Needle sticks and adverse outcomes in office-based allergy practices.

BACKGROUND: In 1984 the first case of needle stick transmitted human immunodeficiency virus was reported. In 1986 Occupational Safety and Health Administration was petitioned by various unions representing health care employees to develop a standard which protects employees from occupational exposure to blood-borne diseases. Congress passed the Needle Stick Safety and Prevention Act. This specifies that "safer medical devices, such as sharps with engineered sharps injury protections and needle-less systems" constitute an effective engineering control, and must be used where feasible. This has been mandated in California as part of the labor code. Blood-borne pathogens of concern in needle stick injuries are human immunodeficiency virus, hepatitis virus B, and hepatitis virus C. OBJECTIVE: The objective of this study was to determine the incidence of accidental needlesticks (ANSs) and disease transmission in the allergy setting. METHODS: A retrospective survey of most California allergy practices and a few large multi-physician allergy practices. We received and used 121 of 400 surveys. RESULTS: Analysis of the survey data showed an overall incidence of 45 ANSs with 7.026 million 26-/27-gauge needles reported. There was zero rate of disease transmission; 6.41 ANSs per million compares favorably with an estimated 267 ANSs per million in the general medical setting. CONCLUSIONS: The rate of ANSs in the allergist's office is 2% that of general medical ANSs. The current "safety" needles have no proven effectiveness. There is no reported disease transmission in the allergist's office setting using existent methods. This solution needs further study before there is generalized implementation of the engineering devices of no proven effectiveness that may in fact increase ANSs.

Impact of respiratory symptoms on health-related quality of life and medical resource utilization of patients treated by allergy specialists and primary care providers.

BACKGROUND: Respiratory symptoms associated with allergy and asthma cause substantial health care burden. OBJECTIVE: This observational pilot study compared internal medicine/family practice (IM/FP) and pediatric primary care providers with allergists in the diagnosis, treatment, and health-related quality of life (HRQL) outcomes of adults and children with respiratory symptoms. METHODS: Two allergists, 2 IM/FP, and 2 pediatricians enrolled 242 patients with respiratory symptoms ages 5 to 16 years old (n = 123) and 17 to 70 years old (n = 119). HRQL questionnaires were completed at enrollment and quarterly for 1 year. The adult questionnaire included SF-36, respiratory symptom role productivity, ITG Asthma Short Form, and allergy symptom index (ASI) scales. The child questionnaire included CHQ-PF28, respiratory symptom family impact, ITG Child Asthma Short Form, and ASI scales. HRQL changes were evaluated over the study period. RESULTS: Adults treated by allergists reported significantly greater improvement in HRQL on 5 of 8 SF-36 scales, the respiratory symptom role productivity scale, 3 of 5 ITG Asthma Short Form scales, and 2 of 4 ASI scales compared with adults treated by an IM/FP (P < 0.05). Pediatric patients treated by allergists had significantly greater improvement on 3 of 15 CHQ-PF28 scales, the respiratory symptom family impact scale, and one ASI scale compared with patients treated by pediatricians (P < 0.05). CONCLUSIONS: Compared with patients treated by primary care physicians, patients treated by allergists reported greater improvement in HRQL in a number of scales. Additional research is required to further evaluate the impact of provider specialty and patterns of care on outcomes of respiratory symptoms patients.