Procedure-Specific Rates for Needlestick Injuries in Health Care Workers
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(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..
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