Preventing Needlesticks

and Other Sharps

Injuries…
Everything You Need to Know

Part I:
Background
• Part I: Background
• Part II: Safer Sharps Devices
• Part III: Safe Work Practices
 The Problem

• CDC estimates ~385,000 sharps injuries

annually among hospital-based healthcare
personnel (>1,000 injuries/day)
– Many more in other healthcare settings (e.g., emergency
services, home care, nursing homes)

• Increased risk for bloodborne virus transmission

• Costly to personnel and healthcare system
Risks of Seroconversion due to Sharps Injury
from a known positive source

Virus Risk (Range)

HBV 6-30%*
HCV ~ 2%
HIV 0.3%

(*Risk for HBV applies if not HB vaccinated)

What is the Risk for HIV Alone?

• Percutaneous 0.3%
• Mucous membrane 0.1%
• Non-intact skin <0.1%
Occupational HIV Transmission among U.S.
Healthcare Personnel, 1985-2004

• 57 documented cases
– i.e., HIV negative at time of exposure and
became HIV positive during follow-up period

• 137 other cases

– i.e., No documented exposure and no
known risk factor for HIV infection
 Occupational HIV Transmission
Documented Cases (n=57)

• 50 (88%) involved percutaneous exposures

45 caused by hollow-bore needles, half of
which were used in a vein or artery

• 5 mucocutaneous exposures
• 2 exposure route unknown
 Costs of Sharps Injuries

• Baseline and follow-up laboratory testing

• Treatment of exposed personnel
– $71-~$5,000 depending on treatment provided
• Lost productivity
• Time to complete paperwork
• Loss of income / loss of career
• Emotional costs
• Societal costs
O’Malley, et. al. Costs of Management of Occupational Exposure to Blood and Body Fluids.
ICHE, July 2007, v 28, No. 7.
 Preventing
Sharps Injuries
is Our Goal!
 How Do Sharps Injuries Happen?

• Who gets injured?

• Where do they happen?
• When do injuries occur?
• What devices are involved?
• How can they be prevented?
 Data Sources

• National Surveillance System

for Healthcare Workers
(NaSH)

• Exposure Prevention
Information Network
(EPINet™)
 Who Gets Injured?

Clerical /
Housekeeping/ Admin
Maintenance 1% Dental
Occupational Groups 3% 1%
Other
of Healthcare Student 5%
4%
Personnel Exposed to
Blood/Body Fluids,
Technician
NaSH June 1995— 15%
Nurse
December 2003 43%
(n=23,197)

Physician
28%
Where Do Sharps Injuries Occur?

• Patient Room 39%

(Inpatient: Medical – ICUs )
• Operating Room 27%
• Outpatient 8%
• ER 8%
• Laboratory 5%
• Other 13%
Source: NaSH, June 1995—December 2003
When Do Sharps Injuries Occur?

• During use 41%

• After use/before disposal 40%
• During and after disposal 15%
• Other 4%

Source: NaSH, June 1995—December 2003

What Devices are Involved in Sharps Injuries?

Six Devices Account for 78% of All Injuries

• Disposable Syringes 30%
• Suture Needles 20%
• Winged-Steel Needles 12%
• Intravenous Catheter Stylets 5%
• Phlebotomy Needles 3%
• Scalpels 8%

Source: NaSH, June 1995—December 2003

 Devices that Require Manipulation after Use
are Associated with an Increased Rate of Injury

40
35
30
25
20
15
10
5
0
Disposable Cartridge Butterfly IV Stylet Phlebotomy IV Tubing
Syringe Syringe Needle Needle

Percentage of injuries Rate/100K devices purchased

Jagger, et al. Rates of needle-stick injury caused by various devices in a university hospital.
NEJM. 1988;319.
How Do Injuries Occur With Hollow-Bore Needles?

Circumstances Associated with Hollow-Bore Needle

Injuries NaSH June 1995—December 2003 (n=10,239)

Transfer/Process Other
Specimens 5% During Sharps
5% Disposal
Access IV Line 13%
5%

Handle/Pass Improper
Equipment Disposal
6% 9% Disposal
Related:
During Clean Up
Recap Needle
9% 35%
6%
In Transit to
Disposal
Collision
4%
W/Worker or
Sharp
Manipulate
10%
Needle in Patient
28%
Sharps Injuries Are Preventable

Preventability of Needlesticks in 78 NaSH Hospitals,

June 1995--December 2004 (n=11,625)

Undetermined
18%

Preventable
Nonpreventabl 64%
e
18%
Preventing Sharps Injuries is a National Priority!

• Federal and state laws increase enforcement

of sharps injury prevention
– Needlestick Safety and Prevention Act, 2000
– OSHA enforcement of needlestick prevention increasing
– 21 states with laws/regulations

• CDC: targets needlesticks for elimination

Sharps Injuries at ______Hospital (period of time)

• Last year _____ sharps injuries were reported by our

employees/staff
• The occupations most affected were _____
• The devices most commonly involved were _____
• The most common ways sharps injuries occurred were
_____
What are Strategies to Eliminate Sharps Injuries?

• Eliminate or reduce the use of needles and

other sharps
• Use devices with safety features to isolate
sharps
• Use safer practices to minimize risk for
remaining hazards
• Part II: Safer Sharps Devices
• Part III: Safe Work Practices