摘要：Objectives . This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses. Methods . We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units in 20 hospitals. Results . Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses. Conclusions . Staffing and organizational climate influence hospital nurses' likelihood of sustaining needlestick injuries. Remedying problems with understaffing, inadequate administrative support, and poor morale could reduce needlestick injuries. Exposures of health care workers to bloodborne pathogens through accidental contact with sharp instruments have been widely publicized, and the prevention and control of exposure to sharp instruments is a high-profile issue. Estimates from the University of Virginia's Exposure Prevention Information Network (EPINet) surveillance system for 1996 placed the number of the percutaneous injuries to US health workers in that year at almost 600 000. 1 In the largest study of needlesticks to date based on nurse reports (as opposed to institutional surveillance), we reported a startlingly high rate of nearly 1 injury per nurse-year using data from a national nurse survey in 1991. 2 Because the potential consequences of hepatitis B and C and HIV and AIDS infection are so severe, the relatively low rates of seroconversion after percutaneous injuries—estimated at less than 0.5% for HIV—are not particularly reassuring. 3– 5 Moreover, because the personal and professional consequences of needlestick injuries can be devastating even when they do not result in infections, 5 needlestick and related injuries remain a very serious occupational health concern for nurses and other health care workers. The dominant perspective in the literature and in most agency guidelines is that the transmission of bloodborne pathogens from patients to health care workers is largely preventable through the use of universal precautions and special equipment (primarily systems that resheathe needles after use and needleless access devices). Exclusive reliance on these strategies is inadequate, however, for several reasons. First, the adoption of universal precautions to date has been far from universal. Studies have shown, for example, that nurse compliance with universal precautions is affected by the availability of protective equipment, the perceived commitment of management to safety, and perceptions regarding the interference of precautions with job performance. 6, 7 Second, the adoption of needleless technology has been widespread, but it is unlikely that any technology can ever entirely remove the need for health professionals to handle bare needles and sharps. Third, awareness is increasing that needlestick accidents, like medical errors, complications, and other reportable incidents in hospitals, may be related to organizational factors such as staffing and the nurse practice environment as well as staff education and the types of equipment used. Although many aspects of sharps injuries and body fluid exposures have been extensively studied, Hanrahan and Reutter 8 noted in their review of the literature that an organizational perspective on this issue is needed. To our knowledge, little research has been conducted to determine what factors produce variations in needlestick injury rates across hospitals or hospital units and whether nurse staffing and organizational climate are important determinants. Examining the organizational context of needlestick injuries is particularly timely, given recent state and national initiatives to reduce bloodborne pathogen exposures by requiring the use of specific types of devices in hospitals and separate broader state initiatives mandating minimum staffing levels in hospitals. In our previous study of AIDS care provided in 20 hospitals across the United States, 1990–1991, we estimated the frequency of needlestick injuries to hospital nurses based on data from various sources. 2 In addition to retrospective reports from surveyed nurses regarding the number of times they were injured with a blood-contaminated needle in the prior month, we asked the same nurses to report needlesticks at the end of every shift they worked for 30 days (i.e., prospectively). On the basis of the prospective shift-based reports, we estimated that the rate of injuries to staff nurses was 0.8 per nurse per year. Prospective and retrospective rates were statistically indistinguishable. Our data also showed that only about 1 in 4 needlestick injuries were reported to hospital authorities. We also found that nurses who reported recapping needles were at heightened risk for injury and that nurses working in magnet hospitals (3 of the 20 hospitals were known for having an especially positive working climate for nurses 9 ) were at significantly reduced risk for injury. The results reported in this article extend the work of that study by exploring how risk factors associated with needlestick injuries and the relative frequency of needlestick injuries among hospital nurses are related to the staffing levels and organizational climates on the hospital units on which nurses work.
