Economic analysis of new workplace technology including productivity and injury: The case of needle-less injection in swine.

Increasing intensification in swine production has led to new and specialized technologies, but the occupational health and safety impacts are rarely quantified in the business plans for adoption. Needle-less injection has potential to increase productivity and eliminate needle stick injury in workers, but it is not clear whether these benefits offset high capital investment and potential increases in musculoskeletal loads. This economic evaluation employed probabilistic scenario analysis using injury, cost, and production data gathered from interviews with swine producers in Manitoba and Saskatchewan. After adoption of needle-less injection, rates of needle-stick injury went down with no measureable effect on upper limb musculoskeletal disorders, resulting in lower health and safety costs for needle-less injectors. Needle-less injection duration was 40% faster once workers acclimatized, but large start-up costs mean economic benefits are realized only after the first year. The incremental benefit cost ratio promoted adoption of needle-less injectors over conventional needles for the base case of a 1200 sow barn; the conventional method is beneficial for barns with 600 sows or less. Findings indicate that well-designed technologies have the potential to achieve the dual ergonomics goals of enhancing human wellbeing and system performance. We anticipate that the economic and decision models developed in this study can be applied to other new technologies in agriculture and animal production.

Process improvement to effectively manage and reduce sharps injuries in a Tertiary Hospital in Northern India.

INTRODUCTION AND OBJECTIVES: Needle stick injuries are associated with a 0.3-30% risk of transmission of Human Immunodeficiency virus, Hepatitis C virus, and Hepatitis B virus. Despite causing psychological trauma they also involve a huge financial burden. A robust process improvement (RPI) toolkit was introduced in order to effectively manage and reduce needle stick injuries, as well as an attempt to report prevalence, post-exposure management, and associated economic burden. MATERIALS AND METHODS: Prospective Observational Study (2015-2018) has been design in a Corporate Tertiary Care Hospital. The participants included were needle stick injuries exposed staff. RPI toolkit was implemented (2015-2018) focusing on root cause analysis, availability of safety engineered devices, immunization and post-exposure management of needle stick injuries exposed staff. The main outcome measure was needle stick injuries incidence. RESULTS: A total of 211 needle stick injuries were reported (mean - 52.72/year, needle stick injury incidence - 13.18/year/100 beds). Yearly trends showed a decrease of 21.3% in injuries from 2015 (61) to 2018 (48). Half (106, 50%) of the total injuries were reported among nurses. Use of hypodermic needles was involved in 116 (55%) injuries, with 114 (54%) occurring due to nonadherence to hospital policies. Overall, 204 staff had protective immunity, and 135 (64%) of these had completed their Hepatitis B immunizations. The source was known in 165 (78%) cases, and 113 of these cases had an injury from a source with negative viral markers. A 6-month follow-up was completed in 90 cases. No seroconversion was reported. Overall costs incurred in post-exposure prophylaxis was approximately €30,000 (mean cost €143.50/needle stick injury). CONCLUSION: Nurses are most at risk of needle stick injury in healthcare settings. Implementation of RPI toolkit led to a 21.3% reduction in sharps injury incidences. These injuries incur huge financial burden on the hospital. Appropriate immunization strategies saved about €1360 expenditure on post-exposure prophylaxis.

Economic burden of needlestick injuries among healthcare workers in China.

Objective: To estimate the economic burden of needlestick injuries (NSIs) among healthcare workers (HCWs) in China.Design: A model was built to evaluate the economic burden of NSIs.Methods: The cost model was developed from a societal perspective, including both direct and indirect costs, with lifetime horizon. The direct costs were categorized into infection prevention and treatment of infections. The indirect cost included productivity loss of both HCWs and his/her family members due to the blood-borne infections. Sub-group analyses were conducted to estimate the cost per NSI when the source patient (SP) was confirmed with hepatitis B virus/hepatitis C virus/human immunodeficiency virus (HBV/HCV/HIV) infection. One-way and probabilistic sensitivity analyses were conducted for all parameters to examine the robustness of the result.Results: The model projected a total cost of ¥699 for each NSI (direct and indirect cost were ¥553 and ¥146, respectively). The cost per NSI when the SP was confirmed with HBV/HCV/HIV was ¥4,238, ¥18,404, and ¥6,152, respectively. The total economic burden of NSIs among HCWs in China was estimated to be ¥5.8 billion, and about half of the cost was associated with NSIs in nurses, at ¥2.8 billion.Limitations: This study did not incorporate the costs of litigation/psychological, and the prevalence of the infections was based on the general population, so the actual costs per NSI may be underestimated. More real-world studies of treatment cost about HBV/HCV are needed to further supporting this study.Conclusions: The economic burden of NSIs among HCWs in China is substantial. Comprehensive NSI prevention programs, including implementation of safety needles and devices, have high potential for healthcare institutions to achieve downstream cost savings and cost offsets.

Job stress and needlestick injuries in nurses: a retrospective observational study.

BACKGROUND: The prevention of needlestick injuries (NSIs) in nurses employed in Emergency Departments (EDs) represents a special issue for healthcare organizations globally. Stressful working conditions, lack of organizational arrangements and lack of supporting one another at work, may contribute to increase the risk of NSIs. METHODS: We conducted an observational study to analyze: 1) the effectiveness of organizational interventions to minimize the occurrence of NSIs in ED nurses; 2) to measure the impact of such interventions on the safety budget. RESULTS: The occurrence of NSIs detected after organizational level interventions was significantly lower than the occurrence observed previously such interventions (p<0,05). By results, cost saving from managing fewer NSIs than the previous period was found. CONCLUSION: The study shows that the proactive, integrated and comprehensive management of organizational features at workplace brings benefits to employees and reduces the burden of the occurrence of NSIs. As result of the reduced NSIs frequency, the overall costs for follow-up of injured workers were reduced. (www.actabiomedica.it).

Estimating the national cost burden of in-hospital needlestick injuries among healthcare workers in Japan.

BACKGROUND: Needlestick injury (NSI) is one of the most burdensome professional hazards in any medical setting; it can lead to transmission of fatal infectious diseases, such as hepatitis B, hepatitis C and human immunodeficiency virus. In the United States, the annual cost burden was estimated as somewhere between $118 million to $591 million; in the United Kingdom it is approximated to be £500,000 (US$919,117.65) per the National Health Service. METHOD: This is the first published paper on the national cost burden of NSIs in Japan. A systematic literature review was conducted to review previous study design in global studies and to extract parameter values from Japanese studies. We conducted abstract searches through PubMed and the Japan Medical Abstracts Society (Ichushi), together with grey literature and snowball searches. A simple economic model was developed to calculate cost burden of NSIs from a societal perspective over a one-year time horizon. We assumed all NSIs are reported and perfect adherence in post NSI management that presented in the labour compensation scheme. Local guidelines were also referenced to extract resource utilization. Lastly, a deterministic sensitivity analysis was conducted and a scenario analysis which considered a payer perspective was also included. RESULT AND CONCLUSION: The national cost burden of in-hospital NSIs is estimated as ¥33.4 billion (US$302 million) annually, based on an average cost per NSI of ¥63,711 (US$577) and number of NSIs at 525,000/year. 70% of the cost is due to initial laboratory tests, followed by productivity loss, estimated at 20% of the total cost. Cost of contaminated NSIs remains at 5% of the total cost. Change in number of NSIs significantly influences outcomes. Variation in post-exposure management practices suggests a need for NSI specific National guidelines and holistic labour compensation scheme development in Japan.

Burden of insulin injection-related needlestick injuries in mainland China-prevalence, incidence, and healthcare costs.

OBJECTIVE: To estimate the prevalence and incidence of needlestick injuries associated with insulin injection among nurses working in hospitals in China and to quantify the direct healthcare costs associated with insulin injection-related needlestick injuries. METHODS: We conducted a large online survey among hospital nurses from 31 provinces, municipal cities, and autonomous regions in China from October 2016 to February 2017. The survey covered a wide range of questions, including geographical location, years of experience, insulin injection practice, number of insulin injection-related needlestick injuries in the past 12 months, interventions for needlestick injuries, and treatment costs. We developed a cost estimate model and categorized costs into two major components: infection prevention and treatment of infections. RESULTS: We received a total of 10,447 questionnaires, of which 9873 were complete and validated. 39.1% of the nurses reported at least one needlestick injury while administering diabetic injections at some point in the past. The incidence of needlestick injuries involving injection pens was 139.5 per 1000 nurses per year and, with adjustment for exposure, 10.2 needlestick injuries per 100,000 injections. Among the respondents, 3.2% reported of having hepatitis B virus infection and 0.9% having hepatitis C virus infection as a result of needlestick injuries. The total costs of one insulin injection-related needlestick injury was estimated to range from ¥1,884 - ¥2,389. CONCLUSIONS: Insulin injection-related needlestick injuries were common in nurses working in hospitals in China and imposed a significant economic burden. More resources should be allocated for preventive efforts for needlestick injuries, including adoption of injection devices with advanced safety features.

Needlesticks with safety devices and accident prevention: an integrative review.

OBJECTIVE: To identify in the literature the efficacy of needlesticks with safety devices to reduce the occurrence of occupational accidents with exposure to biological material among health workers. METHOD: Integrative literature review, structured in the stages: Guiding question, search, categorization of studies, evaluation, discussion and interpretation of results, and synthesis of knowledge. Search for original articles and systematic reviews on the main bases of the Health area, published from 2000 to 2016 in Portuguese, English and Spanish, with descriptors: needlesticks injuries, exposure to biological agents, needles, protective devices, occupational accidents, accident prevention and health personnel. RESULTS: We selected eleven articles, most characterized the passive safety devices as more effective in reducing the occurrence of injuries by needlesticks. CONCLUSION: The use of needlesticks with safety devices reduces the occurrence of accidents, bringing greater solvency when combined with the training of workers.

Needlesticks with safety devices and accident prevention: an integrative review / Agujas con dispositivos de seguridad y prevención de accidentes: revisión integrativa / Agulhas com dispositivos de segurança e a prevenção de acidentes: revisão integrativa

ABSTRACT Objective: To identify in the literature the efficacy of needlesticks with safety devices to reduce the occurrence of occupational accidents with exposure to biological material among health workers. Method: Integrative literature review, structured in the stages: Guiding question, search, categorization of studies, evaluation, discussion and interpretation of results, and synthesis of knowledge. Search for original articles and systematic reviews on the main bases of the Health area, published from 2000 to 2016 in Portuguese, English and Spanish, with descriptors: needlesticks injuries, exposure to biological agents, needles, protective devices, occupational accidents, accident prevention and health personnel. Results: We selected eleven articles, most characterized the passive safety devices as more effective in reducing the occurrence of injuries by needlesticks. Conclusion: The use of needlesticks with safety devices reduces the occurrence of accidents, bringing greater solvency when combined with the training of workers.

RESUMEN Objetivo: Identificar en la literatura la eficacia del uso de agujas con dispositivos de seguridad para reducir la ocurrencia de accidentes del trabajo con exposición a material biológico entre trabajadores de la salud. Método: Revisión integrativa de la literatura, estructurada en las etapas: Cuestión orientadora, búsqueda, categorización de los estudios, evaluación, discusión e interpretación de los resultados, y síntesis del conocimiento. Busca artículos originales y revisiones sistemáticas en las principales bases del área de la salud, publicados desde 2000 hasta 2016 en Portugués, Inglés y Español, con descriptores: lesiones por pinchazo de agujas, exposición a agentes biológicos, agujas, equipos de seguridad, accidentes de trabajo, prevención de accidentes y personal de salud. Resultados: Se han seleccionado once artículos, la mayoría caracterizó los dispositivos de seguridad pasivos como más efectivos en la disminución de la ocurrencia de lesiones por agujas. Conclusión: La utilización de agujas con dispositivos de seguridad reduce la ocurrencia de los accidentes, trayendo mayor resolutividad cuando aliada a la capacitación de los trabajadores.

RESUMO Objetivo: Identificar na literatura a eficácia do uso de agulhas com dispositivos de segurança para reduzir ocorrência de acidentes de trabalho com exposição a material biológico entre trabalhadores de saúde. Método: Revisão integrativa da literatura, estruturada nas etapas: Questão norteadora, busca, categorização dos estudos, avaliação, discussão e interpretação dos resultados, e síntese do conhecimento. Busca a artigos originais e revisões sistemáticas nas principais bases da área da Saúde, publicados de 2000 a 2016 em português, inglês e espanhol, com descritores: ferimentos penetrantes produzidos por agulhas, exposição a agentes biológicos, agulhas, equipamentos de proteção, acidentes de trabalho, prevenção de acidentes e pessoal de saúde. Resultados: Foram selecionados onze artigos, a maioria caracterizou os dispositivos de segurança passivos como mais efetivos na diminuição da ocorrência de lesões por agulhas. Conclusão: A utilização de agulhas com dispositivos de segurança reduz a ocorrência dos acidentes, trazendo maior resolutividade quando aliada à capacitação dos trabalhadores.

Infectious risk for healthcare workers: evaluation and prevention.

Exposure to pathogenic agents is a major occupational risk factor in healthcare facilities. The most common pathogenic agents are human immunodeficiency virus, hepatitis B and C viruses, and Mycobacterium tuberculosis. In Italy, about 70-80% of all cases of exposure to biological agents result from injuries caused by needles or other sharp instruments used during healthcare procedures. These accidents place a high economic burden on healthcare facilities. Indeed, each event is estimated to cost around € 375. Various studies have shown that the adoption of needlestick-prevention devices reduces occupational exposure to biological risk. At regulatory level, Italian Legislative Decrees 81/08 and 19/14 provide for measures to protect healthcare professionals from biological exposure to pathogenic agents.

How Much do Needlestick Injuries Cost? A Systematic Review of the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel.

OBJECTIVE To provide an overview of the economic aspects of needlestick and sharps injury (NSI) management among healthcare personnel (HCP) within a Health Technology Assessment project to evaluate the impact of safety-engineered devices on health care METHODS A systematic review of economic analyses related to NSIs was performed in accordance with the PRISMA statement and by searching PubMed and Scopus databases (January 1997-February 2015). Mean costs were stratified by study approach (modeling or data driven) and type of cost (direct or indirect). Costs were evaluated using the CDC operative definition and converted to 2015 International US dollars (Int$). RESULTS A total of 14 studies were retrieved: 8 data-driven studies and 6 modeling studies. Among them, 11 studies provided direct and indirect costs and 3 studies provided only direct costs. The median of the means for aggregate (direct + indirect) costs was Int$747 (range, Int$199-Int$1,691). The medians of the means for disaggregated costs were Int$425 (range, Int$48-Int$1,516) for direct costs (9 studies) and Int$322 (range, Int$152-Int$413) for indirect costs (6 studies). When compared with data-driven studies, modeling studies had higher disaggregated and aggregated costs, but data-driven studies showed greater variability. Indirect costs were consistent between studies, mostly referring to lost productivity, while direct costs varied widely within and between studies according to source infectivity, HCP susceptibility, and post-exposure diagnostic and prophylactic protocols. Costs of treating infections were not included, and intangible costs could equal those associated with NSI medical evaluations. CONCLUSIONS NSIs generate significant direct, indirect, potential, and intangible costs, possibly increasing over time. Economic efforts directed at preventing occupational exposures and infections, including provision of safety-engineered devices, may be offset by the savings from a lower incidence of NSIs. Infect Control Hosp Epidemiol 2016;37:635-646.

Economic evaluation of occupational safety preventive measures in a hospital.

BACKGROUND: When an organization performs an integrated analysis of risks through its Occupational Health and Safety Management System, several steps are suggested to address the implications of the identified risks. Namely, the organization should make a detailed analysis of the monetary impact for the organization of each of the preventive measures considered. However, it is also important to perform an analysis of the impact of each measure on society (externalities). OBJECTIVE: The aim of this paper is to present a case study related to the application of the proposed economic evaluation methodology. METHODS: An analysis of the work accidents in a hospital has been made. Three of the major types of accidents have been selected: needle stings, falls and excessive strain. Following the risk assessment, some preventive measures have been designed. Subsequently, the Benefit/Cost ratio (B/C) of these measures has been calculated, both in financial terms (from the organization's perspective) and in economic terms (including the benefits for the worker and for the Society). RESULTS: While the financial ratio is only advantageous in some cases, when the externalities are taken into account, the B/C ratio increases significantly. CONCLUSIONS: It is important to consider external benefits to make decisions concerning the implementation of preventive measures in Occupational Health and Safety projects.

Cost-benefit evaluation of a preventive intervention on the biological risk in health: the accidental puncture during the administration of insulin in the University Hospital "Federico II" of Naples.

BACKGROUND: The occupational exposure to biological risk is a frequent event that affects millions of workers in the health sector. Operators are exposed to accidental contact with blood and other potentially infectious biological materials with a frequency higher than that observed in the population (occupational exposure). The pathogens most frequently implicated are the human immunodeficiency virus (HIV), hepatitis C (HCV) and hepatitis B (HBV) viruses. The World Health Organization estimates that each year more than 3 million health workers hurt themselves with an object/edge definitely contaminated with at least one HIV (about 170,000 exposures), hepatitis B (approximately 2,000,000 exposures) and hepatitis C (approximately 900,000 exposures). In Italy approximately 100,000 percutaneous exposures/year are estimated to take place. The needlestick injuries in health care workers are, in large part, preventable by adopting measures such as the use of instrumental needlesticks Prevention Devices - NPDs. The adoption of the NPDs is extremely effective in reducing occupational exposure to biological risk (from 63 % to 100 % reduction). METHODS: The aim of this study was to evaluate whether the adoption of NPDs for insulin therapy is costeffective in terms of prevention of accidents by Biohazard, compared to administration of insulin with traditional methods (syringe + vial). The estimation is carried out both in the light of current legislation (European Directive 2010/32 and 81/08 Italian Law) and epidemiological data and cost of accidents (according to frequency) and alternative interventions. RESULTS: The evaluation of cost-effectiveness included the construction of an economic model that would allow the weighting of the costs of accidents that can occur following the administration of insulin therapy with traditional methods. The economic model was developed taking into account the international literature on the phenomenon of "accidental puncture" and allowed the financial quantification of the event. Then we calculated the cost of insulin therapy using the traditional methodology and the cost has been converted to the cost of insulin therapy when administered by NPDs. The period of the study was the year 2010. CONCLUSIONS: The data thus obtained were used to evaluate the benefits of implementing NPDs for insulin therapy, in terms not only of economic advantage but also of preventive efficacy and on the cost of the accident.

Sharps injuries amongst healthcare workers: review of incidence, transmissions and costs.

BACKGROUND: Sharps injuries and the related risk of infections such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) represent one of the major occupational health risks for healthcare workers (HCWs). LITERATURE REVIEW: An overview of available data on the incidence of sharps injuries and the related HBV, HCV and HIV infections and ensuing costs is provided. RESULTS: Literature reported incidence rates of sharps injuries ranging from 1.4 to 9.5 per 100 HCWs, resulting in a weighted mean of 3.7/100 HCWs per year. Sharps injuries were associated with infective disease transmissions from patients to HCWs resulting in 0.42 HBV infections, 0.05-1.30 HCV infections and 0.04-0.32 HIV infections per 100 sharps injuries per year. The related societal costs had a mean of €272, amounting to a mean of €1,966 if the source patient was HIV positive with HBV and HCV co-infections. CONCLUSION: Sharps injuries remain a frequent threat amongst HCWs. The follow-up and treatment of sharps injuries and the deriving consequences represent a significant cost factor.

Risk of needle-stick injuries associated with the use of subdermal needle electrodes during intraoperative neurophysiologic monitoring.

BACKGROUND: Subdermal needle electrodes are commonly used during intraoperative neurophysiologic monitoring (IONM). However, there is an associated risk of needle-stick exposure to the IONM technologist as well as other operating room personnel. We performed a retrospective study to investigate the incidence and circumstances of needle sticks related to the use of subdermal needle electrodes. METHODS: IONM was performed on 50,665 consecutive surgeries with an estimated use of approximately 2,000,000 needle electrodes. Incident reports of needle exposures were analyzed for personnel, location, and circumstances. Associated Worker's Compensation expenses for the technologists were analyzed. RESULTS: There were 174 reported needle-stick exposures (0.34% incidence) occurring during 173 surgeries, which included 75 IONM technologists (43.1%), 38 anesthesia personnel (21.8%), 34 nurses (19.5%), 16 surgeons (9.2%), and 11 other staff (6.3%). No infectious disease transmission was reported. Fifty-seven technologists incurred expenses totaling $24,174 (average $424 per exposure). The cost for non-IONM personnel was not available. Most needle sticks for technologists occurred during the removal of needles (52.0%) and during patient positioning (67.7%) for non-IONM personnel. CONCLUSIONS: Needle-stick exposure from subdermal needle electrodes during IONM is an infrequent but distressing event occurring in 0.34% of our study group and was not limited to the IONM technologist. Although no infections occurred as a result of needle-stick exposure in this study, steps to minimize needle sticks should be taken during IONM.

Economic benefits of safety-engineered sharp devices in Belgium - a budget impact model.

BACKGROUND: Measures to protect healthcare workers where there is risk of injury or infection from medical sharps became mandatory in the European Union (EU) from May 2013. Our research objective was to estimate the net budget impact of introducing safety-engineered devices (SEDs) for prevention of needlestick injuries (NSIs) in a Belgian hospital. METHODS: A 5-year incidence-based budget impact model was developed from the hospital inpatient perspective, comparing costs and outcomes with SEDs and prior-used conventional (non-safety) devices. The model accounts for device acquisition costs and costs of NSI management in 4 areas of application where SEDs are currently used: blood collection, infusion, injection and diabetes insulin administration. Model input data were sourced from the Institut National d'Assurance Maladie-Invalidité, published studies, clinical guidelines and market research. Costs are discounted at 3%. RESULTS: For a 420-bed hospital, 100% substitution of conventional devices by SEDs is estimated to decrease the cumulative 5-year incidence of NSIs from 310 to 75, and those associated with exposure to blood-borne viral diseases from 60 to 15. Cost savings from managing fewer NSIs more than offset increased device acquisition costs, yielding estimated 5-year overall savings of €51,710. The direction of these results is robust to a range of sensitivity and model scenario analyses. The model was most sensitive to variation in the acquisition costs of SEDs, rates of NSI associated with conventional devices, and the acquisition costs of conventional devices. CONCLUSIONS: NSIs are a significant potential risk with the use of sharp devices. The incidence of NSIs and the costs associated with their management can be reduced through the adoption of safer work practices, including investment in SEDs. For a Belgian hospital, the budget impact model reports that the incremental acquisition costs of SEDs are offset by the savings from fewer NSIs. The availability of more robust data for NSI reduction rates, and broadening the scope of the model to include ancillary measures for hospital conversion to SED usage, outpatient and paramedic device use, and transmission of other blood-borne diseases, would strengthen the model.

Community-acquired, non-occupational needlestick injuries treated in US Emergency Departments.

BACKGROUND: The escalating number of persons self-injecting medications, predominantly insulin, has generated concerns that the public is at risk of acquiring blood-borne infections from discarded needles/syringes. Communities have developed disposal guidelines but a debate continues over the need for further legislation and/or at-home safety devices. This study examines the number, characteristics, treatment and costs of community-acquired needlestick injuries (CANSIs). METHODS: US-representative CANSI rates and characteristics were derived from 2001-08 National Electronic Injury Surveillance System All Injury Program data on product-related injuries treated at US emergency departments (EDs). CANSI-related medical care was examined using 2003-09 National Hospital Ambulatory Medical Care Surveys, representing all US ED visits. Cost analyses used 2010 Current Procedural Terminology Coding and Medicare rates. RESULTS: In 2001-08, an estimated 16 677 CANSIs were treated in US EDs, with an associated annual rate of 0.7 per 100 000 US citizens (95% CI 0.6-0.8) and no observable temporal trend. The estimated maximum annual medical cost of ED-treated CANSIs was $9.8 million, or $0.03 per citizen, $1.66 per insulin-injecting person and $0.0018 per insulin injection. CONCLUSIONS: US ED-treated CANSI rates are extremely low. Stricter disposal programs and the at-home use of safety devices do not appear to be needed at this time.

Costs of postexposure management of occupational sharps injuries in health care workers in the Republic of Korea.

BACKGROUND: Costs of postexposure treatment of sharps injuries (SIs) in health care workers (HCWs) are an economic burden in many countries. This study analyzed the costs associated with SIs in HCWs in the Republic of Korea. METHODS: Between October 1, 2005, and February 28, 2006, general information on SIs among HCWs and the direct costs (eg, laboratory, pharmacy, medical and surgical treatments) and indirect costs eg, (loss of working days) were collected prospectively from 34 hospitals nationwide. RESULTS: A total of 700 SIs were documented, 505 of which (72.1%) generated costs. The average costs per SI were pharmacy, 123,091 won (US$129); laboratory tests, 66,958 won ($70); medical services, 26,332 won ($28); and medical treatments, 9,377 won ($10). The average costs of preventive measures were 160,274 won ($168) for hepatitis B virus (HBV), 127,858 won ($134) for hepatitis C virus (HCV), and 139,552 won ($146) for HIV. Of the laboratory tests, 32.9% were HBV-related, 29.4% were HCV-related, and 19.8% were HIV-related. Of postexposure prophylaxes, 34.9% were HB immunoglobulin and 31.4% were HBV vaccines. We estimated that 7,057.5 SIs generated costs, at a total annual cost of 844,587,577 won ($884,385). CONCLUSIONS: The direct costs of managing SIs among HCWs constitute an economic burden in Korea. More aggressive and comprehensive preventive measures of SIs should be adopted.

Needles and the damage done: reasons for admission and financial costs associated with injecting drug use in a Central London Teaching Hospital.

OBJECTIVES: To establish the clinical reasons for inpatient admissions among injecting drug users. To determine the frequency of behavioural issues during their care and to estimate the financial implications of injecting drug use to the health service. METHODS: Retrospective cohort study at University College London Hospital. Clinical, laboratory and financial data were extracted from case notes and electronic records. The cost of each admission was compared to the income received for the period of care. RESULTS: 124 injecting drug users required 191 admissions between 2005 and 2009. Skin and soft tissue infections (58%) and pneumonia (18%) were the commonest reasons for admission. Bacteraemia at admission was often not accompanied by an inflammatory response. Exposure to HIV (4%), hepatitis B (49%) and C (84%) was common. Drug misuse (16%) during admission was frequent. The cost to the NHS of treating soft tissue infections in drug users was approximately £77 million per annum. After a median follow-up of 40 months, 10 patients (8%) had died. All deaths were attributable to drug use. CONCLUSIONS: Bacterial and viral infections are largely responsible for the significant mortality and morbidity of injecting drug users presenting to secondary care. The financial burden to the NHS is substantial.