Preventing Needlestick Injuries at COVID–19 Vaccination Sites

Posted on by Ahmed Gomaa, L. Casey Chosewood, Marie Haring Sweeney, Susan Afanuh, Sarah Hughes, Adam Hornbeck, and Amy Mobley

 

A needle with an engineered safety device. Photo by ©mmg1design/Getty Images

Note: If you experience a needlestick from a used or contaminated needle, seek immediate evaluation and treatment. Call the PEP (post-exposure prophylaxis) hotline at: 1–888–448–4911 immediately for guidance on treating exposures.

Introduction

The availability of effective vaccines is a major milestone for the fight against the virus that causes COVID–19. However, the effort to administer vaccines to the large number of people who need to be vaccinated in a variety of settings may increase the risk for needlestick injuries among vaccinators and other vaccination site workers. Needlestick injuries have the potential to transmit bloodborne pathogens (BBP), like hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).

Are Needlesticks a Concern for COVID–19 Vaccinators?

On average, hospital-based healthcare personnel experience approximately 385,000 needlesticks/sharps injuries each year [CDC 2015]. In 2019, 1,620 of these reported needlestick injuries involved days away from work [BLS 2020a]. Because of the intense COVID–19 vaccination effort in 2021, a significant increase is expected in the number of vaccinations in the United States, increasing the potential for needlestick injuries.

The need to administer large numbers of COVID–19 vaccines means work conditions may be dramatically different from the traditional setting. For example, instead of a standard healthcare setting, COVID–19 vaccines may be administered in non-traditional settings such as the following:

  • Outdoor tents
  • Sports stadiums/arenas
  • Convention centers
  • Inside vehicles or through vehicle windows (drive up vaccinations)
  • Mobile units dispatched to provide vaccines in communal settings (long-term care facilities, correctional facilities), private homes, or in hard-to-reach areas

Other logistical challenges the vaccinators may encounter include the following:

  • Unfamiliar locations or non-standard equipment (chairs and tables not normally used in clinical settings)
  • Odd positioning of the arm (for example, if vaccine recipients remain in a vehicle for vaccine administration)
  • Additional personal protective equipment (PPE) requirements (because of COVID–19)

Vaccines may be administered by:

  • Trained volunteers
  • Pharmacists
  • Military medical personnel
  • Emergency medical technicians
  • Nursing and medical students
  • Retired healthcare workers

All may benefit from the reminders related to sharps safety.

Protecting Vaccinators from Needlestick Injuries During COVID19 Vaccination

Needlesticks and the potential exposure to bloodborne pathogens pose a risk during COVID–19 vaccinations in both traditional healthcare settings and pop-up vaccination sites. Vaccinators should follow Occupational Safety and Health Administration (OSHA’s) bloodborne pathogens standard [OSHA 1992] to prevent needlestick/sharps injuries.

In addition, employers and workers can take the following safety measures to reduce needlestick injuries and exposures to bloodborne pathogens:

The National Institute for Occupational Safety and Health (NIOSH) recommends the following safety measures to reduce needlestick injuries and exposures to bloodborne pathogens.

What Employers Can Do

At a minimum, ensure that all vaccinators receive training in the following:

  • Bloodborne Pathogens Standard (29 CFR 190.1030): Ensure that an Exposure Control Plan is in place to comply with the Bloodborne Pathogens Standard [OSHA 2003].
  • PPE: Vaccinators should be trained in proper procedures for putting on and removing a NIOSH-approved N95 filtering facepiece respirator or other approved respiratory protection, surgical mask, eye protection, face shield or goggles, and gloves.
  • Sharps disposal: U.S. Food and Drug Administration (FDA)-cleared sharps disposal containers are made from rigid plastic and come marked with a line that indicates when the container should be considered full, which means it’s time to dispose of the container to prevent needlestick injuries or exposures.
  • Definition of needlestick injury: A needlestick injury is defined as penetration of the skin by a needle or other sharp object that was in contact with another person’s blood, tissue, or other body fluid before the injury [CDC 2011; BLS 2020b].
  • Injury reporting: OSHA requires needlestick injuries to be recorded on the OSHA Form 300 (Log of Work-Related Injuries and Illnesses) if the sharp is known to have been contaminated with another person’s blood or other potentially infectious material (OPIM).[1]
  • Sharps injury log: Establish and maintain a separate sharps injury log to track/report the device involved in the incident (not the injury to the person). The sharps log is separate from the OSHA Form 300 (Log of Work-Related Injuries and Illnesses).[2]

Report injuries:

  • Ensure that the vaccination site has a plan for vaccinators to report needlestick injuries and that the plan includes post-exposure protocols and follow-up.
  • Ensure vaccinators are familiar with needlestick injury protocols and the reporting requirements of their specific employer.
  • Be aware that vaccinators who experience a needlestick injury should seek immediate first aid and be evaluated by a licensed healthcare provider.
  • Call the PEP (post-exposure prophylaxis) hotline at 1-888-448-4911 for guidance on treating exposures as soon as possible. This should not wait until the end of a shift or the next day.
  • Have the contact information and location of the nearest Urgent Care available, in addition to the contact information for the local health department, to report any needlestick injuries or exposures to blood or body fluids.
  • Ensure that vaccinators also report near-miss needlestick injuries to site supervisors for documentation and follow-up to help prevent future incidents.[3]

In addition, these safety and health measures can reduce the risk of needlestick injuries:

  • Ensure that vaccinators are up to date on their hepatitis B vaccinations. If the vaccinator had a titer or blood draw to test immunity to HBV after the vaccine series, this is very important to know in the event of a potential exposure to HBV.
  • Provide all necessary PPE for protection from COVID–19 and BBPs.
  • Provide vaccinators with sharps with engineered safety devices to prevent sharps injuries such as self-sheathing and retractable needles. A needle with an engineered safety device should always be the first choice when available to prevent the risk of a needlestick injury (See 1910.1030(d)(2) [Engineering and Work Practice Controls] for detailed information).
  • Provide sharps containers that are closable, puncture-resistant, crush-resistant, leak-proof, color coded, and clearly marked at the level where the container is full (and should be replaced) [FDA 2018].
  • Place containers as close as possible to the vaccinator or place the containers on a table or a cart (as opposed to setting it on the ground) at a height convenient to the vaccinator and within arm’s reach.
  • Provide each vaccinator with a dedicated sharps container where possible.
  • Follow all current CDC and OSHA guidance to reduce the spread of COVID–19, including social distancing recommendations [CDC 2021; OSHA 2020].
  • Ensure that appropriate cleaning and disinfecting products are available for cleaning between vaccine recipients. Provide soap and water if possible, or hand sanitizers (containing at least 60% ethyl alcohol) if soap and water are not available.

What Vaccinators Can Do

Report injuries:

  • If you experience a needlestick from a used/contaminated needle, you may have been exposed to a bloodborne pathogen. This exposure requires urgent evaluation and treatment. It is ideal to seek treatment within 2 hours for the best possible outcome.
  • Call the PEP (post-exposure prophylaxis) hotline at 1-888-448-4911 immediately for guidance on treating exposures.
  • Promptly report the needlestick exposure injury and seek care from a licensed healthcare provider at an occupational health clinic, urgent care, emergency department, or your healthcare provider for appropriate treatment. Refer to the vaccination site and/or your employer’s protocol for reporting guidance which may include local options for seeking care.

Take proper safety measures:

  • Complete required training sessions.
  • Follow proper hand hygiene procedures.
  • Wear all necessary PPE for protection from COVID–19 and blood and body fluid exposure.
  • Do not recap syringes without safety devices.
  • Do not pass a syringe/needle without the cap or engaged safety device between workers.
  • Do not pass medical supplies (gauze, bandages, etc.) between workers, while handling exposed needles.
  • Notify the site supervisor about any needlestick hazards you observe.
  • Promptly report any needlesticks and near-misses to the site supervisor to help prevent future incidents.

Follow steps for safe sharps disposal:

  • Use needles with engineered sharps injury protections (safety devices).
  • Do not recap, shear, or disassemble syringes.
  • Place sharps containers within arm’s reach at a height convenient to the vaccinator and dispose of contaminated sharps immediately into sharps containers.
  • Use sharps containers that are closable, puncture-resistant, crush-resistant, leak-proof, color coded, labeled to warn of hazardous waste inside the container, and clearly marked with a line that indicates when the container should be considered full.
  • Replace sharps containers when they reach the full line as labeled by the manufacturer.

Resources

Many tools from various agencies and organizations are available to ensure that vaccines are administered safely:

PEP Services

The National Clinical Consultation Services website explains PEP services for managing healthcare worker exposures to HIV, HBV, and HCV. (Note that the hotline does not accept calls from blocked numbers.)

CDC

This poster from CDC covers steps to take for Management of Occupational Blood Exposures to HBV, HCV, or HIV.

The CDC resource Sharps Safety for Healthcare Settings gives resources for developing a sharps injury prevention program and teaching tools for training healthcare staff in preventing sharps injuries

The CDC resource Healthcare Providers | Hand Hygiene | CDC provides hand hygiene guidance for healthcare providers.

The CDC resource Healthcare Workers: Information on COVID-19 | CDC provides COVID-19 information for healthcare workers.

The CDC resource Using Personal Protective Equipment (PPE) | CDC provides examples of donning and doffing PPE.

NIEHS

NIEHS has developed a fact sheet Injection Safety for Covid-19 Vaccinators & Vaccine Administrators that gives more information about vaccination safety in nontraditional sites.

FDA

The FDA has provided resources for Medical Device Reporting (How to Report Medical Device Problems)

The FDA has a fact sheet that describes FDA-approved Sharps Disposal Containers and things that can be used as alternative containers (only if FDA-approved containers are not available).

To help address concerns about availability during the COVID–19 pandemic, the FDA has issued Emergency Use Authorizations (EUAs) for certain PPE products including face shields, other barriers, and respiratory protective devices such as respirators.

NIOSH

NIOSH has a comprehensive topic page on Personal Protective Equipment.

The Stop Sticks Campaign was originally created by NIOSH, but is now updated and maintained by the National Occupational Research Agenda (NORA) Healthcare and Social Assistance Sector Council. The Stop Sticks campaign is a communication intervention aimed at raising awareness among health care workers about their risk of workplace exposure to bloodborne pathogens from needlesticks and other sharps-related injuries. The campaign guidance and resources are intended to guide you in developing a successful campaign tailored to your facility’s needs.

NIOSH maintains current information about NIOSH-Approved N95 Particulate Filtering Facepiece Respirators

OSHA

The OSHA fact sheet Keeping Workers Safe at COVID Vaccination Sites (OSHA) covers the main recommendations and precautions for those administering vaccines.

The OSHA Needlesticks/Sharps Injuries page explains the bloodborne pathogens standards, describes sharps injuries and how to prevent them, and also illustrates how to select safe syringes and dispose of sharps safely.

The OSHA fact sheet Protecting Yourself When Handling Contaminated Sharps describes safe medical devices, sharps disposal, and disposal containers.

29 CFR 1910.1030 outlines the requirements for the Bloodborne Pathogens Standard.

 

Ahmed Gomaa, MD, ScD, MSPH, is a Medical Officer in the NIOSH Division of Field Studies and Engineering.

L. Casey Chosewood, MD,MPH, is the Director of the NIOSH Office for Total Worker Health®.

Marie Haring Sweeney, PhD, is Chief of the  Health Informatics  Branch in the NIOSH Division of Field Studies and Engineering.

Susan Afanuh, MA, is a Technical Information Specialist in the NIOSH Division of Science Integration.

Sarah Hughes, MPH, is a Research Health Scientist in the NIOSH Division of Science Integration.

Adam Hornbeck, MSN, APRN, FNP-BC, FNP-C, is a nurse practitioner in the NIOSH National Personal Protective Technology Laboratory Research Branch.

Amy Mobley, MEn, is a Health Communications Specialist in NIOSH’s Health Informatics Branch in the Division of Field Studies and Engineering.

 

References

BLS [2020a]. Nonfatal cases involving days away from work: selected characteristics. Washington, DC: US Department of Labor, Bureau of Labor Statistics.

BLS [2020b]. Survey of occupational injuries and illnesses: concepts. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics.

CDC [2011]. The national surveillance system for healthcare workers (NaSH). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. NaSH Report June 2011 (cdc.gov)

CDC [2015]. Sharps safety for healthcare settings. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

CDC [2021]. COVID–19. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

FDA [2018]. Sharps disposal containers. Washington, DC: Food and Drug Administration.

OSHA [1992]. Bloodborne pathogen standard. Washington, DC: U.S. Department of Labor, Occupational Safety and Health Administration, 29 CFR 1910.1030.

OSHA [2003]. Model plans and programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards. Washington, DC: U.S. Department of Labor, Occupational Safety and Health Administration, OSHA 3186–06R 2003.

OSHA [2020]. Guidance on preparing workplaces for COVID–19. Washington, DC: U.S. Department of Labor, Occupational Safety and Health Administration, OSHA 3990–03 2020.

Endnotes

[1] 1904.8(a) Basic requirement: Record all work-related needlestick injuries and cuts from sharp objects that are contaminated with another person’s blood or other potentially infectious material (as defined by 29 CFR 1910.1030). Enter the case on the OSHA 300 log as an injury. To protect the employee’s privacy, do not enter the employee’s name on the OSHA 300 log (see the requirements for privacy cases in paragraphs 1904.29(b)(6) through 1904.29(b)(9)).

[2] Sharps injury log.

1910.1030(h)(5)(i) The employer shall establish and maintain a sharps injury log for the recording of percutaneous injuries from contaminated sharps. The information in the sharps injury log shall be recorded and maintained in such manner as to protect the confidentiality of the injured employee. The sharps injury log shall contain, at a minimum:

  • 1910.1030(h)(5)(i)(A) The type and brand of device involved in the incident,
  • 1910.1030(h)(5)(i)(B) The department or work area where the exposure incident occurred, and
  • 1910.1030(h)(5)(i)(C) An explanation of how the incident occurred.

1910.1030(h)(5)(ii) The requirement to establish and maintain a sharps injury log shall apply to any employer who is required to maintain a log of occupational injuries and illnesses under 29 CFR part 1904.

1910.1030(h)(5)(iii) The sharps injury log shall be maintained for the period required by 29 CFR 1904.33.

 

[3] OSHA defines a near miss as an incident in which no personal injury was sustained, but where (given a slight shift in time or position) injury could have easily occurred. OSHA encourages employers to investigate near misses to define the problem, disseminate solutions to affected workers, and help prevent future workplace incidents by alerting professionals to hazards and unsafe conditions.

 

Posted on by Ahmed Gomaa, L. Casey Chosewood, Marie Haring Sweeney, Susan Afanuh, Sarah Hughes, Adam Hornbeck, and Amy Mobley

4 comments on “Preventing Needlestick Injuries at COVID–19 Vaccination Sites”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Ahmed Gomaa, L. Casey Chosewood, Marie Haring Sweeney, Susan Afanuh, Sarah Hughes, Adam Hornbeck, and Amy Mobley says:

    Thank you for your comment!

    What if it is a device failure? Many of the safety glide mechanisms will not engage forcing vaccinators to use the ground, a table, a car door jamb to lock dirty needle safety shield in place. This should be a never event!

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Page last reviewed: March 26, 2021
Page last updated: March 26, 2021