By Gary Evans, Relias Media

Needlesticks are threatening to move beyond the hospital in a big way. With a variety of people with various skill sets administering COVID-19 vaccines — sometimes in unusual situations — there is understandable concern about sharps injuries at immunization sites.

As COVID-19 vaccine guidelines expand to more age groups and populations, occupational health experts are reminding HCWs that needlesticks could lead to transmission of bloodborne pathogens. For example, the CDC estimates there are 2.5 million with hepatitis C virus (HCV) — and half of them are unaware.1 In addition, 1 million people are living with HIV in the United States, but 14% are unaware of their infection and are unlikely to be taking viral-suppressing drugs.2 Bloodborne diseases in general have been exacerbated by the national opioid epidemic.

“Since hepatitis C, HIV, and co-infection with both are quite prevalent in the U.S., it is important to remain diligent about not compromising occupational health and safety for the benefit of public health, and vice versa,” says Amber Mitchell, DrPH, MPH, CPH, director of International Safety Center Exposure Prevention Information Network (EPINet). This includes using devices with sharps injury prevention features that are appropriate for drawing up vaccine doses, with a sharps container nearby that is immediately accessible after use.

“These devices, according to compliance with the OSHA Bloodborne Pathogens Standard, need to be identified, evaluated, and selected by nonmanagerial employees responsible for administering vaccines in any setting where COVID-19 vaccination clinics are being administered,” Mitchell tells Hospital Employee Health.

There is no tracking system for needlesticks at COVID-19 vaccination sites. As national officials raise awareness, it will be up to local administrators to set up reporting systems for their vaccinators.

“Given the unprecedented effort to conduct a nationwide vaccination effort, it is important that we share as widely as possible information to help protect healthcare workers from needlestick injuries,” says Ahmed Gomaa, MD, a medical officer at the National Institute of Occupational Safety and Health (NIOSH).

If a needlestick occurs, time is of the essence. NIOSH recommends calling the calling post-exposure prophylaxis (PEP) hotline at (888) 448-4911 immediately for guidance on treating exposures. Ideally, PEP should begin within two hours of the injury.

“In this situation, source testing will be difficult, and protocols should be developed in an exposure control plan for every site according to the OSHA Bloodborne Pathogens Standard,” Gomaa says. “There is no mandate to test the source patient. If the patient is known to have hepatitis B virus (HBV), HCV, or HIV, the worker should be assessed by a healthcare provider for care.”

A Fivefold Increase in Needlesticks

NIOSH is developing additional materials that address sharps disposal for vaccination sites. “Other federal health agencies also have created educational materials to increase awareness about the risk of needlestick injuries at COVID-19 vaccination sites,” Gomaa tells Hospital Employee Health. “It is important that this information is shared widely with the workers and employers at the frontlines of delivering vaccines.”

For example, the National Institute of Environmental Health Sciences (NIEHS) created a fact sheet that gives more information about mass vaccination safety. The NIEHS cites a study that revealed needlesticks were five times greater at a 2009 pandemic influenza mass vaccination site than would normally be expected.3

The highest rate of needlesticks was in inexperienced vaccinators, the researchers reported, with these likely contributing to the injuries:

  • distraction, including crowding and loud noises;
  • difficulty uncapping or recapping the needle;
  • lack of an ideal setting;
  • patient movement;
  • inappropriate technique;
  • selecting an inappropriate needle size or type;
  • needles lack sharps injury prevention features;
  • disposing of needles improperly, or placing used syringe on a surface;
  • fatigue after administering vaccines for seven consecutive days.

In a recent blog post, NIOSH recommended COVID-19 vaccination sites record “near misses” so prevention efforts can be improved.4

“An example of a near-miss is when the syringe’s safety device failed to activate but no needle stick happened,” Gomaa says. “This potential risk should be reported to prevent a similar future failure that results in a needlestick.”

Other safety measures recommended by NIOSH at vaccine sites include:

  • wearing all recommended COVID-19 PPE;
  • not recapping syringes without safety devices;
  • not passing an uncapped needle (or needle without engaged safety device) to other HCWs;
  • not passing medical supplies to other HCWs while handling exposed needles;
  • notifying site supervisors of needlestick hazards or safety concerns;
  • using needles with built-in sharps injury protections;
  • avoiding recapping, shearing, or disassembling syringes;
  • immediately disposing of contaminated sharps in a sharps container placed at arm’s length at a convenient height.


  1. Centers for Disease Control and Prevention. CDC estimates nearly 2.4 million Americans living with hepatitis C. Nov. 6, 2018.
  2. U.S. statistics. Last updated March 17, 2021.
  3. National Institute of Environmental Health Sciences. Injection safety for COVID-19 vaccinators & vaccine administrators: Preventing needlesticks and blood exposures. March 2021.
  4. Gomaa A, Chosewood LC, Sweeney MH, et al. Preventing needlestick injuries at COVID–19 vaccination sites. March 2, 2021.,engaged%20safety%20device%20between%20workers.