Epidemiology of hospital sharps injuries: a 14-year prospective study in the pre-AIDS and AIDS eras

Abstract

The world pandemic of acquired immunodeficiency syndrome (AIDS) has focused enormous attention on the problem of accidental sharps injuries sustained by health care workers (HCWs) and the risk of occupationally acquired infection by human immunodeficiency virus (HIV). At the 1980 Conference, we reported a 4-year epidemiologic study (1975-1979) of sharps injuries in HCWs at our hospital. Using the same reporting system and analyses, we now report the epidemiology of sharps injuries in our center during the current AIDS era (1987-1988) and assess trends over the 14-year period. Despite greatly increased institutional efforts to prevent sharps injuries, the annual incidence has increased more than threefold (60.4 to 187.0/1,000 HCWs), reflecting better reporting and increased exposure. Reported injuries by house officers have increased ninefold. Adjusting for inflation, the direct costs of sharps injuries has increased sevenfold ($5,354 to $37,271/year). Environmental service HCWs (305.8 sharps injuries per 1,000 employees) now have the highest incidence in our center, followed by nursing personnel (196.5/1,000) and laboratory personnel (169.9/1,000), but as in 1975-1979, two thirds of all injuries occur in nursing personnel. Although phlebotomy team members have a very low risk per procedure (1/26,871 draws), their annual incidence is extraordinarily high, 407.0/1,000. Injuries continue to occur mainly during disposal of waste, linen, or used procedure trays (19.7% of all injuries), administration of parenteral injections or infusion therapy (15.7%), surgery (16.0%), blood drawing (13.3%), or recapping of used needles (10.1%). Making disposal units available at every bedside has reduced injuries from needle disposal two-fold since 1975-1979. With consistent application of a stringent postexposure protocol, and wide acceptance of the hepatitis B vaccine, we have had no sharps injury-related infections during the past 3 years. These data indicate the increasing risk, complexity and cost of sharps injuries in HCWs and the need for more innovative--ideally, technology-based--approaches to prevention. Certain groups of HCWs are at very high risk. Comprehensive postexposure protocols that are uniformly applied can provide substantial protection to exposed HCWs.