Karen Daley, PhD (c), MS, MPH, RN

Needlestick Injuries Conference

Dublin 2006

Critical Exposure:My Story

My StoryMy Story

• Details of injury• Occupational health follow-up

Decision to go public

• Personal considerations

• Putting a face to the issue

• Making some sense out of it

Needlestick injuries in the USWhat we knew in 1999:

• Incidence/frequency estimates

• Significant underreporting• More than 20 BBP (most often hep C)• 1000 HCW infections reported/yr• Data quality inconsistent

• Prevention possible

Hepatitis C: An Emerging Silent Epidemic

• 4M estimated cases in US; 170M worldwide

• 4X more prevalent than HIV in US pop• HCWs 3rd highest occupational risk grp • Long latency period with 85% chronic

infection; 20-25% develop cirrhosis• No current vaccine or prophylaxis• Early detection and treatment key

Needlestick injuries in the US What we didn’t know:• Actual numbers of injuries

• Actual number of infected workers

• Injury device specific information

• Device evaluation information

Needlestick injury costs • Lost work/productivity/treatment

• Occupational health follow-up

• Studies suggested $1500-$3000 per exposed worker without infection

• @600,000 injuries/yr = $900M-$1.8B

• One infected worker: $500,000-$1M over lifetime

Potential costs of injuries• Human costs

• Insured costs: medical f/u, HIV prophylaxis, treatment, disability, lost time

• Uninsured costs: paid wages, OT, replacement workers, clerical/supervisor time

• Organizational losses

Safer needle technology in 1999• Available for more than two decades

• 1000 products on current market

• 250 FDA approved

• Poor market penetration (15%)

• Effectiveness varies (need data)

• Cost implications/benefit

Cost of technology (1999)• Standard blood-drawing device: aver $.07

• Safety needle devices: aver $.28 more

• Up front conversion/incremental costs

• One study: 300 bed hospital:$17,000

Safety device costs have declined as market penetration increased

Most effective technologies• Active vs. passive

• Designs: shield; sheath; retractable

• Disposal systems

• Prevent over 80% of injuries

A Journey Beyond the Personal

• Massachusetts Nurses Association legislation

• State advocacy

• Federal advocacy

2000 Federal Needlestick Safety & Prevention Act

• Amends OSHA BBP standard

• Requires use of safer devices

• Frontline nurses and other healthcare workers participate in device selection and evaluation

Federal legislation components

• Device/injury data collection and logs

• Written exposure control plan with annual update

• Ongoing education/training of workers

Where we are today in US

Indicators of progress:• Market conversion to safety devices

• Increase in number of OSHA inspections

• Reduction in number of injuries due to conventional devices

• Overall decline in number of injuries