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Sharps Injuries

The OSHA Bloodborne Pathogens Standard has been in place since 1991 to protect healthcare personnel from occupational exposure to blood and other potentially infectious materials (OPIM). Today, due in part to the use of standard precautions, engineering controls (safer medical devices), and PPE, frequency of these exposures have declined. However, given the rise of aging populations of patients accessing healthcare with active hepatitis C, hepatitis B, HIV and co-infections with one or more of these viruses, the risks faced by healthcare workers are more significant than ever.

The Centers for Disease Control and Prevention (CDC) estimates that hepatitis C virus (HCV) is responsible for the deaths of more baby boomers (born between 1945-1965) than 60 other infectious diseases combined. And of those, only about half know they are infected.  The occupational health risks associated with contaminated sharps injuries become less about national estimates of overall numbers, but more so about identifying how the injuries that are occurring can be prevented in the future.

Sharps injury incident data from the International Safety Center Exposure Prevention Information Network (EPINet) show that injuries since the 1990s have declined due to the increased focus on the use of sharps injury prevention devices.  The greatest decreases have been for injuries occurring from disposable syringes and winged steel needles (butterflies) due to advances in safer technologies. However, injuries from sutures and scalpel blades especially among physicians continue to be high. Injuries from disposable syringes continue to affect nurses more than any other single professional group (53%). In addition, year after year approximately 25% of all injuries occur downstream to the non-user (e.g., clinical team member, EVS personnel, waste hauler, laundry worker, etc.). It is important to remember that the use and activation of safety mechanisms and proper disposal protect not just the user of the device, but those that come into contact with that device throughout its lifespan.

There have been several published reports that clearly illustrate injuries from sharps injury prevention (SIP) devices (engineering controls including sharps with engineered sharps injury protections) are actually increasing. Many of these injuries are occurring prior to activation of a safety feature, therefore it is critical to remain diligent about employing safe work practices when using the devices. Also, activation of the safety feature/mechanism and immediate, safe disposal is crucial in building overall safer sharps safety programs. Since OSHA requires that frontline non-managerial employees are included in device “identification, evaluation, and selection of effective engineering and work practice controls”, including this element into a sharps safety program will ensure that the best devices are implemented based on the procedures being performed and the patient population being treated.

It has been estimated about half or more of sharps injuries go unreported, so the numbers and frequencies that we do have access to are only the tip of the proverbial iceberg. Focusing efforts on improving reporting without fear of retaliation and facility-based surveillance is key to truly understanding the impact that sharps injuries have on occupational and public health. There are several states that require licensed healthcare facilities to report injuries to the state (i.e., MA, TX, WV).

A sharps injury is a penetrating stab wound from a needle, scalpel, or other sharp object that may result in exposure to blood or other body fluids. Sharps injuries are typically the result of using sharp equipment in a fast-paced, stressful, and potentially understaffed environment. These strenuous demands often produce feelings of fatigue, frustration, and occasionally anger. In the operating room, for example, healthcare personnel frequently do not have the luxury of “taking a break,” but must continue with their duties until the procedure is completed. These conditions can increase the risk of injury and subsequent infection or illness for healthcare workers.

Healthcare workers may also incur injuries from unsafe practices, such as passing sharps hand-to-hand between team members, placing sharps in an overfilled disposal container, failing to use a safer device or failing to identify a safer alternative (e.g., blunt tip sutures, alternate skin closure devices/technologies).

The cost of a sharps injury can be a compelling reason to use safer sharps practices. One sharps injury, needlestick or mucocutaneous exposure can cause a number of direct and indirect costs for the healthcare facility, including:

  • Loss of employee time
  • Cost of personnel time to investigate the injury
  • Expense of laboratory testing (source patient and employee)
  • Cost of treatment for post-exposure treatment
  • Cost of replacing or reassigning staff

In addition to costs incurred by the healthcare facility and/or workers compensation provider, the stress on the affected worker and the worker’s family can be enormous. In addition to the initial concern, testing for bloodborne pathogens can last for months, producing feelings of anxiety and distress for an extended period of time.

In addition to the use of sharps devices, injuries are also closely associated with certain work practices that can pose an increased risk of bloodborne pathogen or infectious disease exposure. These work practices include:

  • Disposal-related activities (e.g., overfilled sharps container, sharps container too far away, leaving device on surface) (8%)
  • Activities after use and prior to disposal, such as item disassembly or multi-step process (16%)
  • Recapping a used needle (3%)

Figure 1: Activities Associated with Needlestick or Sharp Object Injury

Figure 1: Activities Associated with Needlestick or Sharp Object Injury

Source: International Safety Center EPINet Report for Needlestick and Sharp Object Injuries, 2016.  N=1,180

What devices are involved with sharps injuries?

Injuries are also closely associated with certain devices that can pose an increased risk of a blood or body fluid exposure. These devices include:

  • Disposable Syringe (27%)
  • Suture Needle (25%)
  • Scalpel Blade (6%)
  • IV Stylet (3%)
  • Winged Steel Needle (2%)

Figure 2: Devices Associated with Percutaneous Injuries by % Total Percutaneous Injuries Reported

Figure 2: Devices Associated with Percutaneous Injuries by %26#37; Total Percutaneous Injuries Reported

Source: International Safety Center EPINet Report for Needlestick and Sharp Object Injuries, 2016.  N=1,180
”Other” includes spinal needle, trocar, drill bit, hemostat, and more (all less than 1%)
*20% of disposable syringe injuries are from 24/25 gauge needles, 18.3% from insulin needles