Economic burden of needlestick injuries among healthcare workers in China

Objective: To estimate the economic burden of needlestick injuries (NSIs) among healthcare workers (HCWs) in China.Design: A model was built to evaluate the economic burden of NSIs.Methods: The cost model was developed from a societal perspective, including both direct and indirect costs, with lifetime horizon. The direct costs were categorized into infection prevention and treatment of infections. The indirect cost included productivity loss of both HCWs and his/her family members due to the blood-borne infections. Sub-group analyses were conducted to estimate the cost per NSI when the source patient (SP) was confirmed with hepatitis B virus/hepatitis C virus/human immunodeficiency virus (HBV/HCV/HIV) infection. One-way and probabilistic sensitivity analyses were conducted for all parameters to examine the robustness of the result.Results: The model projected a total cost of ¥699 for each NSI (direct and indirect cost were ¥553 and ¥146, respectively). The cost per NSI when the SP was confirmed with HBV/HCV/HIV was ¥4,238, ¥18,404, and ¥6,152, respectively. The total economic burden of NSIs among HCWs in China was estimated to be ¥5.8 billion, and about half of the cost was associated with NSIs in nurses, at ¥2.8 billion.Limitations: This study did not incorporate the costs of litigation/psychological, and the prevalence of the infections was based on the general population, so the actual costs per NSI may be underestimated. More real-world studies of treatment cost about HBV/HCV are needed to further supporting this study.Conclusions: The economic burden of NSIs among HCWs in China is substantial. Comprehensive NSI prevention programs, including implementation of safety needles and devices, have high potential for healthcare institutions to achieve downstream cost savings and cost offsets.

Economic analysis of new workplace technology including productivity and injury: The case of needle-less injection in swine

Increasing intensification in swine production has led to new and specialized technologies, but the occupational health and safety impacts are rarely quantified in the business plans for adoption. Needle-less injection has potential to increase productivity and eliminate needle stick injury in workers, but it is not clear whether these benefits offset high capital investment and potential increases in musculoskeletal loads. This economic evaluation employed probabilistic scenario analysis using injury, cost, and production data gathered from interviews with swine producers in Manitoba and Saskatchewan. After adoption of needle-less injection, rates of needle-stick injury went down with no measureable effect on upper limb musculoskeletal disorders, resulting in lower health and safety costs for needle-less injectors. Needle-less injection duration was 40% faster once workers acclimatized, but large start-up costs mean economic benefits are realized only after the first year. The incremental benefit cost ratio promoted adoption of needle-less injectors over conventional needles for the base case of a 1200 sow barn; the conventional method is beneficial for barns with 600 sows or less. Findings indicate that well-designed technologies have the potential to achieve the dual ergonomics goals of enhancing human wellbeing and system performance. We anticipate that the economic and decision models developed in this study can be applied to other new technologies in agriculture and animal production.

Estimating the national cost burden of in-hospital needlestick injuries among healthcare workers in Japan

Background

Needlestick injury (NSI) is one of the most burdensome professional hazards in any medical setting; it can lead to transmission of fatal infectious diseases, such as hepatitis B, hepatitis C and human immunodeficiency virus. In the United States, the annual cost burden was estimated as somewhere between $118 million to $591 million; in the United Kingdom it is approximated to be £500,000 (US$919,117.65) per the National Health Service.

Method

This is the first published paper on the national cost burden of NSIs in Japan. A systematic literature review was conducted to review previous study design in global studies and to extract parameter values from Japanese studies. We conducted abstract searches through PubMed and the Japan Medical Abstracts Society (Ichushi), together with grey literature and snowball searches. A simple economic model was developed to calculate cost burden of NSIs from a societal perspective over a one-year time horizon. We assumed all NSIs are reported and perfect adherence in post NSI management that presented in the labour compensation scheme. Local guidelines were also referenced to extract resource utilization. Lastly, a deterministic sensitivity analysis was conducted and a scenario analysis which considered a payer perspective was also included.

Result and conclusion

The national cost burden of in-hospital NSIs is estimated as ¥33.4 billion (US$302 million) annually, based on an average cost per NSI of ¥63,711 (US$577) and number of NSIs at 525,000/year. 70% of the cost is due to initial laboratory tests, followed by productivity loss, estimated at 20% of the total cost. Cost of contaminated NSIs remains at 5% of the total cost. Change in number of NSIs significantly influences outcomes. Variation in post-exposure management practices suggests a need for NSI specific National guidelines and holistic labour compensation scheme development in Japan.

How Much do Needlestick Injuries Cost? A Systematic Review of the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel

OBJECTIVE To provide an overview of the economic aspects of needlestick and sharps injury (NSI) management among healthcare personnel (HCP) within a Health Technology Assessment project to evaluate the impact of safety-engineered devices on health care METHODS A systematic review of economic analyses related to NSIs was performed in accordance with the PRISMA statement and by searching PubMed and Scopus databases (January 1997-February 2015). Mean costs were stratified by study approach (modeling or data driven) and type of cost (direct or indirect). Costs were evaluated using the CDC operative definition and converted to 2015 International US dollars (Int$). RESULTS A total of 14 studies were retrieved: 8 data-driven studies and 6 modeling studies. Among them, 11 studies provided direct and indirect costs and 3 studies provided only direct costs. The median of the means for aggregate (direct + indirect) costs was Int$747 (range, Int$199-Int$1,691). The medians of the means for disaggregated costs were Int$425 (range, Int$48-Int$1,516) for direct costs (9 studies) and Int$322 (range, Int$152-Int$413) for indirect costs (6 studies). When compared with data-driven studies, modeling studies had higher disaggregated and aggregated costs, but data-driven studies showed greater variability. Indirect costs were consistent between studies, mostly referring to lost productivity, while direct costs varied widely within and between studies according to source infectivity, HCP susceptibility, and post-exposure diagnostic and prophylactic protocols. Costs of treating infections were not included, and intangible costs could equal those associated with NSI medical evaluations. CONCLUSIONS NSIs generate significant direct, indirect, potential, and intangible costs, possibly increasing over time. Economic efforts directed at preventing occupational exposures and infections, including provision of safety-engineered devices, may be offset by the savings from a lower incidence of NSIs. Infect Control Hosp Epidemiol 2016;37:635-646.

Needlestick injuries in a major teaching hospital: the worthwhile effect of hospital-wide replacement of conventional hollow-bore needles

BACKGROUND

Needlestick injury (NSI) with hollow-bore needles remains a significant risk of bloodborne virus acquisition in health care workers. The impact on NSI rates after substantial replacement of conventional hollow-bore needles with the simultaneous introduction of safety-engineered devices (SEDs) including retractable syringes, needle-free intravenous (IV) systems, and safety winged butterfly needles was examined in an 800-bed Australian university hospital.

METHODS

NSIs were prospectively monitored for 2 years (2005-2006) after the introduction of SEDs and compared with prospectively collected preintervention NSI data (2000-2004).

RESULTS

Preintervention hollow-bore NSI rates over 10 years persisted at a constant rate between 3.01 and 3.77 per 100 full-time equivalent employees (FTE) (P = .31). Rates for 2005 (1.93; 95% CI: 1.48-2.47 per 100 FTE) and 2006 (1.50; 95% CI: 1.11-1.97 per 100 FTE) were significantly lower than the average rate for the preintervention years (3.39; 95% CI: 2.7-4.24 per 100 FTE, P = .00004). This represents a fall of 49% (43.1%-55.7%) in hollow-bore NSI, contributed to by the virtual elimination of NSI related to accessing IV lines. More importantly, high-risk injuries were also reduced 57% by retractable syringe use with an overall budgetary increase of approximately US $90,000 per annum.

CONCLUSION

Introduction of SEDs results in an impressive fall in NSI with minimal cost outlay.

Costs of needlestick injuries and subsequent hepatitis and HIV infection

BACKGROUND

Physicians, nurses and other healthcare workers (HCWs) are at risk of bloodborne pathogens infection from needlestick injuries, but costs of needlesticks are little studied.

METHODS

We used the cost-of-illness and incidence approaches. We used the perspective of the medical provider (medical costs) and the individual (lost productivity). Data on needlesticks, infections from hepatitis B and C (HBV, HCV) and human immune-deficiency (HIV) among HCWs, as well as data on per-unit costs were culled from research literature, Centers for Disease Control and Prevention reports, and Bureau of Labor Statistics reports. We also generated estimates based upon industry employment and scenarios for source-patients. These data and estimates were combined with assumptions to produce a model that generated base-case estimates as well as one-way and multi-way probabilistic sensitivity analyses. Future costs were discounted by 3%.

RESULTS

We estimated 644,963 needlesticks in the healthcare industry for 2004 of which 49% generated costs. Medical costs were $107.3 million of which 96% resulted from testing and prophylaxis and 4% from treating long-term infections (34 persons with chronic HBV, 143 with chronic HCV, and 1 with HIV). Lost-work productivity generated $81.2 million, for which 59% involved testing and prophylaxis and 41% involved long-term infections. Combined medical and work productivity costs summed to $188.5 million. Multi-way sensitivity analysis suggested a range on combined costs from $100.7 million to $405.9 million.

CONCLUSION

Detailed methodology was developed to estimate costs of needlesticks and subsequent infections for hospital-based and non-hospital-based health care workers. The combined medical and lost productivity costs comprised roughly 0.1% of all occupational injury and illness costs for all jobs in the economy. We did not account for lost home production or pain and suffering costs, however, nor did we estimate benefit/cost ratios of specific interventions to reduce needlesticks.

Percutaneous injuries among dental professionals in Washington State

BACKGROUND

Percutaneous exposure incidents facilitate transmission of bloodborne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV). This study was conducted to identify the circumstances and equipment related to percutaneous injuries among dental professionals.

METHODS

We used workers' compensation claims submitted to the Department of Labor and Industries State Fund during a 7-year period (1995 through 2001) in Washington State for this study. We used the statement submitted by the injured worker on the workers' compensation claim form to determine the circumstances surrounding the injury including the type of activity and device involved.

RESULTS

Of a total of 4,695 accepted State Fund percutaneous injury claims by health care workers (HCWs), 924 (20%) were submitted by dental professionals. Out of 924 percutaneous injuries reported by dental professionals 894 (97%) were among dental health care workers in non-hospital settings, including dentists (66, 7%), dental hygienists (61, 18%) and dental assistants (667, 75%). The majority of those reporting were females (638, 71%). Most (781, 87%) of the injuries involved syringes, dental instruments (77, 9%), and suture needles (23%). A large proportion (90%) of injuries occurred in offices and clinics of dentists, while remainder occurred in offices of clinics and of doctors of medicine (9%), and a few in specialty outpatient facilities (1%). Of the 894 dental health care workers with percutaneous injuries, there was evidence of HBV in 6 persons, HCV in 30 persons, HIV in 3 persons and both HBV and HVC (n = 2) exposure.

CONCLUSION

Out of hospital percutaneous injuries are a substantial risk to dental health professionals in Washington State. Improved work practices and safer devices are needed to address this risk.

Análisis coste-efectividad de dispositivos sanitarios diseñados para prevenir exposiciones percutáneas

OBJECTIVE

To assess the efficiency of the replacement of several medical devices by engineered sharp injury (SI) prevention devices (ESIPDs).

METHODS

The cost-effectiveness ratios of the replacement of medical devices in use by ESIPDs were estimated: their purchasing costs and the direct costs of sharp injury care were taken into account; the number of SI avoidable by each ESIPD was estimated from the 252 occupational SI notified by healthcare workers at a 1,300 bed hospital from March 2002 to February 2003. The relationship between ESIPD additional costs and the number of high-risk SI was estimated (SI were classified as high-risk if they met two or more of the following criteria: moderately-deep or deep injury, injury with a device previously inserted in an artery or vein, or with a device exposed to blood).

RESULTS

ESIPDs order according to cost-effectiveness ratio: safety needle for implanted ports (-2.65 euro/SI avoided), followed by syringes with protective shield (869.79 euro/SI), resheathable winged steel needles, needleless administration sets, and short catheters with protective encasement. ESIPDs order according to relationship between additional costs and number of high-risk sharp injuries avoided: safety needles for implanted ports, followed by winged steel needles, hypodermic syringes, short catheter and needleless administration sets.

CONCLUSIONS

Savings in SI care outweigh additional costs of certain ESIPDs. Cost-effectiveness analysis is useful in assigning priorities; however the risks of SI by every device must be taken into account.

Workers' compensation claims for needlestick injuries among healthcare workers in Washington State, 1996-2000

OBJECTIVES

To characterize accepted workers' compensation claims for needlestick injuries filed by healthcare workers (HCWs) in non-hospital compared with hospital settings in Washington State.

DESIGN

Descriptive study of all accepted workers' compensation claims filed between 1996 and 2000 for needlestick injuries.

PARTICIPANTS

All Washington State HCWs eligible to file a state fund workers' compensation claim and those who filed a workers' compensation claim for a needlestick injury.

RESULTS

There were 3,303 accepted state fund HCW needlestick injury claims. The incidence of needlestick injury claims per 10,000 full-time-equivalent HCWs in hospitals was 158.6; in dental offices, 104.7; in physicians' offices, 87.0; and in skilled nursing facilities, 80.8. The most common mechanisms of needlestick injury by work location were as follows: for hospitals, suturing and other surgical procedures (16.7%), administering an injection (12.7%), and drawing blood (10%); for dentists' offices, recapping (21.3%) and cleaning trays and instruments (18.2%); for physicians' offices, disposal (22.2%) and administering an injection (10.2%); and for skilled nursing facilities, disposal (23.7%) and administering an injection (14.9%). Nurses accounted for the largest (29%) proportion of HCWs involved, followed by dental assistants (17%) and laboratory technicians and phlebotomists (12%) in non-hospital settings. Rates of needlestick injury claims increased for non-hospital settings by 7.5% annually (95% confidence interval [CI95], 4.89% to 10.22%; P < .0001). Rates decreased for hospital settings by 5.8% annually, but the decline was not statistically significant (CI95, -12.50% to 1.34%; P < .1088). HCWs were exposed to hepatitis B, hepatitis C, and human immunodeficiency viruses in non-hospital settings.

CONCLUSION

There was a difference in the incidence rate and mechanisms of needlestick injuries on review of workers' compensation claim records for HCWs in non-hospital and hospital settings.

Short-term economic impact associated with occupational needlestick injuries among acute care nurses

PURPOSE

Recent survey data have reported the incidence rate of needlestick injuries (NIs) and NIs which draw blood sustained by nurses caring for patients with diabetes in an in-patient hospital setting. The purpose of this study was to deduce the potential short-term annual economic impact resulting from such NI, and to project the potential national economic burden of NI among this population of health care workers (HCWs).

METHODS

Data were obtained from a recently published, IRB-approved, Internet-based survey in which nurses routinely treating patients with diabetes self-reported outcomes of their experience with NI (N = 400). A micro-costing approach was adopted. Direct costs comprised post-exposure testing (PET) for infection, post-exposure health care services utilization, and NI-induced post-exposure prophylactic (PEP) drug utilization. Indirect costs were derived from missed workdays and associated lost productivity. These data were combined with data related to the national epidemiology and total incidence of NIs among HCWs and risk-associated populations to project the national burden.

RESULTS

Among 400 nurses, 110 sustained at least one NI in the past year, with 73 punctures drawing blood. The ensuing total short-term costs of these NIs were calculated to range from 25,896 US dollars to 36,066 US dollars. Indirect costs accounted for 44-62% of this total cost. Average short-term costs per NI ranged from 145 to 201 US dollars, and average short-term costs of NI per injured nurse ranged from 235 to 328 US dollars. Assuming mean values from published literature on the incidence and distribution of NI among nursing populations, an annual national burden of 65 million US dollars was calculated for costs in the immediate period following NI.

CONCLUSIONS

These data suggest substantial economic burden immediately following NI on a national and individual hospital level occurring among acute-care nurses treating patients with diabetes. Long-term treatment costs would add to the overall economic burden.

Get a hold on costs and safety with securement devices

Evidence shows that commercially available catheter securement devices both reduce accidental needlesticks to healthcare workers and prevent catheter-related bloodstream infections by limiting catheter movement.

Needlestick injuries in the United States. Epidemiologic, economic, and quality of life issues

Best evidence from prospective studies with aggressive monitoring suggests that the incidence of needlestick injuries is significantly higher than reported through passive surveillance, ranging from 14 to 839 needlestick injuries per 1,000 health care workers per year. The economic cost of managing these injuries is substantial, ranging from dollars 51 to dollars 3,766 (2002 U.S. dollars). This amount excludes the cost of treating the long-term complications of needlestick injuries, such as HIV and hepatitis B and C infections, each of which can cost several hundreds of thousands of dollars to manage. In addition, health care workers experience significant fear, anxiety, and emotional distress following a needlestick injury, sometimes resulting in occupational and behavior changes. Despite the availability of engineered injury prevention devices, the implementation of these new technologies has been mixed in part because of the perception that these devices are costly and cost ineffective. However, widespread use of safety devices might be more easily justified on economic grounds when the full clinical and economic benefits of these new technologies are considered, especially within the context of injury prevention.

Actualización del coste de las inoculaciones accidentales en el personal sanitario hospitalario

OBJECTIVES

To update the mean cost of each hepatitis B, hepatitis C and HIV follow-up in health personnel accidentally exposed to blood and body fluids, to stratify the cost depending on the serological status of the source, and to identify the items that account for the main part of the cost.

METHODS

A cost analysis was carried out. The postexposure program was modeled on a decision tree combining probabilities (percentage of each type of source depending on positivity for the three viruses and immunization status of the health worker against hepatitis B) and monetary costs (euros in 2002). Costs included salaries, laboratory, pharmacy (including postexposure prophylaxis), water, gas and electricity, cleaning, telephone, medical and office equipment, amortization and lost productivity.

RESULTS

The mean cost was 388 euros, ranging from 1,502 euros (source positive for hepatitis C and HIV) to 172 euros (source negative for the three viruses). If the source was hepatitis B positive, the mean cost was 666 euros when the injured worker was not immunized and was 467 euros if the worker was immunized. Serologic tests and postexposure prophylaxis accounted for the main part of the cost.

CONCLUSIONS

The high cost suggests the need for appropriate risk evaluation to avoid unnecessary follow-ups. The model used allows the cost of each potentially avoidable episode to be determined and could be used in any hospital to perform an economic evaluation of new preventive devices.

Safety syringes can reduce the risk of needlestick injury in venous thromboembolism prophylaxis

Patients undergoing major orthopaedic surgery of the lower extremities are at high risk of developing venous thromboembolism (VTE). Pharmacologic thromboprophylaxis has greatly reduced the likelihood of VTE. The most effective medications are administered once or twice daily by subcutaneous injection, a drug delivery route associated with an increased risk of needlestick injury. Awareness of the potential lethality of needlestick injuries has increased during the past decade, resulting in the development of national safety guidelines from the Occupational Safety and Health Administration on the handling and management of needles and other sharps. This article reviews the potential risks and costs associated with needlestick injury during the administration of VTE prophylaxis in patients undergoing major orthopaedic surgery. The development of novel anticoagulants and accompanying devices to prevent needlestick injury is also discussed.

Willingness to pay to avoid sharps-related injuries: a study in injured health care workers

BACKGROUND

Injuries caused by sharp medical devices are common among health care workers and may result in the transmission of human immunodeficiency virus and hepatitis C virus.

OBJECTIVE

The direct medical costs associated with treating these injuries are well characterized but fail to capture the costs of such intangible factors as worker anxiety and distress. The objective of this study was to estimate these intangible costs.

SUBJECTS

Subjects included health care workers reporting sharps-related injuries to 2 hospital occupational health services.

METHOD

A contingent valuation approach was used to assess willingness to pay to avoid sharps-related injuries among recently injured health care workers. Workers were presented with the option of paying out of pocket for a hypothetical injury-prevention device. The median amount of money subjects were willing to pay was estimated with logistic regression, and multivariable regression was performed to assess confounding by worker characteristics and circumstances surrounding injuries.

RESULTS

Study interviews were conducted for 116 subjects; median time from injury to interview was 3 days (range, 0-15). Most subjects were women (73%), and most were nurses (44%) or trainees (32%). The crude median amount subjects were willing to pay to avert injury was $850 (US); when adjusted for patient risk status (human immunodeficiency virus and hepatitis C virus status), and working with an uncooperative patient at the time of injury, median amount increased to $1270.

CONCLUSION

The high median amount subjects were willing to pay to avoid a sharps-related injury suggests that the costs of "intangible" aspects of worker injury, such as anxiety and distress, may equal costs associated with the medical evaluation of these injuries. These costs should be incorporated in economic analyses of sharps-injury prevention.

Report of the Council on Scientific Affairs: preventing needlestick injuries in health care settings

Needlestick injuries continue to pose a significant risk to health care workers; however, appropriate use of needlestick prevention devices, especially in comprehensive prevention programs, can significantly reduce the incidence of such injuries. Cost analyses indicate that use of these devices will be cost-effective in the long term. To provide more scientific and cost data on the efficacy of needlestick prevention devices, recording of needlestick injuries must be improved. Federal law now requires the use of safety-engineered sharps devises to protect health care workers, and state-level legislation on the use and evaluation of needlestick prevention devices is under consideration. Health care employers should evaluate the implementation of needlestick prevention devices with the participation of employees who will use such devices and, where appropriate, introduce such devices accompanied by the necessary education and training, as part of a comprehensive sharps injury prevention and control program.

Reducing percutaneous injuries in the OR by educational methods

Exposure to bloodborne pathogens (e.g., HIV, hepatitis B, hepatitis C) through percutaneous injuries is an occupational risk for health care workers, especially those in the OR. The incidence of disease continues to rise, although occupational exposures often go unreported. Percutaneous injury prevention methods have included use of safety devices, practice changes, and educational programs. An educational intervention to increase awareness of risk, provide suggestions for injury reduction, and encourage reporting of exposures was performed at a university teaching hospital. Preliminary qualitative results show increased exposure reporting, increased use of personal protective equipment, and increased awareness of disease exposure risk among OR personnel.

Costs and benefits of measures to prevent needlestick injuries in a university hospital

OBJECTIVE

To document the costs and the benefits (both in terms of costs averted and of injuries averted) of education sessions and replacement of phlebotomy devices to ensure that needle recapping did not take place.

DESIGN

The percentage of recapped needles and the rate of needlestick injuries were evaluated in 1990 and 1997, from a survey of transparent rigid containers in the wards and at the bedside and from a prospective register of all injuries in the workplace. Costs were computed from the viewpoint of the hospital. Positive costs were those of education and purchase of safer phlebotomy devices; negative costs were the prophylactic treatments and follow-up averted by the reduction in injuries.

SETTING

A 1,050-bed tertiary-care university hospital in the Paris region.

RESULTS

Between the two periods, the proportion of needles seen in the containers that had been recapped was reduced from 10% to 2%. In 1990, 127 needlestick (12.7/100,000 needles) and 52 recapping injuries were reported versus 62 (6.4/100,000 needles) and 22 in 1996 and 1997. When the rates were related to the actual number of patients, the reduction was 76 injuries per year. The total cost of information and preventive measures was $325,927 per year. The cost-effectiveness was $4,000 per injury prevented.

CONCLUSION

Although preventive measures taken to ensure reduction of needlestick injuries appear to have been effective (75% reduction in recapping and 50% reduction in injuries), the cost of the safety program was high.

Needlesticks: who pays the price when costs are cut on safety

Here is a syringe whose spring-loaded needle automatically retracts into the barrel of the syringe almost quicker than the eye can register--If you've never seen one, you're not alone. Despite the prevalence of needles engineered with safety features to prevent needlesticks, few organizations are using them. The reasons why go far beyond the expense of the syringe.

Accidental needlesticks in the phlebotomy service of the Department of Laboratory Medicine and Pathology at Mayo Clinic Rochester

OBJECTIVE

To determine the change in accidental needlestick rates in the Phlebotomy Service at Mayo Clinic Rochester and to identify safety practices implemented from 1983 through 1996.

MATERIAL AND METHODS

We retrospectively reviewed yearly Phlebotomy Service accidental needlestick rates from 1983 through 1996. Interviews were conducted with representatives of the Infection Control Committee and the management team for the Phlebotomy Service, and minutes of meetings of these two groups were reviewed to identify implemented safety improvements that may have had an effect on accidental needlestick exposures.

RESULTS

Accidental needlestick exposures in the Phlebotomy Service declined from a high of 1.5/10,000 venipunctures to 0.2/10,000 venipunctures. Several safety improvements were made during that time, including the implementation of a one-handed recapping block, change to single-use evacuated tube holders, increased number and improved locations of disposal containers for needles, implementation of resheathing needles and retractable capillary puncture devices, discontinuation of the practice of changing needles before inoculation of blood culture bottles, increased emphasis on safety for new and experienced phlebotomists, and improved exposure reporting tools.

CONCLUSION

We believe that the decrease in our accidental needlestick exposure rate is correlated with the changes in education, practices, and products that we have implemented.

Reducing the risk of needlestick injury associated with implanted ports

Implanted ports give many of our patients a sense of freedom that they have not known since they have been sick. Between infusions, they do not have to be reminded constantly of their illness through an external vascular access device. However, this patient advantage does carry some degree of risk for the nurse working with the patient and the device. Needlestick injuries are serious and expensive. There is a financial and emotional toll that cannot be measured. Each employer is required by OSHA to have an exposure control plan for eliminating or minimizing employee exposure to bloodborne pathogens (OSHA, 1991, 1994). Inventions such as the HuberLoc meet the criteria for devices that can reduce the risk of injury through engineering controls. Agencies need to know that OSHA-mandated worker protection can be both easy to use and cost effective. Home care nurses need to be more proactive in informing agencies about such devices and lobbying for their use.

[Costs of accidental punctures in hospital health personnel]

OBJECTIVES

The aim of this study was to calculate the average cost of each hepatitis B, C and HIV follow-up carried out in the health personnel that have suffered an exposure to blood and body fluids and to estimate the cost for each of the different types of sources as well as to identify the items that account for the main part of the cost.

METHODS

A cost analysis was carried out. The post-exposure programme was modelled in a decision tree combining probabilities (percentage of each type of source in dependence of its positivity for the three viruses and immunization state of the health personnel against hepatitis B) and monetary costs (pesetas from 1994). Costs included: salaries, laboratory, chemist, energy, cleaning, telephone, medical and office equipment, amortization and lost productivity. A sensitivity analysis was carried out with the real fulfillment of the programme.

RESULTS

The average cost was 39,564 ptas. (29,750 ptas. applying the sensitivity analysis), with a range from 86,864 ptas. (source positive for the three viruses and injured subject not immunized) to 23,074 ptas. (source negative for the three viruses). If the source was hepatitis B positive, the average cost was 86,093 ptas. when the injured subject was not immunized and 53,232 ptas. if he was immunized. Serologic tests account for the main part of the cost (range from 72.8% to 87.7%).

CONCLUSIONS

High cost suggests an appropriate risk evaluation in order to avoid unnecessary follow-ups. The model used allows to know the cost of each potentially avoided episode and it could be used for any hospital in order to make an economical evaluation of new preventive devices.

Do protective devices prevent needlestick injuries among health care workers?

OBJECTIVES

To determine the effectiveness and direct of two protective devices-a shielded 3 ml safety syringe (Safety-Lok; Becton Dickinson and Co., Becton Dickinson Division, Franklin Lakes, N.J.) and the components of a needleless IV system (InterLink; Baxter Healthcare Corp., Deerfield, Ill.)--in preventing needlestick injuries to health care workers.

DESIGN

Twelve-month prospective, controlled, before-and-after trial with a standardized questionnaire to monitor needlestick injury rates.

SETTING

Six hospital inpatient units, consisting of three medical units, two surgical units (all of which were similar in patient census, acuity, and frequency of needlesticks), and a surgical-trauma intensive care unit, at a 900-bed urban university medical center.

PARTICIPANTS

All nursing personnel, including registered nurses, licensed practical nurses, nursing aides, and students, as well as medical teams consisting of an attending physician, resident physician, interns, and medical students on the study units.

INTERVENTION

After a 6-month prospective surveillance period, the protective devices were randomly introduced to four of the chosen study units and to the surgical-trauma intensive care unit.

RESULTS

Forty-seven needlesticks were reported throughout the entire study period, 33 in the 6 months before and 14 in the 6 months after the introduction of the protective devices. Nursing staff members who were using hollow-bore needles and manipulating intravenous lines accounted for the greatest number of needlestick injuries in the pre-intervention period. The overall rate of needlestick injury was reduced by 61%, from 0.785 to 0.303 needlestick injuries per 1000 health care worker-days after the introduction of the protective devices (relative risk = 1.958; 95% confidence interval, 1.012 to 3.790; p = 0.046). Needlestick injury rates associated with intravenous line manipulation, procedures with 3 ml syringes, and sharps disposal were reduced by 50%; however, reductions in these subcategories were not statistically significant. No seroconversions to HIV-1 or hepatitis B virus seropositivity occurred among those with needlestick injuries. The direct cost for each needlestick prevented was $789.

CONCLUSIONS

Despite an overall reduction in needlestick injury rates, no statistically significant reductions could be directly attributed to the protective devices. These devices are associated with a significant increase in cost compared with conventional devices. Further studies must be concurrently controlled to establish the effectiveness of these devices.

Emergency needlestick injury

During the course of a year, there are many healthcare workers nationwide who sustain sharps injuries whilst carrying out their duties. Staff who work in the Accident and Emergency (A & E) units are no different from anyone else in this respect. The emotional cost of such an accident cannot be calculated, whereas the financial costs can. This article aims to show how the cost of an injury to a member of staff can be calculated, thus allowing a manager to assess the financial implications of sharps injuries to their department. In the absence of access to an Occupational Health (OH) department, most A & E units have to respond to sharps injuries to healthcare workers in the hospital. This task must be attended to by the medical staff as well as the nursing staff of the A & E unit. Within the following text the appropriate responses and methods to ensure uniformity of response are discussed. The tables and the calculation figures shown are taken directly from the information held in the St James's University Hospital Trust's OH department. All calculations are based on the middle band of the salary scale for each discipline. Accurate costings for each member of staff injured cannot be shown in this article, but the general principle is laid down and can be easily followed for any situation.

Efficacy and cost-effectiveness of a needleless intravenous access system

BACKGROUND

Needlestick injury has been identified as a major cause of exposure to blood and body fluids. The heparin-lock intermittent intravenous procedure was implicated in the largest number of needlestick-related exposures (26%) at this 1100-bed tertiary care hospital, and replacement of this system was imperative. Cost concerns, however, necessitated that replacement products not increase overall hospital costs.

METHODS

A needleless intravenous access system (Interlink i.v. Access System; Baxter Healthcare Corp., Parenterals Division, Deerfield, Ill.) was introduced. Effectiveness and cost-benefit of this system were analyzed by comparing needlestick injuries and their associated costs, as well as costs of relevant products and procedures, for the year before introduction of the new product with those for 1 year after implementation of the new system.

RESULTS

During the study period, the needleless access system was 78.7% effective in reducing intravenous line-related needlestick injuries. There was an overall reduction of 43.4% in total needlestick injuries from all procedures and events. The incremental cost to this hospital ranged from a 5.3% additional cost to a 5.7% savings, without even considering the less quantifiable benefits associated with avoidance of needlestick injury, time saved by using this product, and decreased infection rate.

CONCLUSION

When used as intended, this system was extremely effective in reducing intravenous line-related needlestick injuries, and the system does pay for itself.

Application of cost-effectiveness methodology to the consideration of needlestick-prevention technology

Data from the study of needlestick-prevention devices in 10 New York State hospitals enabled application of cost-effectiveness analysis techniques for determining relative benefits of various safety interventions. This article introduces to infection control practitioners several economic concepts related to cost-effectiveness methodology and provides two examples of how they may be applied for decision-making purposes. A critical aspect of the analysis described is the determination of a base cost of needlestick injury. By applying decision analysis to experience-based data aggregated from participating institutions, base expected cost of needlestick injury was determined to be $363.

Evaluation and implementation of a needleless intravenous system: making needlesticks a needless problem

A needleless intravenous (IV) system with blunt plastic cannulas and specially designed injection sites was introduced at Olive View Medical Center to reduce needlestick injuries, particularly IV-related needlesticks. IV-related needlestick injuries decreased 72% during the first 8 months of use, costs were reduced $1.85 for a typical IV piggyback administration set-up by revising the IV piggyback procedure, and a staff survey revealed satisfaction with the new system.