Use of safety devices and the prevention of percutaneous injuries among healthcare workers

OBJECTIVE. To study the effectiveness of safety devices intended to prevent percutaneous injuries. DESIGN. Quasi-experimental trial with before-and-after intervention evaluation. SETTING. A 350-bed general hospital that has had an ongoing educational program for the prevention of percutaneous injuries since January 2002. methods. In October 2005, we implemented a program for the use of engineered devices to prevent percutaneous injury in the emergency department and half of the hospital wards during the following procedures: intravascular catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood sampling, and intramuscular and subcutaneous injections. The nurses in the wards that participated in the intervention received a 3-hour course on occupationally acquired bloodborne infections, and they had a 2-hour hands-on training session with the devices. We studied the percutaneous injury rate and the direct cost during the preintervention period ( October 2004 through March 2005) and the intervention period (October 2005 through March 2006). RESULTS. We observed a 93% reduction in the relative risk of percutaneous injuries in areas where safety devices were used ( 14 vs 1 percutaneous injury). Specifically, rates decreased from 18.3 injuries (95% confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients in the emergency department (P=.002) and from 44.0 injuries ( 95% CI, 20.1-83.6 injuries) to 5.2 injuries ( 95% CI, 0.1-28.8 injuries) per 100,000 patient-days in hospital wards (P=.007). In the control wards of the hospital (ie, those where the intervention was not implemented), rates remained stable. The direct cost increase was E0.558 (US$ 0.753) per patient in the emergency department and E0.636 ( US$ 0.858) per patient- day in the hospital wards. CONCLUSION. Proper use of engineered devices to prevent percutaneous injury is a highly effective measure to prevent these injuries among healthcare workers. However, education and training are the keys to achieving the greatest preventative effect.