Last updated on 4/19/24 | First published on 4/19/24 | Literature review current through Apr. 2024
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INTRODUCTION
Overview
This topic is part of a document published by the U.S. National Institute for Occupational Safety and Health (NIOSH), which is in the public domain and may be freely copied or reprinted.[1]
Needlestick and other sharps injuries are a serious hazard in any medical care situation. These injuries are caused by different types of needles and sharps, such as scalpels and broken glass containers. Contaminated needles and sharps may inject healthcare workers with blood that contains pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), all of which pose a grave, potentially lethal, risk. Although immunization is available to prevent hepatitis B illness, no immunization is available to prevent HCV or HIV. Preventing injuries from sharps and needlesticks is key to reducing potential exposures to bloodborne pathogens in home healthcare settings.
Background
Relevance
How serious is the risk of exposure from needlestick and sharps injuries?
It is estimated that 385,000 to 800,000 needlestick and other sharps injuries occur annually in all settings, but about half of these are not reported.[2][3][4][5] Home healthcare workers give various reasons for not reporting such injuries: time-consuming post-injury process; anxiety surrounding the post-injury process; fear of being blamed as careless or thought of as a bad nurse by the employer; disease history of a patient (that is, patient thought not to be an infection risk); or fear of implications for present or future job prospects.[6]
Activities associated with needlestick injuries include the following [7][8][9][5][10]:
- Handling needles that must be taken apart or manipulated after use
- Disposing of needles attached to tubing
- Manipulating the needle in the patient
- Recapping needle
- Transferring body fluid between containers using needles or glass equipment
- Failing to dispose of used needles in puncture-resistant sharps containers
- Lack of proper workstations for procedures using sharps
- Rapid work pace and productivity pressures
- Bumping into a needle, sharps, or a worker
- Inadequate staffing and poor leadership
Home healthcare workers are responsible for the use and disposal of sharps equipment that they use in the patient’s home. However, the patient or family may not appropriately dispose of sharps, thus putting the worker at risk. The worker may find contaminated sharps on any surface in the home or in wastebaskets. Focus groups of home healthcare workers have reported that syringes and lancets are left uncovered in various places in the home.[6] The home healthcare worker, without access to a standard sharps disposal container, often uses whatever is available for disposal (for example, coffee cans, milk jugs).[11][12]
Pets and children in the home may be a dangerous distraction, increasing the risk of needlestick injury.[13][12][6] The patient or family members may also be disruptive.
Home healthcare workers may also be exposed to bloodborne pathogens from episodes of sudden profuse bleeding (for example, bleeding tumors and amputations) and tasks involving wound care.[6]
REGULATIONS
What regulations should I be aware of?
Federal legislation has shown an interest in preventing needlestick injuries and the diseases associated with needlestick injuries. The OSHA bloodborne pathogens standard [29 CFR 1910.1030]
[14] is the Federal standard that protects workers against occupational exposures to bloodborne diseases. Since 1991 when the standard was first published, manufacturers have supplied new, safer designs for medical devices to reduce or eliminate needlesticks and other exposure incidents. OSHA updated the standard in 2001 with additional information about needleless systems, needle- containing equipment with safety features, and needlestick safety issues related to the OSHA bloodborne pathogens standard.[15] Employers and home healthcare workers are encouraged to visit the OSHA Web site (www.osha.gov) to obtain complete information about the bloodborne pathogens standard.
Some of the requirements of the standard include the following:
- The employer must create a written exposure-control plan designed to eliminate or minimize worker exposure to bloodborne pathogens, and review it annually. The plan must include a determination of potential employee exposures for the workplace and a consideration of safe medical devices that may be newly available.
- Compliance with standard precautions (formerly known as universal precautions): an infection-control principle that treats all blood and other potentially infectious materials as infectious.
- Engineering controls and work practices to eliminate or minimize worker exposure and training in these controls and work practices. Engineering controls isolate or remove the bloodborne pathogens hazard from the workplace and include
- Sharps disposal containers
- Self-sheathing needles
- Safer medical devices, such as sharps with engineered injury protection and needleless systems
- Input from nonmanagerial employees responsible for patient care in selecting engineering controls (for example, medical devices with safety features) and work practices. This must be documented in the written exposure-control plan.
- Prohibition of bending, recapping, or removing contaminated needles from the syringe unless there is no feasible alternative
- Proper disposal including use of the sharps disposal containers, not overfilling the containers, prohibition of shearing or breaking contaminated needles, and disposal that meets State and Federal medical waste requirements
- Personal protective equipment provided to employees at no cost to them
- Free hepatitis B vaccinations offered to workers with occupational exposure to bloodborne pathogens
- Post-exposure evaluation, with follow-up when appropriate
- Communication of hazards and training of workers
- Recordkeeping, including a sharps injury log maintained by the employer
- Protection of confidentiality of the injured worker in the injury log
- Procedures for evaluating circumstances surrounding exposure incidents
NEEDLELESS SYSTEMS AND NEEDLE DEVICES WITH SAFETY FEATURES
What about needleless systems and needle devices with safety features?
Evidence shows that using needleless systems or needle devices with safety features reduces needlestick injuries in I.V. systems and in relation to blood drawing
[16][17][18][3][19][20][21][22][5].
What needleless systems and needle devices with safety features are available?
Below are examples of needleless systems and sharps with engineered injury protection:
- Needleless connectors for I.V.-delivery systems
- Protected needle I.V. connectors
- Needles that retract into a syringe or vacuum-tube holder (see Figure 1)
- Hinged or sliding shields attached to phlebotomy needles, winged-steel needles, and blood gas needles
- Protective encasements to receive an I.V. stylet as it is withdrawn from the catheter
- Sliding needle shields attached to disposable syringes and vacuum tube holders
- Self-blunting phlebotomy and winged-steel needles (see Figure 1)
- Retractable finger or heel-stick lancets (see Figure 2)
![Figure 4.1. Three examples of syringes with safety features. (These drawings are presented for educational purposes and do not imply endorsement of a particular product by the National Institute for Occupational Safety and Health [NIOSH].)](/files/35101.png "Figure 4.1. Three examples of syringes with safety features. (These drawings are presented for educational purposes and do not imply endorsement of a particular product by the National Institute for Occupational Safety and Health [NIOSH].)")
Figure 1. Three examples of syringes with safety features. (These drawings are presented for educational purposes and do not imply endorsement
of a particular product by the National Institute for Occupational Safety and Health [NIOSH].)
![Figure 4.2. Example lancet with safety features. (This drawing is presented for educational purposes and does not imply endorsement of a particular product by the National Institute for Occupational Safety and Health [NIOSH].)](/files/35102.png "Figure 4.2. Example lancet with safety features. (This drawing is presented for educational purposes and does not imply endorsement of a particular product by the National Institute for Occupational Safety and Health [NIOSH].)")
Figure 2. Example lancet with safety features. (This drawing is presented for educational purposes and does not imply endorsement
of a particular product by the National Institute for Occupational Safety and Health [NIOSH].)
How do I select and evaluate needleless systems and needle devices with safety features?
Selecting and evaluating needle devices with safety features should include the following steps
[23][15][5]:- Forming a multidisciplinary team to develop a plan to reduce needlestick injuries and evaluate needle devices with safety features
- Seeking input from, or including, non-managerial employees responsible for direct patient care and any other workers at risk of sharps injuries (The team should also participate in the implementation and evaluation of the plan that is developed.)
- Identifying whether and how needlestick injuries are occurring and how devices with safety features are being used
- Identifying needles or needleless devices with safety features that differ in design and features
- Performing visual and practical investigation of any design(s) selected
- Evaluating information (preferably from multiple sources) about the devices
- Evaluating the product(s) chosen, including input from workers who represent the range of potential users. The steps of the evaluation should include
- establishing criteria to evaluate the device,
- carrying out follow-up to obtain feedback, identify problems, and provide continued guidance, and
- monitoring the use of a new device to determine any problems or whether further training is needed.
PREVENTION
What can I do to prevent and control needlestick and sharps injuries?
Recommendations for Employers
- Provide a bloodborne pathogens program that meets all the requirements of the OSHA bloodborne pathogens standard (29 CFR 1910.1030).
- Eliminate the use of needle devices whenever safe and effective alternatives are available (for example, connecting parts of an I.V. system).
- Provide needle devices with safety features and determine which safety features are most effective and acceptable for tasks in the workplace.
- Establish an exposure-control plan; evaluate and update it annually.
- Analyze sharps-related injuries in the workplace to determine hazards and injury patterns. If patterns of injury develop, consider the following options:
- Change work practices to decrease the specific activities associated with the injuries.
- Train employees in new ways to do tasks that are known to have caused injury.
- Use different needle devices than those associated with the injuries.
- Promote work practices that decrease the chance of a needlestick injury (for example, methods of transferring body fluids without the use of needles).
- Train workers in the safe use and disposal of all types of sharps and needle devices.
- Train workers to plan for unexpected movement and to watch for improperly disposed needles.
- Establish procedures and systems for the reporting, timely follow-up, and medical evaluation of all needlestick or sharps-related injuries.
- Establish a system to evaluate prevention efforts and provide feedback to workers and management.
- Provide standard-labeled, leak-proof, puncture-resistant sharps containers for workers to carry in their vehicles for use as needed when an adequate sharps container is not easily available in the home.
- Ensure that the patient or any other caregivers for the patient (for example, family members) receive training in infection control to help them understand and comply with the practices and precautions of the home healthcare worker.[24]
- Provide post-exposure evaluation and follow-up, including post-exposure prophylaxis when appropriate.
Recommendations for Workers
- Participate in your employer’s bloodborne pathogens program.
- Avoid using needles whenever safe and effective alternatives are available.
- Help your employer select and evaluate devices with safety features .
- Use devices with safety features provided by your employer.
- Refrain from recapping or bending contaminated needles.
- Before starting a procedure, plan for the safe handling and disposal of needles. Dispose of used needle devices and any potentially contaminated sharps materials promptly in designated sharps disposal containers.
- Carry standard-labeled, leak-proof, puncture-resistant, sharps containers with you to homes; do not assume the containers will be available in the home.
- Secure used sharps containers during transport to prevent spilling.
- Report any needlestick and other sharps injuries promptly to receive follow-up care.
- Follow standard precautions, infection prevention, and general hygiene practices consistently.
MANAGEMENT
What should I do if I am exposed to the blood of a patient?
If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid of a patient during the course of your work, immediately follow these steps:
- Wash needlesticks and cuts with soap and water.
- Flush splashes to the nose, mouth, or skin with water.
- Irrigate eyes with clean water, saline, or sterile irrigants.
- Report the incident to your supervisor.
- Immediately seek medical treatment.
RESOURCES
- CDC. Workbook for designing, implementing, and evaluating a sharps injury prevention program [www.cdc.gov/sharpsSafety/].
- CDC. Viral hepatitis [www.cdc.gov/ncidod/ diseases/hepatitis/index.htm].
- CDC. Hospital infections [www.cdc.gov/ ncidod/dhqp/].
- ECRI. [https://www.ecri.org/Documents/ Sharps_Safety/SSNP_toc.pdf].
- NIOSH. Needlestick injuries and bloodborne infections diseases topic page [www. cdc.gov/niosh/topics/bbp/].
- OSHA. OSHA Pub No. 3186, Model bloodborne pathogens exposure plan [www.osha. gov/Publications/osha3186.html].
- The University of California, San Francisco, toll-free phone number for clinicians to call for advice on post-exposure prophylaxis: 1–888–448–4911.
- California Department of Health Services Occupational Health Branch 1515 Clay Street, Suite 1901 Oakland, CA 94612 [www.ucsf.edu/hivcntr/].
- The University of Virginia International Health Care Workers Safety Center and the EPINet needlestick injury data collection system [ www.healthsystem.virginia.edu/internet/epinet/about_epinet.cfm].
- International Healthcare Worker Safety Center Health Sciences Center, University of Virginia Box 407 Charlottesville, VA 22908 [www.healthsystem.virginia.edu/internet/ epinet/].
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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.
