N Patel1, G H Tignor. 1. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510-2411, USA.
Abstract
BACKGROUND: Whether universal precautions training has reduced percutaneous sharps injuries is questioned. Prevention programs directed to specific problem areas are required to further reduce injury. Our purpose was to identify target areas. METHODS: Device-specific sharps injury rates per 100,000 devices purchased were determined by department at Yale New Haven Hospital (1993 to 1994). Usage per full-time equivalent was calculated by department. Rates were modelled using Poisson regression. RESULTS: Three epidemiologic patterns resulted: (1) injury rates were independent of usage (butterfly needles); (2) injury rates varied directly with usage (lancets); (3) injury rates varied inversely with usage (intravenous catheters, sutures, and scalpels). Device-specific usage and injury rates varied by department. Devices used little (9/full-time equivalent) but under difficult circumstances, such as intravenous catheters in pediatric patients, were associated with high injury rates (67.7/100,000). Devices, sometimes disassembled, such as blood collecting tubes, caused significantly more injury in departments where health care professionals work under time constraints, such as in the emergency department and nursing. Unconventional use of devices (Luer-Lok syringes and scalpels) resulted in higher rates of injury (nursing and laboratories). Building services appeared to be at risk for injury. CONCLUSIONS: With device-specific injury and usage rates by department, injury prevention programs can now focus on specific devices and departments.
BACKGROUND: Whether universal precautions training has reduced percutaneous sharps injuries is questioned. Prevention programs directed to specific problem areas are required to further reduce injury. Our purpose was to identify target areas. METHODS: Device-specific sharps injury rates per 100,000 devices purchased were determined by department at Yale New Haven Hospital (1993 to 1994). Usage per full-time equivalent was calculated by department. Rates were modelled using Poisson regression. RESULTS: Three epidemiologic patterns resulted: (1) injury rates were independent of usage (butterfly needles); (2) injury rates varied directly with usage (lancets); (3) injury rates varied inversely with usage (intravenous catheters, sutures, and scalpels). Device-specific usage and injury rates varied by department. Devices used little (9/full-time equivalent) but under difficult circumstances, such as intravenous catheters in pediatric patients, were associated with high injury rates (67.7/100,000). Devices, sometimes disassembled, such as blood collecting tubes, caused significantly more injury in departments where health care professionals work under time constraints, such as in the emergency department and nursing. Unconventional use of devices (Luer-Lok syringes and scalpels) resulted in higher rates of injury (nursing and laboratories). Building services appeared to be at risk for injury. CONCLUSIONS: With device-specific injury and usage rates by department, injury prevention programs can now focus on specific devices and departments.