Central Nursing Division and ^*Specialty Out-Patient Department, United Christian Hospital, Hong Kong

The process of arterial and venous blood sampling carries with it the risk of transmitting bloodborne organisms through drops of split blood on the work surfaces, needle stick injuries, or aerosol sprays during the process of decapping. A demand for a safeguarded work environment has contributed to a proliferation of safety devices. Closed systems generally involve a vacuum tube with or without anticoagulants. These systems have been evaluated to be superior to the conventional syringe and needle systems in terms of specimen quality and have found to have a lower risk of transmitting bloodborne pathogens. However, due to financial constraints, hospitals are reluctant to change over to closed systems unless the closed systems are proven to cost less. The present study compared the cost-effectiveness of the conventional needle and syringe blood collection system to a closed blood collection system in an out-patient care facility in a regional hospital in Hong Kong. The comparison involved the following: 1) material cost including syringes, needles, needle holders, blood collection tubes, time taken for blood collection and sharp boxes; 2) specimen integrity in terms of blood sample returned for re-sampling because of haemolysis or inadequate volume; 3) ease of use in terms of staff acceptance, frequency of incorrect use of blood collection bottles and frequency of repuncture per patient; 4) risk and cost of needle stick injury; and 5) risk of infection in terms of blood spilt into the environment. It was noted that the closed system reliably and safely yielded blood specimens of better quality and in higher efficiency, in other words, more cost-effective. Closed systems also carried with them a lower potential hazard of contamination through the elimination of transferring blood from syringes to specimen bottles.