Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-22T23:20:03.110Z Has data issue: false hasContentIssue false

Costs and Benefits of Measures to Prevent Needlestick Injuries in a University Hospital

Published online by Cambridge University Press:  02 January 2015

Françoise Roudot-Thoraval
Affiliation:
Department of Public Health, Henri Mondor Hospital, Paris, France
Olivier Montagne
Affiliation:
Department of Medicine, Henri Mondor Hospital, Paris, France
Annette Schaeffer
Affiliation:
Department of Medicine, Henri Mondor Hospital, Paris, France
Marie-Laure Dubreuil-Lemaire
Affiliation:
Department of Clinical Immunology, Henri Mondor Hospital, Paris, France
Danièle Hachard
Affiliation:
Nursing Department, Henri Mondor Hospital, Paris, France
Isabelle Durand-Zaleski*
Affiliation:
Department of Public Health, Henri Mondor Hospital, Paris, France
*
HITEQ, Santé Publique, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France

Abstract

Objective:

To document the costs and the benefits (both in terms of costs averted and of injuries averted) of education sessions and replacement of phlebotomy devices to ensure that needle recapping did not take place.

Design:

The percentage of recapped needles and the rate of needlestick injuries were evaluated in 1990 and 1997, from a survey of transparent rigid containers in the wards and at the bedside and from a prospective register of all injuries in the workplace. Costs were computed from the viewpoint of the hospital. Positive costs were those of education and purchase of safer phlebotomy devices; negative costs were the prophylactic treatments and follow-up averted by the reduction in injuries.

Setting:

A 1,050-bed tertiary-care university hospital in the Paris region.

Results:

Between the two periods, the proportion of needles seen in the containers that had been recapped was reduced from 10% to 2%. In 1990, 127 needlestick (12.7/100,000 needles) and 52 recapping injuries were reported versus 62 (6.4/100,000 needles) and 22 in 1996 and 1997. When the rates were related to the actual number of patients, the reduction was 76 injuries per year. The total cost of information and preventive measures was $325,927 per year. The cost-effectiveness was $4,000 per injury prevented.

Conclusion:

Although preventive measures taken to ensure reduction of needlestick injuries appear to have been effective (75% reduction in recapping and 50% reduction in injuries), the cost of the safety program was high.

Type
Orginal Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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. Jagger, J, Hunt, EH, Brand-Elnaggar, J, Pearson, RD. Rates of needle-stick injury caused by various devices in a university hospital. N Engl J Med 1988;319:284288.Google Scholar
2. Ribner, BS, Landry, MN, Gholson, GL, Linden, LA. Impact of a rigid puncture resistant container system upon needlestick injuries. Infect Control 1987;8:6366.Google Scholar
3. Krasinski, K, LaCouture, R, Holzman, RS. Effect of changing needle disposal system on needle puncture injuries. Infect Control 1987;8:5962.Google Scholar
4. Edmond, M, Khakoo, R, McTaggart, B, Solomon, R Effect of bedside needle disposal units on recapping frequency and needlestick injury. Infect Control Hosp Epidemiol 1988;9:114116.CrossRefGoogle ScholarPubMed
5. Jagger, J, Pearson, RD, Brand, JJ. Avoiding the hazards of sharp instruments. Lancet 1986;1:1274.CrossRefGoogle ScholarPubMed
6. McCormick, RD, Meisch, MG, Ircink, FJ, Maki, DG. Epidemiology of hospital sharps injuries: a 14-year prospective study in the pre-AIDS and AIDS eras. Am J Med 1991;91(3B):301S307S.Google Scholar
7. O'Neill, TM, Abbott, AV, Radecki, SE. Risk of needlesticks and occupational exposure among residents and medical students. Arch Intern Med 1992;152:14511456.Google Scholar
8. Berry, AJ, Greene, ES. The risk of needlestick injuries and needlestick-transmitted diseases in the practice of anesthesiology. Anesthesiology 1992;77:10071021.Google Scholar
9. Klontz, KC, Gunn, RA, Caldwell, JS. Needlestick injuries and hepatitis B immunization in Florida paramedics: a statewide survey. Ann Emerg Med 1991;20:13101313.Google Scholar
10. Mitsui, T, Iwano, K, Masuka, K, Yamazaki, C, Okamoto, H, Tsuda, F, et al. Hepatitis C virus infection in medical personnel after needlestick accident Hepatology 1992;16:11091114.CrossRefGoogle ScholarPubMed
11. Kiyosawa, K, Sodeyama, T, Tanaka, E, Nakano, Y, Furuta, S, Nishioka, K, et al. Hepatitis C in hospital employees with needlestick injuries. Ann Intern Med 1991;115:367369.Google Scholar
12. Cardo, DM, Culver, DH, Ciesielski, CA, Srivastava, PU, Marcus, R, Abiteboul, D, et al. A case-control study of HIV seronconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med 1997;337:14851490.Google Scholar
13. Anderson, DC, Blower, AL, Packer, JM, Ganguli, LA, Preventing needlestick injuries. BMJ 1991;302:769770.CrossRefGoogle ScholarPubMed
14. Abiteboul, D, Antona, D, Bonnet, N, Dagon, C, Domart, M, Florentin, A, et al. Surveillance des accidents du travail avec exposition au sang à l'Assistance Publique-Hôpitaux de Paris. Arch Mal Prof 1994;55:18.Google Scholar
15. Ministère de l’emploi et de la Solidarité. Circulaire DGS/DH/98/249 du 20 avril 1989 relative à la prévention de la transmission d’agents infectieux véhiculés par le sang ou les liquides biologiques lors des soins dans les établissements de santé. Paris, France: Ministère de l'emploi et de la Solidarité.Google Scholar
16. Drummond, M, Stoddart, G, Torrance, G. Methods for Economie Evaluation of Health Care Programmes. Oxford, UK: Oxford University Press; 1989:7184.Google Scholar
17. Jagger, J, Hunt, EH, Pearson, RD. Recapping used needles: is it worse than the alternative? J Infect Dis 1990;162:784785.Google Scholar
18. Needlesticks: preaching to the seroconverted? Lancet 1992;340:640642.CrossRefGoogle Scholar
19. Cummins, AJ, Tedder, RS. Inadequate information on needlesticks accidents. Lancet 1992;339:11781179.Google Scholar
20. Dodging the needle in health care. Science 1992;258:34.Google Scholar
21. Beekman, SE, Vlahov, D, Koziol, DE, McShalley, ED, Schmitt, JM, Henderson, DK, Temporal association between implementation of Universal Precautions and a sustained, progressive decrease in percutaneous exposures to blood. Clin Infect Dis 1994;18:562569.Google Scholar
22. Adai, K, Anglim, AM, Palumbo, CL, Titus, MG, Coyner, BJ, Farr, BM. The use of high-efficiency particulate air-filter respirators to protect hospital workers from tuberculosis. A cost-effective analysis. N Engl J Med 1994;331:169173.Google Scholar
23. Hamory, BH. Underreporting of needlestick injuries in a university hospital. Am J Infect Control 1983;11:174177.Google Scholar
24. Yassi, A, McGill, ML, Khokhar, JB. Efficacy and cost-effectiveness of a needleless intravenous access system. Am J Infect Control 1995;23:5764.Google Scholar
25. Laufer, FN, Chiarello, LA, Application of cost-effectiveness methodology to the consideration of needlestick-prevention technology. Am J Infect Control 1994;22:7582.Google Scholar
26. Tengs, TO, Adams, ME, Pliskin, J, Safran, DG, Siegel, JE, Weinstein, MC, et al. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995;15:369390.CrossRefGoogle ScholarPubMed