Needlestick injuries remain stubbornly common, despite a long-standing federal law and worker safety regulations requiring an annual review of safety devices. Forging a path to improvement requires collaboration with hospital purchasing and quality improvement, says the coordinator of the nation’s most comprehensive needlestick surveillance system.

“It’s clear that devices that lack sharps injury prevention features are still available for purchase and hospitals are buying them,” says Angela Laramie, MPH, epidemiologist with the Massachusetts Department of Public Health Occupational Health Surveillance Program.

Massachusetts hospitals reported 3,019 sharps injuries in 2012, for a rate of 19.1 per 100 beds in acute care hospitals.1 That reflects a decline of about 18% from 2002, when surveillance began. But the rate of sharps injuries remained essentially the same for the past three years.

Why has progress on sharps injury prevention stalled? An increase in reporting could make it seem that prevention efforts aren’t providing new improvements, Laramie cautions. Conversely, as other occupational injuries such as patient handling get more attention, sharps injury awareness may have lagged, she says.

Massachusetts plans to conduct some analysis into the types of devices used and the units where injuries continue to occur, she says.

Some concerning trends are apparent from the surveillance reports. Little progress has been made in the operating room, where 44% of sharps injuries occurred in 2012. Almost one in four injuries (23%) was from a suture needle.

About 200 sharps injuries occurred with hypodermic needles that lacked safety features — although the Bloodborne Pathogen Standard of the Occupational Safety and Health Administration requires employers to use safety-engineered devices, when feasible. About 21% of sharps injuries involved devices from pre-packaged kits used in the OR.

That illustrates why it is important for employee health and infection preventionists to work together with hospital purchasing to ensure that the proper devices are included in kits, says Laramie.

Meanwhile, 54% of sharps injuries occurred with safety devices (excluding suture needles).

“[That] tells us we need to take a look at the devices that do have sharps injury prevention features and we need to do more research on the efficacy of the various mechanisms for these devices,” she says.

“We’ve said consistently that devices with engineered sharps injury protection are not fail-safe and they are not the only answer. They are one component of a comprehensive sharps injury program,” she says.

Look beyond numbers

OSHA requires employers to provide annual training on bloodborne pathogens and sharps injury prevention, and employers must review their safety devices at least annually.

While you should look at your data, go beyond the numbers and ask frontline employees which devices they like or don’t like, Laramie says. If your injuries indicate that the safety feature was not activated, probe deeper, she says.

“Why aren’t people using the mechanism? It might be that they’re unfamiliar with the device. It could be a training issue,” she says. “It could be that it’s a poorly designed device. It should be intuitive. It should be easy and simple. If it’s not, people might not be using it.”

Laramie suggests partnering with quality improvement at the hospital to look more deeply at the causes of sharps injuries. A root cause analysis can reveal factors, such as a device that requires two hands to activate or a nurse feeling uncomfortable with the device.

The best strategy is to eliminate the sharp, such as using surgical glue rather than sutures. Passive devices, such as needles that retract without any additional action, are preferable to devices that require the users to activate the safety feature, Laramie says.

“I think there will always be a human component, but more and more we need to look at the design of devices [to reduce needlesticks],” she says.


  1. Occupational Health Surveillance Program. Massachusetts Department of Public Health. August 2014. Available at