Complacency erodes sharps safety gains

In the July issue, HEH reported on the continuing needlesticks from devices without safety features, despite the requirements of the Bloodborne Pathogens Standard and Needlestick Safety and Prevention Act. Karen A. Daley, PhD, MPH, RN, FAAN, president, American Nurses Association, wrote this commentary for HEH to underscore the need for more progress on reducing sharps injuries.

Injuries from contaminated needles and other sharps that can cause infectious diseases are preventable, and shouldn't be tolerated as a cost of doing business by health care organizations charged with ensuring safety and preventing harm. But unfortunately, whether through ignorance, complacency or frugality, these injuries still are occurring too often — nearly two-thirds of nurses reported being accidentally stuck by a needle in a 2008 national survey conducted by the American Nurses Association (ANA). ANA is urging managers responsible for employees' health and safety to make sharps injury prevention a top priority.

For more than 10 years, health care workers have been protected from these risks to their careers and lives by the Needlestick Safety and Prevention Act of 2000. Progress has been made in many settings, but the law is not enough. We know that through a study published in 2010 in the Journal of the American College of Surgeons that shows sharps injury rates actually increasing by 6.5% in operating room settings since the law's adoption.1

The law provides only a framework. It is up to people to create the culture of safety necessary to minimize incidents — government enforcers, health advocates, safety engineers and hospital personnel, from executives to educators to nurses to housekeepers. That culture must be proactive and place a priority on prevention, workers' health, education and training.

We know from Massachusetts data that more than 3,000 hospital workers in the state still suffer sharps injuries every year, resulting in exposure to dangerous bloodborne pathogens. And that figure only includes reported injuries; many still go unreported. The 2.5% average annual decline in the rate of sharps injuries in Massachusetts from 2002 to 2008 indicates improvement, but does not remove the urgency to take further action.

Thirteen years ago, I was one of those Massachusetts health care workers, stuck by a needle protruding from the sharps container in a hospital emergency department. While infection is rare statistically, it happens. I'm living proof. I contracted hepatitis C and HIV, and didn't know if I would survive as I struggled with fatigue, weight loss and other symptoms. It changed my life forever, as I now live with a chronic disease. It also resulted in my decision to end a 26-year career in direct care nursing that I loved. No one should have to go through what I experienced — especially because we know many of these injuries can be prevented.

ANA is hearing from nurses that even 10 years after enactment of the needlestick prevention law they are not aware of the law or the provisions that affect and empower them, one of which requires employers to involve direct care workers in the identification, evaluation and selection of safety-engineered devices. We also know that compliance with the law is not universal.

Hospital employee health managers can make a huge difference in preventing sharps injuries. ANA urges that you fully comply with the law; ensure that direct care workers participate in evaluating and selecting safer devices; educate your employees about the law and train them in the proper use of safer devices; promote comprehensive reporting of incidents and near misses; and provide timely post-exposure prophylaxis and support for those who are injured.

It's clear that sharps safety warrants renewed attention. We need to explore why these accidents still occur. We need to examine the methods by which, or even whether, hospitals are continually reviewing and updating exposure control plans for injury prevention, as required by law, and determine what obstacles may be limiting the use of safe, effective, readily available sharps injury prevention technologies.

I'm pleased that, as the only state that collects comprehensive data on all reported sharps injuries annually, Massachusetts has been able to contribute important knowledge to this dialogue. The Massachusetts sharps injury data collected from 99 hospitals tells us there is still more work to do in this arena. Approximately 3,000 Massachusetts workers annually still have to go through the distress of getting tested, waiting for results, and in some cases, having to take toxic drug therapies. And 56% of those sharps incidents reported involved conventional devices that lacked any injury prevention features. There is no question in my mind that many of these injuries could have been prevented with proper training and the availability of effective safety devices. Ongoing technology assessment and updating, along with enforcement of the law, are also important components of injury prevention.

It is time to recommit to and prioritize sharps safety. To support employers and nurses, ANA re-launched its Safe Needles Save Lives educational campaign last fall. Resource materials and checklists are available at

Creating and maintaining a culture of safety that minimizes the occupational health risks to nurses and other health care workers goes a long way towards increasing job satisfaction and therefore, reducing staff turnover. Health care organizations that can create cultures of safety that we know increase employee satisfaction will enjoy an advantage in a changing health care system where value-based purchasing and quality outcomes take on greater importance.


1. Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation. J Am Coll Surg 2010; 210:496–502.