23 February

Use of Safety Devices and the Prevention Valls V Original

Özet :

Objectives: To study the effectiveness of safety devices intended to prevent percutaneous injuries.

Design: Quasi-experimental trial with before-and-after intervention evaluation.

Setting: A 350-bed general hospital that has had an ongoing educational program for the prevention of percutaneous injuries since January 2002.

Methods: In October 2005, we implemented a program for the use of engineered devices to prevent percutaneous injury in the emergency department and half of the hospital wards during the following procedures: intravascular catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood sampling, and intramuscular and subcutaneous injections. The nurses in the wards that participated in the intervention received a 3-hour course on occupationally acquired bloodborne infections, and they had a 2-hour “hands-on” training session with the devices. We studied the percutaneous injury rate and the direct cost during the preintervention period (October 2004 through March 2005) and the intervention period (October 2005 through March 2006).

Results:We observed a 93% reduction in the relative risk of percutaneous injuries in areas where safety devices were used (14 vs 1 percutaneous injury). Specifically, rates decreased from 18.3 injuries (95% confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients in the emergency department (p=.002) and from 44.0 injuries (95% CI, 20.1-83.6 injuries) to 5.2 injuries (95% CI, 0.1-28.8 injuries) per 100,000 patient-days in hospital wards (p=.007). In the control wards of the hospital (ie, those where the intervention was not implemented), rates remained stable. The direct cost increase was €0.558 (US$0.753) per patient in the emergency department and €0.636 (US$0.858) per patient-day in the hospital wards.

Conclusion: Proper use of engineered devices to prevent percutaneous injury is a highly effective measure to prevent these injuries among healthcare workers. However, education and training are the keys to achieving the greatest preventative effect.

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