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

Texas Bloodborne Pathogen regulations require governmental entity reporting of contaminated sharps injuries. This report summarizes the information reported by governmental entities in Texas during the year 2002 on contaminated sharps injuries: where the injuries occurred; when did the injury occur by time and date; information about the workers who sustained injuries; what was the original intended use of the sharps device involved in the injury; how the injury occurred; type of sharps device in use at time of injury; worksite safety controls; and safety engineered sharps protection in device involved in the injury.

Comparison of 2001 with 2002 sharps injuries reported

Contaminated sharps injuries reports declined 9% from 2001 through 2002.¹ Decline of reported injuries might be an actual decline in injuries or a decline in reporting injuries. Communicable Disease Control (CDC) reports that surveys of health care workers indicate 50% or more do not report their occupational percutaneous injuries.²

Where Sharps Injuries Occurred

Tables 1 through 4 show where injuries occurred by Texas public health regions, type of facility reporting, type of facility expanded, and work area within a facility. The frequency of injuries reported was proportional to the regional population (Table 1). As shown in tables 2 and 3, hospitals and medical centers reported the greatest percentage of injuries. Table 4 reveals patient/resident room with the highest percentage of injuries at 24% and operating room, second highest percentage at 21%.

Missing information: 5

When Sharps Injuries Occurred

Most injuries occur during the day shift when more healthcare workers are at the worksite (Figure 1). The highest number of injuries was reported in August, which were 175 (11%) of total injuries (Figure 2). Thirty-nine percent of the injuries happened during use of the sharps device and sixty-one percent happened after the use of the sharps device.

Figure 1. Sharps Injuries Reported by Work Shift

Figure 2. Contaminated Sharps Injuries Reported per Month 2002

Sharps Injuries By Healthcare Worker Injured

Registered Nurses sustained the highest percentage of sharps injuries in 2002 at 26% of total injuries, with physicians reporting the second highest number at 22% of the total injuries (Table 5). These injury percentages for Registered Nurses and Physicians are the same as those reported in 2001. Laboratory workers again, as in 2001, reported the third highest number of injuries at 10%. Both L.V.N. and Surgery Assistant/OR Tech had a 1% decline in number of injuries reported in comparison to 2001. First Responders had a 2% decline in sharps injuries reported from 2001 through 2002.

Missing: 2

Gender, Age, and Area of Body Injured

Female healthcare workers sustained 67% of the sharps injuries as may be noted in table 6. The largest age group of injured workers in 2002 occurred in the age distribution of 25 through 34 to be found in table 7, which was also the highest age group in 2001. In table 8, the area of body injured reveals 95% of the injuries occurred in the health care worker’s hand.

Missing: 2

How Sharps Injuries Occurred

As shown in table 9 (condensed), a sum of venous and arterial blood sample collection was 20% of total injuries. Injections (total of subcutaneous, intra dermal, and intra muscular injections) resulted in the second highest number of injuries at 19%. Suturing (sum of Skin and Deep Suturing) resulted in the third highest number of injuries at 18%. Additionally both tables 11 and 12 show suturing and suture needle respectively, at 18% of total injuries.

Figure 3. Original Intended Use of Sharps Device

Selection and use of sharps containers that allow health care workers to see the level of contaminated sharps in the container and placing the container close to place of use are positive steps in sharps container usage.

Table 11 shows suturing, use of the sharps container, and sharps found in an inappropriate place to be involved in the three highest percentages of injuries. Seventy-one injuries occurred while recapping needles. Activation of the safety device resulted in two percent of the injuries.

Missing: 9

Suture needle usage resulted in greatest number of injuries (Table 12). The use of blunt suture needles, as an engineering control is shown to reduce injuries in the operating room.² The second highest numbers resulted from syringes with factory attached needles. Other syringes with needle and the winged steel needle were involved in the next highest numbers of injuries.

Characteristics of devices that increase the risk of injury as defined by National Institute for Occupational Safety and Health (NIOSH 1999) include:

• Devices with hollow bore needles
• Needle devices that need to be taken apart or manipulated
• Syringes that have an exposed needle after use
• Needles that are attached to tubing such as butterflies that can be difficult to place in sharps disposal containers. ³

Worksite Safety Controls

Compliance with worksite safety controls ranged from 85% to 88% (Tables 13).

Work practice controls in the operating room include:

• Using instruments, rather than fingers to grasp needles, retract tissue, and load/unload needles and scalpels;
• Giving verbal announcements when passing sharps;
• Avoiding hand-to-hand passage of sharp instruments by using a basin or neutral zone;
• Using alternative cutting methods such as blunt electrocautery and laser devices when appropriate;
• Substituting endoscopic surgery for open surgery when possible; and
• Using round-tipped blades instead of sharp-tipped blades.²

Safety Engineered Sharps Protection

Both Texas and federal Bloodborne Pathogen regulations require the use of safety engineered sharps devices.^1,4 Thus, health care agencies continue to use frontline teams to screen, test, and implement successive generations of safety engineered devices. Facilities expect the safety sharps to provide safe and efficient service for both the patient and staff. Quality features of safer devices include:

• Device is needleless or covered when contaminated,
• Safety feature is an integral part of the device,
• Safety feature works automatically (passively) without worker activation,
• Device allows single hand use,
• Device allows hands to remain behind the sharp during use,
• The safety feature cannot be deactivated,
• Device is reliable,
• Device is easy to use and practical,
• Device is safe and effective for patient care.
• The user can easily know when the safety feature is activated.³

Tables 14, 15 and 16 display the use or nonuse of safety engineered sharps among injured health care workers. Table 14 shows conventional devices without safety engineering accounted for 68% of injuries. Table 15 shows at what point during use of the safety device, the sharps injury occurred. Table 16 lists a cross tabulation of job classifications by safety engineered sharps use at time of injury.

Missing: 108

Missing: 115

Missing: 7

As depicted above, sharps injuries do occur when safety engineered sharps devices are in use. According to a 2001 study conducted by the International Healthcare Worker Safety Center, the safety feature was not activated in 71% of injuries, and 57% of injuries happened before the safety device was activated.⁵

Effects of Implementing Safety Engineered Devices

A hospital based comparison study of sharps injuries pre implementation (3 years 1998-2000) to post implementation (1 year 2001-2002) of safety-engineered sharps devices, concluded that injury rates were reduced. The mean annual incidence rate of percutaneous injuries decreased from 34.08 per 1,000 fulltime equivalent employees before intervention to 14.25 post intervention (P < .0001). Nurses had the greatest decrease (74.5%, P < .001) in injuries. Injury rates that involved hollow bore needles decreased (70.6%, P < .001).⁶

Sharps Injury Prevention

Quality improvement concepts of teamwork, strategic planning and review in a sharps injuries prevention program provide a strong base for injury prevention.

CDC lists a series of organizational steps designed to ensure that a sharps injury prevention program may be integrated into the current worksite safety program with a focus upon targeting performance improvement areas. These series of steps listed by CDC are as follows:

1. Develop organizational capacity
2. Assess program operation processes
3. Prepare baseline profiles of injuries and prevention priorities
4. Determine intervention priorities
5. Develop and implement action plans
6. Monitor performance improvement.⁷

Since there is possible variation in levels of safe operation among safety engineered sharps, worksite tracking of injuries by specific device is an important part of the safety program. Monitoring performance improvement in the sharps injury prevention program includes also review of: staff competency in both device use and work procedure; with a work process improvement approach rather than a punitive or blaming approach. An example of process review would be to look at how needles/instruments are passed during surgery.

OSHA lists the elements of evaluating an exposure incident as:

• An evaluation of the policies and “failures of control” at time of the incident
• Engineering controls in place
• Work practice and protective equipment or clothing
• The procedure used to carry out the task
• The equipment involved or should have been involved in the incident⁸

Work site review of injuries consider work site climate and staffing present at time of injury.⁹ Corrective action plans include encouragement of staff to continue to report sharps injuries.

Conclusions:

Registered Nurses are at greater risk of sharps injury than other health care providers. Twenty nine percent of the Registered Nurse injuries occurred with a safety engineered sharp. Hospital staff sustained the greatest number of injuries. Collection of blood samples, giving injections and suturing were the three procedures with highest number of associated injuries. The use of safety-engineered devices as reported among injured workers, rose by 6% from 2001 to 2002.

References/Resources:

¹ Texas Bloodborne Pathogen Exposure Control Plan Chapter 81, Health and Safety Code Subchapter H http://www.tdh.state.tx.us/idcu/health/infection_control/bloodborne_pathogens/report/

² CDC Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. Overview: Risks and Prevention of Sharps Injuries in Healthcare Person. Retrieved June 7, 2004 from http://www.cdc.gov/sharpssafety/wk_overview.html

³ Wilburn, S. (2004). Needlestick and Sharp Injury Prevention. Online Journal of Issues in Nursing. Vol.#9No.#3,Manuscript 4 Retrieved October 15, 2004 from http://www.nursingworld.org/ojin/topic25/toc25_4.htm

⁴ U.S. Department of Labor, Occupational Health, and Safety Administration. Bloodborne Pathogens and Needlestick Prevention. Occupational Exposure to Bloodborne Pathogens: Needlestick and Other Sharps-Final Rule-66:5317-5325. Retrieved November 17, 2004 from http://www.osha.gov/SLTC/bloodbornepathogens

⁵ Pyrek, Kelly M. Study shows Needlestick Injuries on the Decline. Infection Control Today. June 2003, Vol. 7, No.6, 38-42

⁶ Sohn, S., et al. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infection Control Hospital Epidemiology.2004 Jul;25(7):536-42. Retrieved October 15, 2004 from http://www.ncbi.nlm.nih.gov/entrez/query

⁷ CDC Workbook for Designing, Implementing, and Evaluating A Sharps Injury Prevention Program. Operational Steps Retrieved June 7, 2004 from http://www.cdc.gov/sharpssafety/wk_steps.html

⁸ Recommendations for Complying with the Bloodborne Pathogen Standard. Retrieved November 17, 2004 from http://www.mdsr.ecri.org/index.asp

⁹ Clarke, Sean et al. Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near misses in hospital nurses. AJIC June 2002 30 (4) 207-216.

Questions or comments may be directed to:

Gary Heseltine MD MPH
Texas Department of State Health Services
Communicable Disease Control Unit
(512) 776-7676
Gary.Heseltine@dshs.state.tx.us

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