HIV Origins

uated engineering controls for several devices.3 Of the 390 syringes collected from the needle disposal boxes during our study period, only 59.5% were activated. Our study of this new safety syringe had several limitations, including a small sample size, such that the expected number of needlestick injuries during the study period was nil. Thus, we did not expect to measure an actual decrease in the number of needlestick injuries as a result of the new syringe. Underreporting of needlesticks is common in the medical field as a whole,4-6 and so it would be naive to think that it did not affect this study as well. It is possible that a needlestick injury did occur with the safety syringe and never was reported. We cannot clearly establish that the safety syringes in fact were activated immediately after use. It is possible the safety device was not activated immediately after use, but only upon disposal, which would not protect the HCW and other staff from accidental needlestick injuries while the uncapped needle was transported to a distant disposal site or was put down on the bed or adjacent table while the patient was stabilized. Finally, this study relied on self-reported data, which may not be entirely accurate. We have demonstrated that the correct use of this safety syringe was at most 60%, even after an educational presentation to a group of experienced nursing personnel. The weakest link in any active safety device clearly is the need for the user to activate the safety feature through one or more additional steps that take time, effort, and remembering to perform the task each time. Based on our results, we would suggest that passive rather than active safety products be developed. 95-CC-039. Address reprint requests to Leland S. Rickman, MD, Epidemiology Unit, UCSD Medical Center 8951, 200 W Arbor Dr, San Diego, CA 92103.