Occupational exposure to blood or body fluids as a result of needlestick injuries and other sharp device injuries among medical residents in Japan.

The Occupational Safety and Health Administration (OSHA) revised the Bloodborne Pathogen Standard and, on July 17, 2001, began enforcing the use of appropriate and effective sharps devices with engineered sharps injury protection. OSHA requires employers to maintain a sharps injury log that records, among other items, the type and brand of contaminated sharps device involved in each injury. Federal OSHA does not require needlestick injury rates to be calculated by brand or type of device. A sufficient sample size to show a valid comparison of safety devices, based on injury rates, is rarely feasible in a single facility outside of a formal research trial. Thus, calculations of injury rates should not be used by employers for product evaluations to compare the effectiveness of safety devices. This article provides examples of sample size requirements for statistically valid comparisons, ranging from 100,000 to 4.5 million of each device, depending on study design, and expected reductions in needlestick injury rates. 3. Occupational Exposure to Blood or Body Fluids as a Result of Needlestick Injuries and Other Sharp Device Injuries Among Medical Residents in Japan • Koji Wada, MD, MSc; Rie Narai, MD; Yumi Sakata, MD; Toru Yoshikawa, MD; Masashi Tsunoda, MD, PhD; Katsutoshi Tanaka, MD, PhD; Yoshiharu Aizawa, MD, PhD Infection Control and Hospital Epidemiology. Volume 28, Issue 4, Page 507–509, Apr 2007 4. Workers' Compensation Claims for Needlestick Injuries Among Healthcare Workers in Washington State, 1996–2000 • Syed M. Shah, MD; David Bonauto, MD; Barbara Silverstein, PhD; Michael Foley, PhC Infection Control and Hospital Epidemiology. Volume 26, Issue 9, Page 775–781, Sep 2005 OBJECTIVES. To characterize accepted workers’ compensation claims for needlestick injuries filed by healthcare workers (HCWs) in non hospital compared with hospital settings in Washington State. DESIGN. Descriptive study of all accepted workers’ compensation claims filed between 1996 and 2000 for needlestick injuries. PARTICIPANTS. All Washington State HCWs eligible to file a state fund workers’ compensation claim and those who filed a workers’ compensation claim for a needlestick injury. RESULTS. There were 3,303 accepted state fund HCW needlestick injury claims. The incidence of needlestick injury claims per 10,000 full time–equivalent HCWs in hospitals was 158.6; in dental offices, 104.7; in physicians’ offices, 87.0; and in skilled nursing facilities, 80.8. The most common mechanisms of needlestick injury by work location were as follows: for hospitals, suturing and other surgical procedures (16.7%), administering an injection (12.7%), and drawing blood (10%); for dentists’ offices, recapping (21.3%) and cleaning trays and instruments (18.2%); for physicians’ offices, disposal (22.2%) and administering an injection (10.2%); and for skilled nursing facilities, disposal (23.7%) and administering an injection (14.9%). Nurses accounted for the largest (29%) proportion of HCWs involved, followed by dental assistants (17%) and laboratory technicians and phlebotomists (12%) in non hospital settings. Rates of needlestick injury claims increased for non hospital settings by 7.5% annually (95% confidence interval [CI95], 4.89% to 10.22%; P < .0001). Rates decreased for hospital settings by 5.8% annually, but the decline was not statistically significant (CI95, 12.50% to 1.34%; P < .1088). HCWs were exposed to hepatitis B, hepatitis C, and human immunodeficiency viruses in non hospital settings. CONCLUSION. There was a difference in the incidence rate and mechanisms of needlestick injuries on review of workers’ compensation claim records for HCWs in non hospital and hospital settings. 5. Costs and Benefits of Measures to Prevent Needlestick Injuries in a University Hospital • Françoise Roudot Thoraval, MD; Olivier Montagne, MD; Annette Schaeffer, MD; Marie Laure Dubreuil Lemaire, MD; Danièle Hachard, RN; Isabelle Durand Zaleski, MD, PhD Infection Control and Hospital Epidemiology. Volume 20, Issue 9, Page 614–617, Sep 1999 OBJECTIVE. To document the costs and the benefits (both in terms of costs averted and of injuries averted) of education sessions and replacement of phlebotomy devices to ensure that needle recapping did not take place. DESIGN. The percentage of recapped needles and the rate of needlestick injuries were evaluated in 1990 and 1997, from a survey of transparent rigid containers in the wards and at the bedside and from a prospective register of all injuries in the workplace. Costs were computed from the viewpoint of the hospital. Positive costs were those of education and purchase of safer phlebotomy devices; negative costs were the prophylactic treatments and followup averted by the reduction in injuries. SETTING. A 1,050 bed tertiary care university hospital in the Paris region. RESULTS. Between the two periods, the proportion of needles seen in the containers that had been recapped was reduced from 10% to 2%. In 1990, 127 needlestick (12.7/100,000 needles) and 52 recapping injuries were reported versus 62 (6.4/100,000 needles) and 22 in 1996 and 1997. When the rates were related to the actual number of patients, the reduction was 76 injuries per year. The total cost of information and preventive measures was $325,927 per year. The cost effectiveness was $4,000 per injury prevented. CONCLUSION. Although preventive measures taken to ensure reduction of needlestick injuries appear to have been effective (75% reduction in recapping and 50% reduction in injuries), the cost of the safety program was high. 6. Use of Safety Devices and the Prevention of Percutaneous Injuries Among Healthcare Workers • Victoria Valls, MD; M. Salud Lozano, RN; Remedios Yánez, RN; María José Martínez, RN; Francisco Pascual, MD; Joan Lloret, MD; Juan Antonio Ruiz, MD Received: March 12, 2007Accepted: July 6, 2007 Infection Control and Hospital Epidemiology. Volume 28, Issue 12, Page 1352– 1360, Dec 2007 Corresponding Author: Address reprint requests to Victoria Valls, MD, Hospital Virgen de la Salud–Elda, Departamento de Salud 18, Carretera Elda Sax s/n, 03600 Elda, Alicante, Spain ([email protected]). Objective. To study the effectiveness of safety devices intended to prevent percutaneous injuries. Design. Quasi experimental trial with before and after intervention evaluation. Setting. A 350 bed general hospital that has had an ongoing educational program for the prevention of percutaneous injuries since January 2002. Methods. In October 2005, we implemented a program for the use of engineered devices to prevent percutaneous injury in the emergency department and half of the hospital wards during the following procedures: intravascular catheterization, vacuum phlebotomy, blood gas sampling, finger stick blood sampling, and intramuscular and subcutaneous injections. The nurses in the wards that participated in the intervention received a 3 hour course on occupationally acquired bloodborne infections, and they had a 2 hour “hands on” training session with the devices. We studied the percutaneous injury rate and the direct cost during the preintervention period (October 2004 through March 2005) and the intervention period (October 2005 through March 2006). Results. We observed a 93% reduction in the relative risk of percutaneous injuries in areas where safety devices were used (14 vs 1 percutaneous injury). Specifically, rates decreased from 18.3 injuries (95% confidence interval [CI], 5.9 43.2 injuries) to 0 injuries per 100,000 patients in the emergency department ( ) and from 44.0 injuries (95% CI, 20.1 83.6 injuries) to 5.2 injuries (95% CI, 0.1 28.8 injuries) per 100,000 patient days in hospital wards ( ). In the control wards of the hospital (ie, those where the intervention was not implemented), rates remained stable. The direct cost increase was €0.558 (US$0.753) per patient in the emergency department and €0.636 (US$0.858) per patient day in the hospital wards. Conclusion. Proper use of engineered devices to prevent percutaneous injury is a highly effective measure to prevent these injuries among healthcare workers. However, education and training are the keys to achieving the greatest preventative effect. 7. Effect of Implementing Safety-Engineered Devices on Percutaneous Injury Epidemiology • SeJean Sohn, MPH; Janet Eagan, RN, MPH; Kent A. Sepkowitz, MD; Gianna Zuccotti, MD, MPH Infection Control and Hospital Epidemiology. Volume 25, Issue 7, Page 536–542, Jul 2004 OBJECTIVE. To assess the effect of implementing safetyengineered devices on percutaneous injury epidemiology, specifically on percutaneous injuries associated with a higher risk of blood borne pathogen exposure. DESIGN. Before and after intervention trial comparing 3 year preintervention (1998–2000) and 1 year postintervention (2001–2002) periods. Percutaneous injury data have been entered prospectively into CDC NaSH software since 1998. SETTING. A 427 bed, tertiary care hospital in Manhattan. PARTICIPANTS. All employees who reported percutaneous injuries during the study period. INTERVENTION. A “safer needle system,” composed of a variety of safety engineered devices to allow for needlesafe IV delivery, blood collection, IV insertion, and intramuscular and subcutaneous injection, was implemented in February 2001. RESULTS. The mean annual incidence of percutaneous injuries decreased from 34.08 per 1,000 full time–equivalent employees preintervention to 14.25 postintervention (P < .001). Reductions in the average monthly number of percutaneous injuries resulting from both low risk (P < .01) and high risk (P was not significant) activities were observed. Nurses experienced the greatest decrease (74.5%, P < .001), followed by ancillary staff (61.5%, P = .03). Significant rate reductions were observed for the following activities: manipulating patients or sharps (83.5%, P < .001), collisions or contact with sharps (73.0%, P = .01), disposal related injuries (21.41%, P = .001), and catheter insertions (88.2%, P < .001). Injury rates involving hollow bore needles also decreased (70.6%, P < .001). CONCLUSIONS. The implementation of safetyengineered devices reduced percutaneous injury rates across occupations, activities, times of injury, and devices. Moreover, intervention impact was observed when stratified by risk for blood borne pathogen transmission. 8. Sharp-Device Injuries to Hospital Staff Nurses in 4 Countries • Sean P. Clarke, PhD, RN, CRNP; Maria Schubert, MSN, RN; Thorsten Körner, MD, MA, MPH Received: April 23, 2006Accepted: July 13, 2006 Infection Control and Hospital Epidemiology. Volume 28, Issue 4, Page 473–478, Apr 2007 Corresponding Author: Address reprint requests to Sean Clarke, PhD, RN, CRNP, Associate Director, Center for Health Outcomes and Policy Research, University of Pennsylvania, 420 Guardian Drive, Philadelphia, PA, 19104 6096 ([email protected]). Objective. To compare sharp device injury rates among hospital staff nurses in 4 Western countries. Design. Cross sectional survey. Setting. Acute care hospital nurses in the United States (Pennsylvania), Canada (Alberta, British Columbia, and Ontario), the United Kingdom (England and Scotland), and Germany. Participants. A total of 34,318 acute care hospital staff nurses in 1998 1999. Results. 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. Conclusions. 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. 9. Evaluation of a Safety Resheathable Winged Steel Needle for Prevention of Percutaneous Injuries Associated With Intravascular Access Procedures Among Healthcare Workers • Meryl H. Mendelson, MD; Bao Ying Lin Chen, MPH; Robin Solomon, RN, MS; Eileen Bailey, RN, MPH; Gene Kogan, MS; James Goldbold, PhD Infection Control and Hospital Epidemiology. Volume 24, Issue 2, Page 105–112, Feb 2003 OBJECTIVE. To compare the percutaneous injury rate associated with a standard versus a safety resheathable winged steel (butterfly) needle. DESIGN. Before–after trial of winged steel needle injuries during a 33 month period (19 month baseline, 3 month training, and 11 month study intervention), followed by a 31 month poststudy period. SETTING. A 1,190 bed acute care referral hospital with inpatient and outpatient services in New York City. PARTICIPANTS. All healthcare workers performing intravascular access procedures with winged steel needles. INTERVENTION. Safety resheathable winged steel needle. RESULTS. The injury rate associated with winged steel needles declined from 13.41 to 6.41 per 100,000 (relative risk [RR], 0.48; 95% confidence interval [CI95], 0.31 to 0.73) following implementation of the safety device. Injuries occurring during or after disposal were reduced most substantially (RR, 0.15; CI95, 0.06 to 0.43). Safety winged steel needle injuries occurred most often before activation of the safety mechanism was appropriate (39%); 32% were due to the user choosing not to activate the device, 21% occurred during activation, and 4% were due to improper activation. Preference for the safety winged steel needle over the standard device was 63%. The safety feature was activated in 83% of the samples examined during audits of disposal containers. Following completion of the study, the safety winged steel needle injury rate (7.29 per 100,000) did not differ significantly from the winged steel needle injury rate during the study period. CONCLUSION. Implementation of a safety resheathable winged steel needle substantially reduced injuries among healthcare workers performing vascular access procedures. The residual risk of injury associated with this device can be reduced further with increased compliance with proper activation procedures. 10. Lessons Regarding Percutaneous Injuries Among Healthcare Providers • Bradley N. Doebbeling, MD, MSc Infection Control and Hospital Epidemiology. Volume 24, Issue 2, Page 82–85, Feb 2003