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To examine a comprehensive approach for preventing percutaneous injuries associated with phlebotomy procedures.
Design and Setting:
From 1993 through 1995, personnel at 10 university-affiliated hospitals enhanced surveillance and assessed underreporting of percutaneous injuries; selected, implemented, and evaluated the efficacy of phlebotomy devices with safety features (ie, engineered sharps injury prevention devices [ESIPDs]); and assessed healthcare worker satisfaction with ESIPDs. Investigators also evaluated the preventability of a subset of percutaneous injuries and conducted an audit of sharps disposal containers to quantify activation rates for devices with safety features.
The three selected phlebotomy devices with safety features reduced percutaneous injury rates compared with conventional devices. Activation rates varied according to ease of use, healthcare worker preference for ESIPDs, perceived “patient adverse events,” and device-specific training.
Device-specific features and healthcare worker training and involvement in the selection of ESIPDs affect the activation rates for ESIPDs and therefore their efficacy. The implementation of ESIPDs is a useful measure in a comprehensive program to reduce percutaneous injuries associated with phlebotomy procedures.
To assess the impact of a needleless intravenous (IV) connection system on the rate of reported intravenous-connection–related (IVCR) percutaneous injuries, and to assess user satisfaction, frequency of use, and barriers to use.
A pre-post inter vention design, with injury incidence rates being compared 3 years before and 1 year after hospitalwide device implementation; and a cross-sectional descriptive user satisfaction survey.
Two tertiar y-care teaching hospitals, one general and one pediatric, located in a large metropolitan medical center.
All IVCR percutaneous injuries reported to the employee health ser vices at both hospitals during the years from 1989 to 1991 and 1993.
Survey participants were selected randomly from licensed nursing employees at both hospitals.
IV connection system consisting of blunt plastic cannulas and compressed latex injection sites.
After device implementation, the IVCR injury rate was reduced 62.4% (rate ratio [RR], 0.38; 95% confidence inter val [CI95], 0.27-0.53) at the general hospital and 70.2% (RR, 0.30; CI95, 0.17-0.53) at the pediatric hospital. After adjusting for the reduction in injury rate due to factors other than device implementation, the IVCR injury rate was reduced 54.5% (adjusted RR, 0.46; CI95, 0.32-0.65) at the general hospital and 57.2% (adjusted RR, 0.43; CI95, 0.24-0.78) at the pediatric hospital. Approximately 94% of survey respondents (n=478, response rate=51%) were satisfied with the device and recommended continued use. However, needles still were being used for activities that could have been performed with the needleless system because of compatibility, accessibility, and other technical problems related to the device.
The device was effective in reducing the rate of reported IVCR percutaneous injuries and users were satisfied with the device, but barriers to universal use were identified.
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