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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), 76^th Legislature.

Texas Bloodborne Pathogen regulations require governmental entity reporting of contaminated sharps injuries. This report summarizes contaminated sharps injuries reported by governmental entities in Texas during the year 2003: 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 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.

Location of Sharps Injuries

Public Health Regions 3 and 6 continue to report the higher numbers of injuries reflecting the large urban populations in those regions (table 1).

A Study of Percutaneous Injury Patterns in a healthcare system of hospitals compares sharps injuries between rural and urban and among sizes of hospitals. A large midwestern healthcare system consisting of 9 hospitals, both rural and urban, conducted a study of differences in patterns of percutaneous injuries in different hospitals between 1997 and 2001. Average annual injury rates were determined to be higher at urban hospitals (22.5 vs 9.5 Pis/100 beds; P = .0001). Small rural hospitals had more injuries than small urban hospitals (14.87 vs 8.02 Pis/100 beds; P = .0143). The prevalence of source patients infected with HIV and Hepatitis C was higher at large hospitals. Conclusions of the study were that significant differences in injury rates and patterns among different types of hospitals could be a base for intervention strategies.¹

National Surveillance Data Of Percutaneous Injuries

A study of the 57 healthcare workers with occupationally acquired HIV infection acquired over the past twenty years, showed most of healthcare workers (88%) had percutaneous injuries.² Conclusions of the study listed prevention strategies that included: the avoidance of blood exposures, education about the benefits and limitations of Post Exposure Prophylaxis (PEP), and technologic advances (such as safety engineered devices) to enhance safety in the health care setting.² Three out of 1000 (.3%) health care workers stuck with a needle contaminated with HIV will become infected with HIV, in comparison, a percutaneous injury with a Hepatitis C contaminated device, there is a 1.8% incidence of infection.³ Hepatitis C is the most frequent infection resulting from sharps injuries.⁶ There is no post exposure prophylaxis for Hepatitis C and 75-80% of persons infected will develop active liver disease, cirrhosis 10-20% and 1-5% of cirrhosis cases will develop liver cancer over a period of years.³ Hepatitis B is preventable due to the available vaccine. Regulations requiring vaccination of health care workers, has resulted in the reduction of cases from 17,000 to 400 annually ⁶. The transmission rate of Hepatitis B is 2 to 40%.⁶

Texas Percutaneous Injuries in 2003

When injuries are reviewed by type of governmental entity (table 2), hospitals accounted for 73% of the injuries and universities 20%.

Missing: 3

In an extended breakdown of the injuries by type of facility (table 3), hospitals report 81% of the total injuries. Likewise, in the previous years of 2001 and 2002, hospital injuries ranged from 78 to 80% of total injuries.

Missing: 6

As shown in table 4, the highest number of sharps injuries in 2003 occurred in the operating room. In 2001 and 2002, the highest numbers of injuries were reported in the patient’s room.

Missing: 21

When Sharps Injuries Occurred

As may be noted in Figures 1, sharps injuries do not appear to be related to season. Figure 2 reflects the greater number of employees and procedures performed on the day shift. Fifty-nine percent of the injuries occurred after a procedure as is seen in table 5.

Figure 1. Sharps Injuries by Month during 2003

Figure 2. Sharps Injuries by Time of Injury

Missing: 18

Texas Health Care Worker Information

Physicians sustained the highest percentage of sharps injuries in 2003 (table 6); this is a change from both 2001 and 2002, in which Registered Nurses had the highest number of injuries (table 7). Females continue to report the greatest number of injuries (table 8). Table 9 shows that health care workers 25 thru 34 years of age sustained the greatest number of injuries. Ninety five percent of the injuries were sustained to the hand (table 10).

Missing: 11

Missing: 104

Missing: 117

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Missing: 5

A Needlestick Injuries Survey Among Medical Students in a Missouri university school of Medicine revealed 30% of the third and fourth year students had at least one needlestick injury. Of the total 59 injuries incurred, 24 were not reported. 4 Most of the needlestick injuries occurred in the operating room during suturing and were most often self-inflicted.⁴

Texas Sharps Injuries And How They Occurred

Suture needles accounts for 21% of injuries in 2003 (table 11), which is an increase from 18% in 2001 and 2002. In the condensed version of table 12, suturing (skin and deep) is 22% of injuries while collection of a blood sample (venous and arterial) and injections (intramuscular, intradermal, and subcutaneous) are both 18% of injuries. In table 13, suturing is the procedure attributed to the highest percentage of injuries.

Missing: 8

Missing: 28

Worksite Safety Controls

An 89% compliance with glove use, hepatitis B vaccine series, and bloodborne pathogen education annually is depicted in table 14. The sharps container was available in 92% of the injuries.

Engineered Sharps Injury Protection (ESIP)

Tables 15 and 16 reflect the usage of engineered sharps injury protection among injured workers during 2003. Figure 3 shows how health care providers among governmental entities in Texas have increased engineered sharp injury protection over three years. Injuries do occur with devices that are considered safety engineered, thus a work site quality improvement program with monitoring of work practice controls, process at time of injury, staff competency in procedure, and efficacy of specific devices are needed for injury prevention.

Missing: 221

National Hospital Survey of ESIP

A random sample telephone survey conducted among 494 hospitals November 1999 through February 2000 revealed 83% adoption of ESIP although adoption was inconsistent across various types of devices. Predictors for adoption included a perception that the cost of ESIPs would not be a problem and state legislative activity on the needlestick issue.⁵ Cost of Sharp Injuries according to the American Hospital Association, one case of serious infection by bloodborne pathogens can cost up to $1 million or more for testing follow-up, lost time and disability costs⁵. A high risk exposure follow-up is almost $3,000 per injury, safe needles cost only 28 cents more than traditional devices.⁶ Additionally, hospitals that do not take the Needlestick Prevention And Safety Act seriously could face big fines with a maximum penalty of $70,000 with possible added fines for deficiencies in the exposure control plan and fill status of the sharps disposal container.⁷

Healthcare Worker Role In Preventing Sharps Injuries

Hospitals can provide safety devices to minimize needlestick injuries, but the rest is up to the employee.⁷ The best way for healthcare workers to protect themselves is learn which devices are higher risk, which devices will reduce risk, and what to do in processes that will always have risks.⁷

Four Year Surveillance from the Northern France Network shows a 30% reduction in needlestick injury (NSIs) incidence rates.⁸ The decrease in bloodborne pathogen exposures is attributed to training in prevention and procedures, access to personal safety equipment, safety containers, safety engineered devices, and focusing health care workers attention through access to post exposure prophylaxis.⁸

Conclusions

Physicians surpassed nurses in sharps injuries among Texas governmental entities in 2003. The use of engineered sharps injury protection is continuing to increase. Facility screening and selection of better designed safety devices combined with tracking sharps injuries, analyzing injury root causes, and thereafter developing and implementing prevention strategies are recommended.

References/Resources

¹ Babcock HM, Fraser V. Differences in percutaneous injury patterns in a multi-hospital system. Infect Control Hosp Epidemiology. October 2003 24 (10) 731-736. Retrieved January 2005 from http://www.premierinc.com

² Do Ann N. et al. Occupational Acquired Human Immunodeficiency Virus (HIV) Infection: National Case Surveillance Data During 20 Years of the HIV Epidemic In The United States. Infection Control Hosp Epidemiology. February 2003 24 (2) 86-96.

³ Rosenstock, Linda. Statement For the Record on Needlestick Injuries. National Institute For Occupational Safety And Health Centers For Disease Control And Prevention U.S. Department Of Health And Human Services Before The House Subcommittee On Workforce Protection Committee On Education And The Workforce, June 22, 2000. Retrieved December 31, 2004 from http://www.hhs.gov/asl/testify/t000622a.html

⁴ Patterson, J. Megan. et al. Needlestick injuries among medical students. AJIC. June 2003 31 (4) 226-230.

⁵ Sinclair, R., et al. Prevalence of safer needle devices and factors associated with their adoption: results of a national hospital survey. Public Health Reports. July-August 2002 117 340-349.

⁶ American Nurses Association. Nursing Facts Needlestick Injury. ANA fact sheet on Needlestick Injury. Retrieved on December 31, 2004 from http://www.nursingworld.org/readroom/fsneedle.htm

⁷ Perry, Jane. et al. How to avoid needlesticks. RNWeb. Retrieved December 31, 2004 from http://www.rnweb.com/rnweb/article/articleDetail.jsp

⁸Tarantola, Amaud. et al. Occupational blood and body fluids exposure in health care workers: Four-year surveillance from the Northern France Network. AJIC. October 2003 31 (6) 357-373.

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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