The EXPO-STOP1 authors recommend that employee health professionals consider the following best practices to prevent needlesticks and other exposures to staff.


  • Require new clinicians to demonstrate competency with all new devices.
  • Discuss exposure prevention individually and in orientation in a personalized way.
  • Build a bloodborne pathogen exposure event into simulation lab training scenarios.
  • Use vendor support and clinical educators to “stretch” resources and provide all-shift coverage.
  • Provide mandatory initial and ongoing education using a variety of methods, including online modules and face-to-face interaction with employee health and/or workers’ compensation nurse case manager.
  • Require a review process and waiver for requests for non-safety-engineered devices.


  • Make initiatives data-driven, and report using metrics aligned with the organization’s goals and reporting style.
  • Be transparent with findings and get them “on the record” by reporting through established committees that reach decision-makers.
  • Encourage reporting (including “near misses”) by making it convenient and efficient, such as a call-in or online reporting system.
  • Develop awareness campaigns to reach frontline staff.
  • Use safety scripting to prepare patients for procedures that are high-risk for employee exposure, such as blood draws.
  • Use flagging outside patient rooms to alert co-workers that a high-risk procedure is in progress to avoid an inadvertent startle and possible injury.


  • “Drill Down” — Conduct a thorough, systematic root cause analysis to avoid assuming causation.
  • Actively involve the manager and the injured employee in the follow-up investigation.


  • Hold both the healthcare worker and management responsible for their roles in the “Safety Formula,” and when they do it well, praise them.
  • Partner with stakeholders using safety forums for discussion. For example: “If you arrived to work today and it was a safer environment, what would it look like?”
  • Include perceptions of workplace safety in employee opinion evaluation.
  • Use frontline staff “Safety Advocates” partnered with employee health and administration in injury reduction initiatives.


  1. Brown C, Dally M, Grimmond T, et al. Exposure Study of Occupational Practice (EXPO-STOP): An update of a national survey of sharps injuries and mucocutaneous blood exposures among healthcare workers in U.S. hospitals. AOHP Jrl 2016:36(1):37-42.