Needlestick prevention devices: data from hospital surveillance in Piedmont, Italy—comprehensive analysis on needlestick injuries between healthcare workers after the introduction of safety devices

Abstract

ObjectiveNeedlestick and sharps injuries (NSIs) involving healthcare workers (HCWs) are worldwide under surveillance since long time; the implementation of the European Directive 32/2010 regarding the mandatory use of safety-engineered devices (SEDs) seems to have reduced the number of these accidents. Our surveillance investigated the frequency and the modality of SED-related NSIs in the Piedmont region to verify changes in the epidemiology of these events.MethodsWe analysed the exposure records of NSIs, device usage data and structural data of 42 acute care hospitals and compared conventional and safety devices. We calculated the accident rates per 100 000 needles and, as a measure of SED efficacy, the relative risk between the use of safety and non-safety devices with a 95% CI. We also described the dynamics of the NSIs and the most involved professional groups of HCWs, procedures and devices.ResultsTotal and specific device accident rates for 100 000 needles were lower with the use of SEDs. In 2015–2016, there were 1640 NSIs, with a decreasing absolute number during the observation period; 18% were SEDs related. Half of the total accidents with SEDs occurred in the patient’s room, and nurses were involved in 78% of the cases. The most involved devices were the butterfly needles and peripheral venous catheters, and the most involved procedures were venous sampling (40%) and phlebotherapy (16%). The exposures occurred mostly during the procedure, and 45% of the SED-related injuries occurred during the disposal of the device; 92% of the SEDs involved had a manual activation mechanism.ConclusionIn agreement with the results of other European studies, our results show that SEDs reduce the risk of percutaneous exposure of HCWs, but in introducing SEDs, we must select those with a higher level of safety (with a passive activation mechanism) and improve the healthcare staff training programmes.

Causes of Needlestick and Sharps Injuries When Using Devices with and without Safety Features

“…In our study sample, NSIs in nurses were more often associated with SEDs than NSIs in physicians. Similar results have been reported by other studies, namely that NSIs associated with SEDs were more likely to occur in nurses whereas NSIs in physicians were more likely associated with non-SEDs [ 11 , 20 ]. With the data available to us, we were unable to conclude whether SEDs were less frequently used by physicians than by nurses.…”

“…However, this survey was performed in 2014 and thus only six months after SEDs had become mandatory in Germany. A hospital survey in Italy using routine data for the period from 2014 to 2016 found that 16% of NSIs were associated with SEDs [ 11 ].…”

“…The present study found that approximately one-third of all NSIs were related to problems with disposal. However, it was shown by out data and by others that users of SEDs or non-SEDs were equally involved in disposal-related NSIs [ 11 ]. Other authors concluded that SED-related injuries were commonly linked to a combination of SEDs not being activated prior to disposal and the unsafe disposition of the device [ 23 ].…”

“…After the introduction of SEDs, several studies have investigated the incidence of NSIs since 2001 and most of these have reported an overall reduction in NSIs due to the impact of SEDs [ 3 , 8 , 9 , 10 , 11 ]. Reviews have found low to moderate quality evidence of the inconsistent effects on NSIs during intravenous and phlebotomy procedures and hypodermic injections [ 12 , 13 , 14 ].…”

Hollow silicon microneedle fabrication using advanced plasma etch technologies for applications in transdermal drug delivery

“…Metal MNs are expensive to produce 17 and it has proven difficult to machine hollow metal MNs in a cost effective production process. In terms of width dimensions, the 32G hypodermic needle is similar to the hollow silicon microneedles presented here, but the risk associated with the much increased length of the hypodermic requires continuous training programmes in order to be handled safely, 18,19 and their use results in more pain compared to microneedles. 3 Hollow bevelled silicon microneedles have been demonstrated, 14 but in general their fabrication either relies heavily on wet chemicals such as KOH or HF for the creation of the bevelled surface, 14,[20][21][22] or plasma etching of the bevel surface results in an unconventional needle shape.…”