Impact of Needlestick Safety & Prevention Act (HR5178) on hospital worker injury.
Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, K01-OH-009140, 2012 Jul; :1-33
Percutaneous injuries from contaminated sharp devices remain an important issue for healthcare workers despite improvements over the past two decades. H.R.5178 (the Needlestick Safety and Prevention Act), enacted in 2000, was intended to protect a high-risk population from injury while performing routine, albeit hazardous procedures. This study quantified changes in hospital worker injury rates associated with the legislation. We employed a historical prospective study design, using surveillance data maintained at the University of Virginia International Healthcare Worker Safety Center. We tracked annual injury rates from 1995 through 2005 (reflecting 23,908 reported injuries from 85 hospitals across 10 states). In addition to calculating changes in overall rates, we estimated job-specific annual injury rates for nurses, the employee group experiencing the largest number of occupational sharps injuries. We analyzed the changes in rates using various denominators (FTEs, beds, admissions). We also examined the change in proportion of injury rates attributable to safety-engineered devices. We observed no decrease in the pre-legislation period, followed by a significant decrease (P<0.001) in 2001for all injury rate analyses. Subsequent injury rates remained well below pre-legislation rates. The decrease varied somewhat (38%-42%) based on the denominator, but the pattern was very similar for all denominators. Nurses experienced a decreased proportion of injuries compared to other workers. 5 Concomitant with the decrease in injuries was an increase in the proportion of injuries from safety-engineered devices. This parallels a steep rise in the sales and use of safety-engineered devices following the legislation, resulting in a larger proportion of a smaller number and rate of injuries. During the period of decreased injury rates, OSHA also reported an increase in citations and fines related to violations of the Bloodborne Pathogens Standard Using the CDC's national estimate of 385,000 annual hospital needlestick injuries [based on 1997-98 injury data], and the GAO's national estimate of $500-$3000 for the cost of needlestick injury follow-up, and a conservative estimate of 36% reduction in needlesticks after the legislation, we estimate an annual reduction of 138,600 needlesticks. Cost savings from follow-up that would have been required are estimated at $69M - $415M for each year since the legislation. These findings add to the body of evidence supporting the use of mandates coupled with enforcement in improving healthcare worker safety. The association between increases in safety-engineered devices and reduction in sharps injuries reinforces the importance of continued development and adoption of safety-engineered devices. Collaboration among device manufacturers and healthcare workers will likely produce the best devices. There are policy implications for the healthcare industry and for worker safety and health related to morbidity and mortality of occupational bloodborne pathogen exposure, costs of injury follow-up, in-service educational requirements and the transition from hospital to non-hospital locus of care delivery. Practitioners, educators, administrators, researchers, device manufacturers and policy makers each have a role in addressing the remaining challenges in the U.S., and in collaborating with colleagues in the global community. Protecting the health of the healthcare workforce is critical to preserving the healthcare infrastructure and the availability of healthcare resources.
Needlestick-injuries; Nursing; Nurses; Legislation; Occupational-hazards; Occupational-exposure; Safety-measures; Safety-practices; Injuries; Medical-personnel; Statistical-analysis
Elayne Kornblatt Phillips, RN, MPH, PhD, University of Virginia, International Healthcare Safety Center, 1224 Jefferson Park Ave, Charlottesville, VA 22903
Final Grant Report
NTIS Accession No.
National Institute for Occupational Safety and Health
University of Virginia, Charlottesville