NIOSH alert urges use of safer needle devices

Agency documents benefits of new technologies

Adding momentum to the push for safer needle devices, the National Institute for Occu pational Safety and Health (NIOSH) has issued an alert urging health care employers to use available technologies to reduce needlestick injuries.

The alert comes on the heels of an updated directive by the U.S. Occupational Safety and Health Administration that mandated the use of "effective engineering controls" to prevent needlestick injuries.

Unlike the OSHA directive, the NIOSH alert does not carry any enforcement weight. However, it does provide a summary of current knowledge about the causes of needlestick injuries and the most effective ways to prevent them. It also provides specific recommendations for employers and health care workers.

"We hope it is a helpful tool for people in the hospital setting to start evaluating and using the safer devices," says Thomas Hodous, MD, associate director for science in the division of safety research at NIOSH in Morgantown, WV. "We hope this will be a stimulus for hospitals and all stakeholders to engage in this area more than they are now and to help them see that there are some clear benefits. There are quite a number of studies that show quite dramatic reductions in injuries with these newer devices and engineering controls."

Those who have advocated for safer technologies for many years welcomed the NIOSH alert.

"The fact that the NIOSH alert was released very shortly after the OSHA compliance directive just adds impact," says Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville and a noted expert on needlestick injuries and safer devices.

"Both of the documents together create momentum and a greater opportunity for faster progress," she says.

30 workers per 100 beds suffer injury

The NIOSH alert outlines in detail the danger to health care workers. That information can help hospital employee health practitioners justify the need for new products or prevention programs.

"It shows a very strong endorsement for the importance of safety technology in reducing health care worker risk," says Jagger. "It conveys a level of urgency."

Some 600,000 to 800,000 needlestick injuries occur each year, half of them unreported, according to estimates cited in the NIOSH alert. At an average hospital, there could be 30 needlesticks per 100 beds per year, according to data from the EPINet reporting system at the International Health Care Worker Safety Center.

The NIOSH alert includes several case studies to illustrate the ramifications of needlestick injuries, including death from HIV and potential serious liver disease from hepatitis C.

Most needlestick injuries are linked to just a few product types. Hollow-bore needles were associated with needlestick injuries in 62% of cases, and winged-steel or butterfly-type needles were involved in 13% of cases, according to the National Surveillance System for Hospital Health Care Workers data from the Centers for Disease Control and Prevention in Atlanta. Almost half (42%) of injuries occur after use of the needle and before disposal, the CDC data show.

Conversely, safer devices can dramatically reduce the rate of needlestick injuries. For example, needleless or protected-needle IV systems decreased injuries related to IV connectors by 62% to 88%, NIOSH states, citing three studies.1-3 Phlebotomy injuries were reduced by 76% with a self-blunting needle and by 66% with a hinged needle shield, according to CDC data.

Hodous noted that the Food and Drug Admi nistration is reviewing a number of other safer needles and other sharps devices, and that efforts to prevent needlestick injuries could become even more effective. "It is definitely an evolving technology," he says.

NIOSH issues

Hospitals and other health care employers should adopt a "comprehensive prevention program," NIOSH advises. Specifically, NIOSH says employers should:

• Eliminate the use of needle devices where safe and effective alternatives are available.

• Implement the use of needle devices with safety features and evaluate their use to determine which are most effective and acceptable.

• Analyze needlestick and other sharps-related injuries in the workplace to identify hazards and injury trends.

• Set priorities and prevention strategies by examining local and national information about risk factors for needlestick injuries and successful intervention.

• Ensure that health care workers are properly trained in the safe use and disposal of needles.

• Modify work practices that pose a needlestick injury hazard to make them safer.

• Promote safety awareness in the work environment.

• Establish procedures for and encourage the reporting and timely follow-up of all needlestick and other sharps-related injuries.

• Evaluate the effectiveness of prevention efforts and provide feedback on performance.

[Editor’s note: A copy of the alert is available on the NIOSH Web site ( or by telephone at 800-35-NIOSH.]


1. Gartner K. Impact of a needleless intravenous system in a university hospital. Am J Infect Control 1992; 20:75-79.

2. Lawrence LW, Delclos GL, Felknor SA, et al. The effectiveness of a needleless intravenous connection system: An assessment by injury rate and user satisfaction. Infect Control Hosp Epidemiol 1997; 18:175-182.

3. Yassi A, McGill ML, Khokhar JB. Efficacy and cost-effectiveness of a needleless intravenous access system. Am J Infect Control 1995; 23:57-64.