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Texas Contaminated Sharps Injuries: 2001

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Injury Data Report

Bloodborne Pathogens Bloodborne Pathogens
(Contaminated Sharps Injuries, Needlestick Prevention)

Related Topics: Infection Control

 

 

This report contains the aggregate contaminated sharps injury data submitted to Texas Department of State Health Services for 2001 as required by Texas Health and Safety Code, Chapter 81, Subchapter H (HB 2085), 76th Legislature.

FEDERAL BLOODBORNE PATHOGEN REGULATIONS

Since the Human Immunodeficiency Virus (HIV) epidemic began in the 1980's, many changes have occurred in the healthcare industry. Just as prior to the advent of antibiotics, healthcare workers have again become at life and death risk at the work site. In response, the Occupational Safety and Health Administration issued the 1991 standard regulating occupational exposure to bloodborne pathogens, including HIV, hepatitis B virus (HBV), hepatitis C virus (HCV) and others. Thereafter, the more stringent federal Needlestick Safety and Prevention Act became law in November 2000. This law revised the previous Bloodborne Pathogen standard to require: the evaluation and implementation of safer needle devices; documentation of the non-managerial staff involvement in the evaluation and selection of safer devices; and the establishment and maintenance of a sharps injuries log.1

TEXAS BLOODBORNE PATHOGEN LAW

The Texas State Legislature and Governor passed House Bill 2085, which contained Bloodborne Pathogens Control regulations effective in 2001. Requirements of the Texas Bloodborne Pathogen Control regulation include: that each governmental unit will comply with minimum standards that are analogous to the standards adopted by the federal Occupational Safety and Health Administration; that governmental entities develop and implement an Exposure Control Plan; that frontline staff make up at least 50% of the team that evaluates and selects needleless systems that are to be implemented in their governmental entity as these become commercially available; that worksites maintain a confidential Sharps Injury Log; and that governmental entities submit sharps injury information to the Texas Department of State Health Services (DSHS). DSHS is required to make available in aggregate form, the submitted data and maintain a registration program for needleless systems and sharps with engineered sharps protection.2

REPORTING OF CONTAMINATED SHARPS INJURIES

The sharps injury information that must be reported to DSHS in a written or electronic form include: date and time of the injury; the type and brand of sharp involved in the exposure incident; a description of the incident that includes job classification of the injured person; the department or work area where the exposure occurred; the procedure that the exposed employee was performing at the time of the incident; how the incident occurred; the body part of the employee that was injured; and whether the sharp had engineered sharps injury protection and if so, did the injury occur before, during or after activation of the protective mechanism.

Types of facilities that reported injuries included hospitals, medical/health centers, colleges/universities, city/county facilities, state facilities, and schools (Figure 1). Sharps injuries by Public Health Regions are shown in Table 1.

Facility Reporting Chart

Table 1: Sharps Injuries by Public Health Region

(n = 1789)

     

PUBLIC HEALTH REGION

NUMBER

PERCENT

1

235

13.14%

2

122

6.82%

3

449

25.10%

4

36

2.01%

5

8

0.45%

6

375

20.96%

7

88

4.92%

8

309

17.27%

9

102

5.70%

10

38

2.12%

11

27

1.51%

TOTAL

1789

100.00%

Table 2 further depicts the types of worksites where injuries occurred. It may be noted that seventy-eight percent (78%) of the 1,798 contaminated sharps injuries were reported as having occurred in hospitals. The tracking of injury trends within a hospital/other facility may be more meaningful than the comparison of injuries between different types of facilities with diverse patient populations, lengths of stay, and services.3 Formulas for calculation of injury rates are listed in Advances in Exposure Prevention.4

Table 2: Sharps Injuries by Facility Type

(n = 1789)

     

TYPE OF FACILITY

NUMBER

PERCENT

Hospital

1399

78.20%

Clinic

133

7.43%

EMS/Fire/Police

67

3.75%

Correctional Facility

42

2.35%

School

38

2.12%

Laboratory (Freestanding)

32

1.79%

Outpatient Treatment

26

1.45%

Dental Facility

10

0.56%

Residential Facility

10

0.56%

Home Health

9

0.50%

Morgue/Medical Examiner

5

0.28%

Bloodbank/Center/Mobile

4

0.22%

Other

14

0.78%

TOTAL

1789

100.00%

Sharps injuries reported by work area within facilities (Table 3) revealed that 455 or 25% of the injuries were sustained in the patient's room and the next greatest number (332 or 19%) occurred in the operating room. Aliitionally, 10% occurred in the procedure room and 9% in the emergency department.

Table 3: Sharps Injuries by Work Area

(n = 1789)

     

WORK AREA

NUMBER

PERCENT

Patient/Resident Room

455

25.43%

Operating Room

332

18.56%

Procedure Room

184

10.29%

Emergency Department

168

9.39%

Laboratory

118

6.60%

Labor & Delivery

89

4.97%

Medical/Outpatient Clinic

79

4.42%

Critical Care

77

4.30%

Rescue Setting (non-ER)

60

3.35%

Floor, Not Patient Room

57

3.19%

School

33

1.84%

Service/Utility Area

28

1.57%

Pre-Op or PACU

20

1.12%

Autopsy/Pathology

15

0.84%

Dialysis Centers

12

0.67%

Home

12

0.67%

Infirmary

9

0.50%

Blood Bank/Center/Mobile

5

0.28%

Other

36

2.01%

TOTAL

1789

100.00%

VARIATIONS IN INJURY REPORTING

Figures 2 and 3 display when injuries occurred during 2001. Figure 2 displays injuries per month while Figure 3, lists injuries by time of injury incident. Figure 2 appears to demonstrate a decreasing trend in sharps injuries per month over time. These variations in reporting of sharps injuries could possibly be the result of a number of factors, such as: increased reporting after an education program on Bloodborne Pathogen Risks, or a drop in reporting after requiring the use of safer sharps devices3 , or a change in reported injuries thought to be related to organizational climate and staffing levels5 . Inconsistency in reporting and profound underreporting may be as high as seventy percent (70%) in some facilities6 . Figure 3 reveals that fifty-six percent (56%) or a total of 998 sharps injuries were sustained on the day shift. The higher number of day shift injuries might be expected to occur because of the possible higher number of risky procedures on the day shift.

Figure 2: Sharps Injuries per Month, 2001
(n = 1789)

Sharps Injuries by Public Health Region

 


Figure 3: Time of Injury

(n=1789)

Sharps Injuries by Facility Type
Day shift: 7:00AM to 2:59PM; Evening shift: 3:00PM to 10:59PM; Night shift: 11:00PM to 6:59AM

HEALTH CARE WORKERS AT BLOODBORNE PATHOGEN RISK

More than eight million health care workers in the United States work in hospitals and other health care services7 . These workers in the health care industry and related occupations are at risk of occupational exposure to bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis C (HCV), hepatitis B virus (HBV), and other infections. As of December 2001, there were 57 "documented" and 135 "possible" cases of occupational HIV transmission to U.S. health care workers as reported to the Centers for Disease Control and Prevention (CDC).

According to the NIOSH Alert in March 1999, an estimated 600,000 to 800,000 needlestick injuries and other percutaneous injuries occur annually among health care workers8 with nurses sustaining the majority of the injuries.7 During 2001, Texas Registered Nurses (R.N.s) likewise, sustained the highest portion of the sharps injuries with 464 or 26% of the total (Table 4). Another 8% of the injuries occurred among Licensed Vocational Nurses (LVNs). These nursing injury statistics are comparable to the injuries reported by the International Health Care Safety Center at the University of Virginia (EPINet).9 The EPINet injury data for 1999 health care facilities showed RN/LVN combined injuries at 40% of the total of the 1,995 injuries reported from hospitals in the data base. During 2001, Texas physicians sustained the second highest number of sharps injuries with 393 (22% of total) reported (Table 4), while laboratory workers were third highest in reported injuries at 179 (10% of the total number).

Table 4: Sharps Injuries by Job Classification

(n = 1789)

     

JOB CLASSIFICATION

NUMBER

PERCENT

RN

464

25.94%

MD/DO

393

21.97%

Laboratory

179

10.01%

LVN

143

7.99%

Surgery Assistant/OR Tech

135

7.55%

First Responder

82

4.58%

Housekeeper/Laundry

80

4.47%

Student

78

4.36%

Aide

51

2.85%

Dental

32

1.79%

Other Techs

26

1.45%

Respiratory Therapist

24

1.34%

Radiology

23

1.29%

School Personnel

13

0.73%

Physician Assistant

9

0.50%

CRNA/NP

8

0.45%

Correctional

6

0.34%

Forensics

5

0.28%

Physical Therapy

5

0.28%

Other

33

1.84%

TOTAL

1789

100.00%



Sixty-five percent (65%) of the injured workers were female (Table 5) and the greatest number of the injured workers was between the ages of 25 to 34 (Figure 4). The hand was the most frequently injured body part with 1,673 hand injuries reported which was 94% of all injuries (Table 6).

Table 5: Sex of Injured Worker

(n = 1789)

     

SEX

NUMBER

PERCENT

Female

1170

65.40%

Male

607

33.93%

Unknown

12

0.67%

TOTAL

1789

100.00%

     

Sharps Injuries by Work Area

Table 6: Area of Body Injured

(n = 1789)

     

INJURED BODY PART

NUMBER

PERCENT

Hand

1673

93.52%

Arm

55

3.07%

Leg/Foot

47

2.63%

Torso

4

0.22%

Face/Head/Neck

3

0.17%

Unknown

7

0.39%

TOTAL

1789

100.00%

HOW CONTAMINATED SHARPS INJURIES OCCURRED

The Texas Bloodborne Pathogen law requires the reporting of how sharps injuries occurred and the use or nonuse of safety engineering controls. The reporting of how the sharps injuries occurred includes: the original intended use of the sharp, the availability of the sharps disposal container as an engineering control, the type of sharp involved, and details of the injury.

Injuries related to the original intended use of the sharp (Table 7) revealed that the use of a sharp to obtain a sample of blood resulted in 307 injuries (17% of total injuries). In fact, The Centers for Disease Control and Prevention (CDC) has categorized phlebotomy as one of the highest risk of the sharps usage procedures due to the hollow-bore needle and the large gauge of the phlebotomy needle.10 An aliitional six percent of the injuries were related to an intravenous aspiration or injection. Suturing (deep and skin) resulted in 317 injuries (18% of reported injuries). Fifteen percent (15%) of the injuries were sustained when the original intended use was to give subcutaneous or intramuscular injections. There were 147 injuries listed as unknown as to the original intended use.

Table 7: Original Intended Use of Sharp When Injury Occurred

(n = 1789)

     

ORIGINAL INTENDED USE OF SHARP

NUMBER

PERCENT

Draw Venous Sample

307

17.16%

Suturing, Skin

195

10.90%

Injection, SC/ID

163

9.11%

Start IV or Set Up Heparin Lock

143

7.99%

Suturing, Deep

122

6.82%

Injection/Aspiration IV

104

5.81%

Injection, IM

100

5.59%

Cutting (Surgery)

79

4.42%

Surgery/Surgical Procedure

70

3.91%

Finger/Heel Stick

68

3.80%

Obtain Body Fluid/Tissue Sample

63

3.52%

Draw Arterial Sample

43

2.40%

Heparin/Saline Flush

37

2.07%

Contain Specimen/Pharmaceutical

32

1.79%

Other Cutting

27

1.51%

Dental Procedure

17

0.95%

Wiring

14

0.78%

Drilling

8

0.45%

Dialysis

5

0.28%

Electrocautery

5

0.28%

Tattooing

4

0.22%

Other

36

2.01%

Unknown

147

8.22%

TOTAL

1789

100.00%

The sharps disposal container was reported as readily available in 92% of the injury cases (Table 8). However, in Table 9, that lists how the injury occurred, fourteen percent (14%) of the injuries were listed as having occurred in the use of the sharps disposal container and twelve percent (12%) were incurred when the sharp was found in an inappropriate place. In Table 9, it may be also noted that 10% were reported as having happened when the patient moved during a procedure. The greatest number of injuries at 318 (18%) were sustained during suturing.

Table 8: Sharps Container Available for Disposal

(n = 1789)

     

SHARPS CONTAINER AVAILABLE

NUMBER

PERCENT

Yes

1643

91.84%

No

130

7.27%

Not Applicable

2

0.11%

Unknown

14

0.78%

TOTAL

1789

100.00%


Table 9: How Injury Occurred

NUMBER

PERCENT

Suturing

318

17.8%

Use Of Sharps Container

245

13.7%

Found In An Inappropriate Place

206

11.5%

Other

197

11.0%

Patient Moved During Procedure

182

10.2%

While Disassembling

147

8.2%

While Carrying/Handling Sharp

80

4.5%

While Recapping

70

3.9%

Laboratory Procedure/Process

58

3.2%

Procedure/Environment

52

2.9%

Interaction With Another Employee/Patient

37

2.1%

Unknown

35

2.0%

During Use Of Device

30

1.7%

Cleaning Instruments/Equipment

29

1.6%

Surgery

27

1.5%

Passing Instruments

23

1.3%

Use Of Iv/Central Line

22

1.2%

Activating Safety Shield

15

0.8%

Device Malfunctioned

14

0.8%

TOTALS

1787

100.0%

**Please Note! The above table is a correction of previously published data.

Scrutiny of injuries by the type of sharp in use at time of the injury revealed a variety of devices: syringes, needles, scalpels, lancets, trocars, surgical instruments, wires, and vacuum tube devices (Table 10). "Suture needles" were listed most frequently at eighteen percent (18%) of the injuries. The next highest number of devices was "other syringe with needle" at 211 (12%) followed by "needle factory-attached to syringe" at 11% of the injuries.

Table 10: Injuries by Type of Sharp

(n = 1789)

     

TYPE OF SHARP

NUMBER

PERCENT

Suture needle

320

17.89%

Other syringe with needle

211

11.79%

Needle factory-attached to syringe

201

11.24%

Winged steel needle

156

8.72%

Other surgical instrument/nonglass sharp

137

7.66%

Other nonsuture needle

113

6.32%

IV catheter, loose

100

5.59%

Scalpel

97

5.42%

Insulin syringe with needle

83

4.64%

Vacuum tube collection

83

4.64%

Lancet

62

3.47%

Tuberculin syringe with needle

34

1.90%

Syringe, other

28

1.57%

Blood gas syringe

26

1.45%

Needle connected to IV line

22

1.23%

Prefilled cartridge syringe

20

1.12%

Blood tube

13

0.73%

Wire

13

0.73%

Trocar

10

0.56%

Other glass

9

0.50%

Ampule

2

0.11%

Staples

2

0.11%

Other

7

0.39%

Unknown

40

2.24%

TOTAL

1789

100.00%

WORKSITE SAFETY CONTROLS

The presence of the following interventions were evaluated at the time of the injury: glove use, hepatitis B vaccine series, bloodborne pathogen education in the last twelve months, and whether the device used had safety engineered sharps protection.

Eighty-four percent (84%) of the injured workers were wearing gloves at the time of their injury (Table 11). Eighty-seven percent (87%) of injured workers had completed the hepatitis B vaccine series at the time of injury (Table 12).

Table 11: Glove Use at Time of Injury

(n = 1789)

     

WEARING GLOVES

NUMBER

PERCENT

Yes

1502

83.96%

No

276

15.43%

Unknown

11

0.61%

TOTAL

1789

100.00%


Table 12: Hepatitis B Vaccine Series Completion Among Injured Workers

(n = 1789)

     

HEP B VACCINE

NUMBER

PERCENT

Yes

1565

87.48%

No

213

11.91%

Unknown

11

0.61%

TOTAL

1789

100.00%

Table 13 demonstrates that eighty-six percent (86%) of the injured workers had had the required education. during the 12 months prior to their injury.

Table 13: Exposure Control Plan Training During Past Twelve Months

(n = 1789)

     

RECEIVED TRAINING

NUMBER

PERCENT

Yes

1532

85.63%

No

233

13.02%

Unknown

24

1.34%

TOTAL

1789

100.00%

SAFETY ENGINEERED SHARPS PROTECTION

Table 14 shows the results of the query concerning whether the device involved in the injury did or did not have safety engineered sharps protection. It may be noted that 74% of the Texas injuries occurred with devices that did not have safety engineered sharps protection. CDC estimates that 62 to 88 percent of sharps injuries can potentially be prevented by the use of safer medical devices.8 Efficacy of safety engineered sharps protection may be reviewed in the November 1999 NIOSH Alert.7

Table 14: Did the Device Have Engineered Sharps Injury Protection

(n = 1789)

     

ENGINEERED SHARPS INJURY PROTECTION

NUMBER

PERCENT

No

1323

73.95%

Yes

264

14.76%

Unknown

202

11.29%

TOTAL

1789

100.00%

SAFETY ENGINEERED SHARPS AND EDUCATION

A Houston hospital study of preimplementation and postimplementation of engineered sharps and education revealed that, with education only, rates of injuries were declining; however, with the combination of education and hospital-wide use of safety engineered syringes and needless-intravenous devices, a “significant” reduction in needle-related injuries was observed. A confounder, as stated in the study, was the continued availability of traditional needled devices.11

SAFE WORK ENVIRONMENT

Although many factors may be listed as essential to a safe work environment, 3 are associated with compliance to bloodborne pathogen exposure regulations:

•  senior management commitment and support for a safe work site;

•  absence of barriers to safe work practices;

•  cleanliness and orderliness at the worksite.12

COST AND BENEFITS OF SAFETY ENGINEERED SHARPS

Implementation of safety engineered sharps can be expected to reduce or eliminate the risk of contaminated sharps injuries and thus benefit both the health care worker and the employer. The new devices however may result in an increased budgetary expense. The possible increased costs of safer devices may be weighed against the benefits of reduced anxiety among staff and the reduced or eliminated employer cost of injured worker evaluation and treatment. The U.S. cost of evaluating and treating injured workers is around $500 million per year.13

CONCLUSIONS:

  1. Texas governmental entities providing health care in Public Health Regions with large urban populations reported the largest numbers of sharps injuries.
  2. Texas hospitals and clinics reported more injuries than other types of facilities.
  3. The patient or resident's room, operating room, procedure room and emergency room were work areas highest in sharps injuries
  4. Registered nurses, physicians and laboratory staff sustained the greater number of sharps injuries.
  5. Blood sample collection, giving an injection, and suturing were worksite activities that resulted in the highest number of sharps injuries.
  6. Thorough worksite investigation and reporting of injury incidents could assist worksite tracking and injury prevention as well as contributing to state-wide review and reporting to promote injury prevention.
  7. The need for the screening, testing, and implementation of safety engineered sharps is demonstrated by the fact that 74% of the injuries were incurred through the use of traditional devices without safety engineering.

REFERENCES/RESOURCES:

1 U.S. Department of Labor Occupational Safety and Health Administration. 12/18 Compliance Directive for Bloodborne Pathogen Standard Updated-Includes revision mandated by the Needlestick Safety and Prevention Act. www.osha.gov

2 Title 25. Health Services Part 1. Texas Department of State Health Services Chapter 96. Bloodborne Pathogen Control. Rules, Forms & Plans July 26, 2000. www.dshs.state.tx.us/idcu/

3 Parker, Ginger et al. EPINet Report: 1999 Percutaneous Injury Rates. Advances in Exposure Prevention; 6 (1) 8.

4 Jagger, Janine. Using Denominators to Calculate Percutaneous Injury Rates. Advances in Exposure Prevention; 6 (1) 8.

5 Clarke, Sean et al. Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near misses in hospital nurses. AJIC; 30 (4) 207-216.

6 DeBaun, Barbara. A decade of needlestick prevention: A California experience. Infection Control Resource; 1 (3) 1-6.

7 U.S. Department of Health and Human Services Center for Disease Control-National Institute for Occupational Health. NIOSH ALERT preventing needlestick injuries in healthcare settings. DHHS (NIOSH) November 1999 (2000-108) 2-12.

8 U.S. Department of Labor Occupational Safety and Health Administration. Safety and Health Topics: Needlestick Prevention November 6, 2002. www.osha.gov

9 Uniform Needlestick and Sharps Object Injury Report U.S. EPINet Network 1999, 21 health care facilities. Advances in Exposure Prevention; 6 (1) 10-11.

10 Anderson, Karen. Phlebotomy-A necessary high-risk procedure. Advances in Exposure; 1 (4) 1.

11 Reliy, Siliharta et al. Assessing the effect of long-term availability of engineering controls on needlestick injuries among health care workers: A 3-year preimplementation and postimpementation comparison. AJIC; 29 (6) 424-427.

12 Lundstrom, Tammy et al. Organizational and environmental factors that affect health and safety and patient outcomes. AJIC 2002; 39 (2) 93-106.

13 U.S. Department of Health and Human Services Research Activities. Sharps-related injuries cause anxiety in health care workers. AHRQ; Number 269, January 2003, 18.

Questions or Comments may be directed to:
Gary Heseltine MD MPH
Texas Department of State Health Services
Infectious Disease Epidemiology and Surveillance
(512) 776-7676
Fax (512) 776-7616
Gary.Heseltine@dshs.state.tx.us


 

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Last updated April 16, 2012