Background
The burden of needlestick injuries
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Testing for infection in the injured worker and, if known, the patient on whom the sharp had been used.
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Post-exposure prophylaxis (PEP) to prevent or manage potential blood-borne virus transmission.
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Short- and long-term treatment of chronic blood-borne viral infections that are transmitted to injured workers.
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Staff absence and replacement.
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Counselling for injured workers.
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Legal consequences (e.g. litigation and compensation claims).
The European directive
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Implementing safe procedures for using and disposing of sharps and contaminated waste.
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Eliminating unnecessary use of sharps, including provision of devices with safety-engineered protection mechanisms.
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Implementing safe systems of work including training and health surveillance procedures.
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Provision of personal protective equipment.
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Vaccination.
Safety-engineered devices (SEDs)
Methods
Model design
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Injection.
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Infusion therapy.
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Blood collection.
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Diabetes insulin administration.
Parameters
Devices and incidence of NSIs
Procedure class | Annual number of devices per bed (estimated) | Average cost of conventional devices (€) | Average cost of SEDs (€) | NSI rate using conventional devices(per 105procedures) | NSI rate using SEDs (per 105procedures)[15] |
---|---|---|---|---|---|
Injection | 553 | 0.014 | 0.046 | 10.8 [15] | 1.5 |
Infusion therapy | 120 | 0.400 | 0.600 | 26.0 [15] | 8.8 |
Diabetes insulin administration | 50 [8] | 0.095 | 0.315 | 23.5 [18] | 3.3** |
Blood collection | 193 | 0.170 | 0.270 | 23.4* [15] | 7.0*** |
Transmission of blood-borne viruses
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The proportion of healthcare workers vaccinated against hepatitis B – 89%, based on a published European range of 85–93% reported by De Schryver et al. [22].
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Prior effectiveness of hepatitis B vaccination deemed to be 90%, based on a reported range of 85–95% effectiveness in preventing hepatitis B infection [23].
Costs
Direct costs of NSIs | |
---|---|
NSI recipient – initial test
| €38.76 |
NSI recipient – follow-up test
| €58.52 |
Source patient (if known)
| €43.91 |
€68.81 | |
NSI from a known and infected source
| €374.61 |
NSI from an unknown source
| €918.76 |
€2,377.44 | |
Hepatitis B (year in which NSI occurred and per subsequent year for three years)
| |
Hepatitis C (year in which NSI occurred only)
| €16,127.76 |
HIV (year in which NSI occurred and per subsequent year)
| €16,999.83 |
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Hepatitis B receive either peginterferon, lamivudine, adefovir dipivoxil or entecavir, as documented by the United Kingdom (UK) National Institute for Health and Care Excellence (NICE) [34].
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HIV incur an annual treatment cost based on the annual cost of antiretroviral therapy reported in the UK for 2006 [37], converted to 2012 Euro [38], making the conservative assumption that all patients remain asymptomatic in the first five years following infection and receive monotherapy treatment.
NSI risk category | Low | High | ||
---|---|---|---|---|
Source patient | Known | Unknown | ||
Infection status | Uninfected | Infected | Uninfected | Infected |
Testing | €141.20 | €141.20 | €85.09 | €85.09 |
Staff and administration | €68.81 | €68.81 | €68.81 | €68.81 |
PEP | – | €374.61 | €918.76 | €918.76 |
Disease treatment | – | €142.99 | – | €142.99 |
Total direct cost per NSI |
€210.01
|
€727.61
|
€1,072.66
|
€1,215.65
|
Relative incidence within risk category |
100%
|
33%
|
58%
|
10%
|
Total direct cost per NSI, by risk category |
€210.01
|
€950.34
|
Sensitivity analysis
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Number of hospital beds (±20%).
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Number of devices used (±20%).
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Cost per conventional device (±20%).
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Cost per SED (±20%).
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Rate of NSIs with conventional devices (±20%).
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Reduction in NSIs with SEDs (±20%).
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Prevalence of hepatitis B, hepatitis C and HIV (±20%).
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Rate of transmission of hepatitis B, hepatitis C and HIV (±20%).
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The proportion of workers vaccinated against hepatitis B set to 85% and 93% – the upper and lower bounds reported by De Schryver et al.[22].
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Direct cost per NSI (±20%).
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Indirect cost per NSI (±20%).
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All compensation and litigation costs excluded from the model.
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Uptake of SEDs decreased to 75% and 50% of all devices used.