Sentinel Event Alert
August 01, 2001

Issue 22 - August 1, 2001

(REVISED - September 28, 2001)


Preventing needlestick and sharps injuries

Health care workers are exposed to a wide range of hazards in the workplace, especially hazards associated with medical equipment. The risk of injury from needles and sharps, including disposable needles, over-the-needle catheters, suture needles, lancets and scalpels, continues to expose health care workers to serious and potentially fatal infections from blood borne pathogens such as hepatitis B, hepatitis C, or human immunodeficiency virus (HIV). "Though most organizations believe they are doing what is necessary to prevent injuries, needlestick and sharps injuries continue to occur," says Nancy Quick, CSP, CIH, compliance assistance specialist, Occupational Safety and Health Administration (OSHA). "And, though cost is often cited as a factor for not using safer devices, it is actually a savings when you consider the cost of treating the individual once an injury occurs." (1)

This issue of Sentinel Event Alert is devoted to increasing organizational understanding of needlestick and sharps injuries and presenting suggestions for preventing their occurrence, as well as advising organizations of the new requirements adopted in the Needlestick Safety and Prevention Act passed unanimously by Congress and signed into law on November 6, 2000.

Risks and causes

While precise numbers are not available, the Centers for Disease Control and Prevention estimates that each year, health care workers sustain more than 600,000 injuries involving contaminated needles or sharps, and approximately one-half of these injuries go unreported. While most needlestick injuries involve nursing staff, other health care workers also sustain injuries. Fortunately, injuries involving patients are less frequent. The Joint Commission's sentinel event database includes two cases--one involving an infant and one a child. Techniques that are used to protect health care workers from needlestick- and sharps-related injuries can also protect patients.

The risk of infection from a contaminated needlestick or sharp is dependent upon the pathogen involved, the severity of the injury, and the availability and use of appropriate prophylactic treatment. Hollow-bore needles-primarily hypodermic needles attached to disposable syringes and winged-steel or butterfly-type needles-are the cause of the majority of reported injuries. Injuries can occur while manipulating the needle in the patient, handling or passing the device after it has been used, recapping the instrument, and transferring a body fluid between containers, or from improper disposal or during clean-up following a procedure.

Prevention strategies

"Though most organizations believe they are doing what is necessary to prevent injuries, needlestick and sharps injuries continue to occur. And, though cost is often cited as a factor for not using safer devices, it is actually a savings when you consider the cost of treating the individual once an injury occurs." 
-Nancy Quick, CSP, CIH, compliance assistance specialist, Occupational Safety and Health Administration 

All health care organizations should have a needlestick prevention program in place as part of their compliance with the existing blood borne pathogen standard established in 1991 by OSHA that requires organizations to use safety-engineered sharps and needleless systems when possible. In addition, in its Preventing Needlestick Injuries in Health Care Settings publication (2), the National Institute for Occupational Safety and Health outlines a number of strategies to help prevent needlestick and sharps injuries:

  • Eliminate the use of needles when safe and effective alternatives are available.
  • Implement the use of devices with safety features and evaluate their use to determine which are most effective and acceptable.
  • Analyze needlestick- and sharps-related injuries in your workplace to identify hazards and injury trends.
  • Set priorities and strategies for prevention by examining local and national information about risk factors for needlestick injuries and successful intervention efforts.
  • Ensure that health care workers are properly trained in the safe use and disposal of needles and sharps.
  • Modify work practices that pose a needlestick injury hazard to make them safer.
  • 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.
  • Encourage health care workers to report any hazards from needles they observe in their work environment and to participate in blood borne pathogen training and follow recommended injury prevention practices, including getting a hepatitis B vaccination.

The Needlestick Safety and Prevention Act

As part of the Needlestick Safety and Prevention Act passed into law in November 2000, new provisions of the blood borne pathogens standard took effect July 17, 2001. The revised provision specifies the types of engineering controls, such as safer medical devices, in the health care setting and adds new requirements for employers. Employers must:

  • Review their exposure control plans annually to reflect changes in technology that will help eliminate or reduce exposure to blood borne pathogens.
  • Involve non-managerial workers in evaluating and selecting safety engineered devices.
  • Maintain a sharps injury log that ensures employee privacy and contains, at a minimum, the type and brand of device involved in the incident, if known; the location of the incident; and a description of the incident.

Recommendations

The Joint Commission requires compliance with "applicable law and regulation" standards in the Governance (GO.2.4) and the Management (MA.2) chapters. Joint Commission surveyors are now asking if health care organization leaders are familiar with the Needlestick Safety and Prevention Act, and whether any action being taken to comply includes staff that use sharps and needles and are therefore at risk for injury. The law requires that these health care workers and other staff be included in the review of safer devices as well as in making recommendations for replacement devices. Health care organizations are not being scored on this at this time. Scoring of this recommendation will begin January 1, 2002 (this is the date after which 90 days have elapsed following publication of issue 22 of Sentinel Event Alert in Joint Commission Perspectives). In April 2002, the Occupational Safety and Health Administration will begin enforcing the new law and organizations that are not found to be compliant by OSHA may be faced with fines for failure to comply.

Accredited health care organizations will find applicable standards in the Environment of Care chapter, the Surveillance, Prevention and Control of Infection chapter, the Care of Patients chapter (TX.3 set of standards – Medication Use), and the Leadership chapter (planning and provision of services, support of quality improvement; and patient, visitor, staff safety). Accredited health care organizations may obtain detailed information about the Needlestick Safety and Prevention Act from the OSHA website.

References

  1. Occupational Safety and Health Administration.
  2. Preventing Needlestick Injuries in Health Care Settings, National Institute for Occupational Safety and Health, U.S. Department of Health and Human Service, Public Health Service, Centers for Disease Control and Prevention; www.cdc.gov/niosh, or by calling 1-800-35-NIOSH.

Published for Joint Commission accredited organizations and interested health care professionals, Sentinel Event Alert identifies the most frequently occurring sentinel events, describes their common underlying causes, and suggests steps to prevent occurrences in the future.

During the on-site survey of accredited organizations, Joint Commission surveyors assess the organization's familiarity with and use of Sentinel Event Alert information. Organizations are expected to (1) review each Sentinel Event Alert, (2) consider the suggestions, as appropriate to the organization's services, and (3) implement the suggestions, or reasonable alternatives, or provide a reasonable explanation for not implementing relevant changes.

Setting the Standard for Quality in Health Care
The Joint Commission
Sentinel Event Hotline (630)792-3700

Please route this issue to appropriate staff within your organization. Sentinel Event Alert may only be reproduced in its entirety and credited to The Joint Commission.