Makofsky D, Cone J E
Center for Occupational and Environmental Health, University of California, San Francisco.
Infect Control Hosp Epidemiol. 1993 Mar;14(3):140-4. doi: 10.1086/646699.
To compare the proportion of recapped needles, an injury surrogate measure, in disposal boxes on two different types of hospital units, both before and after an intervention.
Prospective nonrandomized intervention trial.
A major public teaching hospital.
Specific hospital units. We selected two types of hospital units for study: the first type of hospital unit (medical-surgical ward) had existing mounted in-bathroom needle disposal boxes, and the second type of hospital unit (intensive care unit) had unmounted needle disposal boxes in the room but not necessarily near the patient's bedside.
The installation, in the medical-surgical wards only, of mounted needle disposal boxes on the wall near the patient's bed. The box location in the intensive care units remained the same. In both types of unit, a new mailbox-slot disposal box (SAGE) also was substituted for the previous round-top container.
The baseline proportion of recapped needles in the first medical-surgical unit was 32.6% (+/- 3.8%) and in the second medical-surgical unit it was 27.4% (+/- 4.0%) in the bathroom needle disposal boxes, which was similar to the observed proportion (34.7 +/- 6.4%) in the intensive care unit boxes. Following the intervention, the proportion of recapped needles was significantly reduced in the disposal containers adjacent to the bedside in medical-surgical units, to 27% (a difference of 2.9 standard errors of the baseline distribution) in the first unit and 18.2% (a difference of 4.6 standard errors) in the second. In the intensive care unit, where boxes were not moved but new mailbox-types were simply substituted, no significant change was noted (36.6%, a difference of 0.59 standard errors). A statistically significant reduction was observed in the proportion of needles recapped in both wards combined following the intervention (30.2% to 26.2%, a difference of 2.9 standard errors).
Environmental changes alone are an effective means of altering the risk to healthcare workers from sharp instruments. The use of needle-box counts provides a sensitive and stable instrument to measure injury surrogates and, indirectly, behavioral change in hospital workers.
比较在干预前后，两种不同类型医院科室的处置盒中回套针头的比例（一种伤害替代指标）。
前瞻性非随机干预试验。
一家大型公立教学医院。
特定医院科室。我们选择了两种类型的医院科室进行研究：第一类医院科室（内科 - 外科病房）在浴室已安装针头处置盒，第二类医院科室（重症监护室）在房间内有未安装的针头处置盒，但不一定靠近患者床边。
仅在内科 - 外科病房患者床边的墙上安装针头处置盒。重症监护室的盒子位置保持不变。在这两类科室中，还将之前的圆顶容器换成了新的信箱式处置盒（SAGE）。
在内科 - 外科病房的第一个科室中，浴室针头处置盒中回套针头的基线比例为32.6%（±3.8%），第二个内科 - 外科病房为27.4%（±4.0%），这与在重症监护室盒子中观察到的比例（34.7±6.4%）相似。干预后，内科 - 外科病房床边处置容器中回套针头的比例显著降低，第一个科室降至27%（与基线分布相差2.9个标准误），第二个科室降至18.2%（相差4.6个标准误）。在重症监护室，盒子未移动但只是更换了新的信箱式盒子，未观察到显著变化（36.6%，相差0.59个标准误）。干预后，两个病房合并后回套针头的比例有统计学意义的降低（从30.2%降至26.2%，相差2.9个标准误）。
仅环境改变就是改变医护人员因锐器而面临风险的有效手段。使用针头盒计数提供了一种灵敏且稳定的工具，可用于测量伤害替代指标，并间接衡量医院工作人员的行为变化。
