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Needlesticks, nurses, and organisation 1


Clinical bottom line

Low staffing levels and poor organisational climate are associated with higher rates of needlestick injuries in nurses


SP Clarke et al. Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near misses in hospital nurses. American Journal of Infection Control 2002 30: 207-216.


This study reports on a survey done in 1991 of nurses working on 40 inpatient units in 20 general hospitals in 11 cities in the USA. A retrospective survey of 865 nurses asked about needlestick injuries and near misses in the previous month and year (732 usable responses). Prospective information was also collected at the end of each shift over two one-month periods in 1990 and 1991, with data from 12,349 shifts by 960 regular and temporary nursing staff.


In the retrospective study 34 of 789 (4.3%) nurses reported a needlestick injury in the previous month. Of 962 nurses reporting on at least one shift in the prospective part 53 (5.5%) reported a needlestick or sharp injury involving blood contamination, and 228 (24%) reported a near miss.

Nurses working in hospital units with poor work climates and lower staffing levels were more likely to report the presence of risk factors. Nurses with less adequate resources, lower staffing and less nurse leadership with higher levels of emotional exhaustion were typically twice as likely to report the presence of risks. Needlestick injuries were nearly three times higher when these factors were present, compared to when they were absent.


It's not just what you do, but the way that you do it. A considerable weight of evidence is beginning to accumulate about staffing levels, leadership and organisation for patient outcomes and staff stability. These factors also appear to promote a safer work environment for nurses.