Ginger Parker

Increase in Sharps Injuries in Surgical Settings Versus Nonsurgical Settings after Passage of National Needlestick Legislation

BACKGROUND The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings. STUDY DESIGN We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members. RESULTS Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others. CONCLUSIONS Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeons hands, there are also roles for administrators, educators, and policy makers.

Issues in Understanding the Impact of the Needlestick Safety and Prevention Act on Hospital Sharps Injuries

OBJECTIVE Measuring the effect of the Needlestick Safety and Prevention Act (NSPA) is challenging. No agreement exists on a common denominator for calculating injury rates. Does it make a difference? How are the law and safety-engineered devices related? What is the effect on injuries and costs? This study examines those issues in assessing the impact of the legislation on hospital worker percutaneous injuries. METHODS Using a historic prospective design, we analyzed injury data from 85 hospitals. Injury rates were calculated per 100 full-time equivalents, 100 staffed beds, and 100 admissions each year from 1995 to 2005. We compared changes for each denominator. We measured the proportion of the injury rate attributed to safety-engineered devices. Finally, we estimated a national change in injuries and associated costs. RESULTS For all denominators, a precipitous drop in injury rates of greater than one-third ([Formula: see text]) occurred in 2001, immediately following the legislation. The decrease was sustained through 2005. Concomitant with the decrease in rates, the proportion of injuries from safety-engineered devices nearly tripled ([Formula: see text]) across all denominators. We estimated annual reductions of more than 100,000 sharps injuries at a cost savings of

Increase in Sharps Injuries in Surgical Settings Versus Nonsurgical Settings After Passage of National Needlestick Legislation

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Disposal of sharps medical waste in the United States: impact of recommendations and regulations, 1987-2007.

415 million. CONCLUSIONS While the data cannot demonstrate cause and effect, the evidence suggests a reduction in hospital worker injury rates related to the NSPA, regardless of denominator. It also suggests an association between the increase in safety-engineered devices and the reduction in overall injury rates. The decreases observed translate into significant reductions in injuries and associated costs.

Percutaneous injuries in home healthcare settings.

BACKGROUND The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings. STUDY DESIGN We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members. RESULTS Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others. CONCLUSIONS Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeons hands, there are also roles for administrators, educators, and policy makers.

Risk of bloodborne pathogen exposure among Zambian healthcare workers

BACKGROUND To gauge the impact of regulatory-driven improvements in sharps disposal practices in the United States over the last 2 decades, we analyzed percutaneous injury (PI) data from a national surveillance network from 2 periods, 1993-1994 and 2006-2007, to see whether changes in disposal-related injury patterns could be detected. METHODS Data were derived from the EPINet Sharps Injury Surveillance Research Group, established in 1993 and coordinated by the International Healthcare Worker Safety Center at the University of Virginia. For the period 1993-1994, 69 hospitals contributed data; the combined average daily census for the 2 years was 24,495, and the total number of PIs reported was 7,854. For the period 2006-2007, 33 hospitals contributed data; the combined average daily census was 6,800, and the total number of PIs reported was 1901. RESULTS In 1992-1993, 36.8% of PIs reported were related to disposal of sharp devices. In 2006-2007, this proportion was 19.3%, a 53% decline. CONCLUSIONS This comparison provides evidence that implementation of point-of-use, puncture-resistant sharps disposal containers, combined with large-scale use of safety-engineered sharp devices, has resulted in a marked decline in sharps disposal-related injury rates in the United States. The protocol for removing and replacing full sharps disposal containers remains a critical part of disposal safety.

Chinks in the Armor: Activation Patterns of Hollow-Bore Safety- Engineered Sharp Devices

HOME HEALTH CARE HAS BEEN ONE OF THE fastest-growing sectors in the health care industry, but the prevention of occupational exposures in this setting has not received the attention it deserves. Of the more than 8 million U.S. health care workers who work in hospitals and other health care settings1, between 650,000 and 850,000 are employed in home health care.2 There are few data and no national estimates on the number of needlestick injuries that occur each year in home health care settings. Perhaps because of this lack of documentation, some recent state bills on needlestick prevention, such as the one passed in August in Massachusetts, overlook home health care and other non-hospital settings. But does the absence of data mean absence of risk? From 1993 through 1998, 84 hospitals provided EPINet data on percutaneous injuries to the International Health Care Worker Safety Center. Most of the data were from in-patient settings, but in some instances, home health care agencies were associated with EPINet hospitals, and percutaneous injuries reported from those sites were entered into the EPINet database. Figures 1, 2 and 3 compare the characteristics of percutaneous injuries occurring in hospital patient rooms to those occurring in home health care settings. There were 7,101 percutaneous injuries reported by hospital workers in patient rooms during the six-year interval. Workers’ in home health care settings reported 290 injuries during the same time period. Nurses sustained the overwhelming majority of Percutaneous Injuries in Home Health Care Settings

Nursing2011 survey results: Blood exposure risk during peripheral I.V. catheter insertion and removal.

PURPOSE Understanding the risks of bloodborne pathogen transmission is fundamental to prioritizing interventions when resources are limited. This study investigated the risks to healthcare workers in Zambia. DESIGN A survey was completed anonymously by a convenience sample of workers in three hospitals and two clinics in Zambia. Respondents provided information regarding job category, injuries with contaminated sharps, hepatitis B vaccination status and the availability of HIV post-exposure prophylaxis (PEP). RESULTS Nurses reported the largest number of injuries. The average annual sharps injury rate was 1.3 injuries per worker, and service workers (housekeepers, laundry, ward assistants) had the highest rate of these injuries, 1.9 per year. Injuries were often related to inadequate disposal methods. Syringe needles accounted for the largest proportion of injuries (60%), and 15% of these injuries were related to procedures with a higher-than-average risk for infection. Most workers (88%) reported the availability of PEP, and only 8% were fully vaccinated against hepatitis B. CONCLUSIONS The injury risks identified among Zambian workers are serious and are exacerbated by the high prevalence of bloodborne pathogens in the population. This suggests that there is a high risk of occupationally acquired bloodborne pathogen infection. The findings also highlight the need for a hepatitis B vaccination program focused on healthcare workers. The risks associated with bloodborne pathogens threaten to further diminish an already scarce resource in Zambia - trained healthcare workers. To decrease these risks, we suggest the use of low-cost disposal alternatives, the implementation of cost-sensitive protective strategies and the re-allocation of some treatment resources to primary prevention.

Blood exposure risk during peripheral I.V. catheter insertion and removal

A retrospective review of secondary injury data was used to evaluate the characteristics of percutaneous injuries from safety-engineered sharp devices. Injury rates and safety device activation rates differed by healthcare provider type. Approximately 22.8%-32% of injuries could have been prevented had an available safety feature been activated after use.

Riesgo de exposición a la sangre durante las maniobras de introducción y extracción de catéteres intravenosos periféricos

December l Nursing2011 l 45 LAST SPRING, Nursing2011 invited nurses to participate in a survey exploring blood exposure risks from peripheral I.V. catheter insertion and removal. Although needlestick risk from I.V. catheter devices has been well documented in device studies carried out in the 1990s and early 2000s,1-3 blood exposures sustained by healthcare workers during peripheral I.V. catheter insertion or removal have received less attention. In data from the CDC on occupationally acquired HIV in healthcare workers, I.V. insertion was second only to phlebotomy among procedures causing injuries resulting in infections—despite the fact that I.V. catheter needles represent only a small fraction of sharps used in healthcare delivery.4 Blood exposures to nonintact skin and mucous membranes, while not carrying the same risk as sharps injuries, have nevertheless been the documented source of bloodborne pathogen transmission, although not specifically linked to I.V. catheter insertion or removal.5,6 In the 2001 recommendations for follow-up of occupational exposures, the CDC defined at-risk blood exposures as “contact of mucous membrane or nonintact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious.” For skin exposures, “followup is indicated only if there is evidence of compromised skin integrity.”7 Of nurses responding to this survey (N = 404), 379 indicated that they performed peripheral I.V. catheter insertions, removals, or both (those who indicated they performed neither insertions nor removals were removed from the database). They provided details on the frequency and mechanisms of blood exposures associated with I.V. catheters. For a profile of respondents to this survey, see Take a closer look at respondents. As you review the results summarized here, keep in mind that survey participants were self-selected and not necessarily representative of all nurses. For example, nurses who recently sustained a blood exposure during I.V. catheter insertion or removal might have been more motivated to participate in the survey. In addition, note that not all respondents answered every question. Some percentages don’t add up to 100% due to rounding. survey results