L'Ecuyer P B, Schwab E O, Iademarco E, Barr N, Aton E A, Fraser V J
Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO 63110-1093, USA.
Infect Control Hosp Epidemiol. 1996 Dec;17(12):803-8. doi: 10.1086/647240.
To determine the impact of three needleless intravenous systems on needlestick injury rates.
Randomized controlled trial.
1,000-bed tertiary-care Midwestern hospital.
Nursing personnel from general medical, general surgical, and intensive-care units.
From June 1992 through March 1994, a metal blunt cannula (MBC), two-way valve (2-way), and plastic blunt cannula (PBC) were introduced into three study areas, and needlestick injury rates were compared to three control areas using traditional needled devices.
24 and 29 needlestick injuries were reported in study and control areas. Intravenous-therapy-related injuries comprised 45.8% and 57.1% of injuries in each area. Thirty-seven percent and 20.7% of study and control area needlestick injuries were considered to pose a high risk of bloodborne infection. The 2-way group had similar rates of total and intravenous-related needlestick injuries compared to control groups. The PBC group had lower rates of total and intravenous-related needlestick injuries per 1,000 patient-days (rate ratios [RR], 0.32 and 0.24; 95% confidence intervals [CI95], 0.12-0.81 and 0.09-0.61; P = .02 and P = .003, respectively) and per 1,000 productive hours worked (RR, 0.11 and 0.08; CI95, 0.01-0.92 and 0.01-0.69; P = .03 and P = .005, respectively) compared to controls.
Needlestick injuries continued in study areas despite the introduction of needleless devices, and risks of bloodborne pathogen transmission were similar to control areas. The PBC device group noted lower rates of needlestick injuries compared to controls, but there were problems with product acceptance, correct product use, and continued traditional device use in study areas. Low needlestick injury rates make interpretations difficult. Further studies of safety devices are needed and should attempt greater control of worker behavior to aid interpretation.
确定三种无针静脉输液系统对针刺伤发生率的影响。
随机对照试验。
一家拥有1000张床位的中西部三级医疗医院。
来自普通内科、普通外科和重症监护病房的护理人员。
从1992年6月至1994年3月，将金属钝头套管（MBC）、双向阀（2-way）和塑料钝头套管（PBC）引入三个研究区域，并将针刺伤发生率与使用传统带针装置的三个对照区域进行比较。
研究区域和对照区域分别报告了24例和29例针刺伤。与静脉治疗相关的损伤分别占每个区域损伤的45.8%和57.1%。研究区域和对照区域的针刺伤中有37%和20.7%被认为具有较高的血源感染风险。与对照组相比，双向阀组的总体针刺伤发生率和与静脉治疗相关的针刺伤发生率相似。塑料钝头套管组每1000个患者日的总体针刺伤发生率和与静脉治疗相关的针刺伤发生率较低（发生率比[RR]分别为0.32和0.24；95%置信区间[CI95]分别为0.12 - 0.81和0.09 - 0.61；P值分别为0.02和0.003），每1000个工作生产小时的发生率也较低（RR分别为0.11和0.08；CI95分别为0.01 - 0.92和0.01 - 0.69；P值分别为0.03和P = 0.005）。
尽管引入了无针装置，但研究区域仍存在针刺伤情况，血源性病原体传播风险与对照区域相似。与对照组相比，塑料钝头套管装置组的针刺伤发生率较低，但在研究区域存在产品接受度、正确使用产品以及继续使用传统装置等问题。针刺伤发生率较低使得结果解读困难。需要对安全装置进行进一步研究，并且应尝试更好地控制工作人员行为以辅助解读。
