Objective:To construct a single estimate of the number of percutaneous injuries sustained annually by healthcare workers (HCWs) in the United States.Design:Statistical analysis.Methods:We combined data collected in 1997 and 1998 at 15 National Surveillance System for Health Care Workers (NaSH) hospitals and 45 Exposure Prevention Information Network (EPINet) hospitals. The combined data, taken as a sample of all U.S. hospitals, were adjusted for underreporting. The estimate of the number of percutaneous injuries nationwide was obtained by weighting the number of percutaneous injuries at each hospital by the number of admissions in all U.S. hospitals relative to the number of admissions at that hospital.Results:The estimated number of percutaneous injuries sustained annually by hospital-based HCWs was 384,325 (95% confidence interval, 311,091 to 463,922). The number of percutaneous injuries sustained by HCWs outside of the hospital setting was not estimated.Conclusions:Although our estimate is smaller than some previously published estimates of percutaneous injuries among HCWs, its magnitude remains a concern and emphasizes the urgent need to implement prevention strategies. In addition, improved surveillance could be used to monitor injury trends in all healthcare settings and evaluate the impact of prevention interventions.

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We identified characteristics of devices that caused needle-stick injuries in a university hospital over a 10-month period. Hospital employees who reported needle sticks were interviewed about the types of devices causing injury and the circumstances of the injuries. Of 326 injuries studied, disposable syringes accounted for 35 percent, intravenous tubing and needle assemblies for 26 percent, prefilled cartridge syringes for 12 percent, winged steel-needle intravenous sets for 7 percent, phlebotomy needles for 5 percent, intravenous catheter stylets for 2 percent, and other devices for 13 percent. When the data were corrected for the number of each type of device purchased, disposable syringes had the lowest rate of needle sticks (6.9 per 100,000 syringes purchased). Devices that required disassembly had rates of injury of up to 5.3 times the rate for disposable syringes. One third of the injuries were related to recapping. Competing hazards were often cited as reasons for recapping. They included the risk of disassembling a device with an uncapped, contaminated needle and the difficulty of safely carrying several uncapped items to a disposal box in a single trip. New designs could provide safer methods for covering contaminated needles. Devices should be designed so that the worker's hands remain behind the needle as it is covered, the needle should be covered before disassembly of the device, and the needle should remain covered after disposal. Such improvements could reduce the incentives for recapping needles and lower the risk of needle-stick injuries among health care workers.

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The average estimated risk of human immunodeficiency virus (HIV) infection for health care workers following a percutaneous or mucous exposure is <0.5% in incidence studies, although a case-control study suggests it is much higher for highest-risk percutaneous exposure. To characterize exposures resulting in HIV transmission, we reviewed available data on occupational cases reported worldwide, identifying 94 documented and 170 possible cases. The majority of documented infections occurred in nurses, after contact with the blood of a patient with AIDS by means of percutaneous exposure, with a device placed in an artery or vein. High-exposure job categories, e.g., midwives and surgeons, are represented mostly among possible cases. Transmission occurred also through splashes, cuts, and skin contaminations, and in some cases despite postexposure prophylaxis with zidovudine. Health care workers could benefit if these data were incorporated in educational programs designed to prevent occupational bloodborne infections.