Needlestick Safety

Introduction

needlestick
Blood collection needles are commonly associated with accidental needlestick injuries.

More than 8 million health care workers in the United States work in hospitals and other health care settings. Precise national data are not available on the annual number of needlestick and other percutaneous injuries among health care workers; however, estimates indicate that 600,000 to 800,000 such injuries occur annually. About half of these injuries go unreported.

Always report needlestick injuries to your employer to ensure you receive appropriate follow-up care.

Most reported needlestick injuries involve nursing staff; but laboratory staff, physicians, housekeepers, and other health care workers are also injured. Some of these injuries expose workers to bloodborne pathogens that can cause infection. The most important of these pathogens are HBV, HCV, and HIV. Infections with each of these pathogens are potentially life threatening and preventable.

The emotional impact of a needlestick injury can be severe and long lasting, even when a serious infection is not transmitted. This impact is particularly severe when the injury involves exposure to HIV. In one study of 20 health care workers with an HIV exposure, 11 reported acute severe distress, 7 had persistent moderate distress, and 6 quit their jobs because of the exposure. In addition to the exposed health care worker, colleagues and family members
may suffer emotionally.

1. Most reported needlestick injuries involve _____.

a. physicians
b. laboratory staff
c. nursing staff
d. housekeeping staff

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Needles Usually Associated With Needlestick Injuries

glove

Health care workers use many types of needles and other sharp devices to provide patient care. However, data from hospitals show only a few types of needles and other sharp devices are associated with the majority of injuries. Needles often associated with needlestick injuries include:

  • hypodermic needles
  • blood collection needles
  • suture needles
  • needles used in IV delivery systems

Injuries can occur at every stage of their use, disassembly, or disposal. A report from the Centers for Disease Control and Prevention (CDC) lists the following percentages for injury rates involving hollow-bore needles:

  • During use: 52%
  • After use, before disposal: 19%
  • During or after disposal: 22%

2. Needlesticks occur most often _____.

a. during use
b. after use
c. after use, before disposal
d. during or after disposal

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Work Practices Increasing the Risk of Needlestick Injuries

Past studies have shown that needlestick injuries are often associated with these activities:

  • recapping needles
  • transferring a body fluid between containers
  • failing to dispose of used needles properly in puncture-resistant sharps containers

Past studies of needlestick injuries have shown that 10% to 25% occurred when recapping a used needle. Although recapping by hand has been discouraged for some time and is prohibited under the OSHA bloodborne pathogens standard [29 CFR 1910.1030] unless no alternative exists, 5% of needlestick injuries in hospitals are still related to this work practice.

Injury may occur when a health care worker attempts to transfer blood or other body fluids from a syringe to a specimen container (such as a vacuum tube) and misses the target. Also, if used needles or other sharps are left in the work area or are discarded in a sharps container that is not puncture resistant, a needlestick injury may result.

3. Past studies indicate that needlestick injuries are often associated with each of the following activities EXCEPT _____.

a. hand recapping needles
b. transferring body fluids between containers
c. disposing of hazardous waste bags
d. failing to dispose of used needles properly

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Safer Medical Devices

Safer medical devices must be evaluated annually for its effectiveness in preventing occupational exposures to blood and other potentially infectious materials. Selecting a safer device based solely on the lowest cost is not appropriate, and selection must be based on employee feedback and device effectiveness. If commercially available safer devices are available and appropriate, the use of the safer devices must be implemented.

Examples of safer medical devices are:

  • a syringe with a protective shield surrounding the needle; or
  • a syringe with a retractable needle; or
  • a lancet with a retractable blade; or
  • a device with a blunt tip; or
  • a device that has no needle.

4. Selecting a safer medical device must be based on _____.

a. total cost over time and device efficiency
b. manufacturer criteria and build time
c. lowest cost to build the device
d. device effectiveness and employee feedback

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Preventing Needlestick Injuries

needlestick

Needlestick safety can best be addressed in the setting of a comprehensive prevention program that considers all aspects of the work environment and that has employee involvement as well as management commitment.

You can help protect yourself from needlestick injuries by:

  • avoiding the use of needles where safe and effective alternatives are available
  • helping your employer select and evaluate devices with safety features that reduce the risk of needlestick injury
  • using devices with safety features provided by your employer
  • avoiding recapping needles
  • planning for safe handling and disposal of needles before using them
  • promptly disposing of used needles in appropriate sharps disposal containers
  • reporting all needlestick and sharps-related injuries promptly to ensure you receive appropriate follow-up care
  • telling your employer about any needlestick hazards you observe
  • getting a hepatitis B vaccination

5. Where should you place used needles?

a. Sharps disposal container
b. Leave on counter for housekeeping
c. Tape needle and put in the garbage
d. Take them home

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Case Studies

The following case reports briefly describe the experiences of three health care workers who developed serious infections after occupational exposures to bloodborne pathogens. Their cases illustrate preventable hazardous conditions and practices that can lead to needlestick injuries.

Case 1

A hospitalized patient with AIDS became agitated and tried to remove the intravenous (IV) catheters in his arm. Several hospital staff members struggled to restrain the patient. During the struggle, an IV infusion line was pulled, exposing the connector needle that was inserted into the access port of the IV catheter. A nurse at the scene recovered the connector needle at the end of the IV line and was attempting to reinsert it when the patient kicked her arm, pushing the needle into the hand of a second nurse. The nurse who sustained the needlestick injury tested negative for HIV that day, but she tested HIV positive several months later.

Case 2

A physician was drawing blood from a patient in an examination room of an HIV clinic. Because the room had no sharps disposal container, she recapped the needle using the one-handed technique. While the physician was sorting waste materials from lab materials, the cap fell off the phlebotomy needle, which subsequently penetrated her right index finger. Approximately 2 weeks after the needlestick, the physician developed flu-like symptoms consistent with HIV infection. She was found to be seropositive for HIV when tested 3 months after the needlestick exposure.

Case 3

A nurse sustained a needlestick injury to her finger while removing a hypodermic needle from a patient's arm. At the time of the injury, the source patient had apparent acute non-A, non-B hepatitis. The nurse developed hepatitis 6 weeks after the needlestick injury. Her liver enzymes remained elevated for nearly a year. Later examination of serum samples from the nurse and the source patient showed that both persons were infected with HCV.

Source: NIOSH Publication No. 2000-108

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