Sharps injury recordkeeping activities and safety product use in California health care facilities: pilot study results from the sharps injury control program

Sharps Injuries in the Home Health Care Setting

Home health care nurses are at risk of needle-sticks and blood exposures, yet few studies have been conducted related to such exposures in the home health care setting. This article describes a cross sectional prevalence pilot study of needle-sticks and blood exposures conducted among three home health care agencies in the San Francisco Bay area. Needlestick and blood exposure reports from 1993 to 1996 were submitted from three home health care agencies. The exposures were categorized using an existing categorization system and compiled into a composite report. A total of 52 exposures occurred; nurses sustained 92% of exposures. Twenty-three percent occurred before, during, or after needle disposal; 17% from manipulating intravenous/access ports; 15% from improper disposal; and 13.5% during or after blood draw. Needle safety devices need to be specifically designed for the unique home health care setting and for a standardized rate of calculating needlestick injuries in this setting.

Needlestick Injuries in Nursing Homes: The Prominent Role of Insulin Pens

Causes and circumstances related to 162 needlestick injuries in nursing homes were analyzed. In addition to nurses, geriatrics helpers were found to be an important occupational group at risk. Insulin pens were the most frequent cause of needlestick injuries among nursing personnel. Insulin pens are a major instrument involved with unsafe needle-handling practices.

The Snowman: A model of injuries and near-misses for the prevention of sharps injuries

BACKGROUND

Sharps injuries (SI) and other blood/body fluid exposures (BBFE) present bloodborne pathogen risks for home healthcare (HHC) workers. While SI and BBFE are sufficiently frequent in HHC to be serious public health concerns, even moderately large surveys can still have insufficient power to identify risk factors. In this study, a new conceptual model for using near-misses for SI and BBFE was developed and its utility in statistical analyses of SI and BBFE risk factors was evaluated.

METHODS

A survey of HHC nurses (n = 787) and aides (n = 282) gathered data on the numbers of SI, BBFE, and near-misses in the past year. Questions focused on the circumstances leading up to the SI, BBFE, and near-misses. After evaluating the hypothesis that near-misses and events lie along the same causal pathway, we combined these outcomes to estimate their association with an important risk factor: employment status.

RESULTS

There were similar frequencies of risk factors for the events SI, BBFE, and their near-misses, suggesting that they may share common causal pathways. Combined data on events and near-misses confirmed our hypothesis that part-time and temporary HHC aides were at higher risk than full-timers.

CONCLUSIONS

Analyses combining injuries and near-misses may be useful in risk factor investigations.

Knowledge, attitudes and practices towards blood-borne pathogens in healthcare workers in Banja Luka, Bosnia and Herzegovina

Exposure to blood borne pathogens poses a serious risk to healthcare workers (HCWs). This study was undertaken to investigate knowledge, attitudes and practices among HCWs towards blood borne pathogens. We carried out a cross sectional KAP (Knowledge, Attitudes and Practice) study, using self-administered questionnaire. The study population consisted of 127(23.6%) physicians, and 410 (76.4%) nurses and laboratory technicians. Factor analysis and conditional multiple logistic regression were used in statistical analysis. We found that the knowledge of the epidemiological characteristics of blood-borne infection, the risk of acquisition and available preventative measures among HCWs is insufficient. Doctors were more knowledgeable about the transmissibility of blood borne pathogens regarding sexual transmission after percutaneous exposure (odds ratio) OR=2.71; 95% (confidence interval) CI=1.51–4.84, OR=2.45; 95% CI=1.21–4.96), respectively. Nurses reported professional exposure to patient’s blood more often than doctors (OR=0.90; 95% CI=0.84–0.96). Negative attitudes towards HIV positive patients were also noted. Less than half of HCWs used appropriate barriers (gloves, mask, and glasses) to protect them regularly. The compulsory preventive measures implied by the results of this study are continuous education, immunization against Hepatitis B, implementing Standard Precautions, as well as the development of written guidelines on the prevention of blood-borne infections.

A retractable winged steel (butterfly) needle performance improvement project

A performance improvement project used an interdisciplinary, systematic approach, including frontline staff input, in identifying, selecting, and evaluating a safer needle device. Following adoption of a retractable needle, needlesticks of health care workers decreased from 3.19 to zero incidents per 100,000 needles.

Occupational exposure to blood and body fluids among health care workers in a general hospital, China

OBJECTIVES

To understand current status of occupational exposure to blood and body fluids (BBF), and awareness of knowledge about occupational bloodborne pathogen exposures and universal precaution among hospital-based health care workers (HCWs).

METHODS

A cross-sectional study was conducted during April to May 2004 to study incidence of occupational exposure to BBF among 1,144 hospital-based HCWs.

RESULTS

The total incidence and the average number of episodes exposure to BBF was 66.3/100 HCWs per year and 7.5 per person per year in the past year, respectively. The incidence (per 100/HCWs per year) and the average number of episodes (per HCW per year) of percutaneous injury (PCI), mucous-membrane exposure (MME), and exposure to BBF by damaged skin was 50.3 and 1.8; 34.4 and 1.7; and 37.9 and 4.0, respectively. The leading incidence and the average number of episodes of PCI occurred in delivery room (82.6 and 1.8). The highest percentage of PCI's that occurred during the previous 2 weeks occurred during a surgical operation (22.8%). Of all sharp instruments, the suture needle contributed the highest percentage of PCI's (24.7%) among HCWs in the last 2 weeks. Over two-thirds (68.3%) of respondents were immunized with Hepatitis B vaccine; less than one-half (47%) of HCWs wore gloves while doing procedures on patients. The respondents demonstrated a lack of knowledge regarding transmission of bloodborne diseases and universal precautions.

CONCLUSIONS

Risk for potential exposure to BBF appears high in HCWs, and almost all of episodes are not reported. It is urgent to establish the Guideline for Prevention and Control of Occupational Exposure to Bloodborne Pathogens among HCWs. Am. J. Ind. Med. 52:89-98, 2009. (c) 2008 Wiley-Liss, Inc.

Perceived barriers to implementation of a successful sharps safety program

IN RESPONSE TO INCREASING needle sticks and sharps injuries at a large, urban trauma center in the northeastern United States, a nurse educator assembled a focus group of OR staff members to determine what they perceived to be barriers to successful implementation of a sharps safety program. THE FOCUS GROUP IDENTIFIED inadequate communication, powerlessness, resistance to change, intimidation, inconsistencies in practice, negative attitudes, inexperienced staff members, and time constraints as barriers to a successful change implementation. USING THIS INFORMATION, the nurse educator identified strategies to implement a practice change to decrease the rate of needle sticks and sharps injuries.

Occupational exposure to blood and body fluids among health care workers in Ankara, Turkey

BACKGROUND

The risk of occupational acquisition of bloodborne pathogens via exposure to blood and body fluids is a serious problem for health care workers in Turkey. Because there are no systematic recording programs in Turkey, national data concerning frequency of exposures are not readily available.

OBJECTIVE

To determine the risk factors of exposure to blood and body fluids among health care workers (HCWs).

METHODS

This study was conducted in the hospitals of Ankara University School of Medicine. A structured survey form was administered by person-to-person interview.

RESULTS

The study included 988 HCWs: 500 nurses (51%), 212 residents (21%), 152 nurse assistants (15%), and others (13%). Six hundred thirty-four (64%) of the HCWs had been exposed to blood and body fluids at least once in their professional life (0.85 exposure per person-year). The most frequent cause of the sharps injuries was recapping the needle (45%). Of the injured HCWs, 60 (28%) were not using any personal protective equipment, and 144 (67%) did not seek any medical advice for injury.

CONCLUSIONS

Systematic control measures, including an effective and goal-oriented education program targeting HCWs, prospective record keeping, and instillation of a special unit for the health of HCWs should be implemented in the hospital setting.

Impact of safety devices for preventing percutaneous injuries related to phlebotomy procedures in health care workers

BACKGROUND

Use of protective devices has become a common intervention to decrease sharps injuries in the hospitals; however few studies have examined the results of implementation of the different protective devices available.

OBJECTIVE

To determine the effectiveness of 2 protective devices in preventing needlestick injuries to health care workers.

METHODS

Sharps injury data were collected over a 7-year period (1993-1999) in a 3600-bed tertiary care university hospital in France. Pre- and postinterventional rates were compared after the implementation of 2 safety devices for preventing percutaneous injuries (PIs) related to phlebotomy procedures.

RESULTS

From 1993 to 1999, an overall decrease in the needlestick-related injuries was noted. Since 1996, the incidence of phlebotomy-related PIs has significantly decreased. Phlebotomy procedures accounted for 19.4% of all percutaneous injuries in the preintervention period and 12% in the postintervention period (RR, O.62; 95% CI, 0.51-0.72; P < .001). Needlestick-related injuries incidence rate decreased significantly after the implementation of the 2 safety devices, representing a 48% decline in incidence rate overall.

CONCLUSIONS

The implementation of these safety devices apparently contributed to a significant decrease in the percutaneous injuries related to phlebotomy procedures, but they constitute only part of a strategy that includes education of health care workers and collection of appropriate data that allow analysis of residuals percutaneous injuries.

A review of sharps injuries and preventative strategies

Exposure to bloodborne pathogens from sharps injuries continues to pose a significant risk to healthcare workers (HCW). The number of sharps injuries sustained by HCW is still unclear, primarily due to under-reporting. In this review a mean rate of 4.0% (range 1.0-6.2%) sharps injuries per 10000 HCW was calculated from eight studies involving more than 7000 HCW. Nurses and doctors were most at risk of sharps injuries, frequently from hollow-bore needles. Approaches to reduce this risk have included education and training on the safe handling and disposal of sharp devices, awareness campaigns and legislative action. More recently, preventative strategies have focused on needle protective devices, which may reduce the rate of sharps injuries. Introducing needle protective devices should be considered particularly in high-risk areas, after training, education, evaluation and cost-benefit analysis.

Sharps-related injuries in California healthcare facilities: pilot study results from the Sharps Injury Surveillance Registry

BACKGROUND AND OBJECTIVES

In 1998, the California Department of Health Services invited all healthcare facilities in California (n = 2,532) to participate in a statewide, voluntary sharps injury surveillance project. The objectives were to determine whether a low-cost sharps registry could be established and maintained, and to evaluate the circumstances surrounding sharps injuries in California.

RESULTS

Approximately 450 facilities responded and reported a total of 1,940 sharps-related injuries from January 1998 through January 2000. Injuries occurred in a variety of healthcare workers (80 different job titles). Nurses sustained the highest number of injuries (n = 658). In hospital settings (n = 1,780), approximately 20% of the injuries were associated with drawing venous blood, injections, or assisting with a procedure such as suturing. As expected, injuries were caused by tasks conventionally related to specific job classifications. The overall results approximate those reported by the Centers for Disease Control and Prevention's National Surveillance System for Health Care Workers and the University of Virginia's Exposure Prevention Information Network.

CONCLUSION

These data further support findings from previous studies documenting the complex and persistent nature of sharps-related injuries in healthcare workers. In the future, mandated reporting using standardized forms and consistent application of decision rules would facilitate a more thorough analysis of injury events.