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Universal precautions and percutaneous exposure

 

Clinical bottom line

A training programme for universal precautions and reporting resulted in a fall of about 40% in needlestick injuries.


Reference

SE Beekmann et al. Temporal association between implementation of universal precautions and a sustained, progressive decrease in percutaneous exposures to blood. Clinical Infectious Diseases 1994 18: 562-569.

Study

The setting for the study was the Clinical Centre at the National Institutes of Health in Bethesda. An intensive training programme began in late 1987, with initial training efforts continuing for about a year, involving the use of universal precautions when handling body fluids. New employees also go through the training programme.

The programme uses video and interactive sessions, stressing the need to report all injuries, and the availability of chemoprophylaxis. A computerised database of occupational injuries, including percutaneous and needlestick injuries involving blood or body fluids since 1984.

Results

In the years after the intervention, the number of needlestick injuries fell in absolute terms (from a peak of 170 in 1988 to 110 in 1991), and taking into account a growth in workload and personnel (Figure 1).

Figure 1: Needlesticks per 1,000 discharges


Most needlesticks occurred in nurses, and it was in nurses that the largest fall in absolute numbers of needlestick injuries was seen, from about 11 to 60 per year. Other falls were seen in housekeeping staff and phlebotomists. Although much lower, these fell almost to zero. Injuries to physicians and laboratory technicians were not much affected.

Most injuries occurred during manipulation of intravenous catheters, or recapping needles or disassembling syringes.

Comment

This study is now rather old, but there will be many places which have yet to undertake the same thorough approach to universal precautions as did the NIH. This preceded new safer devices, and is an indication of what can be achieved by universal precautions and training alone.