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Reprint from Journal of Hospital Infection,December, 2005

Passive safety devices aremore effective at reducingneedlestick injuries.Y. linumaab, M. Takeshitab, Y. Hashimotob,N. Fujiharaab, T. Saitoab, S. Takakuraab, S. Ichiyamaaba Department of Clinical Laboratory Medicine,Kyoto University Hospitalb Department of Infection Control and Prevention,

Kyoto University Hospital

Compliments of

BIBRAUNSHARING EXPERTISE

VAD55-4/07-JHI-l0M

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Passive safety devices are more effective atreducing needlestick injuries

Sir,Healthcare workers (HCWs) who use or who areexposed to needles are at risk of receiving needlestick injuries. 13 Such injuries can lead to seriousinfections with blood-borne pathogens such ashuman immunodeficiency virus, hepatitis B virusor hepatitis C virus. To reduce needlestick injuries,hospitals should replace their needles with needlefree safety technology (primary prevention). Whereneedles cannot be replaced, a safety engineeredneedle that covers the sharp after use should beused (secondary prevention).2.3 There are twocategories of safety engineered devices: useractivated safety devices and passive safety devices.A user-activated device requires HCWsto activate asafety mechanism and cover the sharp themselves,and a passive safety device features a design thatautomatically covers the sharp during use.2Kyoto University Hospital (KUH) is a 1200-beduniversity hospital. Approximately 90 sharps-relatedinjuries occurred in this hospital in 1999, about 10%ofwhich were due to intravenous cannulae (IYC). From2000 to 2002, KUH introduced two safety IYC toprevent needlestick injuries. Injury rates with thesesafety devices were lower than with conventionallYC,but these safety IYCwere not widely accepted (usagerate of 40%or lower, Figure 1). Therefore, the totalnumber of needlestick injuries relating to IYCdid not

decrease markedly. The Infection Control Team inKUH decided to look at newer safety technology tohelp with clinical acceptance and to increase the useof safety lYe. Two passive safety IYCwere chosen forevaluation. Both had similar safety mechanisms; theneedle tips were automatically covered with a safetyclip when the needle exited the catheter hub. Thesetwo devices are very similar to conventional IYC,requiring no significant change in insertion technique;therefore, minimal training is required on how to usethem. After close evaluation, Introcan Safety (B.Braun Melsungen AG, Germany) was selected becausethe reliability of its safety mechanism was superior.Introcan Safety@ was introduced into KUH in2003 and has spread rapidly with a usage rate of 84%in 2004 (Figure 1). No injuries occurred with thisdevice in 2004 and the total number of needlestickinjuries caused by IYC decreased by 62.5% whencompared with the conventional device era.When selecting a safety device, the safety mech

anism should be included in the evaluation process.Passivesafety devices are superior in several respectsto user-activated devices.2,4 Firstly, passive featuresare more effective in preventing needlestick injuriesthan devices that rely on a user-activated design.Several injuries have occurred due to non-activationand improper activation of the safety mechanism. Ithas been reported that there is an 85% or loweractivation rate for user-activated safety devices. 5Secondly, devices utilizing passive safety features areeasier to use because they require no change intechnique to activate the safety mechanism. Thirdly,passive designs are similar to conventional devices

D Conventional IVC Safety IVC (user-activated safety design)i:2] Safety IVC (passive safety design)Introcan Safety (passive safety design)

_____ Injuries withconventional IVC- - 0 - - Injuries withsafety IVC

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Figure 1 Trends over time in the share rate of intravenous cannulae (IYC) used in Kyoto University Hospital (KUH) andneedlestick injury rate by conventional and safety IVe.

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Letters to the Editor

with regard to feel, length, balance and weight.Therefore, it is easier to gain clinical acceptance andproduct use among conservative HCWs.However, even passive safety devices have their

l imitations. The passive safety IVC that was initiallyintroduced in 2001was not accepted byHCWsbecauseof the slower backflow of blood into the chamber,which delayed the recognition of vein insertion.Therefore, we needed a more refined passive safetyIVe. After market research, two candidates wereselected and Introcan Safetl" was finally chosen. Todate, we believe that the introduction of IntrocanSafety has contributed to the increasing usage of asafety IVC and the reduction of needlestick injuries.We believe that the eradication of injuries due to IVCcan be accomplished when Introcan Safety hascompletely replaced conventionallVe.

References1. Trim JC, Elliott TSJ. A review of sharps injuries andpreventative strategies. J Hasp Infect 2003;53:237-242.

2. Shelton P, Rosenthal K. Sharps injury prevention: select asafer needle. Nurs Manage 2004;35:25-31.

3. National Institute of Occupat ional Safety and Health. Alert:Preventing needles tick injuries in health care setting[Publication No. 2000-108]. Cincinnati : NIOSH; 1999.

4. American Federation of State, Country, and MunicipalEmployees. Needle points: an AFSCMEguide to sharps safety.Washington, DC: AFSCME; 2002.

5. Mendelson MH, Lin-Chen BY, Solomon R, et al. Evaluation of asafety resheathable winged steel needle for prevention of

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percutaneous injur ies associated with intravascular-accessprocedures among healthcare workers. Infect Control HaspEpidemio/2003;24:105-112.

Y. linumaa.b,*,J. Igawab,

M. Takeshitab,Y. Hashimotob,N. Fuj iharaa,b,T. Saitoa,b,S. Takakuraa,b,S. IChiyamaa,b

Oepartment of Clinical Laboratory Medicine,Kyoto University Hospital, 54Shogoin

Kawahara-cho, Sakyo-ku,Kyoto 606-8507, Japan

bOepartment of Infection Control and Prevention,Kyoto University Hospital, 54Shogoin

Kawahara-cho, Sakyo-ku,Kyoto 606-8507, Japan[-mail address: yiinuma@kuhp.kyoto-u.ac.jp

Available online 13 September 2005

*Corresponding author. Tel.:+81 757513476; fax: +81757513758.

2005 The Hospital Infection Society. Published by Elsevier Ltd.All rights reserved.doi: 10.1 016/j .jhin.2005.04.019