Safer workplace not yet obvious from needle data
Two reports show injury reporting problems
Safer needle devices reduce needlesticks, but that truism so far has been difficult to demonstrate through multihospital data collection. Two new data reports show the persistence of needlesticks and the continued need to implement safer devices and work practices.
The 1999 EPINet data, gathered from 21 health care facilities in the East Coast and Pacific North-west regions, showed an average of 34 needlestick injuries per 100 occupied beds in nonteaching hospitals and 40 needlestick injuries per 100 occupied beds in teaching hospitals. Those numbers actually represent an increase over 1998.1
Yet the number of hospitals reporting also changed, from 52 in 1998. The loss of a large nonteaching hospital with a low injury rate affected the figures, which was 22 per 100 occupied beds in 1998, according to Advances in Exposure Prevention, the publication of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville.
Hospitals varied greatly in their rates of percutaneous injury, from 15 to more than 125 per 100 occupied beds. The mix of patients, underreporting, and facility type could influence those numbers, in addition to the implementation of safety devices, says editor Jane Perry, MA. "Because of these variables, we cannot assume that a health care facility with a low rate of reported injuries per year necessarily has a better safety record than a hospital with a higher rate," she says.
"It’s difficult to take data from several hospitals and demonstrate a reduction in needlesticks," says Janine Jagger, PhD, MPH, director of the center. "The best way to get at that information is to study one [sharps] device against another. You compare the needlestick rates before and after [implementation of a safety device] in one institution or a couple of institutions."
She notes that even different units of a hospital may have variations in their implementation of safety devices. Meanwhile, data collection such as EPINet won’t show a dramatic drop in needlesticks. Many hospitals had implemented safety devices before passage of the Needlestick Preven-tion and Safety Act in 2000 and new Occupational Safety and Health Administration’s regulations. Others still haven’t made significant changes.
"No one is going to be able to get clean before and after data," Jagger says. "We’re not comparing safety implemented after the law vs. nonsafety before the law. This is a gradual transition that the law hasn’t made complete. There are still a lot of conventional devices being used."
California health officials also had hoped to show the impact of new needle safety legislation. That state was the first in the nation to mandate safer sharps, with a 1998 law that became fully enforced in July 1999.
However, the most recent data report covers the period from Jan. 1, 1998, to Dec. 31, 1999, when hospitals were at various states of transition to safety devices. A study by the state’s Sharps Injury Control Program found that just 64% of hospitals were using safety needles or needleless injection systems and 69% were using safety-engineered blood collection devices. The greatest area of implementation was in needleless IV systems, with 88% of hospitals reporting that they used the devices.2
The data are based on 1,940 sharps injury reports from more than 199 different health care institutions, 92% of them hospitals. However, California officials also note the shortcomings of the data collection. Many of the reports were submitted on nonstandard forms, and information frequently was missing. For example, only 69% included the job classification of the employee, and only 24% of those reporting knew the brand of the device they were using.
Of the 119 injured employees responding to a question about injury prevention, 62% said an engineered sharps device could have or would have prevented it. Thirty-eight percent said human factors could have prevented the injury, and 20% cited proper sharps disposal.
In a new data registry, California will try to get more detailed data from a representative sample of hospitals, says James Cone, MD, MPH, chief of the occupational health branch in the California Department of Health Services in Oakland. His department also is conducting a study of implementation of safer sharps at 80 hospitals.
Like Jagger, he says the data don’t fully reflect the implementation of new devices. "It’s hard to prove sometimes the effect of an intervention. It seems like it should be easy, but in practice, it’s quite challenging."
In fact, even using the data as a benchmark is problematic, he says. "Needlesticks are notoriously underreported," Cone says. "As much as 90% of doctors fail to report [sharps injuries]. Whatever trend you see may just be a change in the reporting rate. Nurses report more, but still probably 60% fail to report."
Cone says he hopes to help hospitals develop a model program for analyzing their own needlestick data. "I think individual hospitals could look at their own data and see trends," he says.
(Editor’s note: A copy of the EPINet report is available from the International Health Care Worker Safety Center. Web site: www.med.virginia.edu/medcntr/centers/epinet/. A copy of California’s Sharps Injury Control Program report is available at www.dhs.ca.gov/ohb.)
References
1. Parker G, Perry J, Jagger J. 1999 Percutaneous injury rates. Advances in Exposure Prevention 2002; 6:7-9.
2. California Department of Health Services, Occupational Health Branch. Sharps Injury Control Program Report. Oakland; 2002. Web: www.dhs.ca.gov/ohb/SHARPS/default.htm.
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