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Use of Safety Devices and the Prevention of Percutaneous Injuries Among Healthcare Workers

  • Victoria Valls (a1) (a2), M. Salud Lozano (a3), Remedios Yánez (a3), María José Martínez (a3), Francisco Pascual (a4), Joan Lloret (a4) and Juan Antonio Ruiz (a4)...



To study the effectiveness of safety devices intended to prevent percutaneous injuries.


Quasi-experimental trial with before-and-after intervention evaluation.


A 350-bed general hospital that has had an ongoing educational program for the prevention of percutaneous injuries since January 2002.


In October 2005, we implemented a program for the use of engineered devices to prevent percutaneous injury in the emergency department and half of the hospital wards during the following procedures: intravascular catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood sampling, and intramuscular and subcutaneous injections. The nurses in the wards that participated in the intervention received a 3-hour course on occupationally acquired bloodborne infections, and they had a 2-hour “hands-on” training session with the devices. We studied the percutaneous injury rate and the direct cost during the preintervention period (October 2004 through March 2005) and the intervention period (October 2005 through March 2006).


We observed a 93% reduction in the relative risk of percutaneous injuries in areas where safety devices were used (14 vs 1 percutaneous injury). Specifically, rates decreased from 18.3 injuries (95% confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients in the emergency department (P = .002) and from 44.0 injuries (95% CI, 20.1-83.6 injuries) to 5.2 injuries (95% CI, 0.1-28.8 injuries) per 100,000 patient-days in hospital wards (P = .007). In the control wards of the hospital (ie, those where the intervention was not implemented), rates remained stable. The direct cost increase was €0.558 (US$0,753) per patient in the emergency department and €0.636 (US$0,858) per patient-day in the hospital wards.


Proper use of engineered devices to prevent percutaneous injury is a highly effective measure to prevent these injuries among healthcare workers. However, education and training are the keys to achieving the greatest preventative effect.


Corresponding author

Hospital Virgen de la Salud-Elda, Departamento de Salud 18, Carretera Elda-Sax s/n, 03600 Elda, Alicante, Spain (


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1.Panlilio, AL, Orelien, JG, Srivastava, PU, Jagger, J, Cohn, RD, Cardo, DM;NaSH Surveillance Group;EPINet Data Sharing Network. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infect Control Hosp Epidemiol 2004;25:556562.
2.Hernandez Navarrete, MJ, Campins Marti, M, Martinez Sanchez, EV, Ramos Perez, F, Garcia de Codes Ilario, A, Arribas Llorente, JL;Grupo de Trabajo EPINETAC. Occupational exposures to blood and biological material in healthcare workers. EPINETAC Project 1996-2000 [in Spanish]. Med Clin (Barc) 2004;122:8186.
3.Ippolito, G, Puro, V, Hepstonstall, J, Jagger, J, De Carli, P, Petrosillo, N. Occupational human immunodeficiency virus infection in health care workers: worldwide cases through September 1997. Clin Infect Dis 1999;28:365383.
4.Bi, P, Tully, PJ, Pearce, S, Hiller, JE. Occupational blood and body fluid exposure in an Australian teaching hospital. Epidemiol Infect 2006;134 465471
5.Centers for Diseases Control and Prevention. Case-control study of HIV seroconversion in health-care workers after percutaneous exposure to HIV-infected blood—France, United Kingdom, and United States, January 1988-August 1994. MMWR 1995;44:929933.
6.Beekmann, SE, Vaughn, TE, McCoy, KD, et al. Hospital bloodborne pathogens programs: program characteristics and blood and body fluid exposure rates. Infect Control Hosp Epidemiol 2001;22:7382.
7.Trape-Cardoso, M, Schenck, P. Reducing percutaneous injuries at an academic health center: a 5-year review. Am J Infect Control 2004;32 301305
8.Vaughn, TE, McCoy, KD, Beekmann, SE, Woolson, RE, Tomer, JC, Doebbeling, BN. Factors promoting consistent adherence to safe needle precautions among hospital workers. Infect Control Hosp Epidemiol 2004;25:548555.
9.Geberding, JM. Management of occupational exposures to blood-borne viruses. N Engl J Med 1995;332:444451.
10.US Public Health Service. Updated US Public Health Service guidelines for the management of occupational exposures toHBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001;50(RR-11):152.
11.Panlilio, AL, Cardo, DM, Grohskopf, LA, Heneine, W, Ross, CS. Updated US Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2005;54(RR-09):117.
12.Do, AN, Ciesielski, CA, Metler, RP, Hammett, TA, Li, J, Fleming, PL. Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States. Infect Control Hosp Epidemiol 2003;24:8696.
13.Tomkins, S, Ncube, F. Occupationally acquired HIV: international reports to December 2002. Euro Surveill 2005;10:E050310.2.
14.Yazdanpanah, Y, De Carli, G, Migueres, B, et al. Risk factors for hepatitis C virus transmission to health care workers after occupational exposure: a European case-control study. Clin Infect Dis 2005;41:14231430.
15.Tarantola, A, Abiteboul, D, Rachline, A. Infection risks following accidental exposure to blood or body fluids in health care workers: a review of pathogens transmitted in published cases. Am J Infect Control 2006;34 367375
16.Alweis, RL, DiRosario, K, Conidi, G, Kain, KC, Olans, R, Tully, JL. Serial nosocomial transmission of Plasmodium falciparum malaria from patient to nurse to patient. Infect Control Hosp Epidemiol 2004;25:5559.
17.Wagner, D, de With, K, Huzly, D, et al. Nosocomial acquisition of dengue. Emerg Infect Dis 2004;10:18721873.
18.Sohn, JW, Kim, BG, Kim, SH, Han, C. Mental health of healthcare workers who experience needlestick and sharps injuries. J Occup Health 2006;48:474479.
19.Lee, JM, Botteman, MF, Nicklasson, L, Cobden, D, Pashos, CL. Needlestick injury in acute care nurses caring for patients with diabetes mellitus: a retrospective study. Curr Med Res Opin 2005;21:741747.
20.Occupational exposure to bloodborne pathogens;needlestick and other sharps injuries;final rule. Occupational Safety and Health Administration (OSHA), Department of Labor. Final rule;request for comment on the Information Collection (Paperwork) Requirements. Fed Regist 2001;66 53185325
21.Orenstein, R, Reynolds, L, Karabaic, M, Lamb, A, Markowitz, SM, Wong, ES. Do protective devices prevent needlestick injuries among health care workers? Am J Infect Control 1995;23:344351.
22.Porta, C, Handelman, E, McGovern, P. Needlestick injuries among health care workers: a literature review. AAOHN J 1999;47:237244.
23.Sohn, S, Eagan, J, Sepkowitz, KA, Zuccotti, G. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infect Control Hosp Epidemiol 2004;25:536542.
24.Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures—Minneapolis-St. Paul, New York City, and San Francisco, 1993-1995. MMWR Morb Mortal Wkly Rep 1997;46:2125.
25.Ippolito, G, De Carli, G, Puro, V, et al. Device-specific risk of needlestick injury in Italian health care workers. JAMA 1994;272:607610.
26.Rogues, AM, Verdun-Esquer, C, Buisson-Valles, I, et al. Impact of safety devices for preventing percutaneous injuries related to phlebotomy procedures in health care workers. Am J Infect Control 2004;32:441444.
27.Mendelson, MH, Chen, L, Bailey, E, Finkelstein-Blond, L, Kogan, G. Evaluation of a safety IV catheter (IVC) (Becton Dickinson, Insyte Auto-guard) final report. In: Program and abstracts of the 11th Annual Meeting of the Society for Healthcare Epidemiology of America (Toronto, Ontario, Canada). 2001.
28.Azar-Cavanagh, M, Burdt, P, Green-McKenzie, J. Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers. Infect Control Hosp Epidemiol 2007;28:165170.
29.Lee, JM, Botteman, MF, Nicklasson, L, Cobden, D, Pashos, CL. Needlestick injury in acute care nurses caring for patients with diabetes mellitus: a retrospective study. Curr Med Res Opin 2005;21:741747.
30.Mendelson, MH, Lin-Chen, BY, Solomon, R, Bailey, E, Kogan, G, Goldbold, J. Evaluation of a safety resheathable winged steel needle for prevention of percutaneous injuries associated with intravascular-access procedures among healthcare workers. Infect Control Hosp Epidemiol 2003;24 105112
31.Alvarado-Ramy, F, Beltrami, EM, Short, LJ, et al. A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicenter study, 1993-1995. Infect Control Hosp Epidemiol 2003;24 97104
32.Castella, A, Vallino, A, Argentero, PA, Zotti, CM. Preventability of percutaneous injuries in healthcare workers: a year-long survey in Italy. J Hosp Infect 2003;55:290294.
33.Stone, PW, Clarke, SP, Cimiotti, J, Correa-de-Araujo, R. Nurses' working conditions: implications for infections diseases. Emerg Infect Dis 2004;10:19841989.
34.Ganczak, M, Milona, M, Szych, Z. Nurses and occupational exposures to bloodborne viruses in Poland. Infect Control Hosp Epidemiol 2006;27 175180
35.Cullen, BL, Genasi, F, Symington, I, et al. Potential for reported needlestick injury prevention among healthcare workers through safety device usage and improvement of guideline adherence: expert panel assessment. J Hosp Infect 2006;63:445451.
36.Rivers, DL, Aday, LA, Frankowski, RF, Felknor, S, White, D, Nichols, B. Predictors of nurses' acceptance of an intravenous catheter safety device. Nurs Res 2003;52:249255.
37.Tabak, N, Shiaabana, AM, Shasha, S. The health beliefs of hospital staff and the reporting of needlestick injury. J Clin Nurs 2006;15:12281239.
38.Pellissier, G, Migueres, B, Tarantola, A, Abiteboul, D, Lolom, I, Bouvet, E;the GERES Group. Risk of needlestick injuries by injection pens. J Hosp Infect 2006;63:6064.


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