Needlestick workbook available from CDC

Comprehensive guidance posted on the web

The Centers for Disease Control and Prevention (CDC), which has been criticized for not being more directive and aggressive on preventing needle stick injuries, has posted an impressive, interactive workbook on the issue. The document is on the web site of the CDC’s Division of Healthcare Quality Promotion (formerly the hospital infections program) at www.cdc.gov/ncidod/hip/.

"This workbook contains a practical plan to help health care organizations prevent sharps injuries," the CDC stated. "Once implemented, the program will help improve workplace safety for health care personnel. At the same time, it may help health care facilities meet the worker safety requirements for accrediting organizations [and] federal and state regulatory standards."

Noting that the injuries are "often preventable," the CDC estimates that 385,000 needlesticks — some 1,000 every day — are sustained by hospital-based health care personnel annually. Similar injuries occur in other health care settings, such as nursing homes, clinics, emergency care services, and private homes. Sharps injuries are primarily associated with occupational transmission of hepatitis B virus, hepatitis C virus, and HIV, but include the transmission of more than 20 other pathogens, the CDC stated.

"The true magnitude of the problem is difficult to assess because information has not been gathered on the frequency of injuries among health care personnel working in other settings [e.g., long-term care, home health care, private offices]," the CDC warned. ". . . In addition, surveys of health care personnel indicate that 50% or more do not report their occupational percutaneous injuries."

An effective sharps injury prevention program includes several components that must work in concert to prevent health care personnel from suffering needlesticks and other sharps-related injuries. The CDC plan is designed to integrate into existing performance improvement, infection control, and safety programs. It is based on a model of continuous quality improvement, an approach that successful health care organizations increasingly are adopting. The main concept is a systematic, organizationwide approach for continually improving all processes involved in the delivery of quality products and services. The program plan also draws on concepts from the industrial hygiene profession, in which prevention interventions are prioritized based on a hierarchy of control strategies.

The workbook includes several sections that describe each of the organizational steps and operational processes. A toolkit of forms and worksheets is included to help guide program development and implementation. The workbook also contains:

  • Comprehensive overview of the literature on the risks and prevention of sharps injuries in health care personnel.
  • Description of devices with sharps injury prevention features, and factors to consider when selecting such devices.
  • Internet links to web sites with relevant information on sharps injury prevention.
  • The Joint Commission on Accreditation of Healthcare Organizations standards for surveillance of infection, environment of care, and product evaluation.
  • Center for Medicare & Medicaid Services compliance with the Conditions for Medicare and Medicaid Participation.
  • Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030) and its related field directive, Inspection Procedures for the Occupational Exposure to Bloodborne Pathogens Standard (CPL 2-2.44, Nov. 5, 1999) requiring use of engineered sharps injury prevention devices as a primary prevention strategy (www.osha.gov/SLTC/bloodbornepathogens/index.html).
  • State OSHA plans that equal or exceed federal OSHA standards for preventing transmission of bloodborne pathogens to health care personnel.
  • State-specific legislation that also requires the use of devices with engineered sharps injury prevention features and, in some cases, specific sharps injury reporting requirements (www.cdc.gov/niosh/ndl-law.html).
  • Federal Needlestick Safety and Prevention Act (PL 106-430), (Nov. 6, 2000).