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CDC Study on needlestick prevention during phlebotomy

 

Clinical bottom line

Testing three safety devices for phlebotomy produced substantial reductions in needlestick injury by 23-76% in US hospitals.


Reference

M Mendelson et al. 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: 2 (Jan 17).

Study

Six university-affiliated hospitals in the USA took part in the study over the years 1993-1995. The comparison was safety devices with conventional devices. Devices to be tested were chosen by the hospitals:

Before introducing safety devices each hospital conducted a comprehensive training programme.

In a first phase (average 10 months) conventional phlebotomy devices were used, with enhanced surveillance for injuries. An anonymous survey was conducted in workers regularly engaged in phlebotomy to determine rates of under-reporting, and the average number of phlebotomies done each day, and each week.

In a second phase (average duration 12 months) conventional phlebotomy devices were replaced with safety devices throughout the hospital. The supplies of phlebotomy equipment were monitored, autoclaved hospital waste was examined to determine rates of use, and the enhanced surveillance continued. The anonymous survey was repeated 1-2 months before the end of the period.

Results

Response to the survey was 75% in 3,120 workers in the two surveys. Overall, 54% of needlestick injuries were reported, with 563 needlestick injuries in the previous year: 18% of workers had at least one needlestick injury in the previous year.

Phlebotomists reported 91% of injuries, nurses 68%, medical students 35% and residents 31%.

The introduction of safety devices reduced the number of percutaneous injuries associated with phlebotomy (Table 1). There was a large number of phlebotomies with conventional and safety devices, and in each case the safety device delivered statistically significant reductions in percutaneous injuries, by 23% to 76%.

Table 1: Percutaneous injuries and phlebotomy before and after safety devices introduced

Winged steel needle

Vacuum tube

Safety device

Safety-Lok

Punctur-Guard

Venipuncture Needle-Pro

Number of phlebotomies (,000)

Conventional

2,540

524

895

Safety

1,896

502

628

Percutaneous in juries (total)
Conventional

102

19

33

Safety

58

4

8

Percutaneous in juries (per 100,000)
Conventional

4.0

3.6

3.6

Safety

3.1

0.9

1.2

Percentage reduction

23

76

66

Percentage of safety devices used

56

57

98

Note that total percutaneous injuries is adjusted for under-reporting

Uptake of the safety devices was over half in all cases, but was as high as 98% with the Venipuncture Needle-Pro. This might reflect a low rate of reporting of technical difficulties or adverse patient effects with this device.

Comment

This was a large study, performed with CDC and six large hospitals. It showed a large and relevant reduction in percutaneous needlestick injuries associated with phlebotomy. It underscored the under-reporting of injuries by healthcare workers, especially doctors and students.

The one problem is that it is now (in 2002) over seven years old, and safety devices may have changed over the intervening years. Some may not now be available, or they may have changed. Changing for the worse is unlikely.