Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-19T19:52:08.563Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of a Safety Resheathable Winged Steel Needle for Prevention of Percutaneous Injuries Associated With Intravascular-Access Procedures Among Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Meryl H. Mendelson ,
Bao Ying Lin-Chen ,
Robin Solomon ,
Eileen Bailey ,
Gene Kogan  and
James Goldbold
Meryl H. Mendelson*
Affiliation:
Departments of Medicine and Infection Control, Division of Infectious Diseases, Mount Sinai School of Medicine and Mount Sinai Medical Center, New York, New York
Bao Ying Lin-Chen
Affiliation:
Departments of Medicine and Infection Control, Division of Infectious Diseases, Mount Sinai School of Medicine and Mount Sinai Medical Center, New York, New York
Robin Solomon
Affiliation:
Department of Medicine, Division of Infectious Diseases, Mount Sinai School of Medicine and Mount Sinai Medical Center, New York, New York
Eileen Bailey
Affiliation:
Department of Nursing, Division of Infectious Diseases, Mount Sinai School of Medicine and Mount Sinai Medical Center, New York, New York
Gene Kogan
Affiliation:
Department of Infection Control, Division of Infectious Diseases, Mount Sinai School of Medicine and Mount Sinai Medical Center, New York, New York
James Goldbold
Affiliation:
Department of Community and Preventive Medicine, Division of Infectious Diseases, Mount Sinai School of Medicine and Mount Sinai Medical Center, New York, New York
*
Division of Infectious Diseases, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To compare the percutaneous injury rate associated with a standard versus a safety resheathable winged steel (butterfly) needle.

Design:

Before-after trial of winged steel needle injuries during a 33-month period (19-month baseline, 3-month training, and 11-month study intervention), followed by a 31-month poststudy period.

Setting:

A 1,190-bed acute care referral hospital with inpatient and outpatient services in New York City.

Participants:

All healthcare workers performing intravascular-access procedures with winged steel needles.

Intervention:

Safety resheathable winged steel needle.

Results:

The injury rate associated with winged steel needles declined from 13.41 to 6.41 per 100,000 (relative risk [RR], 0.48; 95% confidence interval [CI95], 0.31 to 0.73) following implementation of the safety device. Injuries occurring during or after disposal were reduced most substantially (RR 0.15; CI95, 0.06 to 0.43 Safety winged steel needle injuries occurred most often before activation of the safety mechanism was appropriate (39%); 32% were due to the user choosing not to activate the device, 21% occurred during activation, and 4% were due to improper activation. Preference for the safety winged steel needle over the standard device was 63%. The safety feature was activated in 83% of the samples examined during audits of disposal containers. Following completion of the study, the safety winged steel needle injury rate (7.29 per 100,000) did not differ significantly from the winged steel needle injury rate during the study period.

Conclusion:

Implementation of a safety resheathable winged steel needle substantially reduced injuries among healthcare workers performing vascular-access procedures. The residual risk of injury associated with this device can be reduced further with increased compliance with proper activation procedures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 2 , February 2003 , pp. 105 - 112
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Centers for Disease Control and Prevention. Immunization of health care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997;46(RR-18):1–42.Google Scholar
2.Alter, MJ. The epidemiology of acute and chronic hepatitis C. Clinics in Liver Disease 1997;1:559–569.Google Scholar
3.Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47(RR-19):1–39.Google Scholar
4.Tokars, JI, Marcus, R, Culver, DH, et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. Ann Intern Med 1993;118:913–919.Google Scholar
5.Henderson, DK, Fahey, BJ, Willy, M, et al. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures: a prospective evaluation. Ann Intern Med 1990;113:740–746.CrossRefGoogle ScholarPubMed
6.Gerberding, JL. Incidence and prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and cytomegalovirus among health care personnel at risk for blood exposure: final report from a longitudinal study. J Infect Dis 1994;170:1410–1417.CrossRefGoogle ScholarPubMed
7.Ippolito, G, Puro, V, De Carli, G, Italian Study Group on Occupational Risk of HPV Infection. The risk of occupational human immunodeficiency virus infection in health care workers: Italian Multicenter Study. Arch Intern Med 1993;153:1451–1458.CrossRefGoogle ScholarPubMed
8. Anonymous. HIV seroconversion after occupational exposure despite early prophylactic zidovudine therapy. Lancet 1993;341:1077–1078.Google Scholar
9.Lot, F, Abiteboul, D. Infections professionnelles par le V.I.N. en France chez le personnel de sante: le point au 30 juin 1995. Bulliten Epidemiologique Hebdomadaire (Paris) 1995.Google Scholar
10.Perdue, B, Wolderufael, D, Mellors, J, et al. HIV-1 transmission by a needlestick injury despite rapid initiation of four-drug postexposure prophylaxis. Presented at the 76th Conference on Retroviruses and Opportunistic Infections; January 31-February 4, 1999; Chicago, IL Abstract 210.Google Scholar
11.Beltrami, EM, Luo, C-C, Dela Torre, N, Cardo, DM. HIV transmission after an occupational exposure despite postexposure prophylaxis with a combination drug regimen. Presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections in conjunction with the 10th Annual Meeting of the Society for Healthcare Epidemiology of America; March 5-9,2000; Atlanta, GA.Google Scholar
12.Beltrami, EM, Cheingsong, R, Respess, R, Cardo, DM, the Occupational HIV Exposure Study Group, CDC. Antiretroviral drug resistance in HIV-infected source patients for occupational exposures to healthcare workers. Presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections in conjunction with the 10th Annual Meeting of the Society for Healthcare Epidemiology of America; March 5-9, 2000; Atlanta, GA.Google Scholar
13.Tack, PC, Bremer, JW, Harris, AA, Landay, AL, Kessler, HA, Kuritzkes, DR. Genotypic analysis of HIV-1 isolates to identify antiretroviral resistance mutations from source patients involved in health care worker occupational exposures. JAMA 1999;281:1085–1086.Google Scholar
14.Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens: final rule. Federal Register 1991;56:64175–64182.Google Scholar
15. Pub L No. 106430, Needlestick Safety and Prevention Act (November 6, 2000).Google Scholar
16.Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries: final rule. Federal Register 2001;66:5318–5325.Google Scholar
17.Cardo, DM, Culver, DH, Ciesielski, CA. et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997;337:1485–1490.Google Scholar
18.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 1997;46:21–25.Google Scholar
19.Mendelson, MH. Incidence and prevalence of needlesticks: an urban university hospital perspective. In: Using Safer Needle Devices: The Time Is Now, Report of the National Committee on Safer Needle Devices. Arlington, TX: J & J Medical; 1998.Google Scholar
20.Cardo, D, Culver, D, Srivastava, P, the NaSH Surveillance Group. Results from first phase of the National Surveillance System for Health Care Workers. Presented at the 7th Annual Meeting of the Society for Healthcare Epidemiology of America; April 27-29, 1997; St. Louis, MO.Google Scholar
21.Agresti, A. Categorical Analysis. New York: John Wiley & Sons; 1990:55–56.Google Scholar
22.Chiarello, L, Nagin, D, Laufer, F. Pilot Study of Needlestick Prevention Devices: Report to the Legislature. Albany, NY: New York State Department of Health; 1992.Google Scholar
23.Gershon, RRM, Pearse, L, Grimes, M, Flanagan, PA, Vlahov, D. The impact of multifocused interventions on sharps injury rates at an acute-care hospital. Infect Control Hosp Epidemiol 1999;20:806–811.Google Scholar
24.Billiet, LS, Parker, CR, Tanley, PC, Wallas, CH. Needlestick injury rate reduction during phlebotomy; a comparative study of two safety devices. Laboratory Medicine 1991;22:122–123.Google Scholar
25.Jagger, J. Reducing occupational exposure to bloodborne pathogens: where do we stand a decade later? Infect Control Hosp Epidemiol 1996;17:573–575.CrossRefGoogle ScholarPubMed
26.Ippolito, G, De Carli, G, Puro, V, et al. Device-specific risk of needlestick injury in Italian health care workers. JAMA 1994;272:607–610.Google Scholar
27.Mendelson, MH, Chen, L, Solomon, R, Bailey, E, Kogan, G, McCarthy, D. Evaluation of a safety IV catheter. Presented at the 9th Annual Meeting of the Society for Healthcare Epidemiology of America; April 18-20, 1999; San Francisco, CA.Google Scholar
28.Mendelson, MH, Chen, L, Bailey, E, Finkelstein-Blond, L, Kogan, G. Evaluation of a safety IV catheter (IVC) (Becton Dickinson, Insyte Autoguard): final report. Presented at the 11th Annual Meeting of Society for Healthcare Epidemiology of America; March 31-April 1, 2001; Toronto, Ontario, Canada.Google Scholar
29.Centers for Disease Control and Prevention. Summary Report for Data Collected From June 1995 Through December 2000. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
30.Centers for Disease Control and Prevention. Documented and possible occupationally acquired AIDS/HIV infection, by occupation. HIV/AIDS Surveillance Report. 2000; 12:24.Google Scholar
31.Ippolito, G, Puro, V, Heptonstall, J, Jagger, J, De Carli, G, Petrosillo, N. Occupational human immunodeficiency virus infection in health care workers: worldwide cases through September 1997. Clin Infect Dis 1999;28:365–383.Google Scholar
32.Campbell, SR, Srivastava, P, Williams, I, Alter, M, Cardo, D, NaSH Surveillance Group. Hepatitis C virus infection after occupational exposure. Presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections and the 10th Annual Meeting of the Society for Healthcare Epidemiology of America; March 5-9, 2000; Atlanta, GA.Google Scholar
33.Chiarello, LA. Selection of needlestick prevention devices: a conceptual framework for approaching product evaluation. Am J Infect Control 1995;25:386–395.CrossRefGoogle Scholar