Needlestick injuries: the continued need for prevention strategies.
Hudson CA; Martin LS; Hudson CA
National Conference on State-Based Occupational Health and Safety Activities, September 3-6, 1991, Cincinnati, Ohio. Cincinnati, OH: National Institute for Occupational Safety and Health, 1991 Sep; :19
Occupational transmission of HIV has been documented. HIV contaminated needles have been reported to pose the most serious risk. Literature reports and meeting abstracts were reviewed to further define factors associated with potential occupational transmission. Most studies were respondent surveys rather than observational; the majority were directed to hospital workers. Study design and data collection varied. Needlestick injuries (NSI) reported as percent of workers in study injured ranged from 34-50%. Denominator figures were unavailable in many studies; NSI were reported as follows: 189/1000 healthcare workers (HCW), 107/1000 HCW, 22/24 exposures, 2134 exposures/7065 patient days, 1.06/nurse day, 200/year, decrease from 234 in 1987 to 201 in 1989. Reports of NSI due to recapping ranged from 10-70%; IV lines were often associated with NSI. Recapping continued even when compliance to other "universal precautions" recommendations was high. One report indicated that recapping injuries were reduced form 61% to 16% following an educational program. Where different occupations were surveyed, nurses predominated with the highest NSI rates. Three reports investigated whether the introduction of bedside boxes (BB) for sharps disposal had changed the NSI rate. The overall rate of NSI did not change, but disposal injuries decreased in some cases. It is difficult to evaluate the impact of BB since emphasis on reporting often results in increased worker compliance to injury reporting. Accumulated data for percutaneous exposure to HIV infected blood still indicate that the risk of transmission is approximately 0.3% per exposure. There are several basic strategies for the prevention of occupational transmission of my: engineering controls, job design, personal protective, alteration of work practices, and training. Review of the current literature suggests that NSI have not been significantly reduced. The development and evaluation of engineering controls will be crucial to prevention of NSI.
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