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In the heady days after passage of the Needlestick Safety and Prevention Act in 2000, zero needlesticks was an aim worth striving for and some lofty goals were on the table. HealthyPeople 2010 set a goal of reducing needlesticks by 30% — from a baseline of 384,000 among hospital-based health care workers in 1998 to 269,000 in 2010.
The National Institute for Occupational Safety and Health (NIOSH) predicted by 2016 the use of safety syringes will be universal, with only 2% of needles (e.g. those with no safety alternative) unprotected. Though needlesticks dropped dramatically for a while, eventually the momentum was lost and the goals faded. While the U.S. Occupational Safety and Health Administration continues to cite hospitals for gaps in their sharps safety programs, and new devices have greatly reduced some hazards, the needlestick problem persists.
From the first survey of its scope, the Association of Occupational Health Professionals in Healthcare (AOHP) estimates that health care workers are sustaining 320,000 needlesticks and 119,000 mucocutaneous, or splash, incidents each year in hospital and non-hospital settings.1
AOHP members from 125 hospitals in 29 states responded to the EXPO-S.T.O.P. survey (Exposure Survey of Trends in Occupational Practice), representing every region in the country. At its peak in 2000, the National Surveillance System for Health Care Workers (NaSH) collected data from 64 health care facilities.
"These exposure incidents are still happening and any one of them, if the source patient was positive [for a bloodborne pathogen], was a potential infection," says co-author Linda Good, RN, PhD, COHN-S, director of Employee Occupational Services at Scripps Health in San Diego, CA.
"I'm hoping that this is an alarm call that we aren't doing as well as we thought we were and we need to do more," adds co-author Terry Grimmond, FASM, BAgrSc, GrDpAdEd, a New Zealand-based microbiologist who works as a sharps safety consultant globally. "We need to find a new vigor."
The sharps safety problem is partly a problem of technology, but many conventional needles remain in use despite safer alternatives.
["They're] not necessary and it's not justifiable," says David Weissman, MD, director of the Division of Respiratory Disease Studies and manager of NIOSH's research agenda for the Healthcare and Social Assistance Sector. "We have safe devices that work well and don't get in the way of patient care and protect health care workers and patients. They should be used."
OSHA places the requirement on employers. Manufacturers can continue to produce conventional devices, but the Bloodborne Pathogen Standard states that "engineering and work practice controls shall be used to eliminate or minimize employee exposure."
The EXPO-S.T.O.P. survey didn't ask detailed questions about the type of sharp involved in the injuries. In 2011, the greatest number of injuries (37%) occurred from disposable syringes, according to EPINet data from the University of Virginia's International Healthcare Worker Safety Center collected from 32 hospitals. About half of the sharps injuries involved conventional devices.
Surveillance of Massachusetts hospitals revealed a similar profile. In 2010, hypodermic needles were the greatest source of needlesticks (29%) and more than half (57%) of the sharps injuries occurred with conventional devices. In fact, one-quarter of the needlesticks with hypodermic needles involved devices with no safety feature.
The EXPO-S.T.O.P. survey needlestick rates were slightly higher than those detected in EPINet and the Massachusetts surveillance.
For non-teaching hospitals, the rate was 17.8 injuries per 100 occupied beds; it was 27.4 per 100 occupied beds for teaching hospitals, and the overall rate was 24.0 per 100 occupied beds.
That rate is a snapshot of the sharps injury risk, not a benchmark, notes Grimmond. "I don't think people should think 'I'm doing all right, I'm up with the U.S. benchmark,'" he says. "We need to put zero back on the radar."
AOHP identified "best practice" hospitals that had lower-than-average needlestick rates. The hospitals provided intense (one-on-one) education with competency testing, involved management in their sharps safety efforts, and monitored and took action on needlestick trends. (See related story, below.)
In successful hospitals, managers and employees took ownership of the sharps safety program. Unit managers were responsible for safe practices, and employees also were expected to use safety devices and follow safety protocols, says Good.
AOHP plans to repeat the survey in 2014. Gathering information from across the country provides valuable information and brings sharps safety back to the forefront, says Dee Tyler, RN, COHN-S, FAAOHN, director of medical management for Coverys Insurance Services in Lansing, MI, and executive president of AOHP.
"We didn't feel there was a lot of good information about what was going on in health care facilities regarding sharps injuries. That's why we felt it was a vital survey," she says.
Each needlestick represents a potential emotional trauma for an employee and a risk for the health care facility, she notes. "Prevention can save not only the individual the tremendous suffering from the results of a sharps injury, but it also impacts the hospital's bottom line," she says. "It only takes one case. A lot of those [HIV or hepatitis] medications are several thousand dollars a month, should they convert."
OSHA requires hospitals to have an exposure control plan that they update annually, as they consider new technology that may further reduce risk. Hospitals should use that annual review as a way to lower their needlestick rates, says Grimmond.
"If you're still getting injuries in certain procedures, don't be satisfied," he says. "Look at new technology. Get your frontline staff to help you find a better way."