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

Autoři: Hiroyuki Kunishima aff001;  Emiko Yoshida aff002;  Joe Caputo aff003;  Hiroshige Mikamo aff004
Působiště autorů: Department of Infectious Diseases, St. Marianna University, Kanagawa, Japan aff001;  Healthcare to All Co. Ltd., Tokyo, Japan aff002;  Vista Health Pte. Ltd., Singapore, Singapore aff003;  Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224142



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.


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.

Klíčová slova:

Hepatitis C virus – Japan – Laboratory tests – Prophylaxis – Social systems – Treatment guidelines – Post-exposure prophylaxis


1. Yoshikawa T., 医療従事者のための針刺し切創対策のページ. The Ohara Memorial Institute for Science of Labour. 2009. Available from:

2. University of Verginia, About EPINet. Available from:

3. Hiramitsu Y. and Yoshikawa T., 針刺し・切創の未報告の有無に関する検証. Japan Medical Journal.2017;4874:42–46.

4. United States General Accounting Office, Occupational Safety: Selected Cost and Benefit Implications of Needlestick Prevention Devices for Hospitals. 2000. Available from:

5. OECD, OECD Data. Available from:

6. Center for Disease Control and Prevention, Measuring the Cost of Sharps Injury Prevention. 2004. Available from:

7. Paterson C, Elder A, Safer Sharps Devices An Evaluation of Utility in NHS Scotland. NHS Scotland. 2005.

8. De Jager P, Zungu M, Dyers R. Economic evaluation of safety-engineered devices and training in reducing needlestick injuries among healthcare workers in South Africa. S Afr Med J. 2018;108(6):477–483. doi: 10.7196/SAMJ.2018.v108i6.12913 30004327

9. de Perio M. Needlestick injuries among employees at retail pharmacy chain–nationwide. Centers for Disease Control and Prevention. 2012.

10. The NHS staff council, Managing the risks of sharps injuries. The NHS staff council. 2015.

11. Arise K, Yoshida S, Okamoto A, Hukui Y, Hara A, Nogawa H, et al. Survey of occurrences of needle stick and cutting injuries in X prefecture, Japan. Japanese journal of environmental infections. 2013:28(3): 147–153.

12. Japan Medical Association. 医療従事者のための医療安全対策マニュアル. 2007. Available from:

13. Fund for Local Government Employees' Accident. 2010. Available from:

14. Yagi T. 医療機関における院内感染対策マニュアル作成のための手引き(案)[更新版] 2013 MHLW Grant report. 2013. Available from:

15. Japanese Association of Dialysis Physicians. Guidelines for Standard Hemodialysis Procedure and Prevention of Infection in Maintenance Hemodialysis Facilities (4th edition). 2015. Available from:

16. Hiroshima City Aki Hospital, 広島市医師会運営・安芸市民病院 針刺し対策マニュアル. 2016. Available from:

17. Saitama Prefecture, 埼玉県血液・体液暴露事故緊急対応マニュアル. 2017. Available from:

18. Hokkaido University Hospital, 北大病院感染対策マニュアル 第6版. 2018. Available:

19. Tsukuba University Hospital, 院内感染対策マニュアル. 2017. Available from:

20. AIDS Clinical Center, 血液・体液暴露事故(針刺し事故)発生時の対応. 2018. Available from:

21. Kagawa University Hospital, not provided. 職業感染防止対策. Available from:

22. AIDS Clinical Center, 血液・体液暴露事故(針刺し事故)発生時の対応. 2018. Available from:

23. Nagoya University Hospital, 針刺し事故対策. Available from:

24. Kagoshima University Hospital, 針刺し・切創・粘膜暴露への対応. Available from:

25. Maizuru Medical Center, 針刺し・切創、血液等暴露事故発生時の対応. Available from:

26. The Research Group of Occupational Infection Control and Prevention in Japan, 血液体液暴露後の対応. Available from:

27. The Japan Society of Hepatology, C型肝炎治療ガイドライン. 2018. Available from:

28. Kimura S, Aoki M, Oka S, Sakurai K, Kidouchi K, Higasi K. [Experience in the care of patients with HIV infection and its associated opportunistic infections and basic date on sharps and needle injury at the referral hospitals in Japan. Nation wide survey]. In MHLW. エイズと日和見感染症に関する臨床研究 平成8年度研究報告書. 1997. pp. 41–60.

29. Kidouchi K, Aoki M, Oka S, Kimura S. [Status of needlestick injuries and the basic strategy for a prevention program at the referral hospitals in Japan. Nation wide survey (1996–1998)]. In Kimura S. HIV感染症に関する臨床研究. MHLW. 2000. pp. 243–250

30. Kimura S. [A survey of current situation and prevention of needlestick and sharps injuries among healthcare workers]. In Kimura S. [Needlestick and sharps injuries among healthcare workers]. MHLW. 2002.

31. Kidouchi K, Kimura S. 針刺し・切創の現状と対策:エイズ拠点病院における1996年-2001年の針刺し・切創. Kou A. 医療従事者における針刺し・切創の実態とその対策に関する調査. MHLW. 2005

32. Maeda H, Tadakuma K, Ieiri Y, Higashi Y, Kawaguchi T. [Questionnaire survey on infection control and prevention for occupational infections among medical facilities in a city. Japanese journal of environmental infections]. 2010;25(4):229–36. doi: 10.4058/jsei.25.229

33. Yoshikawa T, Wada K, Lee J, Mitsuda T, Kidouchi K, Kurosu H, et al. Incidence rate of needlestick and sharps injuries in 67 Japanese hospitals: a national surveillance study. PLoS One. 2013;8:e77524. doi: 10.1371/journal.pone.0077524 24204856

34. Kanda Y, Miyata K, Watanabe H, Kidouchi K, Okubo T, Ota M, et al. [Investigation about the needlestick and sharp instrument injury -From the current result of the questionnaire in the Tokai area-]. Japanese journal of environmental infections. 1998;13(3):161–166. doi: 10.11550/jsei1986.13.161

35. Kidouchi K, Kimura S. [Status of needlestick injuries at the referral hospitals in Japan (1996~2000)]. In Kimura S. 医療従事者における針刺し・切創の実態とsの対策に関する調査. MHLW. 2003.

36. Kou A, Takano Y, Nakagawa M, Lee M, Fujita M. 医療従事者における針刺し・切創の実態とその対策に関する調査 ー2003年と2004年の2年間における37施設のデータ集積結果からー. In Kou A. 医療従事者における針刺し・切創の実態とsの対策に関する調査研究. MHLW. 2004.

37. Kidouchi K, Nakamura C, Kato T, Kashiwamata N, Mizuno Y, Watanabe S. [Effects of a Needlestick Injury Prevention Program in Nagoya Higashi Municipal Hospital:Report Questions of Needlestick Injury and Estimated Numbers of Needlestick Injury].The Japanese journal of medical instrumentation. 1998;68(1):35–39.

38. Honda T, Hitomi S, Ishizuka N, Kimura S. [An Analysis of Needlestick Injures in University of Tokyo Hospital]. The Japanese journal of medical instrumentation, vol. 1998;68(2):72–75.

39. Mitani M, et al. 院内における針刺し事故の実態調査. Medical journal of Kochi Red Cross Hospital. 1999;7(1):55–58.

40. Usami I, Hisano A, Yamada M. 当院〔旭労災病院〕における針刺し事故対策. Japanese journal of environmental infections. 1999;14(3):212–215.

41. Kawatani T, YUzuki Y, Kajiya T, Tanimoto A, Arita C, Kaneda Y, et al. 当院における針刺し・切創事故の現状と問題点. Infection Control. 2000;9(1):86–91.

42. Takase C, Takase H, Shimoyama J, et al. 針刺し事故防止に関する周知度と事故の現状及びその対策. The journal of Nishiwaki City General Hospital. 2002;2:59–66.

43. Sakurada N. 看護師の針刺し事故に関する意識及び実態調査. The Japanese journal of nursing science. 2003;28(9):1066–1070.

44. Umeoka S, et al. 当院における医療従事者の針刺し・切創事故 ーアンケート調査による実態の把握と今後の課題ー. The medical bulletin of Onomichi General Hospital. 2003;13:73–78.

45. Smith DR, Mihashi M, Adachi Y, Nakashima Y, Ishitake T. Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital. Journal of Hospital Infection. 2006;64(1):44–49. doi: 10.1016/j.jhin.2006.03.021 16835002

46. Horikawa S, Umeoka S, Nagaoka F, Uemura M. 針刺し切創事故に対するクリニカルパス活用の試み. Journal of Japanese Society for Clinical Pathway. 2007;9(1):37–48.

47. Smith DR, Mihashi M, Adachi Y, Shouyama Y, Mouri F, Ishibashi N, et al. Organizational climate and its relationship with needlestick and sharps injuries among Japanese nurses. American Journal of Infection Control. 2009;37(7):545–550. doi: 10.1016/j.ajic.2008.11.004 19272674

48. Smith DR, Muto T, Sairenchi T, Ishikawa Y, Sayama S, Yoshida A, et al. Hospital safety climate, psychosocial risk factors and needlestick injuries in Japan. Industrial health. 2010;48(1):85–95. doi: 10.2486/indhealth.48.85 20160412

49. Matsunami T, Okada T, Nakayama M, et al. 針刺し・切創事故の実態と防止対策. Japanese journal of nursing administration. 1999;30:59–61.

50. Ohno S, Sato K, Kataoka K, Tanaka Y, Ohara Y, Noda A, et al. [Epidemiology of needlestick injuries and effect of disposable needle container]. Japanese journal of environmental infections. 2000;15(3):264–268.

51. Yukawa J. 下関市立中央病院における安全器材導入プロセスと費用対効果. Ignazzo. 2005.

52. Koyama S, Momoi Y, Wakayama T, Shibuya Y. [Status of needlestick injuries and the basic strategy for prevention programs in our hospital]. Japanese journal of environmental infections. 2008;23(4):285–289.

53. Tanaka J, Kumagai J, Katayama K, Komiya Y, Mizuno M, Yamanaka R, et al. Sex- and Age- specific carriers of Hepatitis B and C viruses in Japan estimated by the prevalence in the 3,485,648 first-time blood donors during 1995–2000. Intervirology. 2004;47(1):32–40. doi: 10.1159/000076640 15044834

54. Tanaka J, Koyama T, Mizui M, Uchida S, Katayama K, Matsuo J, et al. Total numbers of undiagnosed carriers of Hepatitis C and B viruses in Japan estimated by age- and area- specific prevalence on the national scale. Intervirology. 2011;54(4):185–195. doi: 10.1159/000324525 21454956

55. Tanaka J, Akita T, Ohisa M, Sakamune K, Ko K, Uchida S, et al. Trends in the total numbers of HBV and HCV carriers in Japan from 2000 to 2011. J Viral Hepat. 2018;25(4):363–372. doi: 10.1111/jvh.12828 29193549

56. Statistics Bureau. Statistics Japan. 2018. Available from:

57. Kidoushi K, Kashiwamata M, Nakamura C, Katoh T, Mizuno Y, Watanabe S. [The basics for establishing a needlestick injury prevention program in hospitals]. The journal of the Japanese Association for Infectious Diseases. 1997;71(2):108–115. doi: 10.11150/kansenshogakuzasshi1970.71.108 9077067

58. Suewaka M. [The situation and future problem of needle pad and cut wound accident]. The medical journal of Kawasaki Hospital. 2007;2:108–112.

59. Yamazaki I, et al. [Current situation and counterplan against needlestick and sharps injuries in our hospital]. Infection Control. 2005;14(2):182–187.

60. Hatanaka S, Kadotani M, Takahashi Y, Koizumi Y. [Current situation and problems of needlestick and sharp instrument injuries]. Japanese journal of environmental infections. 2006;21(3):185–190.

61. Nagao Y, Baba H, Torii K, Nagao M, Hatakeyama K, Iimura Y, et al. A long-term study of sharps injuries among health care workers in Japan. Am J Infect Control. 2007;35(6):407–411. doi: 10.1016/j.ajic.2006.03.015 17660012

62. Sumimoto W, Ohashi M, Nakajima H, Masuda C, Nakamichi Y, Shishido K, et al. [The evaluation of the incidence of the needle stick injuries in Kanto Rosai Hospital]. Japanese journal of occupational medicine and traumatology. 2009;57(5):258–262.

63. Onishi T, Matsumoto H. 大崎市民病院における針刺し事故の現状と対策. Journal of Osaki Citizen Hospital. 2011;15(1):44–46.

64. Otsu S. et al. 当院の針刺し切創の現状と対策. Infection Control. 2013;22(5):510–517.

65. Takahashi Y, Arai M, Koshihara K, Kagawa K, Yamamoto Y, Tanaka A, et al. [Management and analysis of occupational needlestick accidents]. Japanese journal of transfusion medicine. 1999;45(4):442–448.

66. National Tax Agency, 民間給与実態統計調査. 2018.

67. Ministry of Health, Labour and Welfare. 医療施設動態調査. MHLW. 2017.

68. The Research Group of Occupational Infection Control and Prevention in Japan (JRGOICP). Available from:

69. Ministry of Health, Labour and Welfare. 2004. Available from:

70. Ministry of Health, Labour and Welfare. 2010. Available from:

71. OECD. OECD.Stat. Available from:

72. OECD. Health at a Glance 2017: OECD Indicators. 2017. Available from: http://dx/

73. The UK Health and Safety Executive. European Commission measures for protecting healthcare workers from infections due to needlestick injuries. HSE/08/60. 2008.

74. The UK Health and Safety Executive. Appraisal values or 'unit costs'. Available from:

75. National Audit Office. A Safer Place to Work. Improving the management of health and safety risks to staff in NHS trusts. The Stationery Office. 2003.

76. Tanaka M, et al.「針刺し事故」の実態と対策. Japanese journal of nursing administration. 1996;6(4):272–278.

77. Urano M, Yano K, Waki S, Murohisa B. 県西部浜松医療センター医療従事者における針刺し・切創事故に関するサーベイランスとコスト試算. Japanese journal of environmental infections. 1997;12(2):94–98.

78. Matsui Y, et al. 針刺しの実態と対策],” The journal of Hamamatsu Medical Center. 2007;1(1):80–85.

79. Nishiuchi Y. 費用対効果の具体例② 血液分注器の導入効果. Infection Control. 2013;22(5):494–500.

80. Suzuki R, Kimura S, Shintani Y, Uchida M, Morisawa Y, Okuzumi K, et al., “The efficacy of safety winged steel needles on needlestick injuries. The journal of the Japanese Association for Infectious Diseases. 2006;80(1):39–45. doi: 10.11150/kansenshogakuzasshi1970.80.39 16519123

81. Jason J. Community-acquired, non-occupational needlestick injuries treated in US Emergency Departments. J Public Health (Oxf). 2013;35(3):422–430. doi: 10.1093/pubmed/fdt033 23554512

82. Tokyo Council. 在宅医療廃棄物の適正処理に関する検討会. Meeting minutes. 2013.

83. Tokyo Building Maintenance Association. 災害発生報告事例集. 2018.

Článek vyšel v časopise


2019 Číslo 11