Needlestick injuries among nursing staff: association with shift-level staffing

Analysis of factors associated with needlestick injuries of clinical nurses by applying a human factor analysis and classification system: A nationwide cross-sectional survey

AIMS

This study aims to investigate the current situation of needlestick injuries (NSIs) of clinical nurses and identify associated factors by using the theoretical framework of the human factors analysis and classification system (HFACS).

DESIGN

A nationwide cross-sectional survey was conducted.

METHODS

Multi-stage sampling was used to investigate 3336 nurses in 14 Chinese hospitals. Descriptive statistics and univariate and multivariate logistic regression were employed to reveal the rate of NSIs and their associated factors.

RESULTS

A total of 970 nurses (29.1%) reported having experienced at least one NSI in the past year. The multivariate logistic regression analysis showed that good hospital safety climate and clinical nurses in intensive care unit (ICU) and emergency department had protective effects against NSIs compared with nurses in internal medicine department. The nurse, senior nurse, and nurse in charge have significantly increased the risk for NSIs compared with the associate chief nurse or above. Patients with poor vision but wearing glasses and poor vision but not wearing glasses were more prone to have NSIs. Working in the operating room compared with internal medicine, average weekly working time of >45 h compared with ≤40 h and poor general health led to increased risk of NSIs.

CONCLUSION

The rate of NSIs in clinical nurses was high in China. Individual factors including professional title, department, visual acuity and general mental health and organisational factors including weekly working hours and hospital safety atmosphere were significantly correlated with the occurrence of NSIs.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should focused on physical and psychological conditions of clinical nurses, and organisational support is required to enhance the hospital safety atmosphere.

NO PATIENT OR PUBLIC CONTRIBUTION

Contributions from patients or the public are irrelevant because this study aims to explore current situation and factors associated with NSIs in clinical nurses.

High-Dimensional Fixed Effects Profiling Models and Applications in End-Stage Kidney Disease Patients: Current State and Future Directions

Profiling analysis aims to evaluate health care providers, including hospitals, nursing homes, or dialysis facilities among others with respect to a patient outcome, such as 30-day unplanned hospital readmission or mortality. Fixed effects (FE) profiling models have been developed over the last decade, motivated by the overall need to (a) improve accurate identification or "flagging" of under-performing providers, (b) relax assumptions inherent in random effects (RE) profiling models, and (c) take into consideration the unique disease characteristics and care/treatment processes of end-stage kidney disease (ESKD) patients on dialysis. In this paper, we review the current state of FE methodologies and their rationale in the ESKD population and illustrate applications in four key areas: profiling dialysis facilities for (1) patient hospitalizations over time (longitudinally) using standardized dynamic readmission ratio (SDRR), (2) identification of dialysis facility characteristics (e.g., staffing level) that contribute to hospital readmission, and (3) adverse recurrent events using standardized event ratio (SER). Also, we examine the operating characteristics with a focus on FE profiling models. Throughout these areas of applications to the ESKD population, we identify challenges for future research in both methodology and clinical studies.

Time Trends of Percutaneous Injuries in Hospital Nurses: Evidence of the Interference between Effects of Adoption of Safety Devices and Organizational Factors

Few studies have focused on the combined effects of devices and work organization on needlestick injuries trends. The aim of the study was to estimate trends of percutaneous injury rates (IR) in nurses (N) and nurse assistants (NA) over a 10 year period, in which passive safety devices were progressively adopted. Percutaneous and mucocutaneous injuries registered in a University Hospital in Northern Italy in Ns and NAs in 2007–2016 were analyzed. Organizational data were also available on shift schedules, turnover, downsizing and age- and skill-mix. We estimated IRs per 100 full-time equivalent workers from Poisson models and their average annual percent changes (APC) from joinpoint regression model. In the entire period, monotonic decreases in percutaneous IRs occurred among day-shift Ns (APC = −20.9%; 95% CI: −29.8%, −12%) and NAs (APC = −15.4%; −32.9%, 2.2%). Joinpoint modeling revealed a turning point in 2012 for night-shift Ns, with a steady decline in 2007–2012 (APC = −19.4%; −27.9%, −10.9%), and an increase thereafter (APC = +13.5%; 1.5%, 25.5%). In comparison to 2008 and 2012, in 2016 night-shift Ns were 5.9 and 2.5 times more likely to be younger and less qualified or experienced than day-shift Ns. The observed declines in percutaneous injury rates occurred in a time period when safety devices were progressively implemented. The causal nature of multiple exposures and organizational procedures in affecting injury time trends should be further addressed by quasi-experimental studies.

Occupational exposure to blood and body fluids among primary healthcare workers in Johannesburg health district: High rate of underreporting

Background

Healthcare workers (HCWs) are at risk of bloodborne infections from sharp instrument injuries and skin and mucous membrane exposures to contaminated blood and body fluids (BBF). While these have clinical and occupational health implications, little is known about BBF exposure and its reporting pattern in South African primary healthcare (PHC). The aim of this study was to determine the rate of BBF exposure, the extent of reporting and the reasons for not reporting among HCWs in PHC facilities in Johannesburg, South Africa.

Methods

In a cross-sectional study involving 444 participants, an 18-item, self-administered questionnaire was used to collect information on socio-demographic characteristics, HCWs’ exposures to BBF in the last year, whether the exposure was reported and the reasons for not reporting. Analysis included descriptive statistics and chi-square test.

Results

Most participants were nurses (87.4%) and female (88.1%). About a quarter of participants (112) reported having at least one BBF exposure in the last year. Overall, there were 355 exposures, resulting in 0.8 BBF exposure per HCW per year. Of these exposures, 291 (82.0%) were not reported. Common reasons for not reporting include lack of time (42.72%), perception that the source patient was at low risk for human immunodeficiency virus (24.7%) and concerns about confidentiality (22.5%). Blood and body fluids exposures involving nurses (p < 0.001), sharp instrument (p < 0.001) and HCWs aged < 50 years (p = 0.02) were significantly more likely to be reported.

Conclusion

This study found a high rate of underreporting of BBF exposures among HCWs in PHC facilities in Johannesburg, suggesting an urgent need for interventions to improve reporting.

Association of US Dialysis Facility Staffing with Profiling of Hospital-Wide 30-Day Unplanned Readmission

Background

Unplanned hospital readmissions are a major source of morbidity among dialysis patients, in whom the risk of hospital readmission is exceptionally high. The contribution of dialysis facility staffing to hospital readmission has been largely overlooked.

Methods

Using annual data of dialysis patients from the United States Renal Data System from 2010 to 2013, we assessed dialysis facilities with a significantly worse (SW) and facilities with a nonsignificant (NS) standardized readmission ratio (SRR). SRR estimates were risk adjusted for patient factors, past year comorbidities, and index hospitalization characteristics. Facility staffing variables were compared between 2 exposure groups: facilities with SW and NS SRRs. Four measures of staffing, including patient-to-staffing ratio, were compared between SW and matched NS facilities.

Results

About 136,000-148,000 dialysis patients with 269,000-319,000 index hospital discharges were used to identify facilities with SW and facilities with NS SRR annually. Approximately 3-4% of facilities were identified as having SW SRR among > 5,000 facilities annually. The percent of nurses-to-total staff was significantly lower in 2010 for SW facilities than in matched NS facilities (42.5 vs. 45.6%, p = 0.012), but this disparity was attenuated by 2013 (44.8 vs. 44.7%, p = 0.949). There was a higher patient-to-nurse ratio for SW facilities than for NS facilities (mean 16.4 vs. 15.2, p = 0.038) in 2010 as well, and the disparity was reduced by 2013. The trends were similar for patient-to-total staff and patient-to-registered nurse, but not statistically significant.

Conclusions

This study found that dialysis facilities with SW 30-day readmission rates had lower proportions of nurses-to-total staff and higher patient-to-nurse ratios, but this disparity improved in recent years. Additional research is warranted focusing on how evidence-based staffing at dialysis facilities can contribute to reduction of hospital readmission, and this knowledge is needed to inform clinical practice guidelines and policy decisions regarding optimal dialysis patient staffing.

Determinants of Workplace Injuries and Violence Among Newly Licensed RNs

Workplace injuries, such as musculoskeletal injuries, needlestick injuries, and emotional and physical violence, remain an issue in U.S. hospitals. To develop meaningful safety programs, it is important to identify workplace factors that contribute to injuries. This study explored factors that affect injuries in a sample of newly licensed registered nurses (NLRNs) in Florida. Regressions were run on models in which the dependent variable was the degree to which the respondent had experienced needlesticks, work-related musculoskeletal injuries, cuts or lacerations, contusions, verbal violence, physical violence, and other occupational injuries. A higher probability of these injuries was associated with greater length of employment, working evening or night shifts, working overtime, and reporting job difficulties and pressures. A lower probability was associated with working in a teaching hospital and working more hours. Study findings suggest that work environment issues must be addressed for safety programs to be effective.

Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.) 2015: A national survey of sharps injuries and mucocutaneous blood exposures among health care workers in US hospitals

BACKGROUND

National blood exposure (BE) surveys are valuable to health care facilities striving to reduce percutaneous sharps injuries (SIs) or mucocutaneous (MC) exposures among their health care workers (HCWs). In the Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.) 2015 we surveyed hospital BE incidence among members of the Association of Occupational Health Professionals in Healthcare.

METHODS

A 23-item electronic survey requested 2015 data on total SI and MC; SI in nurses, doctors, and surgery; staffed beds; teaching status; full time equivalent staff (FTE), nurse FTE, average daily census (ADC), and adjusted patient days (APD).

RESULTS

One hundred eighty-one hospitals in 34 states reported 9,343 BE (71% SI and 29% MC exposures). SI rates were 25.2/100 ADC (17.5 in nonteaching hospitals and 30.4 in teaching hospitals), 2.1/100 FTE (significantly less than that in 2001), 3.2/100 nurse FTE, 0.36/1,000 APD, and 38% occurred during surgery. MC exposure incidence rates were 10.5/100 ADC (8.6 in nonteaching hospitals and 11.7 in teaching hospitals), 0.86/100 FTE, and 0.14/1000 APD.

CONCLUSIONS

BE incidence rates have fallen slowly but significantly since 2001, but the reduction is far less than hoped. Occupied beds (ie, ADC) has become a less-useful denominator. We estimate more than 300,000 HCWs sustain SIs annually in hospital and nonhospital settings. Greater resources are needed for more frequent and correct use of safety devices, training to competency, and root-cause investigation of all SIs.

Long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan: A national survey

BACKGROUND

Needlestick and sharps injuries are prevalent work-related injuries among nurses. Safety devices prevent only one-quarter of related injuries. More studies of modifiable risk factors are needed.

OBJECTIVES

To examine whether long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan.

DESIGN

Cross-sectional survey.

SETTINGS/PARTICIPANTS

This analysis included 19,386 full-time bedside nurses working in 104 hospitals across Taiwan.

METHODS

Participants filled out an anonymous questionnaire from July to September 2014. Chronic insomnia, needlestick injuries, and sharps injuries during the past year were each measured by a yes/no question. Multivariate logistic regression models were applied to examine the effects of long work hours and chronic insomnia on needlestick and sharps injuries, given with control for sex, marital status, educational level, age, years of practice, work unit, and hospital level in the model.

RESULTS

More than 70% of study nurses worked long hours during the previous week (>50h: 27.5%; 41-50h: 43.2%), and 15.5% of nurses reported chronic insomnia. The percentage of sharps injuries (38.8%) was higher than that for needlestick injuries (22.4%) during the previous year among nurses. After adjusting for potential confounders, logistic regression yielded significant results showing that those who worked 41 to 50h per week, >50h per week, and had chronic insomnia were 1.17 times (95% C.I.=1.04-1.32), 1.51 times (95% C.I.=1.32-1.72), and 1.45 times (95% C.I.=1.25-1.68) more likely to experience needlestick injuries, and 1.29 times (95% C.I.=1.17-1.42), 1.37 times (95% C.I.=1.23-1.53), and 1.56 times (95% C.I.=1.37-1.77) more likely to experience sharps injuries, respectively, than those who worked fewer hours and did not have insomnia.

CONCLUSIONS

This nationwide nurse survey showed that high rates of needlestick and sharps injuries persist in hospital nurses in Taiwan. The common problems of long work hours and chronic insomnia increase the risk of these injuries. We suggest that hospital managers follow regulations on work hours and optimize shift schedules for nurses to decrease related injuries.

Scheduling and shift work characteristics associated with risk for occupational injury in newly licensed registered nurses: An observational study

BACKGROUND

Registered nurses across the globe bear a heavy injury burden. Every shift, nurses are exposed to a variety of hazards that can jeopardize their health, which negatively impacts their ability to provide high-quality patient care. Previous research suggests that inexperienced, or newly licensed nurses, may have an increased risk for certain occupational injuries. However, the current knowledge base is insufficient to fully understand how work hours influence newly licensed nurses' occupational injury, given the significant variation in hospital organization and work characteristics.

OBJECTIVE

To describe newly licensed nurses' shift work characteristics and determine the association between shift type and scheduling characteristics and nurse injury, before and after adjusting for individual and combined effects of demographics, external context, organizational context, and work context, following the Organization of Work model.

DESIGN

This study is a secondary analysis of a nationally representative survey of newly licensed registered nurses using a cross-sectional design.

PARTICIPANTS

The analytic sample includes 1744 newly licensed registered nurses from 34 states and the District of Columbia who reported working in a hospital and were within 6-18 months of passing their state licensure exam at the time of survey administration.

METHODS

Descriptive statistics were calculated, followed by bivariate and multivariate Poisson regression models to assess the relationship between shift type and scheduling characteristics and nurse injury. Lastly, full models with the addition of demographics, external context, organizational context, and work context variables were calculated.

RESULTS

The majority (79%) of newly licensed nurses worked 12-h shifts, a near majority worked night shift (44%), and over half (61%) worked overtime (mandatory or voluntary) weekly. Nurses working weekly overtime were associated with a 32% [incidence rate ratio (IRR) 1.32, CI 1.07-1.62] increase in the risk of a needle stick and nurses working night shift were associated with a 16% [IRR 1.16, CI 1.02-1.33] increase in the risk of a sprain or strain injury.

CONCLUSIONS

Overtime and night shift work were significantly associated with increased injury risk in newly licensed nurses independent of other work factors and demographic characteristics. The findings warrant further study given the long-term consequences of these injuries, costs associated with treatment, and loss of worker productivity.

Is There Light? Well It Depends--A Grounded Theory Study of Nurses, Lighting, and Medication Administration

OBJECTIVE

We know that human vision has limitations, medication administration is a high-risk activity, and some nurses work in environments that do not meet recommended lighting standards. The goal of this study was to inform safe medication administration practices and add evidence for establishing guidelines for lighting decisions by understanding registered nurses' (RNs') decision making about lighting during medication administration.

METHODS

Grounded theory methodology was followed (n = 16). Theoretical sampling was used to ensure that participants represented a variety of backgrounds and hospital settings. Results were validated by three expert researchers. Two of the researchers had significant expertise in medication administration errors.

RESULTS

Data analysis culminated in the substantive theory It Depends. This theory describes a process of frequently automatic decision making about lighting, whose aspects include assessing variation, balancing safety and healing, and RN bias. All RNs expressed concerns about perceived risks in relation to lighting, but had difficulty describing how they confirmed when the correct decision about lighting was made.

CONCLUSIONS

Nurses are often unaware of their reasons for lighting decisions, and there is a need for education and other measures to increase the likelihood that lighting decisions that enhance patient safety are made by nurses.

The Prevalence of Accidental Needle Stick Injury and their Reporting among Healthcare Workers in Orthopaedic Wards in General Hospital Melaka, Malaysia

ABSTRACT

Background :Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting in operation theatre 13(37.4%). Among them six (18.8%) were specialist, 12(37.5%) medical officer, 10 (31.2%) house officer and four staff nurses (12.5%). Among the respondents 142 (92.8%) had been immunized against Hepatitis B and 148 (96.7%) participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant.

KEY WORDS

Needle sticks injury, health care workers, and standard precaution.

Staffing matters-every shift: data from the Military Nursing Outcomes Database can be used to demonstrate that the right number and mix of nurses prevent errors

OVERVIEW

Data from the Military Nursing Outcomes Database (MilNOD) project demonstrate that inadequately staffed shifts can increase the likelihood of adverse events, such as falls with injury, medication errors, and needlestick injuries to nurses. Such evidence can be used to show that it takes not only the right number of nursing staff on every shift to ensure safe patient care, but also the right mix of expertise and experience. Based on findings from the MilNOD project, the authors present realistic scenarios of common dilemmas hospitals face in nurse staffing, illustrating the potential hazards for patients and nurses alike.

Blood and body fluid exposures in health-care settings: risk reduction practices and postexposure prophylaxis for health-care workers

This review of last year's literature on blood-borne pathogens (= pathogenic microorganisms that are found in human blood) focuses on hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) as the most common pathogens, despite the fact that other microorganisms may cause blood-borne diseases as well. Since the prevention of blood-borne diseases is something that, in the past, has gotten a lot of attention and by now is fully integrated in all safety structures in the U.S., the recent literatures mainly have been come from resource-limited/developing countries and Europe (which, in the definition of the financial word at the present time, in some parts overlap).

Occupational exposure to blood-borne pathogens in a tertiary hospital: benchmarking using patient days

Incidence and risk factors for occupational exposure to blood-borne pathogens (OEBBPs) in a tertiary hospital in Saudi Arabia was assessed. Reported sharps injuries from 2009 to 2010 were analyzed and benchmarked using patient days. OEBBPs caused by sharps injuries increased from 41 in 2009 to 65 in 2010, with an incidence rate of 4.09/10 000 patient days in 2009 and 5.9/10 000 patient days in 2010. Most episodes (41%) occurred during recapping of hollow bore needles after obtaining blood specimens. The highest incidence was among nursing staff(n/N = 87/106; 82%), and injuries also occurred in housekeeping staff (3.7%). A correlationbetween morning shift and OEBBPs was observed, and the highest number of episodes occurred in the emergency room (21.5%) and renal dialysis unit (16.9%). There was exposure to HCV (n = 13) and HBV (n = 4) but not to HIV (n = 0), and no seroconversions were documented. Education on adherence to universal precaution measures and use of safety engineered devices as well as the introduction of an OEBBP notification hotline are recommended.