Part I:Background

Preventing Needlesticks and Other Sharps

Injuries…Everything You Need to Know

• 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

HBVHCVHIV

Risk (Range)

6-30%*~ 2%

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 TransmissionDocumented 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?

Nurse43%

Technician15%

Student4%

Dental1%

Housekeeping/Maintenance

3%

Clerical / Admin

1%

Other5%

Physician28%

Occupational Groups of Healthcare

Personnel Exposed to Blood/Body Fluids,NaSH June 1995—

December 2003 (n=23,197)

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

0

5

10

15

20

25

30

35

40

DisposableSyringe

CartridgeSyringe

Butterfly IV Stylet PhlebotomyNeedle

IV TubingNeedle

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.

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

How Do Injuries Occur With Hollow-Bore Needles?

During Sharps Disposal

13%

During Clean Up9%

In Transit to Disposal

4%

Handle/Pass Equipment

6%

Improper Disposal

9%

Access IV Line5%

Transfer/Process Specimens

5%

Recap Needle6%

Collision W/Worker or

Sharp10%

Manipulate Needle in Patient

28%

Other5%

Circumstances Associated with Hollow-Bore Needle Injuries NaSH June 1995—December 2003 (n=10,239)

Disposal Related:

35%

Sharps Injuries Are Preventable

Preventable64%Nonpreventabl

e18%

Undetermined18%

Preventability of Needlesticks in 78 NaSH Hospitals, June 1995--December 2004 (n=11,625)

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