Evaluation of institutional practices for prevention of phlebotomy-associated percutaneous injuries in hospital settings.

BACKGROUND: To reduce the incidence of phlebotomy-related percutaneous injuries (PIs), factors that contribute to these injuries must be identified. This study examined institutional phlebotomy practices, policies, perceptions, and culture to identify facilitators and barriers that appear to have the greatest impact in preventing injuries. METHODS: During site visits at study hospitals, observational data were collected during the performance of phlebotomy. In addition, interviews and focus groups were conducted with hospital personnel involved in phlebotomy procedures. RESULTS: Nine hospitals participated in the study. A total of 126 phlebotomy procedures were observed. Health care personnel chose devices with safety features for the majority of observed procedures (n = 122, 97%). Recommended phlebotomy practices for handling needles after use were observed in 42% to 92% of procedures. Adherence varied by type of device, occupation, and facility PI rate. In the 23 interviews and 9 focus groups, participants identified factors that facilitated PI prevention such as the availability and use of devices with safety mechanisms, adherence to recommended safe needle-handling practices, and institutional phlebotomy training. CONCLUSION: The quantitative and qualitative data indicate that a wide array of factors can affect phlebotomy-related practices and perceptions. Prevention of PIs may require comprehensive, multifaceted intervention efforts to improve the safety culture and reduce PIs and exposure to bloodborne pathogens in health care facilities.

Costs of management of occupational exposures to blood and body fluids.

OBJECTIVE: To determine the cost of management of occupational exposures to blood and body fluids. DESIGN: A convenience sample of 4 healthcare facilities provided information on the cost of management of occupational exposures that varied in type, severity, and exposure source infection status. Detailed information was collected on time spent reporting, managing, and following up the exposures; salaries (including benefits) for representative staff who sustained and who managed exposures; and costs (not charges) for laboratory testing of exposure sources and exposed healthcare personnel, as well as any postexposure prophylaxis taken by the exposed personnel. Resources used were stratified by the phase of exposure management: exposure reporting, initial management, and follow-up. Data for 31 exposure scenarios were analyzed. Costs were given in 2003 US dollars. SETTING: The 4 facilities providing data were a 600-bed public hospital, a 244-bed Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a 3,500-bed healthcare system. RESULTS: The overall range of costs to manage reported exposures was $71-$4,838. Mean total costs varied greatly by the infection status of the source patient. The overall mean cost for exposures to human immunodeficiency virus (HIV)-infected source patients (n=19, including those coinfected with hepatitis B or C virus) was $2,456 (range, $907-$4,838), whereas the overall mean cost for exposures to source patients with unknown or negative infection status (n=8) was $376 (range, $71-$860). Lastly, the overall mean cost of management of reported exposures for source patients infected with hepatitis C virus (n=4) was $650 (range, $186-$856). CONCLUSIONS: Management of occupational exposures to blood and body fluids is costly; the best way to avoid these costs is by prevention of exposures.

Nurse staffing and healthcare-associated infections: proceedings from a working group meeting.

The nation is facing a nursing shortage that is creating a crisis for quality healthcare and patient safety. Research has documented that problems with nurse staffing are associated with healthcare-associated infections and other adverse events that affect patient outcomes. These ominous facts, stated during the opening of an expert consultants meeting convened by the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, laid the foundation for a day-long discussion and a call to action to address a growing crisis in healthcare. The authors summarize the proceedings of this meeting and present the consultants' suggestions for drawing national attention to this issue.

Nurse staffing and health care-associated infections: Proceedings from a working group meeting.

The nation is facing a nursing shortage that is creating a crisis for quality health care and patient safety. Research has documented that problems with nurse staffing are associated with health care-associated infections and other adverse events that affect patient outcomes. These ominous facts, stated during the opening of an expert consultants meeting convened by the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, laid the foundation for a day-long discussion and a call to action to address a growing crisis in health care. The authors summarize the proceedings of this meeting and present the consultants' suggestions for drawing national attention to this issue.