Since passage of the Needlestick Safety and Prevention Act (NSPA) in 2000, safer needle devices have become widely available in healthcare workplaces and needlestick injuries have declined significantly. Yet on many fronts, sharp injuries haven’t been addressed adequately. Healthcare delivery, devices, and demands have changed since 2000, and so has the science of safer devices. Even after the first decade of NSPA, large numbers of healthcare workers remain at serious risk for injury.

The goal of every healthcare facility should be to eliminate the risk of needlestick injuries wherever possible. The March 2012 report “Moving the Sharps Safety Agenda Forward in the United States: Consensus Statement and Call to Action” by the International Healthcare Worker Safety Center (IHWSC) aimed to energize comprehensive and expanded efforts to improve the safety of all healthcare workers. The document places special emphasis on workers in surgical or nonhospital settings. (For the full report, see “Consensus Statement and Call to Action” in this supplement.)

IHWSC, the American Nurses Association, and 18 other healthcare and industry groups have focused on several areas of sharps injuries that still need attention. This article also discusses key issues that must be addressed by facilities hoping to achieve a universal and comprehensive reduction in sharps injuries.

Involve multiple disciplines in the prevention team

Healthcare facilities should establish multidisciplinary injury-prevention teams with representatives from all disciplines at risk for harm from bloodborne pathogen exposure. Frontline personnel (nonmanagerial employees responsible for direct patient care) should have the greatest level of representation. Other representatives should come from senior procurement administration, pharmacies, nursing unit management, staff safety, quality management, and infection control. “Downstream” at-risk workers, such as cleaning staff and those responsible for sharps disposal, should be represented as well.

Have an exposure control plan

Healthcare facilities should have a written exposure control plan, with a hard copy available to employees or their representatives within 15 working days of a request. The plan should be reviewed and updated annually or more often as needed, whenever new or modified procedures are adopted or employee positions are revised in a way that creates new potential exposures. The review should include an examination of the most recent technological advances in needle devices. Workers should be made aware of the plan location and the procedures to follow should a sharps injury occur.

Educate frontline workers

Many needlestick injuries occur because workers haven’t received adequate training on correct use of safety devices. While safety equipment should function as closely as possible to standard routine procedures, employee training is always recommended. Employees should receive education and training in the use of needle devices, injury prevention (such as how to dispose of needles properly), and infection control. All employees at risk for occupational exposure to bloodborne pathogens should receive interactive training on use of safer devices, safer work practices, and personal protective equipment (PPE) from a knowledgeable source. Such training should occur at the time of hiring and at least once yearly, or whenever the employee’s tasks or procedures are modified. Training must be provided during work hours at no cost, and employers must keep training records for 3 years.

Frontline workers need to be involved in evaluating and selecting needle devices; many nurses and employees don’t realize that this right to be involved is part of NSPA. (For information on how to evaluate and select a device, see “Choosing wisely: Resources for selecting sharps safety devices” in this supplement.)

Take additional control measures

Additional control measures are especially important in surgical settings and other settings where traditional needle and syringe–based solutions won’t work, as well as nonhospital settings lacking the equipment and disposal infrastructure of hospitals. These control measures include the following:

• Postexposure evaluation and follow-up. Within 2 hours of a sharps injury or other potential exposure to bloodborne pathogens, employees should have access to postexposure evaluation and follow up that conforms to testing and prophylaxis guidelines of the Centers for Disease Control and Prevention (CDC). The hepatitis B vaccine should be made available at no cost, with titer verification as recommended.
• Sharps purchasing decisions. Purchasing decisions for sharps should be based on the products’ proven safety and efficacy.
• Prohibited work practices. Facilities should prohibit such practices as bending, recapping, and removing needles, unless required by a specific medical or dental procedure.
• Cleaning of work surfaces. After contact with blood and other infectious body fluids, work surfaces should be cleaned and decontaminated according to infection-control guidelines.
• PPE provision. Employers must provide PPE, including gloves, gowns, goggles, masks, and face shields, in sizes that fit all workers. PPE must be readily available and of good quality; nonlatex alternatives must be provided.

Use appropriate equipment selection criteria

The bloodborne pathogens standard of the Occupational Safety and Health Administration (OSHA) states that employers must use engineering and work-practice controls that eliminate occupational exposure or reduce it to the lowest feasible extent. OSHA classifies safety devices into the following categories:

• Passive safety devices remain in effect before, during and after use; workers do not have to activate them.
• Active devices require the worker to activate the safety mechanism.
• Integrated safety devices have a built-in safety feature that can’t be removed; this design feature usually is preferred.
• An accessory device is a safety feature that is external to the device and must be carried or be temporarily or permanently affixed to the point of use.

Some experts believe many needlestick injuries result from nonactivation of the safety device. Perception of poor compliance with activation influences many hospitals to select devices with a semiautomatic or passive activation feature.

Enforce sharps injury reporting and records

Healthcare personnel should report needlestick injuries whenever they occur, and employers should maintain detailed records of all occupational exposures. OSHA and some states require a record of the brand and manufacturer of any device involved in a worker injury. To effectively monitor injuries, the following information should be recorded:

• unique identification number for the incident (to protect worker confidentiality)
• incident date and time
• injured worker’s occupation
• department or work area where the incident occurred
• type and brand of device involved
• presence or absence of an engineered sharps injury-prevention feature on the device involved
• purpose or procedure for which the device was being used
• when and how the injury occurred.

Other data that can enhance injury analysis include whether the device had a passive or active safety feature; whether the safety feature (if present) was fully integrated within the device and activated; whether the injury occurred before use, during use, while attempting to activate the safety mechanism, or after use; and whether the injury occurred while the worker followed standard recommended procedures.

Embrace a culture of safety

Needlestick injuries aren’t the sole transmission mode for bloodborne pathogens. Exposure also can occur to nonintact skin as well as mucous membranes of the eyes, nose, and throat. Other modes include aerosolization and splash or spatter of blood, tissue residue, or medication, which may occur with certain safety devices and reuse of nonsterile medical equipment. Although sharps injury prevention has gained renewed attention, healthcare facilities should embrace a culture of safety that seeks to minimize the risk of occupational exposure of all types in all areas.

The CDC recognizes the importance of a culture of safety, making it an integral part of its “Stop Sticks” campaign. (See www.cdc.gov/niosh/stopsticks/safetyculture.html.) The campaign emphasizes that maintaining a culture of safety helps protect patients, workers, and others in the healthcare environment. In such a culture, managers and nonmanagerial employees alike must commit to ensuring a safe work environment.

The CDC lists five strategies for creating a safety culture:

• Ensure organizational commitment.
• Involve workers in planning and implementing activities that promote a safe healthcare environment.
• Identify and remove sharps injury hazards in the work environment.
• Develop feedback systems to increase safety awareness and promote individual accountability.

To achieve universal safety, all advocates must work together to unify agendas and maximize efforts to protect not just all healthcare workers but patients and families as well. Only then will we see the best results.

Selected references

Centers for Disease Control and Prevention. The STOP STICKS Campaign: Safety Culture. Last updated June 24, 2011. www.cdc.gov/niosh/stopsticks/safetyculture.html. Accessed August 7, 2012.

Centers for Disease Control and Prevention. Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. 2008. www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf. Accessed August 7, 2012.

International Healthcare Worker Safety Center, University of Virginia. Moving the sharps safety agenda forward in the United States: consensus statement and call to action. 2012. www.nursingworld.org/MainMenuCategories/WorkplaceSafety/SafeNeedles/SharpsSafety/ConsensusStatement-SharpsSafety.pdf. Accessed August 7, 2012.

Jagger J, Perry J. Comparison of EPINet data for 1993 and 2001 shows marked decline in needlestick injury rates. Adv Exposure Prevent. 2003;6(3):25-7.

Jagger J, Perry J, Gomaa A, Phillips EK. The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: the critical role of safety-engineered devices. J Infect Public Health. 2008;1(2):62-71.

National Institute for Occupational Safety and Health. Alert: Preventing needlestick injuries in health care settings. November 1999. DHHS (NIOSH) Publication No. 2000.108.

Occupational Safety and Health Administration. Standard 1910.1030. OSHA Instruction: enforcement procedures for the occupational exposure to bloodborne pathogens. November 27, 2001.

Panlilio A, Orelien JG, Srivastava PU, et al: NaSH Surveillance Group; EPINet Data Sharing Network. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infect Control Hosp Epidemiol. 2004;25(7):556-62.

Mary Foley is chairperson of the Safe in Common Campaign and past president of the American Nurses Association.

To read another article from this supplement, Moving the Sharps Safety Agenda Forward, please click below:

To reduce sharps injuries, all of us must create a culture of safety in our workplaces

Reducing sharps injuries in non-hospital settings

Practical strategies to prevent surgical sharps injuries

Moving the Sharps Safety Agenda Forward: Consensus Statement and Call to Action

Choosing wisely: Resources for selecting sharps safety devices