Comparison of Mexico and U.S. EPINet Sharps Injury Surveillance Data: Opportunities for Prevention

Background: Prevention research in the field of sharps injury is most commonly based on surveillance data from a single country. Such research, while important, does not reveal divergent causal patterns in different countries. Inter-country comparisons reflect a broader spectrum of practices and are potentially important for identifying the benefits of different national prevention policies, or conversely, idiosyncratic causes of injury that would otherwise go unnoticed.

Objective: We conducted an analysis of sharps injury surveillance data from networks in Mexico and the U.S. using the standardized EPINet Sharps Injury and Blood Exposure Surveillance system, to highlight differences in exposure patterns and identify priorities and opportunities for risk reduction in Mexican healthcare settings.

Methods: The EPINet surveillance system, including Access-based software, was translated into Spanish and customized for Mexican healthcare settings. We compared two years of data from the Mexico EPINet Sharps Injury Surveillance Project coordinated at the National Perinatology Institute in Mexico City, and the U.S. EPINet Sharps Injury Surveillance Research Group coordinated by the International Healthcare Worker Safety Center, University of Virginia. We focused on sharps injuries during blood drawing because of the high risk for bloodborne pathogen transmission during such procedures.

Results: The six participating Mexican hospitals reported a total of 709 percutaneous injuries (PIs) for the two-year period from July 2005 through June 2007 (PI rate = 24.1 per 100 beds). The 33 participating U.S. hospitals reported a total of 1,933 PIs for a two-year period from January 2006-December 2007 (PI rate = 33.6 per 100 occupied beds). In the Mexican hospitals, 22.4% of injuries were associated with venous blood drawing (5.4 PIs per 100 beds), compared to only 11.5% in the U.S. hospitals (3.9 PIs per 100 occupied beds). Furthermore, 84% of phlebotomy-related injuries in the Mexican hospitals were caused by syringes, compared to only 36% in U.S. hospitals.

Conclusions: In Mexico, as in many economically challenged countries, conventional syringes continue to be more commonly used for blood drawing than vacuum-tube phlebotomy sets, placing healthcare workers at high risk for preventable injuries. Furthermore, in the U.S. a 60% drop in phlebotomy-related injuries was documented following the wide-scale adoption of safety-engineered phlebotomy sets, but such equipment is not yet widely used in Mexico. A national plan in Mexico to reduce bloodborne pathogen transmission risk among healthcare workers should focus on this high-risk type of injury. To improve the safety of Mexican healthcare workers, it is important to evaluate in detail all phlebotomy-related procedures, identify the safest equipment configurations that are economically feasible, and develop recommendations for safety practices.