ers, that up to 60 percent of needles were capped (Becker et al., 1990). The effectiveness of work practice controls is of concern and the use of engineering controls would be more effective (Kopfer and McGovern, 1993).

English (1992) reported findings of a study on needlestick injuries conducted for a 1-month period in 17 hospitals in Washington, D.C. Of the 72 injuries reported, 46 percent were from RNs and recapping was most associated with needlestick injuries (14 percent). Eighteen injuries (25 percent) were to "downstream" housekeepers and aides who did not use such devices in their practice. Mallon and colleagues (1992) reported similar findings in a study of 332 reports of occupational blood and body fluid exposure. During a 9-month period needlestick and other sharps injuries accounted for 83.4 percent of all reports. In addition, failure to use universal precautions was cited in 34 percent of the reports.

Much of the concern related to needlestick injuries is related to the possible consequences of contracting AIDS. As of December, 1991, in the United States alone, 218,301 persons had been diagnosed with AIDS. The Centers for Disease Control and Prevention (CDC) reports that this figure may be 50 percent lower than the actual figure, due to inadequate diagnoses and non-diagnosis due to individual fear of positive test results. In addition, as of December 1993 the CDC has identified 123 documented or possible cases of occupationally acquired HIV (CDC, 1994), which represents two-thirds of the 176 documented cases worldwide (Jagger et al., 1994). Nurses and clinical laboratory workers, primarily phlebotomists, ranked first among HIV infected workers, with each group accounting for 24 percent of the 123 cases.

Jagger (1994b) reports surveillance data on percutaneous injuries for a 1-year period (1992–1993) from 58 participating hospitals. Of all the cases reported (n = 471), nurses and phlebotomists each accounted for 157 and 150 injuries (33.3 percent and 31.8 percent) respectively, with two-thirds of the injuries occurring in patient rooms (53.3 percent) and in the emergency department (14.0 percent). Recapping needles has been identified as a continual source of worker exposure (Ribner et al., 1987), and many of these injuries are considered to be preventable through use of safer devices, procedures, and work practices. In another study by Neuberger and colleagues (1988) of RNs and LPNs, needlestick injuries were the most frequently reported (69 percent and 50 percent respectively) and lifting injuries accounted for the most lost work time. Neuberger compared the needlestick injury findings to an earlier study of needlestick injuries (Neuberger et al., 1984) in the same population and found significant reductions (74 percent) in needlestick injury rates. Neuberger contributes these reductions to improved staffing and equipment and to employee education.

Several studies have found that nurses and other health care workers have expressed fear of contagion for self and family members with respect to caring for AIDS patients (Barrick, 1988; Baer and Longo, 1989; Boland, 1990). Based on a statewide survey of 243 Florida hospital nurse administrators, Nagelkerk



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