INSTALLING NEEDLE DISPOSAL BOXES CLOSER TO THE BEDSIDE REDUCES NEEDLE-RECAPPING RATES IN HOSPITAL UNITS

OBJECTIVE: To compare the proportion of recapped needles, an injury surrogate measure, in disposal boxes on two different types of hospital units, both before and after an intervention. DESIGN: Prospective nonrandomized intervention trial. SETTING: A major public teaching hospital. PARTICIPANTS: Specific hospital units. We selected two types of hospital units for study: the first type of hospital unit (medical-surgical ward) had existing mounted in-bathroom needle disposal boxes, and the second type of hospital unit (intensive care unit) had unmounted needle disposal boxes in the room but not necessarily near the patient's bedside. INTERVENTION: The installation, in the medical-surgical wards only, of mounted needle disposal boxes on the wall near the patient's bed. The box location in the intensive care units remained the same. In both types of unit, a new mailbox-slot disposal box (SAGE) also was substituted for the previous round-top container. RESULTS: The baseline proportion of recapped needles in the first medical-surgical unit was 32.6% (+/- 3.8%) and in the second medical-surgical unit it was 27.4% (+/- 4.0%) in the bathroom needle disposal boxes, which was similar to the observed proportion (34.7 +/- 6.4%) in the intensive care unit boxes. Following the intervention, the proportion of recapped needles was significantly reduced in the disposal containers adjacent to the bedside in medical-surgical units, to 27% (a difference of 2.9 standard errors of the baseline distribution) in the first unit and 18.2% (a difference of 4.6 standard errors) in the second. In the intensive care unit, where boxes were not moved but new mailbox-types were simply substituted, no significant change was noted (36.6%, a difference of 0.59 standard errors). A statistically significant reduction was observed in the proportion of needles recapped in both wards combined following the intervention (30.2% to 26.2%, a difference of 2.9 standard errors). CONCLUSION. Environmental changes alone are an effective means of altering the risk to healthcare workers from sharp instruments. The use of needle-box counts provides a sensitive and stable instrument to measure injury surrogates and, indirectly, behavioral change in hospital workers.