JANUARY 2000, VOL 7 1, NO 1 R E V I E W S

RESEARCH REVIEWS

NEEDLESTICK INJURIES AMONG HEALTH CARE WORKERS: A LITERATURE REVIEW C Porta, E Handelman, P McGovern American Association of Occupational Health Nurses Vol47 no 6 (1999)

his article offers the results of an extensive literature T review about needle-stick

injuries. Addressed are needle- stick injury rates and trends, along with current scientific findings pertaining to safer nee- dle devices and their effective- ness in decreasing needle-stick incidents.

Needle-stick injury rates and trends. The US Centers for Disease Control and Prevention estimates that 800,000 exposure incidents occur annually. Determining the scope of needle- stick injuries in the United States, however, is difficult for several reasons. First, national databases do not exist to track or tabulate data about needle-stick injuries. Second, the literature reviewed pertains to hospital sites and may not be representa- tive of other health care settings. Third, researchers have used a variety of methods to evaluate needle-stick injury rates, making it difficult to compare individual findings and determine a stan- dard needle-stick injury rate. Finally, many injuries are not reported. Research regarding underreporting indicates needle- stick injury rates ranging from 21% to 95%.

than 1,OOO US patents in the area of needle-stick prevention devices

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Safer needle devices. MOR

have been issued since the early 1980s. Many studies report that use of safer devices is associated with radical improvements in safety and decreases in reported needle-stick injuries. Some litera- ture, however, reports little or no improvement.

Despite the limitations of these studies, they do offer gen- eralizations about the use of safer devices. First, devices with passive mechanisms of action are recommended over those with active mechanisms of action. Devices with passive mechanisms require no action from the user; thus, they do not add a step to the user’s work procedure.

Second, most of the studies focus on three basic devices: IV equipment, suture needles, and hollow bore needles. Of particu- lar interest to perioperative nurs- es is the fact that suture needles harbor great potential for disease transmission. The good news is that blunt suture needles are associated with significant decreases in needle-stick injuries. The use of these nee- dles, however, is limited to cer- tain surgical procedures.

Third, some studies have attempted to determine the cost-efficiency of using safer needle devices. The studies found that the direct purchasing costs related to safer needle devices are greater than those of traditional devices; however, a comparison of study findings requires the use of standard eco- nomic frameworks.

Finally, the user’s satisfaction is critical to the success of safer needle devices. Dissatisfaction with the devices frequently results in users resorting to tradi- tional devices. This is least

likely to happen when satisfac- tion among users is high. Greater satisfaction is related to the use of training periods that enable users to practice and gain confi- dence in using the new products.

COnClUSlOn. Needle-stick injuries continue to pose a seri- ous threat to perioperative nurs- es, as well as to other health care workers. Needleless IV needles and blunt suture needIes have been developed. Product substi- tution, however, is not sufficient to address the problem. The liter- ature supports comprehensive injury prevention and control strategies, in addition to the use of safer devices. Critical to the success of these strategies and the introduction and use of safer devices is the involvement of the users.

EDWINA A. McCONNELL RN, PnD, FRCNA

NURSING RESEARCH COMMIITEE

RADIAL SCARS IN BENIGN

THE RISK OF BREAST CANCER T W Jacobs et a1 New England Journal of Medicine Vol340 (Feb 11,1999) 430-436

adial scars are benign breast lesions of uncertain clinical R significance. This study

explores the possible risks asso- ciated with radial scars in women with benign breast dis- ease. The main characteristic of radial scars is a fibroelastotic core from which ducts and lob- ules radiate. These scars are usu- ally incidental microscopic find- ings in breast tissue that are sometimes removed because of other possible abnormalities. Mammography examinations, however, have shown an

BREAST-BIOPSY SPECIMENS AND

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increased incidence of large radi- al scars.

The similarity of radial scars to cancer and the findings of carcinoma in some scars have suggested the possibility of a relationship between radial scars and certain types of breast can- cer. Other studies have not demonstrated this relationship because the controls were not suitable. This particular study was a case-control study within the Nurses’ Health Study, which is a long-term prospective evalu- ation of risk factors for breast carcinoma in women in the United States.

Methods. The f is t part of the Nurses’ Health Study began in 1976, when 121,701 female RNs born between 1921 and 1946 responded to a mailed question- naire about their potential risk factors for breast cancer and their medical history. The second part of the Nurses’ Health Study included 1 16,67 1 female RNs born between 1946 and 1964. These nurses also responded to a mailed questionnaire and answered questions regarding past diagnosis of benign breast disease that required hospitaliza- tion or was confirmed by a breast biopsy. Eligible partici- pants included RNs who had not received a diagnosis of cancer at the beginning of each two-year follow-up interval and who reported a diagnosis of benign breast disease. Nurses reporting a diagnosis of breast cancer after at least one year of reported benign breast disease were matched to four RNs (ie, the controls) who did not have can- cer, were born the same year, and received the diagnosis of benign disease the same year. Participants provided permission

to obtain slides of biopsy tissue for comparison. Slides were reviewed with no prior knowl- edge of whether the participant had cancer.

Results. Among the 1,396 women with benign breast dis- ease whose biopsy specimens were reviewed, 99 (ie, 7.1%) had radial scars identified. Women with radial scars were older and more likely to be menopausal. Participants with radial scars and subsequent breast cancer were more likely to have a family his- tory of breast cancer. No rela- tionship was found between the presence of radial scars and menarche, parity, age at birth of first child, or body mass index. Radial scars were present in 12.5% of the women with subse- quent breast cancer and in 5.9% of the controls.

study demonstrate that the pres- ence of radial scars almost dou- bles the risk of breast cancer, regardless of the histologic cate- gory of benign breast disease. Pathologists examining breast biopsy specimens should report the presence of radial scars in benign breast disease and note the size and number of the lesions. The researchers suggest that women should undergo reg- ular clinical and mammography follow-up examinations recom- mended for other patients with benign breast lesions. The radial scars noted in this study were small lesions that were detected incidentally. Whether these results can be extrapolated to large radial scars detected by mammography is unresolved and requires further investigation.

MARYANNE K. COUGHLIN RN, MBA, CNOR

NURSING RESEARCH COMM~EE

Discussion. The results of this

CHILDREN’S PREOPERATIVE COPING AND ITS EFFECTS ON POSTOPERATIVE ANXIETY AND RETURN TO NORMAL ACTIVITY L L LaMontagne et a1 Nursing Research Vol45 (MaylJune 1996)

erioperative nurses often face the challenge of deal- P ing with anxious pediatric

patients. Although we have rec- ognized the importance of help- ing children cope with the stress- ful surgical experience, little is known about how this coping influences patient outcomes. The purpose of this study was twofold:

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determine whether the relation- ships found previously between coping and its ante- cedents (eg, age, information given, locus of control) would be replicated with a sample of children undergoing major, rather than minor, elective sur- gery and test a model that relates coping to two different postoperative outcomes (ie, anxiety and return to normal activities). Creating a model. Research-

ers reviewed theories on stress and coping, as well as research conducted on children undergo- ing minor surgery. The study was grounded on Lazarus’ theo- ry of stress and coping, which describes coping as the process used to alter, manage, or tolerate a disturbance in a personal or sit- uational relationship. Previous research has found that children vary in their method of coping with stress, such as that caused by upcoming surgery. The use of avoidance is associated with external locus of control. Children who receive more

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