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Bloodborne Pathogen Standard Turns 30


Needle stick injuries

By Barbara Braun, Associate Director, Department of Research

This year, 2021, has been a memorable one for many reasons, and it is especially poignant that this is the 30th anniversary of the Needlestick Safety and Prevention Act (NSPA) and its amendment to the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030) (OSHA, 2001).

Those of us who have had long careers in health care remember a time when sharps safety was not something to be taken for granted. The standard continues to be effective in significantly reducing:

  • Needlesticks
  • Sharps injuries
  • Blood and body fluid exposures
  • Resulting infections from bloodborne viruses

According to the EPINet Sharps Injury and Blood and Body Fluid Exposure Surveillance Research Group  (EPINet®) coordinated by the International Safety Center, there has been a documented decline in sharps injuries in the eight years after enactment of the Bloodborne Pathogens Standard (BPS) in 1992. This decline continued through 2010 following passage of the NSPA in 2020 and subsequent revisions to the BPS and was documented by both EPINet and the Massachusetts Sharps Injury Surveillance System. Also, 2011 was a banner year in that less than 2,000 sharps injuries were recorded in acute care hospitals per 100 beds. This represents amazing progress, and it is absolutely a milestone worthy of celebration.

However, our work in reducing needlestick injuries is far from over.

The decline in sharps injuries has not been sustained, and sharps injuries are increasing in the American health care system. This is quite disturbing. Pressure is mounting on health care providers to see more patients in less time. This environment creates a perfect storm for sharps injuries.

Improvement Opportunities
The anniversary of this standard could not come at a better time to recommit to reducing needlestick injuries. The fact that the anniversary is occurring in the midst of an ongoing global pandemic highlights the importance of the task ahead. 

The International Safety Center prepared a 2020 consensus statement and call to action — “Moving the Sharps Safety in Healthcare Agenda Forward in the U.S.” — that calls upon organizations to establish robust surveillance systems to capture information about at-risk occupations, departments and workplaces.

Currently, the largest percentage of all sharps injuries occurred in the OR, with the greatest numbers among physicians. A large proportion of injuries are sustained by workers other than the original user of the device. Data released in 2018 shows that most sharps injuries involve devices lacking sharps injury prevention features.

The shift in settings from hospitals to ambulatory surgery centers also has highlighted a need for valid non-hospital sharps injury data in these environments. While that makes logistical sense, it is somewhat of a tall order as non-hospital settings do not typically have the benefit of dedicated occupational safety and health professionals.

OSHA Recommendations
The Occupational Safety and Health Administration (OSHA) offers tips to prevent sharps and needlestick injuries on their website. They are:

  1. Plan safe handling and disposal before any procedure.
  2. Use safe and effective needle alternatives when available.
  3. Activate the device’s safety features.
  4. Immediately dispose of contaminated needles in OSHA-compliant sharps containers.
  5. Complete bloodborne pathogen training.

Following these tips is truly the best way to commemorate this milestone anniversary. The bloodborne pathogen standard did its job 20 years ago in showing us that needlestick injury prevention is possible. The ball is in our court now, and I know my fellow health care professionals are up to the task. 

Barbara Braun is currently Associate Director, Health Services Research, in the Division of Healthcare Quality Evaluation at The Joint Commission. She is a member of the CDC National Institute of Occupational Safety and Health (NIOSH) National Occupational Research Agenda Healthcare and Social Assistance Sector Council which is charged with developing an industry-specific research agenda for the nation, and is co-leader of The Joint Commission/JCR/OSHA Alliance activities. She has been involved in Joint Commission research, evaluation, and performance measurement activities for more than 20 years.  Prior to this position, she worked for the Veterans Administration health services research department in Hines IL on projects related to home care, long term care, and infectious diseases.