• 沒有找到結果。

Procedure-Specific Rates for Needlestick Injuries in Health Care Workers

N/A
N/A
Protected

Academic year: 2021

Share "Procedure-Specific Rates for Needlestick Injuries in Health Care Workers"

Copied!
3
0
0

加載中.... (立即查看全文)

全文

(1)Journal of Occupational Health. J Occup Health 2001; 43: 278–280. Procedure-Specific Rates for Needlestick Injuries in Health Care Workers Lukas Jyuhn-Hsiarn LEE1, Chih-Ting YU2 and Jung-Der WANG1, 3 1. Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, 2Department of Occupational Safety and Health, National Taiwan University Hospital, Taipei and 3Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Abstract: Procedure-Specific Rates for Needlestick Injuries in Health Care Workers: Lukas JyuhnHsiarn LEE, et al. Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University—To assess the rates of needlestick injuries (NSIs) from different types of injection procedures in health care workers, we conducted a prospective study in a university hospital in Taiwan. NSIs in the departments of internal medicine and surgery were prospectively monitored during July 1994–March 1995. All the injured were interviewed to identify their associated procedures. The corresponding numbers of injection procedures were collected during the study period to estimate the denominator of medical procedures. A total of 81 cases of contaminated NSIs were actively collected over a 9-month period compared with 54 NSIs from a routine self-reporting system. Procedures involving intravenous catheter stylets had the highest needlestick injury rate, 43.5/100,000, followed by blood transfusion and blood drawing, 17.7 and 13.3/100,000, respectively. These rates may aid priority setting to introduce safer needle devices when resources are limited. (J Occup Health 2001; 43: 278–280) Key words: surveillance. Needlestick injury (NSI), Active. Needlestick injuries (NSIs) are the most common type of occupational hazards for health care workers (HCWs)1). There are more than 20 pathogens transmitted through contaminated needlesticks that have been reported in medical literature2) among which the primary agents of significant concern are hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus Received 1 May, 2001; Accepted 14 July, 2001 Correspondence to: J.-D. Wang, Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, No. 1, Section 1, Jen-Ai Road, Taipei, 100 Taiwan. (HIV)3). Questionnaire surveys conducted retrospectively were the most common type of studies to provide descriptive statistics, including the first multi-center survey in Taiwan4), but these data usually cannot directly be applied to estimate the risk of NSIs because of recall bias and underreporting which may result in underestimation of the true number of injury cases in retrospective studies5). Device-specific injury rates were prospectively documented in two prototypical studies: one in a university hospital in the United States6), and the other through a multi-hospital surveillance database in Italy7). These rates were calculated by collecting the cases of NSIs from a routine self-reporting database divided by the total quantity of devices purchased, but HCWs frequently use the same type of needle device for different injection procedures. For example, disposable syringes may be used for blood drawing and intravenous introduction of medications in routine clinical practices. Therefore, the epidemiologic method first described by Jagger et al.6) for measuring the device-specific injury rates may need to be refined according to specific procedures. The recent revision of the U.S. Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard has taken effect since April 18, 2001. The standard declares that it is obligatory for employers to consider and implement effective safer medical devices, and it is HCWs’ right to get involved in identifying and selecting the devices8). It is important to characterize the injury rates from various injection procedures in health-care settings, especially in developing countries where resources are limited and a comprehensive replacement of medical devices may not be feasible. We therefore conducted this prospective study to document procedure-specific rates for NSIs.. Materials and Methods The departments of Internal medicine and Surgery with a total of 740 beds in a tertiary care teaching hospital in.

(2) Lukas Jyuhn-Hsiarn LEE, et al.: Procedure-Specific Rates for Needlestick Injuries. 279. Table 1. Frequencies of needlestick injuries and procedure-specific rates in various kinds of medical injection procedures Category of injection procedure Intravenous catheter Blood transfusion Blood drawing Insulin injection Intravenous drip Hypodermic injection Intramuscular injection Intravenous push Blood sugar test (fingerstick) Intravenous nutrition Intradermal injection Arterial chemotherapy Housekeeping Others Not available in interview Total. Numbers of needlestick injuries. Total numbers of procedures used in medical injections. Injury rate (per 100,000). 14 2 15 3 14 1 1 13 1 0 0 0 9 3 5 81. 32,169 11,291 113,187 24,922 130,993 10,965 25,801 362,096 58,013 7,786 1,139 15. 43.5 17.7 13.3 12.0 10.7 9.1 3.9 3.6 1.7 0 0 0. Taiwan were recruited in the study. The population at risk of occupational exposure to NSIs included all the HCWs working in the 20 wards of these two departments. We conducted a prospective study with an active surveillance system to monitor all NSIs which occurred in the workplace from July 1, 1994 to March 31, 1995. Head nurses of these 20 wards were first instructed to actively monitor every case of NSI for the 9-month period, and one of the investigators, CT Yu, went to each ward every Monday and obtained information on NSIs from all the head nurses. Each person with NSI was interviewed face-to-face by her to gather detailed information on the associated procedures and devices used. The corresponding numbers of medical injection procedures were collected from hospital computerized billing files during the study period to estimate the denominators for medical procedures. Subsequently we calculated the rates of NSIs for different injection procedures among HCWs.. Results Records of a total of 81 persons injured by contaminated needles were actively collected over a 9month period. During the same period, the routine selfreporting database from the Department of Occupational Safety and Health gathered 54 self-reported cases, which accounted for only 63 percent of the study’s active surveillance. Procedures involving intravenous catheter stylets had the highest needlestick injury rate (43.5/ 100,000 procedures), followed by blood transfusion and blood drawing, 17.7 and 13.3/100,000, respectively, as. summarized in Table 1.. Discussion To our knowledge, this is the first prospective study to estimate needlestick injury rates for conventional medical injection procedures. We found that procedures involving intravenous catheter stylets had the highest injury rate among various procedures. 7 out of 14 injuries occurred after intravenous injection with the catheter, and before disposal of the contaminated stylet. During the installation of an intravenous catheter, HCWs must carefully handle the device to minimize blood leakage from the catheter while the stylet is withdrawn. They are frequently requested to inject additional medication through the newly installed intravenous route. Stylets were often put aside on beds without immediate disposal, which resulted in a prolonged time of exposure and increased the risk of injury. 3 cases occurred during recapping of the stylets, and 2 additional cases resulted from stylets piercing the caps. We also consistently found that recapping was the major mechanism in injuries from other procedures, which accounted for 8 out of 15 injuries that occurred when drawing blood with disposal syringes, for example. Therefore, immediately disposing of used needles in safe containers and strict avoidance of recapping should be standard practices for the prevention of needlestick injuries in traditional injection procedures. In order to have an accurate estimate of the needlestick injury rate, one must correctly measure both the numerator and the denominator, but underreporting of needlesticks is a common problem, though hospital.

(3) 280. employees are generally requested to report all of them9). The extent of underestimation of injured cases in routine data can be reduced to a minimum by utilizing an active surveillance system as described in our study. Moreover, we collected the corresponding numbers of specific medical injection procedures directly from the computerized billing files for the estimation of denominators, so that our estimates of the denominators for every procedure are likely to be more accurate than studies simply counting the total number of needle devices purchased. Because different prices were billed for different procedures, our computerized data files were generally accurate to prevent any error or unnecessary cost to the hospital or patients. For example, the use of disposable syringes was consistently found to result in the lowest injury rates6, 7), but syringe needles could be used both for blood drawing and intravenous introduction of drugs, and were found to have injury rates of 13.3 and 3.6 per 100,000 procedures, respectively in our study. Therefore, our study identified the most hazardous procedures frequently encountered in conventional injection activities. We recommend that the development of safer needle devices and standard operation procedures for safer clinical practices should be given priority according to procedure-specific rates. In addition, on the basis of these rates a health-care institute can evaluate product performance for selecting cost-effective devices with safety features10). Acknowledgment: This study was supported in part by the National Science Council of ROC, Taiwan (NSC 892314-B-002-433-M56). The first author, Lukas J-H Lee is a recipient of the NHRI MD-PhD & DDS-PhD Predoctoral Fellowship (RE89M003).. J Occup Health, Vol. 43, 2001. References 1) Sepkowitz KA. Occupationally acquired infections in health care workers: Part II. Ann Intern Med 1996; 125: 917–928. 2) Collins CH, Kennedy DA. Microbiological hazards of occupational needlestick and ‘sharps’ injuries. J Appl Bacteriol 1987; 62: 385–402. 3) Gerberding JL. Management of occupational exposures to blood-borne viruses. N Engl J Med 1995; 332: 444– 451. 4) Guo YL, Shiao JSC, Chuang YC, Huang KY. Needlestick and sharps injuries among health-care workers in Taiwan. Epidemiol Infect 1999; 122: 259– 265. 5) Hamory BH. Underreporting of needlestick injuries in a university hospital. Am J Infect Control 1983; 11: 174–177. 6) Jagger J, Hunt EH, Brand-Elnaggar J, Pearson RD. Rates of needle-stick injury caused by various devices in a university hospital. N Engl J Med 1988; 319: 284– 288. 7) Ippolito G, De Carli G, Puro V, et al. Device-specific risk of needlestick injury in Italian health care workers. JAMA 1994; 272: 607–610. 8) U.S. Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlestick and other sharps injury; final rule. Fed Regist 2001; 66: 5318–5325. 9) Shiao JSC, McLaws ML, Huang KY, Ko WC, Guo YL. Prevalence of nonreporting behavior of sharps injuries in Taiwanese health care workers. Am J Infect Control 1999; 27: 254–257. 10) Chiarello LA. Selection of safer needle devices: A conceptual framework for approaching product evaluation. Am J Infect Control 1995; 23: 386–395..

(4)

參考文獻

相關文件

Including government health establishments such as public health centres and Medical Check-up Centre for Civil Servants, and private clinics including establishments of health

Including government health establishments such as public health centres and Medical Check-up Centre for Civil Servants, and private clinics including establishments of health

Including government health establishments such as public health centres, Medical Check-up Centre for Civil Servants, etc., and private clinics including establishments of health

Including government health establishments such as public health centres, Medical Check-up Centre for Civil Servants, etc., and private clinics including establishments of health

The 2007 Health Care Survey collected information from 713 health care establishments, comprising the 3 hospitals providing hospital care services, 477 private clinics and

a) Describe the changing trend of daily patronage of different types of public transport modes in Hong Kong from 2000 to 2015.. b) Discuss the possible reasons leading to

Topic 4 - Promotion and Maintenance of Health and Social Care in the Community 4CAspects of risk assessment and

between the roles of the individuals (private sector) and the public or government in the provision of social care and health services responsibility of the government, e.g.