Preventing Needlesticks and Sharps Injuries: Reflecting on the 20th Anniversary of the Needlestick Safety and Prevention Act

November marked the 20th anniversary of the passage of the Needlestick Safety and Prevention Act (PL 106-430) into law. The act required that OSHA amend its Bloodborne Pathogens Standard to include additional protections for workers to prevent occupational exposures to blood and body fluids. This included:

• new requirements for the evaluation and use of engineering controls (sharps with engineered sharps injury protections and needleless systems),
• annual employer considerations of safer medical devices and new technologies that reduce exposures,
• non-managerial frontline employee feedback on the selection and use of these devices, and
• the requirement to keep a Sharps Injury Log in addition to the OSHA Recordkeeping requirements.

These additions encouraged healthcare employers to think beyond the role of personal protective equipment in preventing exposures to blood and other potentially infectious materials (OPIM) and implement engineering and administrative controls. They also prompt employers to identify ways to eliminate needles or sharps if possible or substitute them with other therapeutic or clinical options. These approaches are higher up in the hierarchy of controls and are more effective than personal protective equipment alone.

While these efforts have reduced sharps injuries, they continue to occur. Current data from both the International Safety Center Exposure Prevention Information Network (EPINet®)(2019) and the Massachusetts Department of Public Health Sharps Injury Surveillance System (2018) collected from U.S. hospitals, show that the devices most frequently involved in sharps injuries are disposable hypodermic syringes (19.5 and 34% respectively) and suture needles (22% in each system). Since workers continue to be injured when using these devices, employers need to identify, evaluate, select, and implement new technologies and safer options, ensuring that frontline workers are central to the evaluation and selection of new devices.

Elimination and Substitution

There are commercially available devices that can eliminate the sharp altogether for administering medications and closing skin or internal fascia during surgical procedures. These can come in the form of the use of nasal delivery systems for vaccines, drug patches, or oral medications. Alternative methods of closure also exist for closing an incision, including zipper closures, adhesives, and more.

Engineering Controls

Safer options for sharps injury prevention (SIP) have been available for decades and yet many facilities do not use them. In fact, data indicates that during an injury, at least 39% of devices are not ones with SIP features such as retracting or shielded needles or blades. Similarly, in Massachusetts, 37% of injuries involved devices that lack SIP features. Given wide availability on the market, adoption and use of safer devices as well as safe SIP feature activation and disposal is key to preventing exposures among healthcare workers.

PPE 

For the last several years, when an employee reports a mucocutaneous splash or splatter of blood or body fluid to the face (eyes, nose, or mouth), less than 7% are wearing face protection – including eye protection, face shields, masks, or respirators. As we assess 2020 EPINet data and the exposures experienced in health care around the country, these numbers must change.

Impact of Co-Morbidities

Given that the prevalence of hepatitis C is high among older individuals, who also tend to access health care frequently, and the growing population of people self-injecting medications like insulin for diabetes, it is important now more than ever to keep sharps injuries as low as possible. The increasing prevalence of bloodborne disease paired with the increasing use of needles, results in an unacceptable risk of infectious disease for healthcare workers. Other situations may introduce additional factors, such as fatigue and the need for emergency procedures, which may place healthcare workers at greater risk of exposure. Safe practices surrounding all patient care is critical to protect healthcare workers.

2020 Sharps Safety Consensus Statement

Since 2010, there have been ongoing efforts among a variety of stakeholders, including global sharps safety experts, clinicians, members of professional associations, partners in the federal government, and representatives from the medical device industry, to keep national focus on improving policies to prevent injuries. Stakeholders created the consensus statement to refocus attention on sharps injuries. The consensus statement – Moving the Sharps Safety in Health Care Agenda Forward in the United States: 2020 Consensus Statement and Call to Action – was created as an update to the 2010 statement and highlights the additional work that needs to be done to create safer environments for healthcare workers. It provides data on rates of injury and circumstances surrounding sharps injuries, outlines the requirements of the OSHA Bloodborne Pathogens Standard, lists facility-based measures and controls for prevention of injury and exposure, and provides policy-based recommendations to protect healthcare workers today and into the future.

Ultimately, preventing the spread of bloodborne diseases like HIV, hepatitis B (HBV), and hepatitis C (HCV) have been foundational to occupational health in healthcare. Though there is an immunization for HBV, HIV post-exposure prophylaxis is effective and HCV treatments can be successful, there are more than 20 other bloodborne pathogens to which healthcare workers may be exposed. For this reason, we must continue to focus on preventing injuries and exposures. This is particularly important as the world embarks on a mass vaccination effort. It is in prevention that we can keep our healthcare workforce safe and well, so that they can care for others – especially during such critical times as these.

Please share your thoughts in the comment section below. What innovative steps is your healthcare facility taking to reduce sharps injuries? How are you making sure that your facility remains diligent about preventing occupational exposures to bloodborne pathogens?

Amber Hogan Mitchell, DrPH, MPH, CPH, is the President and Executive Director of the International Safety Center. She also serves as a Senior Science Advisor to the NIEHS Worker Training Program COVID19 and is Adjunct Faculty at the University of Maryland Medical School, Department of Environmental Occupational Medicine.

This blog is part of a series hosted by NIOSH to commemorate nurses during the Year of the Nurse.

Other blogs in the series include:

• Year of the Nurse
• Managing Fatigue During Times of Crisis: Guidance for Nurses, Managers, and Other Healthcare Workers
• Nurses’ and Other Health Professionals’ Wellness and Safety Resource Update
• Surgical Smoke Inhalation: Dangerous Consequences for the Surgical Team
• Safety Culture and Health Care
• Work Ability among Older Nurses
• The Unique Occupational Environment of the Home Healthcare Worker
• Can Exoskeletons Reduce Musculoskeletal Disorders in Healthcare Workers?