Sohn SeJean, Eagan Janet, Sepkowitz Kent A, Zuccotti Gianna
Infectious Disease Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Infect Control Hosp Epidemiol. 2004 Jul;25(7):536-42. doi: 10.1086/502436.
To assess the effect of implementing safety-engineered devices on percutaneous injury epidemiology, specifically on percutaneous injuries associated with a higher risk of blood-borne pathogen exposure.
Before-and-after intervention trial comparing 3-year preintervention (1998--2000) and 1-year postintervention (2001--2002) periods. Percutaneous injury data have been entered prospectively into CDC NaSH software since 1998.
A 427-bed, tertiary-care hospital in Manhattan.
All employees who reported percutaneous injuries during the study period.
A "safer-needle system," composed of a variety of safety-engineered devices to allow for needle-safe IV delivery, blood collection, IV insertion, and intramuscular and subcutaneous injection, was implemented in February 2001.
The mean annual incidence of percutaneous injuries decreased from 34.08 per 1,000 full-time-equivalent employees preintervention to 14.25 postintervention (P < .001). Reductions in the average monthly number of percutaneous injuries resulting from both low-risk (P < .01) and high-risk (P was not significant) activities were observed. Nurses experienced the greatest decrease (74.5%, P < .001), followed by ancillary staff (61.5%, P = .03). Significant rate reductions were observed for the following activities: manipulating patients or sharps (83.5%, P < .001), collisions or contact with sharps (73.0%, P = .01), disposal-related injuries (21.41%, P = .001), and catheter insertions (88.2%, P < .001). Injury rates involving hollow-bore needles also decreased (70.6%, P < .001).
The implementation of safety-engineered devices reduced percutaneous injury rates across occupations, activities, times of injury, and devices. Moreover, intervention impact was observed when stratified by risk for blood-borne pathogen transmission.
评估实施安全设计装置对经皮损伤流行病学的影响，特别是对与血源性病原体暴露高风险相关的经皮损伤的影响。
干预前后试验，比较干预前3年（1998 - 2000年）和干预后1年（2001 - 2002年）的情况。自1998年以来，经皮损伤数据已前瞻性地录入美国疾病控制与预防中心的针刺安全与预防（NaSH）软件。
曼哈顿一家拥有427张床位的三级护理医院。
在研究期间报告经皮损伤的所有员工。
2001年2月实施了一种“更安全的针头系统”，该系统由多种安全设计装置组成，可实现安全的静脉输液、采血、静脉穿刺以及肌肉和皮下注射。
经皮损伤的年平均发生率从干预前每1000名全职工当量员工34.08例降至干预后14.25例（P <.001）。观察到低风险（P <.01）和高风险（P无统计学意义）活动导致的经皮损伤平均每月数量均有所减少。护士减少幅度最大（74.5%，P <.001），其次是辅助人员（61.5%，P =.03）。以下活动的发生率显著降低：处理患者或锐器（83.5%，P <.001）、与锐器碰撞或接触（73.0%，P =.01）、与处置相关的损伤（21.41%，P =.001）以及导管插入（88.2%，P <.001）。涉及空心针的损伤率也有所下降（70.6%，P <.001）。
安全设计装置的实施降低了各职业、活动、损伤时间和器械导致的经皮损伤率。此外，按血源性病原体传播风险分层时也观察到了干预效果。
