Effectiveness of measures to prevent needlestick injuries among ...

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5 Cost effectiveness After the implementation of the needleless system, Yassi et al. reported that the number of NSI decreased by 122 within one year. Using this hospital-wide number, the authors calculated the range of net savings in costs from NSI between CAN $ 10,100 and CAN $ 68,214. The overall range of net increase in costs/net benefits therefore was between a net annual increase of CAN $ 24,400 and a net savings of CAN $ 33,700. However, as noted, the authors used for their cost-benefit analysis the total reduction in NSI in the hospital, not the NSI related specifically to the replacement equipment. Using only the reduction in NSI expected from the replacement equipment, the annual net increase in costs would have been between CAN $ 30,500 and CAN $ 7,700 [54]. Mendelson et al. conducted a cost-benefit analysis for their 1991 intervention in which a needleless IV access system was introduced (see evaluation section). The cost per needlestick was estimated at US $ 636, including testing and PEP as well as work time for health personnel time involved in the evaluation, counseling and management of the injured HCW, and cost for lost work time of the injured HCW. The purchase price of the safer system was about four times higher than the cost of the standard device. The projected annual hospital-wide incremental costs of the needleless IV access system compared to the conventional heparin-lock system were about US $ 116,000 and the savings through the reduction of NSI about US $ 33,000 (based on projected 52 injuries prevented). The net increase in costs, therefore, was US $ 83,000, or US $ 230 per bed. The cost per injury prevented was estimated to be about $ 1,600 [47]. 5.2.3.3 Retractable lancets Roudot-Thoraval et al. introduced several interventions (devices with retractable needles for vacuum-tube phlebotomy, safe devices for hypodermic needles and protected short catheters) to reduce NSI in a large hospital in France beginning in 1990. The authors compared pre-intervention NSI rates with the average rates in 1995 to 1997. The total annual costs of safer devices and of training were calculated as US $ 309,000 (in 1998 US dollars). The cost of NSI was calculated at US $ 1,796 including costs for blood testing, PEP and lost work time. The underlying assumption was 100 % Report „Needlestick injuries“ 66
5 Cost effectiveness compliance with the management guidelines. This would have led to costs of about US $ 2,300 (calculated by the authors) per injury prevented, based on a reduction of 76 NSI. However, the empirical, real cost per NSI was only US $ 325, due to a poor compliance with treatment guidelines, which led to costs of about US $ 3,700 (calculated by the authors) per injury prevented [67]. Two problems make the assessment of this publication difficult: a) There are large inconsistencies in the text and the data reported in the table regarding annual purchase and training costs and, b) According to the text, the total purchase costs of safety devices and not the incremental purchase costs were used for the analysis. Peate described the implementation of automatic self-retracting lancet in a population of 477 active-duty emergency medical system workers for a municipal fire department in the US between 2000 and 2001. The average cost of a NSI was US $ 1,035 including physician evaluation and counseling, testing and PEP. The author mentioned additional direct and indirect costs, but it is unclear whether or not these were included in the estimates. Annual purchase costs increased minimally (US $ 366) and the net annual savings due to use of safer devices were estimated at US $ 5,160 [68]. 5.2.3.4 Disposal containers In an early evaluation study, Ribner et al. reported on the introduction of a rigid, puncture resistant disposal system during the year from 1983 to 1984. The costs of disposal related NSI were estimated at US $ 183, including "personnel time" (not specified), HBV testing and PEP. Due to the time period, no HCV or HIV testing or PEP was offered. Costs were high in this study due to the fact that, in most cases, the origin of the needle remained unknown. The annual increase in purchase costs was US $ 3,081. With a 75 % reduction (n = 21) in disposal related NSI, the net annual savings was estimated at US $ 750 [78]. Hatcher compared NSI rates with the use of a straight drop disposal box vs. use of a letter drop box in a university medical center in the US in 1999. She reported that the occupational health division conducted a direct cost analysis of a single NSI, Report „Needlestick injuries“ 67
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Effectiveness of measures to preven
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Authors: Sandra I. Sulsky, Thomas B
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Wirksamkeit und Wirtschaftlichkeit
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Eficacia y rentabilidad de medidas
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5 Cost effectiveness ..............
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Preface Preface It has long been re
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1 Introduction 1 Introduction Altho
Page 17 and 18: 1 Introduction scientific laborator
Page 19: 1 Introduction To complete each of
Page 23 and 24: 3 Descriptive epidemiology of NSI 3
Page 25 and 26: 3 Descriptive epidemiology of NSI a
Page 27 and 28: 3 Descriptive epidemiology of NSI c
Page 29 and 30: 3 Descriptive epidemiology of NSI s
Page 31 and 32: 3 Descriptive epidemiology of NSI h
Page 33 and 34: 4 Intervention program evaluation 4
Page 35 and 36: 4 Intervention program evaluation u
Page 37 and 38: 4 Intervention program evaluation d
Page 39 and 40: 4 Intervention program evaluation (
Page 41 and 42: 4 Intervention program evaluation c
Page 43 and 44: 4 Intervention program evaluation t
Page 45 and 46: 4 Intervention program evaluation a
Page 47 and 48: 4 Intervention program evaluation d
Page 53 and 54: 4 Intervention program evaluation b
Page 55 and 56: 4 Intervention program evaluation 4
Page 57 and 58: 4 Intervention program evaluation C
Page 59: 4 Intervention program evaluation a
Page 62 and 63: 5 Cost effectiveness Both costs and
Page 64 and 65: 5 Cost effectiveness 21 % by using
Page 66 and 67: 5 Cost effectiveness the high HBV v
Page 70 and 71: 5 Cost effectiveness estimating cos
Page 73 and 74: 6 Discussion 6 Discussion This repo
Page 75: 7 Recommendations 7 Recommendations
Page 78 and 79: 8 Bibliography [12] Verordnung übe
Page 80 and 81: 8 Bibliography A retrospective stud
Page 82 and 83: 8 Bibliography [48] Gartner, K.: Im
Page 84 and 85: 8 Bibliography [66] O'Connor, R. E.
Page 86 and 87: 8 Bibliography [86] Thomas, S.; Aga
Page 89 and 90: Tables Table 1: Overview of prevent
Page 91 and 92: Tables Table 3: Distribution of cou
Page 93 and 94: Tables Table 5: Distribution of nee
Page 95 and 96: Tables Table 7: Activity during nee
Page 97 and 98: Tables Table 9: Screening Criteria
Page 99 and 100: Tables Table 11: Quality indicators
Page 101 and 102: Tables Table 13: Examples of estima
Page 103 and 104: Annex 1: Glossary and abbreviations
Page 105 and 106: Annex 1: Glossary and abbreviations
Page 107 and 108: Annex 2: QBCR review form COMPARISO
Page 109 and 110: Annex 2: QBCR review form Character
Page 111 and 112: Annex 2: QBCR review form DISCUSSIO
Page 113 and 114: Annex 3: Definitions/guidelines for
Page 115 and 116: Annex 3: Definitions/guidelines for
Page 117 and 118: Annex 4: Working group Needlestick
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