Latest data show drop in needlestick injuries
Combining NaSH, EPINet provides best picture yet
The most comprehensive analysis of national needlestick data ever conducted has revealed an encouraging sign: The injury estimate of about 384,000 is considerably less than the 600,000-plus previously cited.1 That may indicate that needlestick prevention programs and safety devices are having an impact, says Adelisa Panlilio, MD, MPH, medical epidemiologist in the Hospital Infections Program at the Centers for Disease Control and Prevention in Atlanta.
"There may be reason to believe [needlesticks] might really have dropped," Panlilio says. "There has been a lot more attention paid to injuries. There are devices which may reduce the risk of injury which are in more widespread use, although some would argue they aren’t as widely used as we would like."
Panlilio acknowledges that it’s difficult to compare the current data with estimates developed by researchers using a different base of sample hospitals. For the first time, the CDC combined its National Surveillance System for Healthcare Workers (NaSH) data with that of the EPINet system run by the International Health Care Worker Safety Center at the University of Virginia in Charlottesville.
"For the first time we have accurate data," says Jane Perry, MA, editor of Advances in Exposure Prevention, a publication of the center. Perry notes that the most recent EPINet estimates placed in-hospital percutaneous injuries at 295,082, a figure close to the combined NaSH/EPINet figure.
Information on the effect of safer devices on injury rates is still anecdotal or based on focused studies, Perry says. "The signs of optimism are in individual hospitals that see a decrease in their sharps injury rate after they implement devices," she says.
The two surveillance systems contain data from varying types of hospitals. Hospitals involved in the NaSH system tend to be larger than average and located in the Northeast, while EPINet hospitals are smaller and mostly on the West Coast and in southeastern states. The injury data were weighted based on hospital size to reflect admissions. Panlilio and her colleagues also adjusted the figures based on under-reporting that has been estimated for different health care professions.
"We’re hoping that by combining the two data sets and our different hospitals that participate in them, we may get a more representative picture [of needlesticks nationally]," she says.
The estimate also provides a starting point for the CDC to track needlestick injuries, using a consistent statistical methodology, she says. "It’s useful to have a benchmark figure to follow a trend," she says. "We’re going to promote prevention. We would like to know as we look over time, as these prevention measures are adopted, if we see an effect."
While the number of injuries may be dropping, the estimate of almost 400,000 per year is still staggering, says Panlilio. "Needlestick injuries remain a concern," she says. "The prevention of injuries needs to be addressed."
CDC to offer advice on prevention
Prevention of needlestick injuries means more than evaluating and implementing safer devices, Panlilio notes. The CDC is encouraging hospitals to use data to track their own needlesticks and focus their prevention efforts. By the end of this year, the agency plans to release a workbook that will assist employee health professionals in developing a comprehensive sharps safety program.
The workbook will include information on how to collect and use injury data to set priorities, how to establish an action plan, and how to evaluate the outcomes of prevention efforts.
"It’s important that a prevention program be comprehensive, not just the implementation of engineering controls," says Linda Chiarello, RN, MS, epidemiologist in CDC’s hospital infections program.
For example, employee health professionals may look at policies and procedures, work practices, education, enforcement of educational directives, and how to encourage a safety culture, she says.
Data are central to any prevention plan, Chiarello notes. "With the [current] regulatory environment, people are going to have to show accountability for their prevention programs," she says. "We’re trying to provide them the tools to do that in an effective way. To be able to show that impact, you have to have a level of detail with the data that provides information on all the factors that are contributing to injury, looking not only at the type of device or procedure but why those injuries are occurring," she says.
For example, at one hospital, 80% of injuries during blood collection were associated with winged-steel needles. At another hospital, due to a preference for different devices, the injuries might be associated with vacuum tube needles.
The data might prompt a discussion about why that needle was selected and what alternative the staff might accept.
21% of needlesticks are unpreventable’
Of course, you should focus your efforts and resources on those areas that will produce the greatest level of prevention. In analyzing the national data, the CDC determined that 21% of needlesticks are "unpreventable." In another 19%, the information wasn’t complete enough to determine preventability.
"Theoretically, every injury is preventable," says Scott Campbell, RN, MSPH, a CDC epidemiologist. "But the most difficult ones to prevent are procedures that necessitate the use of a sharp object and the injury occurs when the device is in use. Let’s say I’m drawing blood and during the procedure, while I’m still in the vein, the patient moves. It’s very difficult to protect the worker from injury during the blood-draw procedure itself."
Analysis of the data may show some surprises. "There are needle injuries that still occur where needles aren’t even necessary," says Campbell. For example, a nurse may use a syringe in a needleless IV system — perhaps out of habit, in time pressure, or out of confusion over the difference between the needleless and standard systems.
The NaSH software doesn’t currently include analysis of injuries by preventability, but the reports can easily be customized to include variabilities relating to that, says Campbell. Future versions of the software may contain the preventability factor, he says.
Based on the national data, employee health professionals will find that the great majority of needlesticks are preventable — and their challenge will be to find out how to prevent them, notes Campbell.
[Editor’s note: CDC is accepting applications for future enrollment in NaSH. Software and technical support are free of charge. For more information about NaSH, please contact the Hospital Infections Program by telephone at (800) 893-0485 or by e-mail at [email protected]. EPINet is no longer accepting new members into its database, but hospitals may use the Windows-based EPINet software free of charge, which can be downloaded from the Becton-Dickinson Web site at www.bd.com. For technical support or help with EPINet, contact Ginger Parker at (804) 982-0702.]
Reference
1. Henry K, Campbell S. Needlestick/sharps injuries and HIV exposures among health care workers: National estimates based on a survey of U.S. hospitals. Minn Med 1995; 78:1,765-1,768.
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