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Factors Promoting Consistent Adherence to Safe Needle Precautions Among Hospital Workers

Published online by Cambridge University Press:  02 January 2015

Thomas E. Vaughn ,
Kimberly D. McCoy ,
Susan E. Beekmann ,
Robert F. Woolson ,
James C. Torner  and
Bradley N. Doebbeling
Thomas E. Vaughn
Affiliation:
Department of Health Management and Policy, The University of Iowa College of Public Health, Iowa City, Iowa
Kimberly D. McCoy
Affiliation:
Roudebush Veterans Affairs Medical Center, Regenstrief Institute for Health Care, and the Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
Susan E. Beekmann
Affiliation:
Department of Pathology, The University of Iowa College of Medicine, Iowa City, Iowa
Robert F. Woolson
Affiliation:
Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, South Carolina
James C. Torner
Affiliation:
Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa
Bradley N. Doebbeling*
Affiliation:
Roudebush Veterans Affairs Medical Center, Regenstrief Institute for Health Care, and the Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
*
Roudebush VA Medical Center, Health Services Research and Development (11H), 1481 W. 10th Street, Indianapolis, IN 46202
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Abstract

Objective:

To examine organizational factors and occupational characteristics associated with adherence to occupational safety guidelines recommending never recapping needles.

Design:

Mail surveys were conducted with healthcare workers (HCWs) and infection control professionals (ICPs).

Setting:

The surveys were conducted at all non-federal general hospitals in Iowa, except one tertiary-care hospital. Survey data were linked to annual survey data of the American Hospital Association (AHA).

Participants:

HCWs were sampled from statewide rosters of physicians, nurses, and laboratory workers in Iowa. Eligible HCWs worked in a setting and position in which they were likely to routinely handle needles. ICPs at all hospitals in the state were surveyed.

Results:

Ninety-nine ICPs responded (79% response rate). AHA data were available for all variables from 84 (85%) of the hospitals. Analyses were based on 1,454 HCWs who identified one of these hospitals as their primary hospital (70% response rate). Analyses were conducted using multiple logistic regression. Positive predictors of consistent adherence included infection control personnel hours per full-time–equivalent employee (odds ratio [OR], 1.03), frequency of standard precautions education (OR, 1.11), facilities providing personal protective equipment (OR, 1.82), facilities using needleless intravenous systems (OR, 1.42), and management support for safety (OR, 1.05). Negative predictors were use of “blood and body fluid precautions” isolation category (OR, 0.74) and increased job demands (OR, 0.90).

Conclusion:

Healthcare organizations can improve staff safety by investing wisely in educational programs regarding approaches to minimize these risks, providing protective equipment, and eliminating the use of blood and body fluid precautions as an isolation policy.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 7 , July 2004 , pp. 548 - 555
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.National Institute for Occupational Safety and Health. NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings. Cincinnati, OH: National Institute for Occupational Safety and Health; 1999. DHHS (NIOSH) publication no. 2000-108.Google Scholar
2.Wilkinson, WE, Salazar, MK, Uhl, JE, Koepsell, TD, DeRoos, RL, Long, RJ. Occupational injuries: a study of health care workers at a northwestern health science center and teaching hospital. AAOHN J 1992;40:287–293.Google Scholar
3.Doebbeling, BN. Percutaneous injury: risks and management. In: Schlossberg, D, ed. Current Therapy of Infectious Disease, ed. 2. St. Louis: Mosby-Year Book; 2000:402–407.Google Scholar
4.Alter, HJ, Seef, LB, Kaplan, PM. Type B hepatitis: the infectivity of blood positive for e antigen and DNA polymerase after accidental needlestick exposure. N Engl J Med 1976;295:909–913.CrossRefGoogle ScholarPubMed
5.Alter, MJ. Occupational exposure to hepatitis C virus: a dilemma. Infect Control Hosp Epidemiol 1994;15:742–744.CrossRefGoogle ScholarPubMed
6.Artenstein, AW, Hicks, CB, Goodwin, BS JrHilliard, JK. Human infection with hepatitis B virus following a needlestick injury. Reviews of Infectious Diseases 1991;13:288–291.CrossRefGoogle Scholar
7.Gerberding, JL, Bryant-LeBlanc, CE, Nelson, K, et al.Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and hepatitis B virus to health care workers exposed to patients with AIDS and AIDS-related conditions. J Infect Dis 1987;156:1–8.CrossRefGoogle ScholarPubMed
8.Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens, final rule. 29 CFR 1910.1030 (1991).Google Scholar
9.Garner, JS. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
10.Occupational Safety and Health Administration. Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens. Washington, DC: U.S. Government Printing Office; 1999. CPL2-2.44D.Google Scholar
11.Aiken, LH, Sloane, DM, Klocinski, JL. Hospital nurses' occupational exposure to blood: prospective, retrospective, and institutional reports. Am J Public Health 1997;87:103–107.CrossRefGoogle ScholarPubMed
12.Beekmann, SE, Doebbeling, BN. Vaccine-preventable diseases. Baillieres Clinical Infectious Disease 1998;5:389–404.Google Scholar
13.Hersey, JC, Martin, LS. Use of infection control guidelines by workers in healthcare facilities to prevent occupational transmission of HBV and HIV: results from a national survey. Infect Control Hosp Epidemiol 1994;15:243–252.CrossRefGoogle ScholarPubMed
14.Tan, L, Hawk, C IIISterling, ML. Report of the Council on Scientific Affairs: preventing needlestick injuries in health care settings. Arch Intern Med 2001;161:929–936.Google Scholar
15.Porta, C, Handelman, E, McGovern, P. Needlestick injuries among health care workers. AAOHN J 1999;47:237–244.Google Scholar
16.McCormick, RD, Maki, DG. Epidemiology of needle-stick injuries in hospital personnel. Am J Med 1981;70:928–932.CrossRefGoogle ScholarPubMed
17.Ruben, FL, Norden, CW, Rockwell, K, et al.Epidemiology of accidental needle-puncture wounds in hospital workers. Am J Med Sci 1983;286:26–30.Google Scholar
18.Jagger, J, Hunt, EH, Brand-Elnagger, J, Pearson, RD. Rates of needlestick injury caused by various devices in a university hospital. N Engl J Med 1988;319:284–288.Google Scholar
19. Needlestick Safety and Prevention Act of 2000. Pub L No. 106-430, 114 Stat 1901 (2000).Google Scholar
20.Jagger, J, Pearson, RD. Universal precautions: still missing the point on needlesticks. Infect Control Hosp Epidemiol 1991;12:211–213.Google Scholar
21.Billiet, LS, Parker, CR, Tanley, PC, et al.Needlestick injury rate reduction during phlebotomy: a comparative study of two safety devices. Laboratory Medicine 1991;22:120–123.CrossRefGoogle Scholar
22.Orenstein, R, Reynolds, L, Karabaic, M, Lamb, A, Markowitz, SM, Wong, ES. Do protective devices prevent needlestick injuries among health care workers? Am J Infect Control 1995;23:344–351.CrossRefGoogle ScholarPubMed
23.L'Ecuyer, PB, Schwab, EO, Iademarco, E, Barr, N, Aton, EA, Fraser, VJ. Randomized prospective study of the impact of three needleless intravenous systems on needlestick injury rates. Infect Control Hosp Epidemiol 1996;17:803–808.CrossRefGoogle ScholarPubMed
24.Rogers, B, Goodno, L. Evaluation of interventions to prevent needlestick injuries in health care occupations. Am J Prev Med 2000;18(4 suppl):90–98.CrossRefGoogle ScholarPubMed
25.Gershon, RR, Pearse, L, Grimes, M, Flanagan, PA, Vlahov, D. The impact of multifocused interventions on sharps injury rates at an acute care hospital. Infect Control Hosp Epidemiol 1999;20:806–811.CrossRefGoogle ScholarPubMed
26.Clarke, SP, Rockett, JL, Sloane, DM, Aiken, LH. Organizational climate, staffing and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses. Am J Infect Control 2002;30:207–216.CrossRefGoogle ScholarPubMed
27.Nelsing, S, Nielsen, TL, Nielsen, JO. Noncompliance with universal precautions and the associated risk of mucocutaneous blood exposure among Danish physicians. Infect Control Hosp Epidemiol 1997;18:692–698.CrossRefGoogle ScholarPubMed
28.Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures: Minneapolis-St. Paul, New York City, and San Francisco, 1993-1995. MMWR 1997;46:21–25.Google Scholar
29.Turner, HS, Hurley, JL, Butler, KM, Holl, J. Accidental exposures to blood and other body fluids in a large academic medical center. J Am Coll Health 1999;47:199–206.CrossRefGoogle Scholar
30.Dejoy, DM, Gershon, RRM, Murphy, LR, Wilson, MG. A work-systems analysis of compliance with universal precautions among health care workers. Health Education Quarterly 1996;23:159–174.Google Scholar
31.Gershon, RR, Vlahov, D, Felknor, SA, et al.Compliance with universal precautions among health care workers at three regional hospitals. Am J Infect Control 1995;23:225–236.CrossRefGoogle ScholarPubMed
32.Michalsen, A, Delclos, GL, Felknor, SA, et al.Compliance with universal precautions among physicians. J Occup Environ Med 1997;39:130–137.Google Scholar
33.Linnemann, CC JrCannon, C, DeRonde, M, Lanphear, B. Effect of educational programs, rigid sharps containers, and universal precautions on reported needlestick injuries in healthcare workers. Infect Control Hosp Epidemiol 1991;12:214–219.Google Scholar
34.McCormick, RD, Meisch, MG, Ircink, FG, Maki, DG. Epidemiology of hospital sharps injuries: a 14-year prospective study in the pre-AIDS and AIDS eras. Am J Med 1991;91(suppl 3B):301S–307S.Google Scholar
35.Whitby, M, Stead, P, Najman, JM. Needlestick injury: impact of a recapping device and an associated education program. Infect Control Hosp Epidemiol 1991;12:220–225.Google Scholar
36.Eisenstein, HC, Smith, DA. Epidemiology of reported sharps injuries in a tertiary care hospital. J Hosp Infect 1992;20:271–280.CrossRefGoogle ScholarPubMed
37.Beekmann, SE, Vlahov, D, Koziol, DE, McShalley, ED, Schmitt, JM, Henderson, DK. Temporal association between implementation of universal precautions and a sustained, progressive decrease in percutaneous exposures to blood. Clin Infect Dis 1994;18:562–569.CrossRefGoogle Scholar
38.Rattner, SL, Norman, SA, Berlin, JA. Percutaneous injuries on the “front line”: a survey of housestaff and nurses. Am J Prev Med 1994;10:372–377.CrossRefGoogle ScholarPubMed
39.Jackson, MA, Williams, K, Olson-Burgess, C, Kinney, J, Olson, LC, Burry, VF. Needlestick injuries in a pediatric hospital. Pediatr Infect Dis J 1994;13:318–319.Google Scholar
40.Pettit, LL, Gee, SQ, Begue, RE. Epidemiology of sharp object injuries in a children's hospital. Pediatr Infect Dis J 1997;16:1019–1023.Google Scholar
41.Stotka, JL, Wong, ES, Williams, DS, Stuart, CG, Markowitz, SM. An analysis of blood and body fluid exposures sustained by house officers, medical students, and nursing personnel on acute-care general medical wards: a prospective study. Infect Control Hosp Epidemiol 1991;12:583–590.CrossRefGoogle ScholarPubMed
42.Roudot-Thoraval, F, Montagne, O, Schaeffer, A, Dubreuil-Lemaire, ML, Hachard, D, Durand-Zaleski, I. Costs and benefits of measures to prevent needlestick injuries in a university hospital. Infect Control Hosp Epidemiol 1999;20:614–617.Google Scholar
43.Albertoni, F, Ippolito, G, Petrosillo, N, et al.Needlestick injury in hospital personnel: a multicenter survey from central Italy. Infect Control Hosp Epidemiol 1992;13:540–544.Google Scholar
44.Clarke, SP, Sloane, DM, Aiken, LH. Effects of hospital staffing and organizational climate on needlestick injuries to nurses. Am J Public Health 2002;92:1115–1119.CrossRefGoogle Scholar
45.Alvarado, F, Panlilio, A, Cardo, D, NaSH Surveillance Group. Percutaneous injury reporting in U.S. Hospitals. Infect Control Hosp Epidemiol 2000;21:106.Google Scholar
46.Becker, MH, Janz, NK, Band, J, Bartley, J, Snyder, MB, Bayunes, RP. Noncompliance with universal precautions policy: why do physicians and nurses recap needles? Am J Infect Control 1990;18:232–239.Google Scholar
47.American Hospital Association. Annual Survey Database: Fiscal Year 1996. Chicago: American Hospital Association; 1997.Google Scholar
48.Scott, R. Innovation in medical care organizations: a synthetic review. Medical Care Organizations 1990;47:165–192.Google Scholar
49.Murphy, L, Gershon, RM, DeJoy, DM. Stress and Occupational Exposure to HIV: Handbook of Stress Medicine. Boca Raton, FL: CRC Press; 1995.Google Scholar
50.Murphy, L, Sturdivant, K, Gershon, R. Organizational and employee characteristics predict compliance with universal precautions. Presented at the Annual Meeting of the American Psychological Society; June 25-28, 1993; Chicago, IL.Google Scholar
51.DeJoy, D, Murphy, LR, Gershon, RM. Safety climate in health care settings. In: Bittner, AC, Champney, PC, eds. Advances in Industrial Ergonomics and Safety VII. New York: Taylor & Francis; 1995:923–929.Google Scholar
52.Leliopoulou, C, Waterman, H, Chakrabarty, S. Nurses failure to appreciate the risks of infection due to needle stick accidents: a hospital based survey. J Hosp Infect 1999;47:53–59.CrossRefGoogle Scholar
53.Hosmer, D, Lemeshow, S. Applied Logistic Regression. New York: John Wiley and Sons; 1989.Google Scholar
54.Greenfield, S, Kaplan, SH, Kahn, R, Ninomiya, JL, Griffith, JL. Profiling care provided by different groups of physicians: effects of patient case-mix (bias) and physician-level clustering on quality assessment results. Ann Intern Med 2002;136:111–121.CrossRefGoogle ScholarPubMed
55.O'Boyle Williams, C, Campbell, S, Henry, K, Collier, P. Variables influencing worker compliance with universal precautions in the emergency department. Am J Infect Control 1994;22:138–148.Google Scholar
56.Gershon, RR, Flanagan, PA, Karkashian, C, et al.Health care workers' experience with postexposure management of bloodborne pathogen exposures: a pilot study. Am J Infect Control 2000;28:421–428.Google Scholar
57.Lundstrom, T, Pugliese, G, Bartley, J, Cox, J, Guither, C. Organizational and environmental factors that affect worker health and safety and patient outcomes. Am J Infect Control 2002;30:93–106.Google Scholar