Safety success: Sharps injuries are cut in half

New devices lead to fewer needlesticks

Safer sharps led to a dramatic decline in the number of needlesticks, with nurses sustaining about half as many injuries in 2001 as they did in 1993.1

The study, one of the first to document the impact of the Needlestick Safety and Prevention Act of 2000, involved an analysis of data from the EPINet Multihospital Sharps Injury database of the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville.

"It’s great news for health care workers," says Jane Perry, MA, director of communications for the center. Sharps injuries likely will continue to decline as hospitals fully implement safety devices, she says.

Perry and center director Janine Jagger, PhD, MPH, compared the percutaneous injuries for nurses at teaching hospitals per 100 occupied beds. As a group, teaching hospitals have a higher rate of needlesticks than community hospitals, and nurses sustain more of the injuries than other occupational groups.

Overall, injuries from conventional devices dropped from 18.75 per 100 occupied beds to 7.3. Yet there was tremendous disparity in the implementation of effective safety devices.

Needleless IV systems eliminated sticks from needles on IV lines; there were no such injuries among 11 teaching hospitals in 2001. Yet there was virtually no change in the injury rate from suture needles — a decline of only 5%.

In most conventional device categories, percutaneous injuries declined by more than 50%. Injuries from phlebotomy needles declined by 70%, and those from intravenous catheters declined by 55%.

The data also illustrate the difficulty in completely eliminating conventional devices. By 2001, OSHA regulations required hospitals to convert all sharps to safety devices, except in rare cases where such a device was not available or medically acceptable. Yet the hospitals continued to use conventional devices.

"The reality is that it takes time to evaluate and implement safety devices," Perry says. "It’s definitely a step-by-step process."

The operating room has been one area in particular that has lagged behind, she says. In the EPINet data as a whole, covering 58 hospitals in 2001, 29% of all percutaneous injuries occurred in the OR.

"It’s been very difficult to get surgical personnel and particularly surgeons to convert to the safety devices," she says.

As injury rates from conventional devices have declined, needlesticks from safety devices have increased. Safety devices were involved in 2.3 nurse injuries per 100 occupied beds in 2001.

About 30% of all needlesticks occur during use, according to EPINet data. "Whether it’s [safety engineered] or not, that’s the fraction of injuries that will be difficult to eliminate," Perry says.

"We’re not going to get rid of needlestick injuries with safety devices," she says. "Our data on safety devices show that they do still occur."

The next step for injury prevention will involve getting rid of sharps altogether through alternatives, such as needle-free injectors or adhesives instead of sutures, she says.

Reference

1. Jagger J, Perry J. Marked decline in needlestick injury rates. Advances in Exposure Prevention 2003; 6:25.