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Sharps injuries among hospital workers in Massachusetts, 2010: findings from the Massachusetts Sharps Injury Surveillance System.

Laramie-AK; Davis-LK; Miner-C; Pun-VC; Laing-J; DeMaria-A Jr.
Boston, MA: Massachusetts Department of Public Health, 2012 Mar; :1-24
Recently published findings from the Massachusetts Sharps Injury Surveillance System suggest that there has been a significant decline in sharps injury rate among Massachusetts hospital workers since 2001 when the MDPH regulations were implemented (Laramie, et al., 2011). This is important progress. However, the data for 2010 presented in this report indicate that much remains to be done. There were 2,964 injuries reported in 2010 and an unacceptably high proportion (53%) was associated with devices without sharps injury prevention features. Many of these were with devices, such as hypodermic needles, for which alternatives have been on the market for decades. Previous studies have shown that implementation of devices with sharps injury prevention features can reduce injuries related to those device types by as much as 86% (Adams & Elliot, 2006; Muntz & Hultburg, 2004). Hospitals are reminded that MDPH regulations require that sharps injury prevention technology must be used in the provision of care to patients, an inventory of devices lacking sharps injury prevention features that are still in use must be developed and justification of the continued use of devices lacking sharps injury prevention features must be documented. The requirement to maintain an inventory is intended to provide a way for hospitals to document devices in need of conversion and serve as a useful tool in developing a plan for implementing devices with sharps injury prevention features (SESIPs). Many hospitals have found it useful to enlist unit and department managers as well as procurement staff in this process, rather than ask one individual (generally employee health or infection control) to develop the entire list. Hospitals should use their Annual Summary data along with the inventory of devices lacking sharps injury prevention features to establish priorities for device conversion. They should proceed with evaluating devices with sharps injury prevention features and implementing the most effective where clinically appropriate. As mandated by MDPH and OSHA, clinical staff should be involved in the selection of new devices. The mechanism of the sharps injury prevention feature is an important consideration in selection of devices. As described, there are many different sharps injury prevention mechanisms along the continuum from active to passive technology. Active technology requires the user to complete additional steps to engage the sharp injury prevention features (e.g. hinged arm). Passive technology, however, allows the sharps injury prevention of features to engage during the clinical use of the device, with no extra steps (e.g. retractable needles). While more research of the efficacy of different types of mechanisms in needed, results from a recent study suggest that devices with passive sharps injury prevention features are more protective than those with active features (Tosini, et al., 2010). This annual report for the first time includes information about the mechanism of the sharps injury prevention features for those injuries involving SESIPS. Among these injuries, the majority involved devices with active sharps injury prevention features. As noted previously, this information alone cannot be used to assess efficacy of the different mechanisms because information about the number of devices used or purchased is not collected. It does however indicate that many devices with active features are in use. As hospitals continue to evaluate devices as part of continuous quality improvement, consideration of devices with passive sharps injury prevention features is strongly encouraged. While use of SESIPs is critical to preventing sharps injuries, the devices are not fail safe. Hospitals should provide training on the use of devices and should implement safe work practices as part of a comprehensive sharps injury prevention program. Training should be provided not only to employees, but also to contract staff, per diem staff, interns, residents and students. Close to a quarter of the injuries reported occurred with devices used for injection procedures. More than 75% of injuries during injections were performed with devices with sharps injury prevention features, highlighting the need to implement work practice controls. Factors such as position of the healthcare worker relative to the patient and injection site along with disposal practices, in addition to engineering controls and the selection of devices should be considered. Devices with mechanisms which require an extra step to activate, or with mechanisms that can be removed or disengaged should be closely evaluated to see if there are more effective passive alternatives available for use. Injuries in operating and procedure rooms constitute 45% of all reported injuries. Work-practice controls are particularly important in operating and procedure rooms because some devices have fewer alternatives with sharps injury prevention features. These measures include use of neutral zones for hands free passing and increased verbal communications regarding the transfer of devices among staff. Evaluation of devices used, and consideration of those with safety features, such as scalpel blades and blunt suture needles, is also needed. Together with OSHA, NIOSH issued a safety and health information bulletin (SHIB) regarding the implementation of blunt suture needles in 2007. Prior to the NIOSH SHIB, the American College of Surgeons issued a statement at the 2005 Annual Meeting supporting "the universal adoption of blunt suture needles as the first choice for fascial suturing to minimize or eliminate needle-stick injuries from surgical needles". In addition to suture needles, evaluation of the practice of multi-dose administration of various medications via injection should also be reviewed and alternative practices evaluated, as this practice does not allow for the use of hypodermic needles/syringes with safety features and helps to prevent the risk of cross-contamination and transmission of infections to patients (MMWR, 2008). The Massachusetts Sharps Injury Surveillance System is a collaborative effort between the MDPH and hospitals, professional associations and community advocates. The success of the program in collecting data is a result of this collaboration. MDPH will continue to work with these groups to conduct surveillance, review exposure control activities in hospitals, and facilitate the exchange of information among hospitals about successful prevention strategies.
Health-care-personnel; Medical-personnel; Exposure-levels; Needlestick-injuries; Public-health; Hazards; Nurses; Nursing; Workers; Health-care-facilities; Health-care; Preventive-medicine; Safety-practices; Safety-measures; Safety-education; Training; Disease-prevention; Disease-transmission; Disease-control; Work-practices; Worker-health; Surveillance-programs; Employee-exposure; Statistical-analysis
Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research and Evaluation, Occupational Health Surveillance Program, 250 Washington Street, 6th Floor, Boston, MA 02108
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Sharps injuries among hospital workers in Massachusetts, 2010: findings from the Massachusetts Sharps Injury Surveillance System
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Massachusetts State Department of Public Health - Boston