Skip to main content

Costs and Benefits of Measures to Prevent Needlestick Injuries in a University Hospital

  • Françoise Roudot-Thoraval (a1), Olivier Montagne (a2), Annette Schaeffer (a2), Marie-Laure Dubreuil-Lemaire (a3), Danièle Hachard (a4) and Isabelle Durand-Zaleski (a1)...
Abstract Objective:

To document the costs and the benefits (both in terms of costs averted and of injuries averted) of education sessions and replacement of phlebotomy devices to ensure that needle recapping did not take place.


The percentage of recapped needles and the rate of needlestick injuries were evaluated in 1990 and 1997, from a survey of transparent rigid containers in the wards and at the bedside and from a prospective register of all injuries in the workplace. Costs were computed from the viewpoint of the hospital. Positive costs were those of education and purchase of safer phlebotomy devices; negative costs were the prophylactic treatments and follow-up averted by the reduction in injuries.


A 1,050-bed tertiary-care university hospital in the Paris region.


Between the two periods, the proportion of needles seen in the containers that had been recapped was reduced from 10% to 2%. In 1990, 127 needlestick (12.7/100,000 needles) and 52 recapping injuries were reported versus 62 (6.4/100,000 needles) and 22 in 1996 and 1997. When the rates were related to the actual number of patients, the reduction was 76 injuries per year. The total cost of information and preventive measures was $325,927 per year. The cost-effectiveness was $4,000 per injury prevented.


Although preventive measures taken to ensure reduction of needlestick injuries appear to have been effective (75% reduction in recapping and 50% reduction in injuries), the cost of the safety program was high.

Corresponding author
HITEQ, Santé Publique, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
Hide All
1. Jagger J, Hunt EH, Brand-Elnaggar J, Pearson RD. Rates of needle-stick injury caused by various devices in a university hospital. N Engl J Med 1988;319:284288.
2. Ribner BS, Landry MN, Gholson GL, Linden LA. Impact of a rigid puncture resistant container system upon needlestick injuries. Infect Control 1987;8:6366.
3. Krasinski K, LaCouture R, Holzman RS. Effect of changing needle disposal system on needle puncture injuries. Infect Control 1987;8:5962.
4. Edmond M, Khakoo R, McTaggart B, Solomon R Effect of bedside needle disposal units on recapping frequency and needlestick injury. Infect Control Hosp Epidemiol 1988;9:114116.
5. Jagger J, Pearson RD, Brand JJ. Avoiding the hazards of sharp instruments. Lancet 1986;1:1274.
6. McCormick RD, Meisch MG, Ircink FJ, Maki DG. Epidemiology of hospital sharps injuries: a 14-year prospective study in the pre-AIDS and AIDS eras. Am J Med 1991;91(3B):301S307S.
7. O'Neill TM, Abbott AV, Radecki SE. Risk of needlesticks and occupational exposure among residents and medical students. Arch Intern Med 1992;152:14511456.
8. Berry AJ, Greene ES. The risk of needlestick injuries and needlestick-transmitted diseases in the practice of anesthesiology. Anesthesiology 1992;77:10071021.
9. Klontz KC, Gunn RA, Caldwell JS. Needlestick injuries and hepatitis B immunization in Florida paramedics: a statewide survey. Ann Emerg Med 1991;20:13101313.
10. Mitsui T, Iwano K, Masuka K, Yamazaki C, Okamoto H, Tsuda F, et al. Hepatitis C virus infection in medical personnel after needlestick accident Hepatology 1992;16:11091114.
11. Kiyosawa K, Sodeyama T, Tanaka E, Nakano Y, Furuta S, Nishioka K, et al. Hepatitis C in hospital employees with needlestick injuries. Ann Intern Med 1991;115:367369.
12. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R, Abiteboul D, et al. A case-control study of HIV seronconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med 1997;337:14851490.
13. Anderson DC, Blower AL, Packer JM, Ganguli LA, Preventing needlestick injuries. BMJ 1991;302:769770.
14. Abiteboul D, Antona D, Bonnet N, Dagon C, Domart M, Florentin A, et al. Surveillance des accidents du travail avec exposition au sang à l'Assistance Publique-Hôpitaux de Paris. Arch Mal Prof 1994;55:18.
15. Ministère de l’emploi et de la Solidarité. Circulaire DGS/DH/98/249 du 20 avril 1989 relative à la prévention de la transmission d’agents infectieux véhiculés par le sang ou les liquides biologiques lors des soins dans les établissements de santé. Paris, France: Ministère de l'emploi et de la Solidarité.
16. Drummond M, Stoddart G, Torrance G. Methods for Economie Evaluation of Health Care Programmes. Oxford, UK: Oxford University Press; 1989:7184.
17. Jagger J, Hunt EH, Pearson RD. Recapping used needles: is it worse than the alternative? J Infect Dis 1990;162:784785.
18. Needlesticks: preaching to the seroconverted? Lancet 1992;340:640642.
19. Cummins AJ, Tedder RS. Inadequate information on needlesticks accidents. Lancet 1992;339:11781179.
20. Dodging the needle in health care. Science 1992;258:34.
21. Beekman SE, Vlahov D, Koziol DE, McShalley ED, Schmitt JM, Henderson DK, Temporal association between implementation of Universal Precautions and a sustained, progressive decrease in percutaneous exposures to blood. Clin Infect Dis 1994;18:562569.
22. Adai K, Anglim AM, Palumbo CL, Titus MG, Coyner BJ, Farr BM. The use of high-efficiency particulate air-filter respirators to protect hospital workers from tuberculosis. A cost-effective analysis. N Engl J Med 1994;331:169173.
23. Hamory BH. Underreporting of needlestick injuries in a university hospital. Am J Infect Control 1983;11:174177.
24. Yassi A, McGill ML, Khokhar JB. Efficacy and cost-effectiveness of a needleless intravenous access system. Am J Infect Control 1995;23:5764.
25. Laufer FN, Chiarello LA, Application of cost-effectiveness methodology to the consideration of needlestick-prevention technology. Am J Infect Control 1994;22:7582.
26. Tengs TO, Adams ME, Pliskin J, Safran DG, Siegel JE, Weinstein MC, et al. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995;15:369390.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 2 *
Loading metrics...

Abstract views

Total abstract views: 193 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd January 2018. This data will be updated every 24 hours.