Journal
of Hospital
Infection
Epidemiology
(1992)
20, 271-280
of reported tertiary care H. C. Eisenstein
Mount Accepted
Sinai
sharps hospital
and
Medical
in a
D. A. Smith
Center,
for publication
injuries
NY,
USA
27 November
1991
Summary: Over a 12-month period 233 puncture wounds were reported in a 1112-bed tertiary medical care centre. Accident forms were reviewed to determine the epidemiology of puncture injuries. The nursing department accounted for the majority of all puncture injuries (68%). For nurses, medical and surgical units represented those clinical areas with the greatest number of puncture injuries. Areas with the highest incidence rates, however, included the clinical research centre, the emergency room, the surgical intensive care unit and areas where the intravenous team operated. Activities involving direct contact of a sharp instrument with a patient accounted for the majority of puncture injuries. Disposable syringes and loose needles were implicated in 50% of injuries although the incidence of injury per individual s low (3.2 out of 100,000 purchased). Recommendations include the redesigning of sharp instruments and the focusing of education programmes to target personnel for whom incidence rates are the highest. Keywords: instruments.
Skin
puncture
wounds;
epidemiology
of puncture
injuries;
sharp
Introduction Puncture wounds that occur in a hospital setting provide the means for transmission of potentially fatal diseases to hospital employees.’ It is therefore imperative that the health-care professions take the proper precautions to ensure the safety of their members while continuing to provide high quality care to their patients. In order to promote safety while providing care in the face of an ever increasing patient population of human immunodeficiency virus (HIV) and hepatitis B and C infected individuals, an epidemiological study of accident reports from 1989 was undertaken to document activities, work sites and equipment that contribute most to a health care worker’s risk of a sharps injury. Incidence rates of injury both by exposed employee and by sharps device add some insight into the epidemiology of needlestick injury within the hospital.
Correspondence New York,
NY
to: Donald A. Smith, 10029, USA.
Mount
Sinai
0195-6701/92/040271+10$03.00/0
Medical
Center,
Box
1014,
0
271
1992
1 Gustave
The
Hospital
Levy
Infection
Place,
Society
272
C. Eisenstein Materials
and A. Smith and
methods
This study was conducted at Mount Sinai Medical Center, a 1112-bed academic medical centre in New York. The study population included all employees who reported puncture wounds in 1989. In 1989 the needle disposal policy present in this institution conformed to the 1983 Centers for Disease Control (CDC) recommendations that employees were not to bend, break or recap used needles.2 Instead, sharp instruments were to be deposited in puncture proof containers for disposal. ‘Sharps-a-Gator’ Sharps Disposal System containers (Devon Products, Chatsworth, California) had been placed at nursing stations in December 1987. Sage In-room Sharps Disposal containers (Sage Products, Cary, Illinois) had been placed in individual patient rooms in August 1988, and a full-time housekeeper was hired to maintain the containers. Hospital policy requires that all employees who suffer a work-related injury file an accident report describing the event. All accident reports filed in the 12-month period from January 1 to December 31 1989, were reviewed. Reports involving puncture wounds obtained through contact with needles, disposable syringes, intravenous catheters, winged steel needle infusion sets, lancets or scalpel blades were recorded and included under the generic term ‘sharps injuries’. Information recorded from accident reports included the employee’s department, the clinical area where the incident occurred, the device or instrument responsible and the most specific employee activity that resulted in injury. The activity categories used in this paper were derived from two separate needlestick studies previously reported in the literature.3,4 Incidence rates of sharps injuries were calculated for individual departments by dividing the number of injuries per department by the total number of employees in that department. A separate calculation for the most clinically active nurses, i.e. registered nurses (RNs) and senior clinical nurses (SCNs), was also computed. Incidence rates among RNs and SCNs were also grouped by clinical nursing areas by dividing their number of injuries occurring in a particular clinical area by the total number of registered nurses and senior clinical nurses assigned to that area. Sharps-injury incidence rates for various devices were calculated by dividing the number of puncture wounds reported as caused by that device by the total quantity of that device purchased in 1989. Estimates of under-reporting of needlestick injury by official accident reports were calculated as follows. State-required annual health reviews in the form of a questionnaire were distributed to all medical centre personnel and collected by the Employee Health Service (EHS). Two questions asked whether the employee had suffered a needlestick accident since filling out their last annual health review and, if yes, whether the needle was in direct contact with blood or body fluids of a patient. Under-reporting of needlestick accidents by RNs and SCNs was estimated by reviewing the first 393 responses received in the first 10 months to 1059 surveys sent to
Sharps
injuries
among
hospital
workers
273
registered nurses and senior clinical nurses. The incidence rate from this annual questionnaire was used to calculate the number of needlestick injuries expected in the entire RNjSCN group. The expected number minus the actual number of needlestick injuries reported on accident forms divided by the expected number, provided the percentage of needlesticks not reported. The percentage of needlesticks involving contact with patient blood or bodily fluids was calculated from the percentage of positive responses to that question by RNs and SCNs on the annual questionnaire.
Results
Two hundred and thirty-three puncture wounds were reported in this institution for 1989. Table I indicates the distribution of sharps injuries among the various hospital departments and the calculated incidence rates per 100 employees. The nursing department accounted for the majority of the year’s occupational sharps injuries (68%), followed by the departments of building services (8%), clinical microscopy (6%), radiology (4%) and the housestaff (2%). The highest incidence rates of injury, however, were reported by the clinical microscopy department (19.4 cases per 100 employees) followed by the nursing department (7.8 cases per 100 employees), which includes registered nurses, senior clinical nurses, clerks, nursing aides, licensed practical nurses (LPNs), and administrative and educational personnel. The incidence of needlestick injuries for all nursing department employees and for RNs and SCNs in various clinical areas of the hospital are shown in Table II. The results indicate that the greatest absolute number of nursing injuries for the year occurred on the medical/surgical
Table
I. Incidence
of sharps
injuries
Total no. injuries
Department Nursing Regd/Sen. Building Clinical Radiology Housestaff Nuclear Centre processing Laundry Patient Other Total
in various hospital reports)
clin. nurses* service microscopy medicine for sterile service dietetic
* Sub-group
service
of total
nursing
staff.
159 138 19 15 9 4 2 2
(68%) (59%) (8%) (6%) (4%) (2%) (Cl%) (Cl%)
2 2 19 233
(
of Hospital
Infection
Epidemiology
(1992)
20, 271-280
of reported tertiary care H. C. Eisenstein
Mount Accepted
Sinai
sharps hospital
and
Medical
in a
D. A. Smith
Center,
for publication
injuries
NY,
USA
27 November
1991
Summary: Over a 12-month period 233 puncture wounds were reported in a 1112-bed tertiary medical care centre. Accident forms were reviewed to determine the epidemiology of puncture injuries. The nursing department accounted for the majority of all puncture injuries (68%). For nurses, medical and surgical units represented those clinical areas with the greatest number of puncture injuries. Areas with the highest incidence rates, however, included the clinical research centre, the emergency room, the surgical intensive care unit and areas where the intravenous team operated. Activities involving direct contact of a sharp instrument with a patient accounted for the majority of puncture injuries. Disposable syringes and loose needles were implicated in 50% of injuries although the incidence of injury per individual s low (3.2 out of 100,000 purchased). Recommendations include the redesigning of sharp instruments and the focusing of education programmes to target personnel for whom incidence rates are the highest. Keywords: instruments.
Skin
puncture
wounds;
epidemiology
of puncture
injuries;
sharp
Introduction Puncture wounds that occur in a hospital setting provide the means for transmission of potentially fatal diseases to hospital employees.’ It is therefore imperative that the health-care professions take the proper precautions to ensure the safety of their members while continuing to provide high quality care to their patients. In order to promote safety while providing care in the face of an ever increasing patient population of human immunodeficiency virus (HIV) and hepatitis B and C infected individuals, an epidemiological study of accident reports from 1989 was undertaken to document activities, work sites and equipment that contribute most to a health care worker’s risk of a sharps injury. Incidence rates of injury both by exposed employee and by sharps device add some insight into the epidemiology of needlestick injury within the hospital.
Correspondence New York,
NY
to: Donald A. Smith, 10029, USA.
Mount
Sinai
0195-6701/92/040271+10$03.00/0
Medical
Center,
Box
1014,
0
271
1992
1 Gustave
The
Hospital
Levy
Infection
Place,
Society
272
C. Eisenstein Materials
and A. Smith and
methods
This study was conducted at Mount Sinai Medical Center, a 1112-bed academic medical centre in New York. The study population included all employees who reported puncture wounds in 1989. In 1989 the needle disposal policy present in this institution conformed to the 1983 Centers for Disease Control (CDC) recommendations that employees were not to bend, break or recap used needles.2 Instead, sharp instruments were to be deposited in puncture proof containers for disposal. ‘Sharps-a-Gator’ Sharps Disposal System containers (Devon Products, Chatsworth, California) had been placed at nursing stations in December 1987. Sage In-room Sharps Disposal containers (Sage Products, Cary, Illinois) had been placed in individual patient rooms in August 1988, and a full-time housekeeper was hired to maintain the containers. Hospital policy requires that all employees who suffer a work-related injury file an accident report describing the event. All accident reports filed in the 12-month period from January 1 to December 31 1989, were reviewed. Reports involving puncture wounds obtained through contact with needles, disposable syringes, intravenous catheters, winged steel needle infusion sets, lancets or scalpel blades were recorded and included under the generic term ‘sharps injuries’. Information recorded from accident reports included the employee’s department, the clinical area where the incident occurred, the device or instrument responsible and the most specific employee activity that resulted in injury. The activity categories used in this paper were derived from two separate needlestick studies previously reported in the literature.3,4 Incidence rates of sharps injuries were calculated for individual departments by dividing the number of injuries per department by the total number of employees in that department. A separate calculation for the most clinically active nurses, i.e. registered nurses (RNs) and senior clinical nurses (SCNs), was also computed. Incidence rates among RNs and SCNs were also grouped by clinical nursing areas by dividing their number of injuries occurring in a particular clinical area by the total number of registered nurses and senior clinical nurses assigned to that area. Sharps-injury incidence rates for various devices were calculated by dividing the number of puncture wounds reported as caused by that device by the total quantity of that device purchased in 1989. Estimates of under-reporting of needlestick injury by official accident reports were calculated as follows. State-required annual health reviews in the form of a questionnaire were distributed to all medical centre personnel and collected by the Employee Health Service (EHS). Two questions asked whether the employee had suffered a needlestick accident since filling out their last annual health review and, if yes, whether the needle was in direct contact with blood or body fluids of a patient. Under-reporting of needlestick accidents by RNs and SCNs was estimated by reviewing the first 393 responses received in the first 10 months to 1059 surveys sent to
Sharps
injuries
among
hospital
workers
273
registered nurses and senior clinical nurses. The incidence rate from this annual questionnaire was used to calculate the number of needlestick injuries expected in the entire RNjSCN group. The expected number minus the actual number of needlestick injuries reported on accident forms divided by the expected number, provided the percentage of needlesticks not reported. The percentage of needlesticks involving contact with patient blood or bodily fluids was calculated from the percentage of positive responses to that question by RNs and SCNs on the annual questionnaire.
Results
Two hundred and thirty-three puncture wounds were reported in this institution for 1989. Table I indicates the distribution of sharps injuries among the various hospital departments and the calculated incidence rates per 100 employees. The nursing department accounted for the majority of the year’s occupational sharps injuries (68%), followed by the departments of building services (8%), clinical microscopy (6%), radiology (4%) and the housestaff (2%). The highest incidence rates of injury, however, were reported by the clinical microscopy department (19.4 cases per 100 employees) followed by the nursing department (7.8 cases per 100 employees), which includes registered nurses, senior clinical nurses, clerks, nursing aides, licensed practical nurses (LPNs), and administrative and educational personnel. The incidence of needlestick injuries for all nursing department employees and for RNs and SCNs in various clinical areas of the hospital are shown in Table II. The results indicate that the greatest absolute number of nursing injuries for the year occurred on the medical/surgical
Table
I. Incidence
of sharps
injuries
Total no. injuries
Department Nursing Regd/Sen. Building Clinical Radiology Housestaff Nuclear Centre processing Laundry Patient Other Total
in various hospital reports)
clin. nurses* service microscopy medicine for sterile service dietetic
* Sub-group
service
of total
nursing
staff.
159 138 19 15 9 4 2 2
(68%) (59%) (8%) (6%) (4%) (2%) (Cl%) (Cl%)
2 2 19 233
(
