.5 SIs generated costs, at a total annual cost of 844,587,577 won ($884,385). The direct costs of managing SIs among HCWs constitute an economic burden in Korea. More aggressive and comprehensive preventive measures of SIs should be adopted.

From bedside to bench: A pilot study to measure the force required to activate a retractable safety syringe

BACKGROUND/OBJECTIVES: This laboratory in Tampa, Florida, has established a program to evaluate objective and subjective criteria for safer needle devices designed to prevent or reduce sharps injuries in healthcare workers. The goal of this pilot study was to determine whether the force required to activate one particular retractable intramuscular syringe was due to the activation media or the healthcare worker. METHODS: One hundred devices of a particular brand were subjected to activation while suspended in the air and while the needle was inserted into simulated patient material (SPM). Each researcher tested 25 devices in air first and 25 in SPM first, resetting the device before switching media. After each activation, the compression force needed to activate the retraction mechanism on each individual syringe was measured in pounds (lbs.) using a Com-Ten™ Model # CER02000 Digital Force Gauge (DFG). The data were immediately recorded in an Excel™ spreadsheet. RESULTS: Overall, the mean activation force was significantly greater (p = 0.05) while the needle was activated in SPM (3.56 lbs.) versus air (2.80 lbs.), regardless of the sequence or researcher. In addition, there was a statistically significant difference, regardless of sequence, in the device's mean activation force between researchers 1 and 2 (2.78 lbs. versus 3.57 lbs.; p = 0.05). CONCLUSIONS: In healthcare settings, the force required to activate the device is clinically relevant. If a healthcare worker perceives that force required to activate the device equates with pain felt by the patient, then the HCW may activate the device while in the air, increasing the risk of sharps injury. This would also defeat the purpose of this particular safety mechanism, of particular concern as this category of device generally costs more than other safety intramuscular syringes. We demonstrated a significant difference in mean force using one particular device due to the media in which the device was activated. This has implications for manufacturers in designing future models. Significant variability existed between healthcare workers in the force necessary to activate the retractable mechanism of an intramuscular device. In future studies of this kind, we recommend that one researcher be used in initial pilot studies in the laboratory setting. Finally, the phenomenon of perceived versus exerted force and whether force equates with pain are two areas for potential future studies.

Needlestick and sharps injuries among health-care workers in Taiwan.

Sharps injuries are a major cause of transmission of hepatitis B and C viruses and human immunodeficiency virus in health-care workers. To determine the yearly incidence and causes of sharps injuries in health-care workers in Taiwan, we conducted a questionnaire survey in a total of 8645 health care workers, including physicians, nurses, laboratory technicians, and cleaners, from teaching hospitals of various sizes. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 per person in the past 12 months, respectively. Of most recent episodes of needlestick/sharps injury, 52.0% were caused by ordinary syringe needles, usually in the patient units. The most frequently reported circumstances of needlestick were recapping of needles, and those of sharps injuries were opening of ampoules/vials. Of needles which stuck the health-care workers, 54.8% had been used in patients, 8.2% of whom were known to have hepatitis B or C, syphilis, or human immunodeficiency virus infection. Sharps injuries in health-care workers in Taiwan occur more frequently than generally thought and risks of contracting blood-borne infectious diseases as a result are very high.

A needleless intravenous system: an effective risk management strategy.

Historically, healthcare workers have not taken accidental needlesticks seriously and often have not even reported them. In the last five years, healthcare workers' awareness that needlesticks are a serious source of workplace exposure to hepatitis B virus (HBV) or the human immunodeficiency virus (HIV) has resulted in far more reported needlestick injuries. The risk of seroconversion following a needlestick with HIV-infected blood is approximately 1 in 300.1 Along with the risks of HIV and HBV numerous other infections can be transmitted by needlesticks. There is also the psychological effect on healthcare workers who may fear the possibility of contracting an infection every day while at work. In October 1989, at Columbia Hospital in Milwaukee, Wisconsin, a 394-bed facility, a needlestick task force was formed to address the number of employee needlestick occurrences reported to the occupational health department Members of the task force included an infectious disease physician and representatives from the infection control department, emergency department, pharmacy, operating room, intensive care unit, occupationalhealth department, laboratory department, housekeeping department, infusion therapy team, and materials distribution department. The goal of the needlestick task force was to reduce the number of blood exposure needlesticks to employees. The first strategy to reduce needlesticks was to re-educate staff to practice safety by avoiding recapping and properly taping all connections with needles on intravenous tubing lines and intravenous piggyback lines. This attempt was unsuccessful. Healthcare workers continued to have needlestick injuries bec us changing their clinical practice was too difficult. Studies have indicated that healthcare workers, in gene al, are not compliant with intravenous needle safety issues such as recapping and p operly taping intravenous lines. In a report on the epidemiology of hospital sharps injuries, Dennis G. Maki, MD, states, As have others, we have come to the conclusion that the greatest impact in reducing sharps injuries in HCW (healthcare workers) might be achieved by innovative technology-based approaches to prevention that implicitly reduce the risk of injury, despite carelessness or apathy on the part of an HCW ...analogous to mandating airbags in cars. Making impervious disposal units conveniently available was a first step. However, we need far more: systems that permit vascular access in drawing blood in which the user is implicitly shielded from contact with the used needle such as 'needleless systems' for administrating parenteral medications.2 Having learned this, the next step for the task force at Columbia Hospital was to investigate new products designed to eliminate needlestick injuries. After many months of testing and evaluating new roducts, a needleless intravenous system was approved. The product consisted of a reflux valve that locks on the end of the angiocatheter and a protector needle that can be used with the reflux valve on a rubber port anywhere on the intravenous line. The plastic reflux valve is accessible only by intravenous tubing or syringes without needles. Once the initial venipuncture is performed, the intravenous tubing system is completely needleless. Intravenous piggyback medications are con-

Epidemiology of hospital sharps injuries: A 14-year prospective study in the pre-AIDS and AIDS eras

The world pandemic of acquired immunodeficiency syndrome (AIDS) has focused enormous attention on the problem of accidental sharps injuries sustained by health care workers (HCWs) and the risk of occupationally acquired infection by human immunodeficiency virus (HIV). At the 1980 Conference, we reported a 4-year epidemiologic study (1975–1979) of sharps injuries in HCWs at our hospital. Using the same reporting system and analyses, we now report the epidemiology of sharps injuries in our center during the current AIDS era (1987–1988) and assess trends over the 14-year period. Despite greatly increased institutional efforts to prevent sharps injuries, the annual incidence has increased more than threefold (60.4 to 187.0 1,000 HCWs), reflecting better reporting and increased exposure. Reported injuries by house officers have increased ninefold. Adjusting for inflation, the direct costs of sharps injuries has increased sevenfold ($5,354 to $37,271/year). Environmental service HCWs (305.8 sharps injuries per 1,000 employees) now have the highest incidence in our center, followed by nursing personnel ( 196.5 1,000 ) and laboratory personnel ( 169.9 1,000 ), but as in 1975–1979, two thirds of all injuries occur in nursing personnel. Although phlebotomy team members have a very low risk per procedure ( 1 26,871 draws), their annual incidence is extraordinarily high, 407.0 1,000 . Injuries continue to occur mainly during disposal of waste, linen, or used procedure trays (19.7% of all injuries), administration of parenteral injections or infusion therapy (15.7%), surgery (16.0%), blood drawing (13.3%), or recapping of used needles (10.1%). Making disposal units available at every bedside has reduced injuries from needle disposal two-fold since 1975–1979. With consistent application of a stringent postexposure protocol, and wide acceptance of the hepatitis B vaccine, we have had no sharps injury-related infections during the past 3 years. These data indicate the increasing risk, complexity and cost of sharps injuries in HCWs and the need for more innovative—ideally, technology-based—approaches to prevention. Certain groups of HCWs are at very high risk. Comprehensive postexposure protocols that are uniformly applied can provide substantial protection to exposed HCWs.