Acidentes perfurocortantes e avaliação do impacto de um dispositivo de segurança para a sua prevenção em um hospital geral terciário do Rio de Janeiro (2001-2011)

Background Healthcare workers are exposed to bloodborne pathogens through occupational injuries and the replacement of sharps by safety-engineered devices has been r ecommended as a key preventive measure. This recommendation has been difficult to implement in B razil. Objectives: (1) Primary. To evaluate the impact of safety-engineered devices (SEDs) introduced since 2008, on the profile of percutaneous exposures reported in a tertiary gener al hospital in Rio de Janeiro. (2) Secondary. To determine the nature of avoided exposures, the occupational group(s) benefited by the SEDs and the hypothetical impact of purcha sing the device(s) on costs for the institution. Methods. Retrospective study of a database of blood and body fluid exposures reported from January 2001 through December 2011 in a public general hospital in Rio de Janeiro where, from the end of 2009, along with SEDs for IV usage, a safety lancet for blood glucose testing (BGT) was introduced. A log-Poisson r egression model was used to determine the effect of selected co-variates on total percutaneous injuries (PIs) and PIs during BGT. The hypothetical impact of purchasing the safety lancet on costs was also analyzed. Results. An inverse relation was apparent between average length of professional experience and absolute number of PIs. Nursing staff had a significant reduction in rate of PIs per 100 full-time equivalents from 2007 to 2011 (P<0.001), while medical residents had the highest rate throughout the same period. A reduction of PIs by sma ll-gauge needles was observed since 2009 and injuries during BGT fell abruptly in 2010 and 2011 paralleling the number of purchased safety lancets (P<0.001). No reduction was obs erved for procedures involving large-bore needles and/or blood vessels. Conclusions The adoption of a single safety device, which required no training, significantly reduced PIs am ong the nursing staff. No apparent increase in costs is to be expected. New staff should receive t raining on standard precautions and older staff should be re-trained periodically.