Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, Virginia, USA.
Infect Control Hosp Epidemiol. 2013 Sep;34(9):935-9. doi: 10.1086/671733. Epub 2013 Jul 31.
Measuring the effect of the Needlestick Safety and Prevention Act (NSPA) is challenging. No agreement exists on a common denominator for calculating injury rates. Does it make a difference? How are the law and safety-engineered devices related? What is the effect on injuries and costs? This study examines those issues in assessing the impact of the legislation on hospital worker percutaneous injuries.
Using a historic prospective design, we analyzed injury data from 85 hospitals. Injury rates were calculated per 100 full-time equivalents, 100 staffed beds, and 100 admissions each year from 1995 to 2005. We compared changes for each denominator. We measured the proportion of the injury rate attributed to safety-engineered devices. Finally, we estimated a national change in injuries and associated costs.
For all denominators, a precipitous drop in injury rates of greater than one-third ([Formula: see text]) occurred in 2001, immediately following the legislation. The decrease was sustained through 2005. Concomitant with the decrease in rates, the proportion of injuries from safety-engineered devices nearly tripled ([Formula: see text]) across all denominators. We estimated annual reductions of more than 100,000 sharps injuries at a cost savings of $69-$415 million.
While the data cannot demonstrate cause and effect, the evidence suggests a reduction in hospital worker injury rates related to the NSPA, regardless of denominator. It also suggests an association between the increase in safety-engineered devices and the reduction in overall injury rates. The decreases observed translate into significant reductions in injuries and associated costs.
衡量针刺安全与预防法案（NSPA）的效果具有挑战性。对于计算伤害率的共同基准尚无共识。这有区别吗？法律和安全工程设备之间有什么关系？对伤害和成本有什么影响？本研究通过评估该法规对医院工作人员经皮损伤的影响来研究这些问题。
使用历史前瞻性设计，我们分析了 85 家医院的伤害数据。从 1995 年到 2005 年，每年按每 100 个全职等效值、每 100 个床位和每 100 个入院人数计算伤害率。我们比较了每个分母的变化。我们测量了安全工程设备对伤害率的归因比例。最后，我们估计了全国范围内的伤害和相关成本的变化。
对于所有分母，伤害率均急剧下降，超过三分之一（[公式：见正文]），2001 年在立法之后立即发生。这种下降一直持续到 2005 年。随着率的下降，安全工程设备造成的伤害比例在所有分母中几乎翻了三倍（[公式：见正文]）。我们估计每年可减少超过 10 万例锐器伤害，节省 6900 万至 4.15 亿美元。
虽然数据不能证明因果关系，但证据表明与 NSPA 相关的医院工作人员伤害率有所降低，而与分母无关。它还表明安全工程设备的增加与整体伤害率的降低之间存在关联。观察到的减少转化为伤害和相关成本的显著减少。
