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Multifocused interventions to reduce sharps injuries

 

Clinical bottom line

A hospital wide comprehensive multifocused programme reduced sharps injuries by 69%, and had other benefits in terms of occupational safety.


Reference

R Gershon et al. The impact of multifocused interventions on sharps injury rates at an acute-care hospital. Infection Control and Hospital Epidemiology 1999 20: 806-811.

Study

A 450 bed acute care hospital in washington, DC, was the site of this study. A task force charged with developing a comprehensive programme to reduce needlestick injuries produced recommendations that were implemented during the calender year of 1992.

The intervention consisted of the introduction of needless systems for intravenous therapy and a new sharps disposal system. The disposal system consisted on new, wide-mouthed containers, together with a new system of changing the containers on a regular basis, and before they were full. In addition there was:

The safety programme became an important management tool, and the use of safety procedures and compliance with them were built into employee and manager performance evaluations.

Sharps injury data were collected from 1990 to 1998, a period when reporting was mandatory, with incentives to encourage reporting. A questionnaire was used to elicit information about the cause and nature of the injury. Information reported was on all personnel other than doctors.

Results

The incidence of sharps injuries declined over the period, from 82/1,000 whole time equivalent employees in the preintervention period of 1990-1991, to 24 per 1,000 in the period 1997-1998 (Figure 1). This represents a 69% reduction in needlestick injuries over the period. Throughout the period the most common type of sharp involved in injury was hollow bore needles, usually involved in over two-thirds of cases.

Figure 1: Rate of sharps injuries before and after the introduction of a multifocused intervention (red)


There were dramatic changes in the factors related to needlestick injuries comparing the 1990-1991 preintervention period with the latest postintervention period of 1997-1998 (Figure 2). Only for injuries caused by coworkers was there no reduction in injury rates.

Figure 2: Factors related to sharps injuries in the period before and the latest after the intervention


Comment

This is an interesting and important study. It was probably begun as an idea back in about 1990, well over a decade ago, and before the issue was raising as much attention as it does today.

The results were very good, with a very large reduction in sharps injuries. Other benefits were also seen, like an increase in appropriate glove use in exposed workers, from 50% in 1990 to 81% in 1998. Improved compliance with occupational and other safety standards were also documented.

This study emphasises that there are no quick fixes. Yes, some benefits can be immediate, but it is in the longer term, as more people become "sold" on the programme, and as it matures (with the annual retraining included in this one), benefits continue to accrue.

There are lessons here for healthcare workers (why is this programme not being adopted in my institution?), administrators (why an I not adopting this programme in my institution?) and politicians (why on earth are we not doing this in ALL our hospitals?). These are interesting questions.