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General Accounting Office review of needlestick prevention in the USA

 

Clinical bottom line

The US General Accounting Office estimates that about 69,000 needlesticks in hospitals can be prevented each year through using needles with safety features. This could reduce occupational infections by 25 cases of HBV and 16 cases of HCV each year.


The General Accounting Office in the United States has published a document on needlestick prevention (GAO-01-60R) that reviews data from the CDC on needlestick injuries in the USA , and how safety devices and other interventions may affect this number. It has also done a costing exercise.

The arguments are summarised here, but those who want a copy of the GAO document (18 pages) can download it from here as a PDF.

Preventable needlesticks

The number of percutaneous injuries caused by needles each year in hospital workers in the USA is estimated at 384,000, with about 236,000 arising from hollow bore needles. Most injuries occur after the device has been used and therefore exposed to potentially contaminated blood.

About a quarter of the needlesticks occur during use of a needle in a patient, for instance on insertion or withdrawal, or with sudden patient movement. These are probably not preventable with safety devices.

Safer technology

Hospitals using needles with safety features are reducing the number of needlestick and other types of percutaneous injury. Training and education help, as do safer working practices.

The weight of evidence for needlestick reductions with new devices is not exhaustive, but, for instance, a CDC study on use of safer devices for phlebotomy over about six million phlebotomies showed a substantial fall in needlestick rates.

Safer devices, though, are not suitable for every occasion, and cost and resistance to change can limit their effectiveness.

Reduction of needlestick injuries in hospitals

The GAO believe that about 29% of needlesticks in hospitals (69,000 injuries a year) can be prevented by safer devices, and that a further 109,000 by eliminating use of unnecessary needles, education and safer working practices (Table 1).

Table 1: Annual preventable needlesticks in hospitals in the USA

 

Number

Percent

Annual number of needlesticks

236,000

100

Not currently preventable

59,000

25

Preventable needlesticks

177,000

75

Using safety devices

69,000

29

Eliminating unnecessary use

58,000

25

Using safer work practices

51,000

21


Number of needles used

The GAO estimates for the number of needles and types used in hospitals in the USA every year is shown in Table 2. The estimates for the additional costs of purchasing this number of safety devices ranged from $70 million to $352 million per year.

Table 2: Annual use of needles in hospitals in the USA

Needle type

Number used each year

Number per hospital bed

Hypodermic needle/syringe

367,000,000

367

Vacuum blood collection tube

217,000,000

217

IV catheter

111,000,000

111

Winged-steel needle

56,000,000

56


Reducing occupational infections in hospitals

Preventing needlestick injuries in turn prevents occupational exposure to bloodborne diseases, and consequent infection of hospital workers. Using information collected in the USA, the number of preventable HBV and HCV infections in a year in hospitals in the USA is 65 and 42 cases respectively (Table 3).

Table 3: Projected number of HBV and HCV infections avoided from needlesticks

Mode of prevention

HBV

HCV

Using safety devices

25

16

Eliminating unnecessary use

21

14

Using safer work practices

19

12


Cost of treating workers injured by needlesticks

The costs of postexposure treatment vary widely, and depend on the situation. Estimates for postexposure treatment run from $500 to $3,000 per injury sustained. Using three levels of assumed cost of $500, $1,500 and $2,500, the GAO estimate for treating needlestick injuries in hospitals in the USA every year was between $37 million and $173 million per year.

This did not include longer term costs, which are potentially significant. The cost of treating a person with HIV has been estimated at about $25,000 a year. No account was taken for any legal costs for negligence, nor any compensation for lost employment or other damages.

These longer term costs could be substantial, and add significantly to the costs of immediate care.


Costs and benefits

Within the background set out, the cost and benefit scenarios with different scenarios for postexposure prophylaxis treatment costs, and different scenarios for cost of safety devices (from 1.5 times to 3.5 times more expensive than conventional needles) are set out in Table 4.

Table 4: Computation of range of costs and benefits for safety needles in US hospitals

 

Cost of postexposure treatment

Safety vs conventional needles

$500

$1,500

$2,500

1.5 x more costly

-$47

$21

$90

2.5 x more costly

-$129

-$60

$9

3.5 x more costly

-$374

-$306

-$237

Scenarios with higher costs of safety relative to conventional needles, and lower costs for postexposure treatment, are generally more costly. Red areas show where costs exceed benefits.

Scenarios with lower relative costs between safety and conventional devices and higher costs of postexposure treatment are generally cost saving. Blue areas show where benefits exceed costs.

In this computation, no allowance was made for the possible longer term costs, and costs of litigation or compensation.


Comment

The GAO has drawn together available information that could inform the argument about the benefits and costs of safer needles, and has produced a balanced report within the limits of that information. In its pages it gives the assumptions for costs it assumes, so that even with a little brain we can follow their argument.

The results are balanced. The range of possibilities encompasses a cost to US hospitals of $374 million a year to a saving of $90 million a year. That is either a lot of money, or no big deal, depending where one stands. But increased use of safety devices should drive costs down (or else purchasing managers are not doing their job), and the longer-term costs omitted in the calculation favour a cost saving scenario.

And there are the people. Modern healthcare is stressed enough, so reducing one more risk would be a real benefit to individuals as well as workers.

In the UK we will probably take a narrower and more jaundiced view, focussing on increased acquisition costs and forgetting the benefits, because that's someone else's budget. We shouldn't.