Major Articles
Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses*,**

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Abstract

Background: Recently passed federal legislation requires institutions to adopt safety equipment to prevent needlesticks, but there is little empirical evidence of the effectiveness of specific types of safety devices or the contribution of safety devices to reducing needlesticks relative to the contributions of staffing, organizational climate, and clinicians' experience. Method: In 1998, 2287 medical-surgical unit nurses in 22 US hospitals were surveyed in regard to staffing and organizational climate in their hospitals and about patient and nurse outcomes, including needlestick injuries. Hospitals provided information about available protective devices at the time of the survey. Relationships between nurse and hospital characteristics and protective equipment and the likelihood of needlestick injuries and near-miss incidents were examined. Results: Poor organizational climate and high workloads were associated with 50% to 2-fold increases in the likelihood of needlestick injuries and near-misses to hospital nurses. Capless-valve secondary intravenous set systems and use of any type of protective equipment for IV starts or blood draws were associated with 20% to 30% lowered risks of both event types. Conclusions: Nurse staffing and organizational climate are key determinants of needlestick risk and must be considered with the adoption of safety equipment to effectively reduce sharps injuries. (Am J Infect Control 2002;30:207-16.)

Section snippets

Sample

In 1998, 22 hospitals across the United States were selected for a study of organizational factors and outcomes of nursing care. Twenty of these hospitals were magnet hospitals.13 Sixteen hospitals that had reputations for attracting and retaining clinical nurses (magnet hospitals by reputation) and had been studied in 1986 were asked to participate in the 1998 study, which examined changes in organization and staffing over time. Thirteen of the 16 agreed to participate. In addition, all 7

Results

The mean age of the 2287 nurses in our sample was 37.3 years (SD, 9.9). Nearly two thirds of the nurses (63%) held a baccalaureate or higher degree in nursing, and 6% were men. Table 1 indicates that a sizeable majority (85.2%) reported always wearing gloves in situations in which body fluid contact was possible.

. Nurses' perceptions of risks for needlestick injuries (N = 2287)

Empty Cell%
Frequency wearing gloves for venipuncture and procedures involving body fluids
Always87.6
Sometimes10.8
Never or rarely1.7

Discussion

In this relatively homogeneous group of hospitals with superior reputations for nursing or medical care during the past 2 decades, we find the clear associations between staffing and organizational climate and needlesticks that were noted in our previous survey in 1991.9 The impacts of staffing and organization on injuries and near-misses here appear to be somewhat smaller than in the first study (in which odds ratios generally exceeded 2.0), probably as a result of the similarity of the

Conclusions

This study provides evidence that the risk of sharps injuries in nurses is importantly related to nurse staffing levels and working climate. Safety equipment may have an important effect on reducing injuries, but so do the general working conditions of nurses. Working conditions appear to be more important in determining risk than does safety equipment. At a time when safety concerns and nurse shortages in hospitals are more prominent issues than ever, the consideration of organizational

Acknowledgements

We thank the nurse executives and staff nurses at the following hospitals for their participation: Arlington Hospital, Arlington, Virginia; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Evanston Hospital, Evanston, Illinois; Inova Fairfax Hospital, Falls Church, Virginia; Fort Sanders Regional Medical Center, Knoxville, Tennessee; Franklin Square Hospital, Baltimore, Maryland; Hackensack Medical Center, Hackensack, New Jersey; Hospital of the University of Pennsylvania,

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    *

    Collection of the data was conducted under Grant R01 NR02280-04A1, Outcomes of Inpatient AIDS Care from the National Institute of Nursing Research (Dr Linda Aiken, principal investigator). Preparation of this manuscript was assisted in part by an institutional postdoctoral fellowship (T32-NR07104), National Institute of Nursing Research, held by Dr Sean Clarke at the Center for Health Outcomes and Policy Research, University of Pennsylvania.

    **

    Reprint requests: Sean Clarke, RN, PhD, Center for Health Outcomes and Policy Research, University of Pennsylvania, 420 Guardian Dr, Philadelphia, PA 19104-6096.

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