Needleless and needle protection devices: a second look at efficacy and selection.

Needlestick injuries (NSI) in healthcare workers (HCWs) are an increasingly common and costly problem. Approximately 800,000 NSI occur in the United States per year, which cost the institutions in which they occur an estimated $405 per injury.1 Of these costs, 60% are attributed to hepatitis B virus (HBV) screens, 23% to human immunodeficiency virus (HIV) screens, and 9% to employee health personnel time.1 This cost does not include the possible costs of zidovudine (AZT) prophylaxis or the direct and indirect costs of seroconversion to acquired immunodeficiency syndrome (AIDS). Several studies have examined these costs and found the price tag for the direct cost of medication, evaluation, and follow-up for AZT to range from $900 to $2,000; personal medical care for an AIDS patient to be $32,000; and the indirect cost of morbidity and mortality to total $13,000 and $210,000, respectively.2 Because of the AIDS epidemic, NSI in HCWs have been well described in the literature and are becoming an important subject of epidemiologic research. NSI frequently have been related to needle recapping, heparin lock and intravenous (IV) medication administration, IV set-up, and improper disposal of needles. Nurses (particularly in the emergency room and intensive care unit), medical students, house staff, attending physicians, and even housekeeping personnel and emergency medical technicians are at increased risk for NSI. Although the literature suggests that many HCWs are at risk for NSI in the healthcare setting, underreporting of NSI makes the true magnitude of the problem difficult to assess. Several researchers have concluded that accidental needlesticks represent the single greatest threat of exposure to HBV and HIV among HCWs. The risk of an HCW contracting HBV at work is much greater than the risk of acquiring HIV; however, the cost of AIDS, if it develops, is much greater in both human suffering and healthcare dollars. Increasing pressure from healthcare worker union organizations and the Occupational Safety and Health Administration (OSHA) for safety in the workplace has escalated the marketing, purchase, and use of expensive devices for needle protection in the healthcare setting. Many organizations, including The Society for Hospital Epidemiology of America (SHEA) and the Association for Practitioners in Infection Control (APIC), are calling for safety devices that both reduce and prevent risk of puncture injuries to HCWs.3 They urge healthcare facility decision-makers to move expeditiously to implement devices that incorporate technology-based approaches that prevent injuries by the nature of the design of the devices. Many organizations and individuals have contributed to the effort to protect HCWs and reduce risk from NSI. The American Hospital Association (AHA), Service Employees International Union (SEIU), the Centers for Disease Control and Prevention, OSHA, and the Food and Drug Administration (FDA) all have collaborated to provide healthcare facilities with the necessary support to move toward needle-safe and needle-free devices. Congressmen Pete Stark and Ronald Wyden each have expressed increasing support for adoption of safer medical devices. Many manufacturers have introduced needleless and needle protection devices in order to reduce the