Janine Jagger

Rates of Needle-Stick Injury Caused by Various Devices in a University Hospital

We identified characteristics of devices that caused needle-stick injuries in a university hospital over a 10-month period. Hospital employees who reported needle sticks were interviewed about the types of devices causing injury and the circumstances of the injuries. Of 326 injuries studied, disposable syringes accounted for 35 percent, intravenous tubing and needle assemblies for 26 percent, prefilled cartridge syringes for 12 percent, winged steel-needle intravenous sets for 7 percent, phlebotomy needles for 5 percent, intravenous catheter stylets for 2 percent, and other devices for 13 percent. When the data were corrected for the number of each type of device purchased, disposable syringes had the lowest rate of needle sticks (6.9 per 100,000 syringes purchased). Devices that required disassembly had rates of injury of up to 5.3 times the rate for disposable syringes. One third of the injuries were related to recapping. Competing hazards were often cited as reasons for recapping. They included the risk of disassembling a device with an uncapped, contaminated needle and the difficulty of safely carrying several uncapped items to a disposal box in a single trip. New designs could provide safer methods for covering contaminated needles. Devices should be designed so that the workers hands remain behind the needle as it is covered, the needle should be covered before disassembly of the device, and the needle should remain covered after disposal. Such improvements could reduce the incentives for recapping needles and lower the risk of needle-stick injuries among health care workers.

ESTIMATE OF THE ANNUAL NUMBER OF PERCUTANEOUS INJURIES AMONG HOSPITAL-BASED HEALTHCARE WORKERS IN THE UNITED STATES, 1997-1998

OBJECTIVE To construct a single estimate of the number of percutaneous injuries sustained annually by healthcare workers (HCWs) in the United States. DESIGN Statistical analysis. METHODS We combined data collected in 1997 and 1998 at 15 National Surveillance System for Health Care Workers (NaSH) hospitals and 45 Exposure Prevention Information Network (EPINet) hospitals. The combined data, taken as a sample of all U.S. hospitals, were adjusted for underreporting. The estimate of the number of percutaneous injuries nationwide was obtained by weighting the number of percutaneous injuries at each hospital by the number of admissions in all U.S. hospitals relative to the number of admissions at that hospital. RESULTS The estimated number of percutaneous injuries sustained annually by hospital-based HCWs was 384,325 (95% confidence interval, 311,091 to 463,922). The number of percutaneous injuries sustained by HCWs outside of the hospital setting was not estimated. CONCLUSIONS Although our estimate is smaller than some previously published estimates of percutaneous injuries among HCWs, its magnitude remains a concern and emphasizes the urgent need to implement prevention strategies. In addition, improved surveillance could be used to monitor injury trends in all healthcare settings and evaluate the impact of prevention interventions.

Occupational Human Immunodeficiency Virus Infection in Health Care Workers: Worldwide Cases Through September 1997

The average estimated risk of human immunodeficiency virus (HIV) infection for health care workers following a percutaneous or mucous exposure is <0.5% in incidence studies, although a case-control study suggests it is much higher for highest-risk percutaneous exposure. To characterize exposures resulting in HIV transmission, we reviewed available data on occupational cases reported worldwide, identifying 94 documented and 170 possible cases. The majority of documented infections occurred in nurses, after contact with the blood of a patient with AIDS by means of percutaneous exposure, with a device placed in an artery or vein. High-exposure job categories, e.g., midwives and surgeons, are represented mostly among possible cases. Transmission occurred also through splashes, cuts, and skin contaminations, and in some cases despite postexposure prophylaxis with zidovudine. Health care workers could benefit if these data were incorporated in educational programs designed to prevent occupational bloodborne infections.

Epidemiologic features of head injury in a predominantly rural population

The characteristics of occurrence of head trauma were studied in north central Virginia. In 1978, 735 cases of head trauma were identified with documented head injuries occurring within the defined service area, and with a minimum overnight hospital stay. Overall occurrence was 208/100,000 population. The highest occurrence was found in the 15-19 age group (407/100,000). Nonwhites showed higher rates than whites. Motor vehicle crashes were the most frequent mechanism of injury (55% of patients) followed by falls (20%), and interpersonal violence (11%). Short-term time trends reveal unique daily, weekly, and seasonal patterns for motor vehicle crashes, falls, and interpersonal violence. Selected prevention strategies are discussed. The use of passive restraints in motor vehicles is recommended as one important means of reducing the occurrence and severity of head injuries.

Effect of Alcohol Intoxication on the Diagnosis and Apparent Severity of Brain Injury

Because alcohol intoxication is common among brain-injured patients, we performed this study to determine the extent to which alcohol alters the initial assessment of brain injury severity in these patients by depressing the level of consciousness. The Glasgow coma scale was used to measure the level of consciousness of 257 brain-injured adults admitted to the University of Virginia Hospital, both on arrival in the emergency room and 6 to 10 hours later. Improvement in the level of consciousness between the first and second measurements was significantly related to the blood alcohol concentration on admission. Patients with the highest blood alcohol concentrations showed the greatest improvement. Most of this effect occurred in patients with a blood alcohol concentration of 0.20% or higher. Alcohol intoxication is a potential source of bias in the clinical classification of brain injuries according to severity.

Risk of needle stick and sharp object injuries among medical students

BACKGROUND Much is known about sharp object and needle stick injuries among employee health care workers, but relatively little attention has been directed to exposures among medical students. METHOD The frequency and mechanisms of needle stick and sharp object injuries were determined retrospectively by surveying students in their fourth year of medical school. Students were questioned about the number of percutaneous injuries that they had sustained during their clinical years. Descriptive information was collected on their most recent injury. RESULTS Of 137 students in the class, 106 (77%) responded. Thirty-five (33%) of the students who responded sustained one or more injuries; 24 (69%) were injured while on a surgical service, and 60% of the injuries occurred in an operating room. Suturing was the procedure most frequently associated with injury. In 34% of cases, the injury was caused by a needle or device being used by another person. The most frequent site of injury was the hand (97%). Ninety-four percent of students were wearing gloves at the time of the injury. None of the injuries was associated with recapping needles. Only 43% of students reported their injuries to proper authorities. CONCLUSION Medical students frequently sustain needle stick and sharp object injuries during their clinical training. Concerted efforts are needed to protect them.

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.

Air bags: reducing the toll of brain trauma

Motor vehicle crashes account for approximately one-half of all hospitalized patients with brain injury. Therefore, measures to reduce the frequency and severity of injuries from motor vehicle crashes have the potential for making a substantial impact on the incidence and severity of brain trauma. Occupant restraints, including seat belts and air bags, have been proven highly effective in preventing injuries, yet the specific benefits for the brain, the face, and the cervical spine provided by air bags have not been widely publicized. Air bags prevent the violent whiplash motion of the head in a frontal crash, resulting in a more controlled deceleration of the brain. Wrenching forces exerted on the cervical spine are attenuated, and the face is protected from contact with hard or lacerating surfaces. Furthermore, compliance is not a problem with air bags. When a car is equipped with air bags, they are in effect 100% of the time, which is important for the protection of high risk groups, such a teenage boys, who tend to wear seat belts less often than other groups. It is estimated from national data and from epidemiological studies that air bags could have prevented or reduced brain injury for 25% of the hospitalized, brain-injured population. If provided as standard equipment on both the driver and the passenger side, air bags could do more to reduce the toll of brain trauma than any other available intervention. Air bags were ready for introduction into the marketplace 15 years ago. Since then, approximately 150,000 preventable deaths and more than 1,500,000 preventable brain injuries have occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Sharp object injuries in the hospital: Causes and strategies for prevention

We identified characteristics of items causing sharp object injuries in hospital personnel during a 10-month interval. Sharp objects were defined as items that were not hollow-bore needles, that cause lacerations or puncture wounds. Workers reporting sharp object injuries were interviewed to determine what items caused injury and the circumstances of their injuries. Of 89 incidents, 51% were surgical instrument injuries, 19% were lancet injuries, 16% were glass injuries, and 15% were caused by other sharp items. A frequent feature of sharp objects causing injuries was the necessity of disengaging a disposable sharp item from a reusable holder. The application of manual force to fragile glass items also caused many injuries. Opportunities for safer product design and improved materials are discussed to reduce this common occupational hazard.

Occupational Exposure to Blood among Medical Students

One of the most serious threats medical students face during their clinical training is the possibility of exposure to blood-borne pathogens, with the attendant risk of infection with the human imm...