To investigate reported needlestick injuries in hospital workers from an adult learner theory perspective: identifying safe needle device knowledge and practice, and flaws in needle designs and management practices surrounding such problems.

Exploratory descriptive study of reported needlestick injuries from hollow needled devices in a hospital. Injured healthcare workers were counseled via hospital protocol, then a survey was filled out containing no identifiers of individual or institution.

Seventeen Metropolitan Washington, DC, area hospitals.

All workers reporting needlestick injuries during February 1-28, 1990.

Seventy-two injuries were reported; there were no multiple injuries to any individual. Thirty-three (45.8%) were to registered nurses (RNs)-more than any other group of workers. Recapping accounted for a higher percentage than any other activity (10 sticks, 14.1%). Of workers incurring recapping injuries, 3 identified a knowledge of a one-handed spearing technique and did not practice it; 4 neither knew nor practiced it. Eighteen (25.0%) were to “down-stream” housekeepers and aides who did not use such devices in their practice. Disposable needle/syringes caused 49.3% of injuries; hypodermic needles on intravenous lines caused 16.9%. Of the needlesticks, 60.6% were after use and before disposal, 4.2% occurred as the worker was putting an item into a needlebox, and 9.9% occurred from needles protruding from inappropriate bags. Many injuries occurred in the first 2 hours of work after being off the previous day, on Sunday, and on Monday

Of nurses and medical technologists reporting knowledge of a spearing recapping technique, 97.3% suffered injury via other methods. This strongly suggests that knowledge leads to different action. Safer needled devices and needle-free systems would make a safer workplace. Further study is indicated to identify if and why the first two hours after returning to work on Sunday or Monday are risky for needlestick injuries. Management practices must ensure compliance to safe practice both by employees and related medical staff.

To decrease the numbers of needlesticks among healthcare workers.

All reported needlestick injuries at Santa Clara Valley Medical Center, San Jose, California, were reviewed, analyzed, and tabulated by the infection control department yearly from 1986 to 1990.

A 588-bed county teaching hospital in San Jose, California, affiliated with Stanford University.

All employees of Santa Clara Valley Medical Center who reported needlestick injuries on injury report forms.

From April to December 1987, more needle disposal containers were added to as many patient care areas and as close to the area of use as possible. Results of 1986, 1988, 1989, and 1990 analyses were communicated yearly to all personnel, extensive educational programs were conducted in 1987 and 1988, and educational efforts continued in 1989 and 1990.

In 1986, there were 259 needlestick injuries at our institution, 22% (32) from recapping. After needle disposal containers were added to all patient care areas, needlestick injuries for 1988 totalled 143, a 45% decrease in the total needlestick injuries and a 53% decrease in recapping injuries. Communication of results to all areas of the hospital and educational activities were started in 1987 and continued through the next 3 years. In 1989, there were 135 needlestick injuries, a decrease of 6% from 1988; recapping injuries decreased 40% from 1988. In 1990, there were 104 needlestick injuries, a 23% decrease since 1989, and a 33% decrease in recapping injuries. The total number of needlestick injuries from 1986 to 1990 decreased by 60%, and those injuries from recapping decreased by 81% to 89%.

We have continued to monitor needlestick injuries, communicate findings to all personnel, and include needlestick prevention in educational programs. We contend that more convenient placement of needle disposal containers, communication of tidings, and education do decrease needlestick injuries in healthcare workers.

To review the current recommendations for immunoprophylaxis and chemoprophylaxis of infection in adults, including those who are at increased risk from occupation, lifestyle, travel, or pre-existing medical conditions.

Review of the pertinent literature.

Adult ambulatory care.

Guidelines for the prevention of several diseases including measles, tuberculosis, and bacterial endocarditis recently have been changed. Current recommendations for immunization, immune globulin therapy, and chemotherapy for these and other common infections are reviewed.

To investigate a cluster of postoperative bleeding following open heart surgery.

A cohort and case/control study.

Palo Alto Veterans Administration Medical Center, Palo Alto, California.

Six (21.4%) of 28 patients undergoing open heart surgery who developed severe, nonsurgical, postoperative bleeding from July 1 through August 30, 1988 (outbreak period). All case-patients had chest tube drainage of > 1000 ml within 4 hours of surgery but did not have identifiable bleeding vessel(s) on exploration.

Upon comparison of the pre-outbreak (January 1986 through June 1988) and the outbreak period, a significant increase was found in the incidence of postoperative nonsurgical bleeding (5/440 versus 6/28, p = .0006), but not of postoperative surgical bleeding (8/440 versus 0/28, p = 1 .0). Of all patients undergoing open heart surgery during the outbreak period, case patients were found to be older (67.8 versus 60.6, p= .02) and to have received a larger volume of hetastarch (HES), a synthetic colloidal plasma-volume expander (mean = 19.4 ml/kg versus 14.1 ml/kg, p= .02).

We conclude that the use of large volumes of HES during surgery in the elderly open heart surgery patient may increase the risk for severe, nonsurgical postoperative bleeding, probably caused by alterations of the coagulation system. As the incidence of open heart surgery increases among the elderly, surgeons and anesthesiologists should be alert to possible adverse reactions from exposures not associated with adverse reactions in younger patients.