Are your ED staff at risk for needlestick injury?

OSHA citations have increased dramatically

Are potential violations of the Emergency Medical Treatment and Labor Act high on your "worry list?" Here’s another high-risk area that you should add to your list: Occupational Safety & Health Administration (OSHA) citations for violations of the Bloodborne Pathogens Standard (BPS). This standard requires you to take steps to protect health care workers from needle stick injuries.

Citations of health care facilities, including EDs, for BPS violations have increased dramatically in the last few years, according to Jane Perry, director of communications for the University of Virginia’s International Healthcare Worker Safety Center, based in Charlottesville, VA. Penalties can be as high as $70,000.

According to the Washington, DC-based National Institute for Occupational Safety and Health, an estimated 600,000 to 800,000 needlestick injuries occur annually in hospitals, with nursing staff most frequently injured.

Many EDs still are using unsafe devices and practices, and some now face stiff fines as a result, says Perry. From OSHA’s point of view, health care facilities have had more than enough time to implement safety devices, says Perry. "So there are really no more excuses for noncompliance," she says. "Safety devices are not optional."

To avoid violations, you must do the following:

  • Use safety devices whenever possible.

The rule of thumb is that all needles and sharp devices used on patients should have a safety feature to protect the user from injury, Perry says. "If safety devices aren’t being used for particular procedures, find out why," she says. "OSHA has made it clear, in recent citations, that the goal is 100% compliance."

Perry points to a study on percutaneous injuries in EDs that showed that 86% of injuries were from conventional devices.1 "My guess is that many EDs still utilize at least some conventional sharp devices," she says.

  • Make implementation of safety butterfly needles and safety intravenous (IV) catheters a priority.

Data from a network of hospitals that use the Exposure Prevention Information Network (EPInet) surveillance program to track sharps injuries show that the most frequent source of high-risk injuries for ED staff — those from blood-filled, hollow-bore needles — are butterfly needles and IV catheter stylets, says Perry. "These should be considered a top priority when EDs are implementing safety devices."1

  • Give nurses thorough training in the correct use of safety devices.

"This is one of the most crucial steps in the whole process of implementing safety devices, and it’s important to have the participation of the whole staff," says Perry. She suggests the following:

— Once a new device is implemented, make sure that nurses don’t hoard the old devices.

— Allow enough training time so that all ED staff are comfortable using the device and have made any necessary adjustments in technique.

— Make sure the product representative is willing to troubleshoot or give additional training if problems or questions arise once the device is implemented.

  • Use devices consistently.

Even when safer devices are available, nurses may be tempted to improvise in order to save a few seconds, warns Stacey Westphal, RN, MS, CEN, clinical educator for emergency services at Cape Canaveral Hospital in Cocoa Beach, FL.

Busy ED nurses may not take the few extra seconds to activate the protective feature on a safety device, especially if they haven’t had enough training on it, says Perry. "And a used safety device with the protective feature not activated is just as dangerous as a conventional device," she underscores. She recommends looking for safety devices or equipment that are "passive," with the safety feature automatically activating after use or requiring as few steps as possible to activate.

When you do implement a safety device, get rid of the conventional alternatives, advises Perry. "If a nurse has a choice between a device she has used for years and one that she is less familiar with, she will most likely pick the one she is more comfortable with in an emergency situation," she explains.

  • Ask nurses for input.

After new blood drawing needles were implemented, ED nurses reported a problem with blood splashing, and a decision was made to discontinue use of the device, says Westphal. "Staff do have the power to take a device out of circulation if they identify a problem with safety," she says.

When there’s a problem with a safety device, it’s important to find out if it’s due to the device itself, or to lack of training or improper use, advises Perry. "For most device categories, there are a number of safety alternatives available, so it is important to evaluate at least several different brands to find the one staff are most comfortable with," she says.

  • Encourage nurses to use personal protective equipment including goggles.

Blood or bodily fluids splashed over a distance are a more common occurrence in the ED compared to other clinical areas, says Perry. For eye protection to be effective, it has to have a seal above the eyes to prevent blood or body fluids from dripping down into the eyes, she notes.

"It also needs a side shield," she recommends. "And it has to be comfortable, or it will be less likely to be used consistently by staff."


1. Perry J, Jagger J. Percutaneous injuries and blood exposures in emergency department settings. Adv Exposure Prev 2002; 6:13, 20-22.


For more information on preventing needlestick injuries in the ED, contact:

  • Jane Perry, Director of Communications, International Health Care Worker Safety Center, P.O. Box 800764, University of Virginia, Charlottesville, VA 22908-0764. Telephone: (434) 982-3763. Fax: (434) 982-0821. E-mail:
  • Stacey Westphal, RN, MS, CEN, Clinical Educator, Emergency Services, Cape Canaveral Hospital, 701 W. Cocoa Beach Causeway, Cocoa Beach, FL 32931. Telephone: (321) 868-7651. E-mail:
  • The National Institute for Occupational Safety and Health (NIOSH) web site ( has a variety of free resources pertaining to prevention of needle-stick injuries under the headings "Preventing Needlesticks and Sharps Injuries" and "Safer Needle Device Listings."
  • The International Health Care Worker Safety Center web site ( offers an updated list of safety devices organized by product type. Click on "Safety Device List and Other Products Designed to Prevent Blood and Body Fluid Exposures." It also offers a checklist to use when implementing safety devices. Click on "Checklist for Sharps Injury Prevention (PDF file)."