E-2 Sample Worksheet for Estimating Device-Specific Percutaneous Injury
Costs

The following sample worksheet is designed to assist in assessing the
economic impact of injuries associated with specific types of needles
and other sharp devices. Completion of this worksheet requires knowledge
of the average cost of a needlestick injury in a facility (See Appendix
E-1 *Worksheet for Estimating the Annual and Average Cost of
Needlesticks and Sharps-Related Injuries*). When the worksheet is
completed, the facility will have a picture of the cost impact of
specific types of devices that can be used for considering priorities
for intervention.

Sample Worksheet for Estimating Device-Specific

Percutaneous Injury Costs

+--------------------------+-----------------+---+---------------------+
| ## Device Type           | **\# Injuries   |   | **Cost of Injuries  |
|                          | in Previous     |   | Associated with     |
|                          | Year**          |   | Device\***          |
+--------------------------+-----------------+---+---------------------+
| Hypodermic               |                 |   | \$                  |
| needle/syringe           |                 |   |                     |
+--------------------------+-----------------+---+---------------------+
| # Phlebotomy needle      |                 |   | \$                  |
+--------------------------+-----------------+---+---------------------+
| # Winged steel needle    |                 |   | \$                  |
+--------------------------+-----------------+---+---------------------+
| Intravenous catheter     |                 |   | \$                  |
| stylet                   |                 |   |                     |
+--------------------------+-----------------+---+---------------------+
| Cartridge-type           |                 |   | \$                  |
| syringe/needle           |                 |   |                     |
+--------------------------+-----------------+---+---------------------+
| Suture needle            |                 |   | \$                  |
+--------------------------+-----------------+---+---------------------+
| Scalpel                  |                 |   | \$                  |
+--------------------------+-----------------+---+---------------------+
| Lancets                  |                 |   | \$                  |
+--------------------------+-----------------+---+---------------------+
| Other device:            |                 |   | \$                  |
| \_\_\_\_\_\_\_           |                 |   |                     |
| \_\_\_\_\_\_\_\_\_\_\_\_ |                 |   |                     |
+--------------------------+-----------------+---+---------------------+
| Other device:            |                 |   | \$                  |
| \_\_\_\_\_\_\_           |                 |   |                     |
| \_\_\_\_\_\_\_\_\_\_\_\_ |                 |   |                     |
+--------------------------+-----------------+---+---------------------+
| Other device:            |                 |   | \$                  |
| \_\_\_\_\_\_\_           |                 |   |                     |
| \_\_\_\_\_\_\_\_\_\_\_\_ |                 |   |                     |
+--------------------------+-----------------+---+---------------------+
| Other device:            |                 |   | \$                  |
| \_\_\_\_\_\_\_           |                 |   |                     |
| \_\_\_\_\_\_\_\_\_\_\_\_ |                 |   |                     |
+--------------------------+-----------------+---+---------------------+

*\* Average cost of percutaneous injuries (Appendix E-1) multiplied by
the number of injuries with the device.*