Safety-engineered device implementation: does it introduce bias in percutaneous injury reporting?
Safety-engineered device implementation: does it introduce bias in percutaneous injury reporting?
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安全设计设备的实施：是否会在经皮损伤报告中引入偏差？
DOI：
10.1086/502437
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发表时间：
2004
影响因子：
4.5
通讯作者：
Sepkowitz,KentA
中科院分区：
文献类型：
--
作者：
Sohn,SeJean;Eagan,Janet;Sepkowitz,KentA
目的 检验 2001 年安全工程设备的实施是否对医护人员报告的经皮损伤 (PI) 率有影响。设计干预前后试验，比较干预前 3 年（1998 年至 2001 年）和干预后 2 年（2001 年至 2002 年）。来自匿名、自我管理调查的 PI 数据被前瞻性地输入 CDC NaSH 软件。设置曼哈顿有 427 个床位的三级护理医院。参与者参加国家规定的培训课程并完成调查的医护人员（干预前 1,132 人；干预后 821 人）。干预实施由各种针安全电视安全工程设备组成的“更安全针系统”结果干预前，调查中自我报告的 PI 总体年率为每 100 名受访者 36.5 名，而干预后为每 100 名受访者 13.9 名 (P < .01)。正式报告 PI 的年率从每 100 名受访者 8.3 下降到 3.1 (P < .01)。报告率因职业组而异（P ≤ .02）。尽管护士的报告有所改善（23.6% 至 44.4%，P = .03），而建筑服务人员的报告有所恶化（90.5% 至 50%，P = .03），但总体比率在研究期间没有变化（22.7% 至 22.3%）。在调查中自我报告 Pi 数量较多的医护人员正式报告伤害的可能性较小 (P < .01)。不报告的两个最常见原因（即认为伤害风险较低或认为患者患血源性疾病的风险较低）在干预前和干预后没有变化。结论安全设计设备的实施降低了调查中正式报告和自我报告的 Pi 比率。然而，这种干预措施加上强化教育，对不同职业的报告行为产生了不同的影响，但对总体报告率的影响却很小。
ObjectiveTo examine whether implementation of safety-engineered devices in 2001 had an effect on rates of percutaneous injury (PI) reported by HCWs.DesignBefore-and-after intervention trial comparing 3-year preintervention (1998–2001) and 2-year postintervention (2001–2002) periods. PI data from anonymous, self-administered surveys were prospectively entered into CDC NaSH software.SettingA 427-bed, tertiary-care hospital in Manhattan.ParticipantsHCWs who attended state-mandated training sessions and completed the survey (1,132 preintervention; 821 postintervention).InterventionImplementation of a “safer-needle system” composed of various safety-engineered devices for needle-safe TV delivery-insertion, blood collection, and intramuscular-subcutaneous injection.ResultsPreintervention, the overall annual rate of PIs self-reported on the survey was 36.5 per 100 respondents, compared with 13.9 per 100 respondents postintervention (P < .01). The annual rate of formally reported PIs decreased from 8.3 to 3.1 per 100 respondents (P < .01). Report rates varied by occupational group (P ≤ .02). The overall rate did not change between study periods (22.7% to 22.3%), although reporting improved among nurses (23.6% to 44.4%, P = .03) and worsened among building services staff (90.5% to 50%, P = .03). HCWs with greater numbers of Pis self-reported on the survey were less likely to formally report injuries (P < .01). The two most common reasons for nonreport (ie, thought injury was low risk or believed patient was low risk for blood-borne disease) did not vary from preintervention to postintervention.ConclusionsSafety-engineered device implementation decreased rates of Pis formally reported and self-reported on the survey. However, this intervention, with concomitant intensive education, had varying effects on reporting behavior by occupation and a minimal effect on overall reporting rates.