Impact of safety needle devices on occupationally acquired needlestick injuries: a four-year prospective study

Prevalence, response and associated factors of needlestick injury among health care workers in Orotta National Referral Hospital, Eritrea

BACKGROUND

Healthcare workers are at risk of occupational exposure to blood and other body fluids after sustaining needlestick injury which constitutes a risk for transmission of blood-borne pathogens such as Hepatitis B virus, Hepatitis C virus or Human Immune-deficiency Virus.

OBJECTIVES

To assess the prevalence, response, and associated factors of needlestick injury by medical sharps among healthcare workers in Orotta National Referral Hospital, Asmara, Eritrea.

METHODS

Cross sectional study was conducted between September and December 2017 among healthcare workers. This was a census study whereby a total of 383 healthcare workers who had contact with sharp medical equipment were taken as study population. An aided self-administered questionnaire, checklist and key informant interviews were used as data collection tools. Analysis was done using Statistical Package for Social Sciences, version 22. Bivariate and binary logistic regression analyses were carried out and the level of significance was set at P < .05.

RESULTS

The prevalence of needlestick injury 12 months preceding the study was 37.1% (134/361). Midwives had the highest occurrence (45%) among others while adult intensive care unit were found to have higher prevalence of needlestick injury (61.5%) as compared to the other sections. As an immediate response to needlestick injury, only 15.7% washed the injured part with soap and water. The factors associated with needlestick injury include age > 40 years (AOR = .314, p = .05), marital status (married (AOR = 0.595, p = .05)), additional duty that made healthcare workers rush during working hours (AOR = 2.134, p = .002) and back bone problem (AOR = 2.239, p = .002).

CONCLUSION

The overall finding of the study indicated that there was a great risk of contracting blood-borne infections among the healthcare workers especially midwives. Therefore, there is need for adequate supply of safety engineered devices, Hepatitis B vaccine, better reporting, and surveillance of needlestick injury cases at the hospital. Moreover, further research on assessment of the knowledge, attitude, and practice of healthcare workers toward occupational safety and health, particularly needlestick injury, is necessary.

Knowledge, Attitude, and Practice Regarding Needle Stick Injuries Among Health Care Workers in Baghdad Teaching Hospital and Ghazy Al-Hariri Hospital for Surgical Specialties in 2020

Background: Needle stick injuries are serious occupational hazards in the transmission of a variety of bloodborne diseases, more than twenty pathogens can be transmitted through NSI including hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (AIDS) among healthcare workers. Objectives: Assess the knowledge, attitude and practice of health care workers towards needle stick injuries. Determine the prevalence of needle stick injuries among healthcare workers and its predisposing factors.  Methods: Cross-sectional descriptive study, a convenient sample of 260 health care workers was selected from Baghdad Teaching hospital and Ghazy Al Hariri hospital in Baghdad, Iraq. Data were collected by an anonymous questionnaire from January to June 2020. The collected data were analyzed by using statistical package for the social sciences (SPSS version 23). Results Prevalence of NSIs among HCWs was found to be 53.8%, which was higher in nurses (29.3%) and laboratory technicians (28.5%) followed by surgeon doctors (15.7%), assistant surgeons (13.6%) and dentists (12.9%) .The highest number of needle stick injuries occurred by recapping of needles (41.4%) followed by during drug administration (27.9%), from hand to hand  (10.7%) and during blood drawing (7.9%). A proportion of (64.5%) of  health care workers whom sustained needle stick injury had reported their Injury. Doctors scored better than others regarding mean scores of knowledge, attitude and practice. There was a highly significant association among knowledge, attitude and practice scores of the HCWs (P<0.001). A considerable percentage of the participants (80.2%) were completely immunized against HBV. Conclusions: The study showed a high prevalence of NSIs among health care workers. The score of knowledge was high, moreover acceptable responses were obtained in most attitude and practice statements, except for recapping of needles statements.  

Investigation and Analysis of Sharp Injuries among Health Care Workers from 36 Hospitals in Shandong Province, China

Background

This study investigated and analyzed the current situation of sharp injuries among health care workers (HCWs) in China's Shandong Province.

Methods

By means of questionnaire survey, the incidence of sharp injuries among HCWs from 36 hospitals in China's Shandong Province in October 2019 was investigated, and the results of this survey were compared with those of October 2012.

Results

A total of 48165 HCWs were investigated. 549 cases of sharp injuries occurred. The incidence of sharp injuries was 1.14%, which was significantly lower than that in October 2012 (9.71%). In the occupational distribution of sharp injuries among HCWs, the proportion of nurses was 58.65%, doctors 23.32%, and interns 12.02%. Among the distribution of sharp injury departments, general wards, operating rooms, intensive care units, disinfection supply centers, and outpatient clinics were the high-incidence sites of occupational exposure among HCWs. The main instruments causing sharp injuries in HCWs were syringes, scalp steel needles, surgical suture needles, vacuum blood collection needles, and glass slides. Drug administration, double-handed loop needle cap, blood extraction, surgical suture needle, and arteriovenous needle extraction were high-risk operations causing sharp instrument injuries in HCWs.

Conclusion

The incidence of sharp injuries among HCWs from 36 hospitals in Shandong Province in October 2019 was significantly lower than that in October 2012. Sharp injuries were a common type of occupational exposure for HCWs. The occurrence of sharp injuries should be effectively reduced by changing wrong habitual behavior and implementing standard protective measures.

Patient-Reported Preference and Clinical Efficacy of Insulin Pen Devices With Safety Needles in Adolescents and Young Adults With Type 1 Diabetes: A Prospective Study

Purpose Current evidence indicates that diabetic patients' preference and medication adherence can be affected by the type of insulin pen needles. We aimed to assess the impact of insulin pen devices with safety needles (SPN) on the usability, behavioral, lifestyle, and emotional aspects of type 1 diabetes mellitus (T1DM) in adolescents and young adults. Patients and methods We conducted a prospective single-center study on adolescent T1DM patients treated with multiple insulin doses using basal-bolus therapy for at least one year. Patients were followed for 12 weeks to compare the changes in the baseline usability and insulin fear of self-injection scales between SPN and conventional needles. Results In this 12-week study, we included 72 participants with a mean age of 15.5 ± 1.3 years. The mean disease duration was 5.1 ± 2.2 years. At 12 weeks, substantial improvement was evident in the SPN group, compared to the conventional group, in terms of the overall satisfaction score with a mean difference (MD) of 4.1 ± 1.9 (p < 0.01). Participants in the SPN group reported significant reduction in all aspect of fear from self-injection, such as being restless (MD = -1.4 ± 0.9), tense (MD = -1.8 ± 0.9), afraid (MD = -1.9 ± 0.9), worried (MD = -1.9 ± 0.9), nervous (MD = -1.7 ± 0.9), and brood using the SPN needles (MD = -1.6 ± 0.9), as compared to the conventional needles group. The glycemic control parameters, as determined by HbA1c and fasting blood glucose, exhibited significant improvements in the SPN group compared to the conventional group (p < 0.05). Conclusion SPN significantly improved usability, glycemic parameters, and reduced the fear of insulin self-injections amongst T1DM patients compared to conventional pen therapy.

Education and training for preventing sharps injuries and splash exposures in healthcare workers

BACKGROUND

In healthcare settings, health care workers (HCWs) are at risk of acquiring infectious diseases through sharps injuries and splash exposures to blood or bodily fluids. Education and training interventions are widely used to protect workers' health and safety and to prevent sharps injuries. In certain countries, they are part of obligatory professional development for HCWs.

OBJECTIVES

To assess the effects of education and training interventions compared to no intervention or alternative interventions for preventing sharps injuries and splash exposures in HCWs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, NHSEED, Science Citation Index Expanded, CINAHL and OSH-update (from all time until February 2016). In addition, we searched the databases of Global Health, AustHealth and Web of Science (from all time until February 2016). The original search strategy was re-run in November 2019, and again in February 2020. In April 2020, the search strategy was updated and run in CINAHL, MEDLINE, Scopus and Web of Science (from 2016 to current).

SELECTION CRITERIA

We considered randomized controlled trials (RCTs), cluster-randomized trials (cluster-RCTs), controlled clinical trials (CCTs), interrupted time series (ITS) study designs, and controlled before-and-after studies (CBA), that evaluated the effect of education and training interventions on the incidence of sharps injuries and splash exposures compared to no-intervention.

DATA COLLECTION AND ANALYSIS

Two authors (SC, HL) independently selected studies, and extracted data for the included studies. Studies were analyzed, risk of bias assessed (HL, JL) , and pooled using random-effect meta-analysis, where applicable, according to their design types. As primary outcome we looked for sharps injuries and splash exposures and calculated them as incidence of injuries per 1000 health care workers per year. For the quality of evidence we applied GRADE for the main outcomes.

MAIN RESULTS

Seven studies met our inclusion criteria: one cluster-RCT, three CCTs, and three ITS studies. The baseline rates of sharps injuries varied from 43 to 203 injuries per 1000 HCWs per year in studies with hospital registry systems. In questionnaire-based studies, the rates of sharps injuries were higher, from 1800 to 7000 injuries per 1000 HCWs per year.  The majority of studies utilised a combination of education and training interventions, including interactive demonstrations, educational presentations, web-based information systems, and marketing tools which we found similar enough to be combined. In the only cluster-RCT (n=796) from a high-income country, the single session educational workshop decreased sharps injuries at 12 months follow-up, but this was not statistically significant either measured as registry-based reporting of injuries (RR 0.46, 95% CI 0.16 to 1.30, low-quality evidence) or as self-reported injuries (RR 0.41, 95% CI 0.14 to 1.21, very low-quality evidence) In three CCTs educational interventions decreased sharps injuries at two months follow-up (RR 0.68, 95% CI 0.48 to 0.95, 330 participants, very low-quality evidence). In the meta-analysis of two ITS studies with a similar injury rate, (N=2104), the injury rate decreased immediately post-intervention by 9.3 injuries per 1000 HCWs per year (95% CI -14.9 to -3.8). There was a small non-significant decrease in trend over time post-intervention of 2.3 injuries per 1000 HCWs per year (95% CI -12.4 to 7.8, low-quality evidence). One ITS study (n=255) had a seven-fold higher injury rate compared to the other two ITS studies and only three data points before and after the intervention. The study reported a change in injury rate of 77 injuries per 1000 HCWs (95% CI -117.2 to -37.1, very low-quality evidence) immediately after the intervention, and a decrease in trend post-intervention of 32.5 injuries per 1000 HCWs per year (95% CI -49.6 to -15.4, very low quality evidence). None of the studies allowed analyses of splash exposures separately from sharps injuries. None of the studies reported rates of blood-borne infections in patients or staff. There was very low-quality evidence of short-term positive changes in process outcomes such as knowledge in sharps injuries and behaviors related to injury prevention.  AUTHORS' CONCLUSIONS: We found low- to very low-quality evidence that education and training interventions may cause small decreases in the incidence of sharps injuries two to twelve months after the intervention. There was very low-quality evidence that educational interventions may improve knowledge and behaviors related to sharps injuries in the short term but we are uncertain of this effect. Future studies should focus on developing valid measures of sharps injuries for reliable monitoring. Developing educational interventions in high-risk settings is another priority.

Occupation-Related Injuries Among Healthcare Workers: Incidence, Risk Groups, and the Effect of Training

Background and objective

Occupation-related injuries (ORIs) are undesirable and harmful situations among healthcare workers (HCWs) and may have serious consequences. In this study, we aimed to identify and analyze ORI incidences, risk groups, and the outcomes of a training program to prevent them.

Materials and methods

Between January 2011 and December 2019, HCWs who applied for infection prevention and control (IPC) due to ORIs (percutaneous needlestick and sharp-object injury or contact with blood or body fluids) were included in the study. Their characteristic features, vaccine histories, injury types, viral serologies, and administered prophylaxis were recorded. After 2014, a periodic ORI training program was started. We used joinpoint regression analysis to compare the ORI incidences before and after the education program.

Results

During the nine-year study period, 965 ORIs were registered. The mean age of HCWs was 39.3 ± 8.4 years, and 67.9% of them were female. The total injury incidence for all professions was 34.1 (95% CI: 33.1-37.5) per 1,000 HCWs. The injury incidences were significantly higher in nurses compared to other HCWs (p<0.01). Most of the injuries occurred in the ward setting (37%). HCWs were injured most commonly while administering treatment (36.7%). The trend analysis for the incidence of injuries showed no significant change throughout the study period. The trend in personal protective equipment (PPE) use showed a significant increase (annual percentage change: 1.7, p<0.01).

Conclusions

The major finding of this study with respect to its implication on the healthcare system is that nurses are an important risk group for ORIs. Although the ORI incidence did not change during the study period, a significantly increased use of appropriate PPE following a systematic training program implementation was observed.

UK safety-engineered device use: changes since the 2013 sharps regulations

BACKGROUND

The 2013 UK sharps safety regulations require healthcare facilities to use safety-engineered devices (SEDs) to protect staff. The recent increase in UK-reported occupational exposures could indicate increased reporting or increased exposures from suboptimal SED use.

AIMS

To ascertain SED use through examination of sharps container contents in a sample of UK hospitals.

METHODS

Reusable sharps containers (RSCs) were selected from seven UK hospitals in 2013 and seven different hospitals in 2016. At licensed processing facilities, the operator, wearing protective apparel, decanted RSCs, separated hollow-bore needles (HBNs) from other sharps and enumerated HBNs into capped/uncapped non-SEDs, activated/non-activated/tampered SEDs, and blunt draw-up SEDs. Probability, risk ratios (RRs) and 95% confidence limits (95% CLs) were calculated using WinPepi v2.78.

RESULTS

In 2013 and 2016, respectively, 2545 HBNs were categorized from 22 RSCs versus 2959 HBNs from 33 RSCs; 70% of HBNs were SEDs versus 93% (P < 0.001; RR 1.33; CL 1.30-1.37); 32% of activatable HBNs were not activated versus 22% (<0.001; 0.67; 0.60-0.76); 41% of HBNs were discarded 'sharp' versus 20% (<0.001; 0.48; 0.44-0.52); 25% of HBNs were uncapped needles versus 6% (<0.001; 0.22; 0.19-0.26); 5% of HBNs were capped needles versus 1% (P > 0.05); and 1% of SEDs were tampered with in both years (P > 0.05). Hospital practices varied widely.

CONCLUSIONS

SED use and activation have increased significantly since 2013. Of concern is that in 2016, 22% of SEDs were non-activated and 20% of sharps were discarded 'sharp'. Increased training in SED handling, assiduous adherence to safe sharps work practices and a higher level of individual safety-ownership are indicated.

Overcoming public health risks to staff during the management of waste from healthcare facilities

Purpose The management of public health risks is a key focus for the European Union. One of the key factors that has been shown to pose a public health risk is that of the management of needles from healthcare facilities. The paper aims to discuss this issue. Design/methodology/approach Using audits of two case study hospitals based in northern Italy, this study sought to examine the key factors that resulted in needle stick injuries amongst staff and suggest measures to minimise these risks. Findings The number of needle stick injuries was influenced by various key factors including the time period during the year, the length of time employed, the location within the site, staff category and working hours. Practical implications Suggestions for overcoming the risk factors, including redesigning working patterns, staff training and awareness building, and the use of safety-engineered devices are outlined. Originality/value This study examined the incidence of needle stick injuries amongst healthcare staff in two Italian hospitals, which was lower than in other countries due to various factors, including recapping of needles not being allowed, the introduction of self-retractable needles and awareness campaigns about the correct disposal procedures of potentially infectious waste.

Elimination of Lancet-Related Needlestick Injuries Using a Safety-Engineered Lancet: Experience in a Hospital

Background

Lancet-related needlestick injuries (NSIs) occur steadily in clinical practices. Safety-engineered devices (SEDs) can systematically reduce NSIs. However, the use of SEDs is not active and no study to guide the implementation of SEDs was known in South Korea. The lancet-related NSIs may be eliminated to zero incidence using a SED lancet with effective sharp injury protection and reuse prevention features.

Materials and Methods

We implemented a SED lancet by replacing a conventional prick lancet in a tertiary hospital in a sequential approach. A spot test of the new SED was conducted for 1 month to check the acceptability in practice and a questionnaire survey was obtained from the healthcare workers (HCWs). A pilot implementation of the SED lancet in 2 wards was made for 1 year. Based on these preliminary interventions, a hospital-wide full implementation of the SED lancet was launched. The incidence of NSIs and cost expenditure before and after the intervention were compared.

Results

There were 29 cases of conventional prick lancet-related NSIs for 3 years before the full implementation of SED lancet. The proportion of prick lancet-related NSIs among yearly all kinds of NSIs during two years before the pilot study was average 11.7% (22/188). Pre-interventional baseline incidence of all kinds of NSIs was 7.01 per 100 HCW-years. After the full implementation of SED lancet, the lancet-related NSIs became zero in the 2nd year (P = 0.001). The average direct cost of 18,393 US dollars (USD) per year from device and post-exposure medical care before the intervention rose to 20,701 USD in the 2nd year of the intervention. The incremental cost-effectiveness ratio was 210 USD per injury avoided.

Conclusion

The implementation of a SED lancet could eliminate the lancet-related NSIs to zero incidence. The cost increase incurred by the use of SED lancet was tolerable.

Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers

Introduction

Needlestick injuries (NSIs) from a contaminated needle put healthcare workers (HCWs) at risk of becoming infected with a blood-borne virus and suffering serious short- and long-term medical consequences. Hypodermic injections using disposable syringes and needles are the most frequent cause of NSIs.

Objective

To perform a systematic literature review on NSI and active safety-engineered devices for hypodermic injection.

Methods

MEDLINE, EMBASE, and COCHRANE databases were searched for studies that evaluated the clinical, economic, or humanistic outcomes of NSI or active safety-engineered devices.

Results

NSIs have been reported by 14.9%–69.4% of HCWs with the wide range due to differences in countries, settings, and methodologies used to determine rates. Exposure to contaminated sharps is responsible for 37%–39% of the worldwide cases of hepatitis B and C infections in HCWs. HCWs may experience serious emotional effects and mental health disorders after a NSI, resulting in work loss and post-traumatic stress disorder. In 2015 International US$ (IntUS$), the average cost of a NSI was IntUS$747 (range IntUS$199–1,691). Hypodermic injections, the most frequent cause of NSI, are responsible for 32%–36% of NSIs. The use of safety devices that cover the needle-tip after hypodermic injection lowers the risk of NSI per HCW by 43.4%–100% compared to conventional devices. The economic value of converting to safety injective devices shows net savings, favorable budget impact, and overall cost-effectiveness.

Conclusion

The clinical, economic, and humanistic burden is substantial for HCWs who experience a NSI. Safety-engineered devices for hypodermic injection demonstrate value by reducing NSI risk, and the associated direct and indirect costs, psychological stress on HCWs, and occupational blood-borne viral infection risk.

Causes of needlestick injuries in three healthcare settings: analysis of accident notifications registered six months after the implementation of EU Directive 2010/32/EU in Germany

BACKGROUND

Needlestick injuries (NSIs) are the most common cause of sharps injuries and pose a serious risk to healthcare workers (HCWs). In 2014, 'Technical rule for biological agents in healthcare and welfare facilities' (TRBA 250) was modified in Germany in order to promote the prevention of sharps injuries.

AIMS

To examine the epidemiology of NSIs among HCWs in hospitals, doctor's offices and in- and outpatient care; to collect information on the causes of the accidents when safety-engineered devices (SEDs) are used; and to compare the results with the main principles of TRBA 250.

METHODS

The survey was based on HCWs' compensation claims for NSIs, as notified within a four-week period in November 2014. Detailed information on the NSI was collected by telephone interview.

FINDINGS

In total, 533 HCWs participated. Subcutaneous needles were most often involved in NSIs, regardless of the healthcare setting (39% of all NSIs). Insulin pens were involved in 48% of NSIs in in- and outpatient care. Disposal of sharps devices accounted for 38% of the injuries. SEDs were used in 20% of NSIs. Lack of activation was the most important cause of failure when SEDs were used.

CONCLUSION

Despite the binding recommendations of TRBA 250, more efforts are needed to increase the experience of HCWs in terms of working with SEDs. All professional groups must be encouraged to be more aware of the risks associated with sharps disposal. Safe handling practices for disposal of insulin pens are needed in in- and outpatient care settings.

Risk Reduction of Needle Stick Injuries Due to Continuous Shift from Unsafe to Safe Instruments at a German University Hospital

This study assessed protective effects of a continuous introduction of safe instruments in terms of reduction of needle stick injuries. The retrospective study analyzed correlations between the increasing proportion of safe instruments and a reduction of the incidence of needle stick injuries linked to such instruments in a German university hospital over 5 years. Incidents declined about 17.6% from 80.3 incidents per 1000 employees to 66.2, associated with an increase in the proportions of injuries due to instruments without protective mechanisms such as scalpels or hypodermic needles by 12.2%. For injuries due to venipuncture cannulae in various surgical and internal medicine departments, there was a negative association between the proportion of safe instruments and the incidence of injuries. For injection needles, portacath needles, and lancets in selected internal medicine departments, the number of injuries also dropped during this study interval. However, there was no clear-cut association with the percentage of safe instruments. This observational study suggests a correlation between the implementation of use of safe instruments and the reduction of needle stick injuries in a case of a graduated implementation. However, the effects are much less pronounced than in previous interventional studies.

New Insulin Delivery Recommendations

Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes.

Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis

BACKGROUND

The acquisition of needle-stick injuries (NSI) in a healthcare setting poses an occupational hazard of transmitting blood-borne pathogens from patients to healthcare workers (HCWs). The objective of this study was to systematically review the evidence about the efficacy and safety of using safety-engineered intravenous devices and safety-engineered phlebotomy devices by HCWs.

METHODS

We included randomized and non-randomized studies comparing safety-engineered devices to conventional/standard devices that lack safety features for delivering intravenous injections and/or for blood-withdrawal procedures (phlebotomy). The outcomes of interest included NSI rates, and blood-borne infections rates among HCWs and patients. We conducted an extensive literature search strategy using the OVID interface in October 2013. We followed the standard methods for study selection and data abstraction. When possible, we conducted meta-analyses using a random-effects model. We used the GRADE methodology to assess the quality of evidence by outcome.

RESULTS

We identified twenty-two eligible studies: Twelve assessed safety-engineered devices for intravenous procedures, five for phlebotomy procedures, and five for both. Twenty-one of those studies were observational while one was a randomized trial. All studies assessed the reduction in NSIs among HCWs. For safety-engineered intravenous devices, the pooled relative risk for NSI per HCW was 0.28 [0.13, 0.59] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.34 [0.08,1.49] (low quality evidence). For safety-engineered phlebotomy devices, the pooled relative risk for NSI per HCW was 0.57 [0.38, 0.84] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.53 [0.43,0.65] (moderate quality evidence). We identified no studies assessing the outcome of blood-borne infections among healthcare workers or patients.

CONCLUSION

There is moderate-quality evidence that the use of safety-engineered devices in intravenous injections and infusions, and phlebotomy (blood-drawing) procedures reduces NSI rates of HCWs.

Knowledge, attitudes, beliefs, values, preferences, and feasibility in relation to the use of injection safety devices in healthcare settings: a systematic review

Background

Adopting technologies such as injection safety devices in healthcare settings can enhance injection safety. Developing guidelines for appropriate adoption of such technologies need to consider factors beyond evidence for their health effects. The objective of this study is to systematically review the published literature for evidence among healthcare workers and patients about knowledge, attitudes, beliefs, values, preferences, and feasibility in relation to the use of injection safety devices in healthcare settings.

Methods

We included both qualitative and quantitative studies conducted with the general public, patients, and healthcare workers, administrators, or policy makers. We searched MEDLINE, EMBASE, CINHAL and CENTRAL. We used a duplicate and independent approach to title and abstract screening, full text screening, data abstraction and risk of bias assessment.

Results

Out of a total of 6568 identified citations, we judged fourteen studies as eligible for this systematic review. All these studies were surveys, conducted with healthcare workers in high-income countries. We did not identify any qualitative study, or a study of the general public, patients, healthcare administrators or policy makers. We did not identify any study assessing knowledge, or values assigned to outcomes relevant to injection safety devices. Each of the included studies suffered from methodological limitations, which lowers our confidence in their findings. Based on the findings of six studies, the injection safety devices were generally perceived as easy to use and as an improvement compared with conventional syringes. Some of these studies reported few technical problems while using the devices. In three studies assessing perceived safety, the majority of participants judged the devices as safe. Two studies reported positive perceptions of healthcare workers regarding patient tolerance of these injection safety devices. One study found that less than half the nurses felt comfortable using the insulin pens. Findings from four studies assessing preference and satisfaction were not consistent.

Conclusions

This systematic review identified evidence that injection safety devices are generally perceived as easy to use, safe, and tolerated by patients. There were few reports of technical problems while using the devices and some discomfort by nurses using the insulin pens.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-016-0505-8) contains supplementary material, which is available to authorized users.

Safety engineered injection devices for intramuscular, subcutaneous and intradermal injections in healthcare delivery settings: a systematic review and meta-analysis

BACKGROUND

Occupational sharps injuries are associated with transmission of bloodborne viruses to healthcare workers, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Similarly reuse of syringes in healthcare settings might transmit these infections between patients. The objective of this study was to systematically review the evidence about the effects of the use by health care workers of two types of safety engineered injection devices, when delivering intramuscular, subcutaneous, or intradermal injectable medications: sharps injury protection syringes and reuse prevention syringes.

METHODS

We included both randomized and non-randomized studies comparing safety syringes to syringes without safety features. Outcomes of interest included needlestick injuries, and HIV, HBV and HCV infections amongst HCWs (for sharps injury prevention syringes) and patients (for reuse prevention syringes). When possible, we conducted meta-analyses using a random-effects model. We tested results for heterogeneity across studies using the I statistic. We assessed the quality of evidence by outcome using the GRADE methodology.

RESULTS

We included nine eligible studies: six assessed devices that qualify as sharps injury prevention devices, and three assessed devices that qualify as both injury prevention devices and reuse prevention devices. Eight studies were observational while one was randomized. All studies assessed a single outcome: needle stick injuries among healthcare workers. For sharp injury prevention syringes, the meta-analysis of five studies resulted in a pooled relative risk of 0.54 [0.41, 0.71] for the effect on needlestick injuries per healthcare worker. The associated quality of evidence was rated as moderate. For reuse prevention syringes, data from one study provided a relative risk of 0.40 [0.27, 0.59] for the effect on needlestick injuries per healthcare worker. The associated quality of evidence was rated as moderate. We identified no studies reporting on the effect on the reuse of syringes.

CONCLUSIONS

We identified moderate quality evidence that syringes with sharps injury prevention feature reduce the incidence of needlestick injuries per healthcare worker. We identified no studies reporting data for the remaining outcomes of interest for HCWs. Similarly we identified no studies reporting on the effect of syringes with a reuse prevention feature on the reuse of syringes or on the other outcomes of interest for patients.

Prevention of needle-stick injuries in healthcare facilities: a meta-analysis

OBJECTIVE To estimate the summary effectiveness of different needle-stick injury (NSI)-prevention interventions. DESIGN We conducted a meta-analysis of English-language articles evaluating methods for reducing needle stick, sharp, or percutaneous injuries published from 2002 to 2012 identified using PubMed and Medline EBSCO databases. Data were extracted using a standardized instrument. Random effects models were used to estimate the summary effectiveness of 3 interventions: training alone, safety-engineered devices (SEDs) alone, and the combination of training and SEDs. SETTING Healthcare facilities, mainly hospitals PARTICIPANTS Healthcare workers including physicians, midwives, and nurses RESULTS From an initial pool of 250 potentially relevant studies, 17 studies met our inclusion criteria. Six eligible studies evaluated the effectiveness of training interventions, and the summary effect of the training intervention was 0.66 (95% CI, 0.50-0.89). The summary effect across the 5 studies that assessed the efficacy of SEDs was 0.51 (95% CI, 0.40-0.64). A total of 8 studies evaluated the effectiveness of training plus SEDs, with a summary effect of 0.38 (95% CI, 0.28-0.50). CONCLUSION Training combined with SEDs can substantially reduce the risk of NSIs.

Safety-engineered intravenous catheter utilization among Canadian pediatric anesthesiologists

INTRODUCTION

Compared with other specialties, anesthesiologists are at increased risk of acquiring a blood-borne pathogen (BBP) through needle-stick injuries (NSIs). Safety-engineered intravenous catheters (SEICs) have been designed to reduce NSIs but have not been well received. Our objective was to determine SEIC usage by pediatric anesthesiologists, including availability, utilization, perceived utility, and sources of NSI before and after legislation mandating their use in Canada.

METHODS

After Ethics Committee approval, we conducted two electronic surveys of Canadian pediatric anesthesiologists (CPAs) based in tertiary care settings. Survey responses from May through August 2012 and June through September 2006 were considered. In addition to SEIC use and perceived utility, respondents described factors influencing SEIC adoption and workplace NSIs. Standard metrics of survey validity and reliability were employed.

RESULTS

Completed questionnaires were returned by 154 (69%) and 124 (53%) respondents in 2012 and 2006, respectively, representing 15 of 16 Canadian pediatric tertiary care centres. Reported SEIC availability increased in hospitals (82% vs 98%; difference in proportion 16%, 95% confidence interval [CI]: 9 to 24%; P < 0.001) and in operating rooms (62% vs 86%; difference in proportion 24%, 95% CI: 13 to 34%; P < 0.001) Respondents' report of "routine" personal use of SEICs increased from 43 of 76 (56%) to 112 of 132 (85%) (difference in proportion 29%, 95% CI: 16 to 41%; P < 0.001). Attitudes concerning perceived utility of SEICs remained unchanged and evenly split between respondents. "Awkward handling" remained the primary reason for non-use. In all, 71 (48%) and 60 (48%) respondents reported recent contaminated NSIs in 2012 and 2006, respectively. The majority were related to a needle on a disposable syringe.

DISCUSSION

Despite only moderate perceived utility, SEIC uptake among CPAs is high. However, NSIs remain common. Several opportunities to reduce the risk for work-related BBP transmission among CPAs were evident.

The serious and ongoing issue of needlestick in Australian healthcare settings

Australian healthcare workers and especially nurses repeatedly have their safety and health jeopardized through occupational exposures to blood and body fluids. Percutaneous or needlestick injuries are especially concerning and consistent. The purpose of this article is to again draw attention to the serious and costly issue of needlestick injuries in Australian healthcare settings. Specifically it considers the context of needlestick injuries and safety engineered devices within Standard 3 of the Australian Commission on Safety and Quality in Health Care's National Standards reform agenda. Given that Standard 3 alone will likely be insufficient to reduce needlestick injuries, this article also discusses improvements and current challenges in international needlestick injury reduction in an attempt to stimulate key opinion leader consideration of Australia adopting similar strategies.

Sharps Injuries among Employees of Acute Care Hospitals in Massachusetts, 2002–2007

Objective.

Sharps with engineered sharps injury protections (SESIPs) have been found to reduce risk of sharps injuries (Sis). We examined trends in SI rates among employees of acute care hospitals in Massachusetts, including the impact of SESIPs on SI trends during 2002-2007.

Design.

Prospective surveillance.

Setting.

Seventy-six acute care hospitals licensed by the Massachusetts Department of Public Health.

Participants.

Employees of acute care hospitals who reported Sis to their employers.

Methods.

Data on Sis in acute care hospitals collected by the Massachusetts Sharps Injury Surveillance System were used to examine trends in SI rates over time by occupation, hospital size, and device. Negative binomial regression was used to assess trends.

Results.

During 2002-2007, 16,158 Sis among employees of 76 acute care hospitals were reported to the surveillance system. The annual SI rate decreased by 22%, with an annual decline of 4.7% (P< .001). Rates declined significantly among nurses (—7.2% per year;P< .001) but not among physicians (—0.9% per year;P= .553). SI rates associated with winged steel needles and hypodermic needles and syringes also declined significantly as the proportion of injuries involving devices with sharps injury prevention features increased during the same time period.

Conclusion.

SI rates involving devices for which SESIPs are widely available and appear to be increasingly used have declined. The continued use of devices lacking SI protections for which SESIPs are available needs to be addressed. The extent to which injuries involving SESIPs are due to flaws in design or lack of experience and training must be examined.

Two-year follow-up of the Collision Auto Repair Safety Study (CARSS)

This paper presents an evaluation of the sustainability of health and safety improvements in small auto collision shops 1 year after the implementation of a year-long targeted intervention. During the first year (active phase), owners received quarterly phone calls, written reminders, safety newsletters, and access to online services and in-person assistance with creating safety programs and respirator fit testing. During the second year (passive phase), owners received up to three postcard reminders regarding the availability of free health and safety resources. Forty-five shops received an evaluation at baseline and at the end of the first year (Y1). Of these, 33 were evaluated at the end of the second year (Y2), using the same 92-item assessment tool. At Y1, investigators found that between 70 and 81% of the evaluated items were adequate in each business (mean = 73% items, SD = 11%). At Y2, between 63 and 89% of items were deemed adequate (mean = 73% items, SD = 9.5%). Three safety areas demonstrated statistically significant (P < 0.05) changes: compressed gasses (8% improvement), personal protective equipment (7% improvement), and respiratory protection (6% decline). The number of postcard reminders sent to each business did not affect the degree to which shops maintained safety improvements made during the first year of the intervention. However, businesses that received more postcards were more likely to request assistance services than those receiving fewer.

The importance of implementing safe sharps practices in the laboratory setting in Europe

Healthcare workers are at risk of sharps injuries and subsequent infection from more than 40 bloodborne pathogens or species. Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) together account for the vast majority of cases. The Directive 2010/32/EU “Prevention from sharp injuries in the hospital and healthcare sector”, issued to protect workers from these risks, requires an integrated approach to prevention including awareness-raising, education, training, elimination of unnecessary needles, safe procedures for sharps use and disposal, banning of recapping, vaccination, use of personal protective equipment, provision of safety-engineered devices, and appropriate surveillance, monitoring, response and follow-up.

As laboratories represent a high-risk setting both in the preanalytical and analytical phase, we reviewed accidents and prevention in this setting in the light of the new legislation.

Phlebotomy is the procedure carrying the highest risk of exposure and infection, involved in 30–50% of HIV and HCV cases detected in nationwide systems following accidental blood exposures implemented since the 1990s in Italy and France. In laboratories, problems in the management of sharps containers, recapping, needle disassembly by hand and blood transfer from syringes into tubes were observed and accounted for two-thirds of injuries. These accidents could be reduced through education and monitoring of behaviours, and introduction of medical devices incorporating safety-engineered protection mechanisms with appropriate training. Laboratory staff should be immunized against HBV, and know policies and procedures for the post-exposure management and prophylaxis. The management commitment to safety is crucial to ensure the necessary support to these changes.

epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England

National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of health care in NHS hospitals in England can be minimised.

Safeguarding the process of drug administration with an emphasis on electronic support tools

AIMS

The aim of this work is to understand the process of drug administration and identify points in the workflow that resulted in interventions by clinical information systems in order to improve patient safety.

METHODS

To identify a generic way to structure the drug administration process we performed peer-group discussions and supplemented these discussions with a literature search for studies reporting errors in drug administration and strategies for their prevention.

RESULTS

We concluded that the drug administration process might consist of up to 11 sub-steps, which can be grouped into the four sub-processes of preparation, personalization, application and follow-up. Errors in drug handling and administration are diverse and frequent and in many cases not caused by the patient him/herself, but by family members or nurses. Accordingly, different prevention strategies have been set in place with relatively few approaches involving e-health technology.

CONCLUSIONS

A generic structuring of the administration process and particular error-prone sub-steps may facilitate the allocation of prevention strategies and help to identify research gaps.

FIT4Safety: recommendations in the diabetes care setting

Sharps injuries pose a serious threat to health professionals, patients, and downstream workers. FIT4Safety is an initiative that seeks to promote safety and best practice in the diabetes setting. An Introduction to FIT4Safety and its Recommendations for the Safety of Sharps in the Diabetes Care Setting explains how and why the FIT4Safety initiative was formed, what it aims to achieve, and the importance of ensuring safety in the diabetes care setting. Outputs from FIT4Safety include Injection Safety in UK and Ireland: Safety of Sharps in Diabetes Recommendations. These recommendations were developed to provide a resource for all those directly involved in, or overseeing, diabetes care. The main topics and guidance detailed within the recommendations are discussed, as well as EU Directive 2010/32 on sharps injury prevention and the UK's Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

Sharps injuries: the risks and relevance to plastic surgeons

Surgeons are at risk for injury in the operating room daily. Because of the ubiquity of occupational hazards, injuries remain prevalent and expensive. Although occupational hazards can include musculoskeletal conditions, psychosocial stress, radiation exposure, and the risk of communicable diseases, sharps injuries remain the most common among surgeons in practice and the most frequent route of transmission of blood-borne pathogens. Therefore, increased attention to the health, economic, personal, and social implications of these injuries is essential for appropriate management and future prevention.

Chinks in the armor: percutaneous injuries from hollow bore safety-engineered sharps devices

BACKGROUND

Despite their overwhelming efficacy, safety-engineered sharp devices (SESDs) cause a residual fraction of injuries. Although the fraction of injuries from SESDs is less than that reported for nonsafety devices, it remains a "preventable fraction" and is a sizable target for further advances.

METHODS

A retrospective review of 3,297 percutaneous injuries from hollow bore safety-engineered devices occurring between 2001 and 2009 was conducted examining the Exposure Prevention Information Network (EPINet) needlestick surveillance data.

RESULTS

Nurses sustain 64.6% of all SESD injuries. 42.9% Of SESD injuries occur after device use and are likely preventable through consistent and effective use of safety-engineered technology. Excluding injuries that occurred during device use or between procedural steps, 71.8% (n/N = 28/39) of physician injuries, 58.2% (n/N = 645/1,109) of injuries to nurses, and 45.8% (n/N = 88/192) of injuries to phlebotomists occurred when an available SESD was not fully activated.

CONCLUSION

Passive devices that do not require action on the part of the end user to engage a safety feature currently represent a small portion of the SESD market. Wider dissemination of a broader array of passive SESDs coupled with continual education of end users is essential to an effective sharps injury prevention program.

Needlestick and sharps injuries among housekeeping workers in hospitals of Shiraz, Iran

BACKGROUND

Needlestick and sharps injuries (NSSIs) are one of the major risk factors for blood-borne infections (BBPs) at healthcare facilities. This study examines the current prevalence of NSSIs among housekeeping workers engaged in the handling and disposal of biomedical waste (BMW) at government and private hospitals in Shiraz, Iran, and furthermore, explores strategies for preventing these injuries.

FINDINGS

Using a cross-sectional study design, NSSI's and associated protective measures for housekeeping workers throughout hospitals in Shiraz were evaluated from 2009 onwards. Using a questionnaire, data was collected for 92 workers who had engaged directly with BMW. Data was analyzed using Chi-square, student t-test and where appropriate, SPSS version 12. 90.2 % of housekeeping workers were warned of the dangers associated with waste, 87.5 % in government and 93.2 % in private hospitals (P = 0.0444). 83.7 % had attended educational programs on biomedical waste (BMW) management and injury prevention at their hospital in the preceding year. 16.3 % had not been trained in biomedical waste management (P = 0.0379) and 88.9 % had a sufficient supply of safety wear.

CONCLUSIONS

NSSIs are a common risk factor for infection among health care workers within hospitals in Iran. For the effective prevention of these injuries, health boards and hospital trusts need to formulate strategies to improve the working conditions of health care workers, discourage the excessive use of injections, and increase their adherence to universal precautions.

Conventional and sharp safety devices in 6 hospitals in British Columbia, Canada

BACKGROUND

Reengineered sharp safety devices have been recommended to reduce occupational percutaneous injury risk in health care facilities. We conducted this study just over 1 year after passage of legislation requiring the use of sharp safety medical devices to assess the frequency of safety and conventional sharp device use and whether safety features were being activated to cover sharp points after safety devices were used and before disposal.

METHODS

Approximately equal numbers of sharps disposal containers from various wards in 6 nonprofit adult and pediatric British Columbia hospitals were audited by paired research assistants, wearing protective clothing.

RESULTS

In the 699 audited sharps containers, 7% (1,690/25,910) of all devices were conventional devices, specifically 2% (96/4,702) of all phlebotomy devices, 7% (1,240/17,705) of all syringes, and 10% (354/3,503) of all intravenous catheters. In addition, 94% (4,344/4,602) of all safety phlebotomy devices, 95% (2,955/3,119) of all safety intravenous devices, and 80% (13,050/16,420) of all safety syringes had been activated before disposal.

CONCLUSION

More than 1 year after legislation was passed mandating the use of sharp safety devices in British Columbia hospitals, the risk from sharps remains excessive because of the ongoing use of conventional sharp devices and nonactivation of safety devices.

Safety syringes and anti-needlestick devices in orthopaedic surgery

BACKGROUND

The American Academy of Orthopaedic Surgery (AAOS), The Joint Commission, the Occupational Safety and Health Administration (OSHA), and the Needlestick Safety and Prevention Act encourage the integration of safety-engineered devices to prevent needlestick injuries to health-care workers and patients. We hypothesized that safety syringes and needles could be used in outpatient orthopaedic injection and aspiration procedures.

METHODS

The study investigated the orthopaedic uses and procedural idiosyncrasies of safety-engineered devices, including (1) four safety needles (Eclipse, SafetyGlide, SurGuard, and Magellan), (2) a mechanical safety syringe (RPD), (3) two automatic retractable syringes (Integra, VanishPoint), (4) three manual retractable syringes (Procedur-SF, Baksnap, Invirosnap), and (5) three shielded syringes (Safety-Lok, Monoject, and Digitally Activated Shielded [DAS] Syringe). The devices were first tested ex vivo, and then 1300 devices were used for 425 subjects undergoing outpatient arthrocentesis, intra-articular injections, local anesthesia, aspiration biopsy, and ultrasound-guided procedures.

RESULTS

During the clinical observation, there were no accidental needlesticks (0 needlesticks per 1300 devices). Safety needles could be successfully used on a Luer syringe but were limited to ≤1.5 in (≤3.81 cm) in length and the shield could interfere with sonography. The mechanical safety syringes functioned well in all orthopaedic procedures. Automatic retractable syringes were too small for arthrocentesis of the knee, and the plunger blew out and prematurely collapsed with high-pressure injections. The manual retractable syringes and shielded syringes could be used with conventional needles for most orthopaedic procedures.

CONCLUSIONS

The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting safety-engineered devices for an orthopaedic clinic, conventional syringes larger than 20 mL and conventional needles longer than 1.5 in (3.8 cm) are necessary.

Insulin administration: selecting the appropriate needle and individualizing the injection technique

INTRODUCTION

Patients with diabetes who receive insulin therapy often fail to meet their targets for metabolic control with insulin injections. Their inadequate glycemic control may be related to incorrect injection procedure.

AREAS COVERED

This review examines the latest data related to insulin injection and needle characteristics, which play an integral role in patient satisfaction. Searches of Medline and Cumulative Index to Nursing and Allied Health Literature databases were conducted. Results show that optimal insulin injection can facilitate glycemic control in pediatric and adult patients. In general, needles shorter than 8 mm are appropriate for normal weight, obese pediatric and adult patients. However, body mass index, gender, race, age and injection site can influence the depth of subcutaneous tissue and thus, the desired needle size and injection technique. Although the abdomen, thighs and buttocks are all recommended injection sites, abdominal injections disperse insulin slightly more rapidly than thigh injections.

EXPERT OPINION

Wider acceptance of needles shorter than 6 mm will occur with more evidence of their safety and efficacy, particularly in children. Development of shorter and thinner needles to make injections even easier and less burdensome may be expected in the future.

Ongoing use of conventional devices and safety device activation rates in hospitals in Ontario, Canada

This study assessed voluntary compliance with the use of sharp safety devices in lieu of conventional ones and the activation status of these safety devices: VanishPoint syringes, Terumo Surshield butterflies, and Insyte Autoguard IV catheters. Sharps disposal containers from various wards in three private, not-for profit, university-affiliated Ontario hospitals were audited during 9 days in August 2007. In the 149 audited sharps containers, 55% of all syringes found were conventional compared with 45% that were safety syringes. In the three hospitals, the percentages of conventional (non-safety) vs. safety syringes found in used sharps containers were as follows, respectively: (i) 72% conventional and 28% safety, (ii) 55% conventional and 45% safety, and (iii) 65% conventional and 35% safety. In addition, it was found that 77% of 2131 Terumo butterflies, 97% of 1117 Insyte Autoguard IV catheters, and 87% of 4897 VanishPoint syringes in the containers had been activated. This study, carried out approximately 1 year before it was legally required to use safety instead of sharp conventional devices, found that most devices in use were conventional ones. It was also found that only the activation rate for the safety IV device was acceptable.

New injection recommendations for patients with diabetes

AIM

Injections administered by patients are one of the mainstays of diabetes management. Proper injection technique is vital to avoiding intramuscular injections, ensuring appropriate delivery to the subcutaneous tissues and avoiding common complications such as lipohypertrophy. Yet few formal guidelines have been published summarizing all that is known about best practice. We propose new injection guidelines which are thoroughly evidence-based, written and vetted by a large group of international injection experts.

METHODS

A systematic literature study was conducted for all peer-reviewed studies and publications which bear on injections in diabetes. An international group of experts met regularly over a two-year period to review this literature and draft the recommendations. These were then presented for review and revision to 127 experts from 27 countries at the TITAN workshop in September, 2009.

RESULTS

Of 292 articles reviewed, 157 were found to meet the criteria of relevance to the recommendations. Each recommendation was graded by the weight it should have in daily practice and by its degree of support in the medical literature. The topics covered include The Role of the Professional, Psychological Challenges, Education, Site Care, Storage, Suspension and Priming, Injecting Process, Proper Use of Pens and Syringes, Insulin analogues, Human and Pre-mixed Insulins, GLP-1 analogs, Needle Length, Skin Folds, Lipohypertrophy, Rotation, Bleeding and Bruising, Pregnancy, Safety and Disposal.

CONCLUSION

These injecting recommendations provide practical guidance and fill an important gap in diabetes management. If followed, they should help ensure comfortable, effective and largely complication-free injections.

Image-directed fine-needle aspiration biopsy of the thyroid with safety-engineered devices

PURPOSE

The purpose of the present study was to integrate safety-engineered devices into outpatient fine-needle aspiration (FNA) biopsy of the thyroid in an interventional radiology practice.

MATERIALS AND METHODS

The practice center is a tertiary referral center for image-directed FNA thyroid biopsies in difficult patients referred by the primary care physician, endocrinologist, or otolaryngologist. As a departmental quality of care and safety improvement program, we instituted integration of safety devices into our thyroid biopsy procedures and determined the effect on outcome (procedural pain, diagnostic biopsies, inadequate samples, complications, needlesticks to operator, and physician satisfaction) before institution of safety devices (54 patients) and after institution of safety device implementation (56 patients). Safety devices included a patient safety technology-the mechanical aspirating syringe (reciprocating procedure device), and a health care worker safety technology (antineedlestick safety needle).

RESULTS

FNA of thyroid could be readily performed with the safety devices. Safety-engineered devices resulted in a 49% reduction in procedural pain scores (P < 0.0001), a 56% reduction in significant pain (P < 0.002), a 21% increase in operator satisfaction (P < 0.0001), and a 5% increase in diagnostic specimens (P = 0.5). No needlesticks to health care workers or patient injuries occurred during the study.

CONCLUSIONS

Safety-engineered devices to improve both patient and health care worker safety can be successfully integrated into diagnostic FNA of the thyroid while maintaining outcomes and improving safety.

Management practices and risk of occupational blood exposure in U.S. paramedics: Needlesticks

BACKGROUND

The purpose of this study was to present risk estimates for needlestick in U.S. paramedics and estimated risk ratios for selected management practices.

METHODS

A mail survey was conducted among a national sample of U.S. paramedics in 2002-2003.

RESULTS

The adjusted response rate was 55% (n = 2,664). The overall 12-month risk of needlestick was 6.7% (95% confidence interval, 5.4-7.9). Risk ratios for provision of safety-engineered medical devices and two supervisory behaviors that emphasized safe work practices ranged from 2.5 to 3.2. The protective effect of working in an environment that included both of the supervisory behaviors was greater than the protective effect of always being provided with safety devices. A sensitivity analysis indicated that the risk ratio estimates were unlikely to be inflated by nonresponse bias.

CONCLUSIONS

These results suggest that greater provision of safety devices and interventions aimed at management practices that promote worker safety could substantially reduce the risk of needlestick among U.S. paramedics.

Needlestick injury rates according to different types of safety-engineered devices: results of a French multicenter study

OBJECTIVES

To evaluate the incidence of needlestick injuries (NSIs) among different models of safety-engineered devices (SEDs) (automatic, semiautomatic, and manually activated safety) in healthcare settings.

DESIGN

This multicenter survey, conducted from January 2005 through December 2006, examined all prospectively documented SED-related NSIs reported by healthcare workers to their occupational medicine departments. Participating hospitals were asked retrospectively to report the types, brands, and number of SEDs purchased, in order to estimate SED-specific rates of NSI. Setting. Sixty-one hospitals in France.

RESULTS

More than 22 million SEDs were purchased during the study period, and a total of 453 SED-related NSIs were documented. The mean overall frequency of NSIs was 2.05 injuries per 100,000 SEDs purchased. Device-specific NSI rates were compared using Poisson approximation. The 95% confidence interval was used to define statistical significance. Passive (fully automatic) devices were associated with the lowest NSI incidence rate. Among active devices, those with a semiautomatic safety feature were significantly more effective than those with a manually activated toppling shield, which in turn were significantly more effective than those with a manually activated sliding shield (P < .001, chi(2) test). The same gradient of SED efficacy was observed when the type of healthcare procedure was taken into account.

CONCLUSIONS

Passive SEDs are most effective for NSI prevention. Further studies are needed to determine whether their higher cost may be offset by savings related to fewer NSIs and to a reduced need for user training.

Does sonographic needle guidance affect the clinical outcome of intraarticular injections?

OBJECTIVE

This randomized controlled study addressed whether sonographic needle guidance affected clinical outcomes of intraarticular (IA) joint injections.

METHODS

In total, 148 painful joints were randomized to IA triamcinolone acetonide injection by conventional palpation-guided anatomic injection or sonographic image-guided injection enhanced with a one-handed control syringe (the reciprocating device). A one-needle, 2-syringe technique was used, where the first syringe was used to introduce the needle, aspirate any effusion, and anesthetize and dilate the IA space with lidocaine. After IA placement and synovial space dilation were confirmed, a syringe exchange was performed, and corticosteroid was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks), and changes in pain scores were measured with a 0-10 cm visual analog pain scale (VAS).

RESULTS

Relative to conventional palpation-guided methods, sonographic guidance resulted in 43.0% reduction in procedural pain (p < 0.001), 58.5% reduction in absolute pain scores at the 2 week outcome (p < 0.001), 75% reduction in significant pain (VAS pain score > or = 5 cm; p < 0.001), 25.6% increase in the responder rate (reduction in VAS score > or = 50% from baseline; p < 0.01), and 62.0% reduction in the nonresponder rate (reduction in VAS score < 50% from baseline; p < 0.01). Sonography also increased detection of effusion by 200% and volume of aspirated fluid by 337%.

CONCLUSION

Sonographic needle guidance significantly improves the performance and outcomes of outpatient IA injections in a clinically significant manner.

[Waste management in hospitals. Current situation in the state of North Rhine-Westphalia]

In 20 hospitals in North Rhine-Westphalia in-plant handling wastes and the delivery of the waste to the disposer were examined. Deficits were seen regarding risk assessment and operating instructions, support by company doctors, personal protection equipment, and break areas for the waste collecting personnel. Also the qualification of the waste management officer and his/her time contingent, correct declaration of the wastes, the training of the waste collecting personnel, the cleaning of multi-use containers and transportation vehicles, storage of the wastes at the collecting points, and the use of sharp collecting boxes were to be partly criticized. Consequences and recommendations are given, concerning the company's obligations (e.g., provide risk assessment, operating instructions), waste management officer (e.g., qualification, enough time contingent, regular inspections), waste collecting personnel (e.g., training courses), industrial safety (e.g., protection equipment, break area wash places), company doctors, transportation vehicles in the house (e.g., regular cleaning), one-way collectors (e.g., labelling at the site of the collection), multi-use collectors (e.g., cleaning), and compressing containers (e.g., larger maintenance openings).