REDUCING THE RATE OF PARAMEDIC NEEDLESTICKS IN EMERGENCY MEDICAL-SERVICES - THE ROLE OF SELF-CAPPING INTRAVENOUS CATHETERS

Objective: To determine whether the frequency of unintentional needles ticks can be reduced by replacing conventional IV catheters with self- capping ones. Methods: Retrospective cohort, historically controlled s tudy, conducted in an emergency medical services advanced life support (ALS) service. The ALS service annually transports 12,000 patients, f or whom IV therapy is attempted in about 65% of cases. The needlestick rate per 1,000 patients receiving attempts at IV access was examined during the 2 10-month periods, before and after introduction of a self -capping IV catheter. Results: For the 2 periods, the percentage of pa tients for whom IV access was attempted remained constant at 65%. The success rate for IV access was statistically unchanged from 88% to 90% (p > 0.5, power = 0.995). During the period prior to use of the new c atheter, 44 injuries were reported overall. Of these, 15 were due to u nintentional needlesticks, 11 associated with contaminated needles. Fo llowing the system-wide introduction of the new catheter, only 1 of 31 reported injuries was due to needlestick (uncontaminated). The extrap olated annual incidence of contaminated needlesticks decreased from 16 9 (95% CI; 85, 253) to 0 (95% CI; 0, 46) per 100,000 IV attempts. The extrapolated incidence for all needlesticks decreased from 231 (95% CI ; 132, 330) to 15 (95% CI: 0, 40) per 100,000 IV attempts. The absolut e number of needlesticks and the proportion of injuries due to needles ticks decreased significantly (p < 0.005). Conclusion: The use of IV c atheters with self-capping needles was associated with a significant r eduction in the absolute number of inadvertent needlesticks as well as the proportion of injuries due to needlesticks among ALS providers. T he use of self-capping IV catheters was feasible and did not appear to be a deterrent to initiating IV therapy in the out-of-hospital enviro nment.