To the Editor:—
The incidence of needlestick injuries is thought to be higher than reported, which has ranged from 14 to 839 injuries per 1,000 healthcare workers annually.1
In one study, 74% of needlestick injuries were due to incorrect technique.2
In that study, it was concluded that the injuries could have been prevented by the use of safety needles. In 2001, the Occupational Safety and Health Administration mandated the use of safety needles.
I would like to report our experience with safety needles. When the Occupational Safety and Health Administration mandated the use of safety needles, we chose the Portex Needle-Pro needle with needle protection device (Keene, NH). This safety needle contains a plastic cover, which is snapped over the needle after its use, with a one-handed technique (fig. 1
). However, it was found that the device was bulky to use, and almost all physicians would simply remove the safety device (fig. 2
). This led to multiple needlestick injuries. Despite the availability of the safety needle and knowledge of how to use the device, the safety feature was easily eliminated by the physicians using the device.
We then ordered the 18-gauge Blunt fill needle by Becton Dickinson (Franklin Lakes, NJ). Although the tip of the needle is blunt, it can produce a needlestick injury, but it takes much more force. We have had this needle for approximately 1 yr, and have had only one needlestick injury. I have stressed to the staff, in educational memos, that it needs to be treated as a sharp needle. The Blunt fill needle has been very well received by the staff. The Blunt-tip needle cannot be used percutaneously, so we also maintain a supply of the Portex needles for that use only.
For infiltration of local anesthesia, we have the Becton Dickinson Integra 3 ml syringe. The plunger of this syringe contains a button on the end. When the button is double clicked, the needle retracts into the syringe. I have found that the cover for the needle does tend to get loose if not capped tightly. There has been one needlestick injury with this needle. Many of the doctors still use the Portex needle, with the safety device detached, for infiltration of local anesthesia before placing an intravenous line.
In conclusion, the introduction of a safety needle, and education on its use, is not a guarantee that it will be used properly, and will in fact reduce needlestick injuries.
Steven Neustein, M.D.
The Mount Sinai Medical Center, New York, New York. firstname.lastname@example.org
1. Lee JM, Botteman MF, Xanthakos N, Nicklasson L: Needlestick injuries in the United States: Epidemiologic, economic, and quality of life issues. AAOHN J 2005; 53:117–33
2. Castella A, Vallino A, Argentero PA, Zotti CM: Preventability of percutaneous injuries in healthcare workers: A year-long survey in Italy. J Hosp Infect 2003; 55:290–4
© 2006 American Society of Anesthesiologists, Inc.