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Needlesticks, nurses, and organisation 2


Clinical bottom line

Nurse staffing and organisation are key determinants of needlestick risk. More experienced nurses have fewer needlestick injuries.


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.


The sample for this study was nurses working in 22 hospitals across the USA, 20 of which had reputations for attracting and retaining clinical nurses. In 1998 4,085 nurses were sent questionnaires asking about needlestick injuries, staffing, organisation, and the use of protective equipment. There were 2,287 replies (56% response rate).


Respondent nurses were frequently well educated, with 63% having some higher nursing qualification. Most (85%) reported always using gloves in situations where contact with body fluids was possible. Half the nurses (4*%) had at least one needlestick injury in their career, 9% had a needlestick injury in the previous year and 1.2% in the previous month. There was a reported near miss incidence of 23% in the prior month.

The probability of ever having had a needlestick injury was inversely related to years of experience, with about 60^ of nurses having at least one needlestick over a 20-year career, rising to 100% by 45 years (Figure 1).

Figure 1: Probability of needlestick injury and years of work

The probability of a needlestick injury in the previous year was also related to experience, being lower in nurses with more than five years of experience (Figure 2).

Figure 2: Probability of needlestick injury in previous year and experience

Needlestick injuries were not always reported to hospital officials, though in this sample 85% of those occurring in the previous year were reported. The circumstances of the injuries are shown in Table 1. Venipuncture, and needle disposal and recapping accounted for about 70% of injuries.

Table 1: Description of needlestick injuries

Circumstances of injury
Percent of total (n=197)
Needle disposal
Needle recapping
improper disposal of uncapped needle
Emergency situation

Organisational features also influenced the needlestick injury rate. Low levels of administrative support and highest hospital-level average day shift patient loads were both associated with significantly higher rates of needlestick injury. The use of protective equipment for phlebotomy was associated with lower rates.


To some extent the results of this study are what we might expect. More experience leads to a reduced rate of needlestick injuries, as does the use of safety equipment, but higher workload and less administrative support increases it. The sample was arguably some of the best US hospitals in terms of staff recruitment and retention, so probably some of the better hospitals. That the organisational factors feature here suggests that needlestick rates would be heavily influenced by much higher workloads, much worse organisational support, and lower nurse experience.