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    Infectious Disease Control Unit
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    PO BOX 149347 - Austin, TX 78714-9347
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TEXAS CONTAMINATED SHARPS INJURIES: 2004

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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 as required by Texas Health and Safety Code, Chapter 81, Subchapter H (HB2085), 76 th Legislature.

Texas Bloodborne Pathogen law and federal bloodborne pathogen regulations seek to protect the health care worker from worksite acquired bloodborne diseases. Bloodborne pathogens of concern at the healthcare worksite are human immunodeficiency virus (HIV), Hepatitis B (HBV) and Hepatitis C (HCV) infections. United States (U.S.) and global surveillance of HIV, HBV and HCV acquired in the community and at the healthcare worksite are described below.

HIV/AIDS Statistics

At end of the year 2000, there was an estimated 36.1 million adults and children living with HIV/AIDS throughout the world 1 and an estimated 340,000 persons were living with AIDS in the U.S. at the conclusion of 2000. 2 More than 1 million persons were estimated to be living with HIV infection in the U.S. in 2003. 3 Due to the highly active antiretroviral therapy (HAART) since 1996, persons with HIV are living longer and the progression to AIDS has lessened. 3 CDC thus recommends that states and territories adopt confidential, name-based surveillance systems that report HIV infections because AIDS surveillance no longer provides an accurate population-based monitoring of the epidemic. 3

Global and US Bloodborne Pathogen Infections among Health Care Workers

Reports of bloodborne infections among the estimated 35 to 100 million global health care workers world wide are fortunately small in comparison to the size of the at risk population: 65,000 Hepatitis B (HBV) infections, 16,400 Hepatitis C (HCV) and 1000 Human immunodeficiency virus (HIV) infections in the year 2000. 4 There continues to be fifty-seven health personnel in the U.S. that have been documented to seroconvert to HIV following occupational exposures. 5 Additionally, 139 other cases of HIV infection or AIDS have occurred among healthcare workers who have not reported other risk factors for HIV infection. 5 No new cases of occupational acquired HIV/AIDS have been documented since the end of 2001 in the U.S. 5

Texas Contaminated Sharps Injuries Reported in 2004

Texas Bloodborne Pathogen regulations require governmental entity reporting of contaminated sharps injuries as shown in table 1. A contaminated sharps injury is defined as any sharps injury that occurs with a sharp used or encountered in a health care setting that is contaminated with human blood or body fluids. 6

Table 1. Texas Sharps Injuries

Year Reported

Number

2001

1789

2002

1622

2003

1779

2004

1686

Aggregate reporting of contaminated sharps injuries among governmental entities in Texas during 2004 includes the following: 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 status of device involved in the injury. 6

Where Sharps Injuries Occurred in Texas

Higher percentages of sharps injuries continue to reflect the higher urban populations and greater number of health care facilities in Health Service Regions 1, 3, and 6 (table 2).

Table 2. Health Service Regions (HSR) Injuries (n=1686)

Health Service Region

Injuries per Region

Percent

1

198

11.86%

2

102

6.11%

3

340

20.37%

4

58

3.48%

5

17

1.02%

6

609

36.49%

7

100

5.99%

8

96

5.75%

9

99

5.93%

10

41

2.46%

11

9

0.54%

Missing

17

1.02%

Total

1686

100.00%

Governmental entity hospital/medical/health centers continue to report the greatest number of injuries as shown in table 3. These numbers could be expected in relationship to higher number patient and staff populations and the higher number of procedures with potential sharps risk in a hospital, health care centers, and medical centers.

Table 3. Injuries by Type of Governmental Entity (n=1686)

Facility

Count

Percent

Hospital/Medical/Health Centers

1211

71.83%

Colleges/Universities

366

21.71%

City/County Services

61

3.62%

State Facilities

22

1.30%

Schools

13

0.77%

Home Health

6

0.36%

Other

3

0.18%

LTC

3

0.18%

Federal Facilities

1

0.06%

Total

1686

100.00%




Table 4. Injuries by Further Definition of Type of Facility (n=1686)

Facility Type

Number

Percent

Hospital

1410

83.63%

Clinic

109

6.47%

EMS/Fire/Police

32

1.90%

School

26

1.54%

Correctional Facility

25

1.48%

Morgue/Medical Examiner

22

1.30%

Home Health

17

1.01%

Dental Facility

13

0.77%

Outpatient Treatment

12

0.71%

Residential Facility

10

0.59%

Other

4

0.24%

Laboratory (Freestanding)

3

0.18%

Bloodbank/Center/Mobile

2

0.12%

Ambulance

1

0.06%

Total

1686

100.00%




Table 5. Work Area Where Injury Occurred (n=1686)

Work area

Number of Injuries

Percent

Operating Room

478

28.35%

Patient/Resident Room

323

19.16%

Procedure Room

167

9.91%

Emergency Dept

154

9.13%

Laboratory

81

4.80%

Medical/Outpatient Clinic

67

3.97%

L & D/Gynecology Unit

72

4.27%

Critical Care

63

3.74%

Other

44

2.61%

Autopsy/Pathology

30

1.78%

Floor, Not Patient Room

27

1.60%

Pre-Op Or PACU

25

1.48%

Service/Utility Area

25

1.48%

Home

15

0.89%

Law Enforcement

12

0.71%

Nursery

10

0.59%

Dental Clinic

10

0.59%

Ambulance

10

0.59%

Rescue Setting (Non ER)

15

0.89%

Field (Non EMS)

9

0.53%

Radiology

9

0.53%

School

7

0.42%

Infirmary

7

0.42%

Central Supply

5

0.30%

CATH Lab

4

0.24%

Medical/Surgical Unit

4

0.24%

Dialysis Room/Center

3

0.18%

Blood Bank Center/Mobile

3

0.18%

Radiology Department

2

0.12%

Pharmacy

2

0.12%

Physical Therapy

2

0.12%

Hospice

1

0.06%

Total

1686

100.00%

As noted in table 5, the highest percentage of sharps injuries were reported to have occurred in the operating room. It is of interest also, to compare reported operating room injuries with patient’s room injuries over time as seen in table 6.

Table 6. Comparison of Operating Room and Patient Room Injuries Over Time

Year

Percentage of Injuries Reported In Operating Room

Percentage of Injuries Reported In Patient’s Room

2001

19%

25%

2002

21%

24%

2003

25%

21%

2004

28%

19%

The changes in percentages in table 6 could be possibly attributed to an increase in the use of safer devices or perhaps changes in reporting by healthcare workers or other unknown factors.

When Injuries Occurred

Sharps injuries per month do not reflect a seasonal variation. The majority of injuries continue to be reported during the day shift (7 am to 3 pm) as to be expected considering the greater number of both staff and procedures during the day shift. The greatest number of injuries continue to be reported to have occurred after use of a sharps device.

Table 7. Sharps Injuries Per Month 2004 (n=1686)

Month of Injury

Number

Percent

January

150

8.90%

February

147

8.72%

March

148

8.78%

April

152

9.02%

May

140

8.30%

June

140

8.30%

July

125

7.41%

August

143

8.48%

September

144

8.54%

October

111

6.58%

November

145

8.60%

December

141

8.36%

Total

1686

100.00%




Table 8. Time of Sharps Injuries (n=1686)

Time of Injury

Number

Percent

7:00 am through 2:59 pm

973

59.08%

3:00 pm through 10:59 pm

507

30.78%

11:00 pm through 6:59 am

167

10.14%

Unknown

39

23.67%

Total

1647

100.00%




Table 9. Sharps Injuries by Phase of Procedure (n=1686)

When Injury Occurred

Number

Percent

After

939

55.89%

During

641

38.15%

Unknown

94

5.60%

Before

12

0.71%

Total

1686

100.00%

Texas Health Care Worker Information

The medical and nursing professions reported the highest number of injuries. Females ages 25 through 34 continued to report the most injuries and the greatest number of injuries were sustained to the hand.

Table 10. Sharps Injuries By Job Classification (n=1686)

Job Classification

Number

Percent

RN

399

23.67%

MD/DO

374

22.18%

Intern/Resident

146

8.66%

Surgery Assistant/OR Tech

117

6.94%

Laboratory

107

6.35%

LVN

105

6.23%

Student

86

5.10%

Housekeeper/Laundry

53

3.14%

First Responder

47

2.79%

Aide

40

2.37%

Dental

31

1.84%

Unknown

26

1.54%

Physician Assistant

21

1.25%

Other Techs

20

1.19%

Radiology

18

1.07%

Research

17

1.01%

CRNA/NP

17

1.01%

Respiratory Therapist

16

0.95%

Other

15

0.89%

Forensic

10

0.59%

Maintenance Services

9

0.53%

School / College

6

0.36%

Central Supply

5

0.30%

Physical Therapy

3

0.18%

Pharmacist

3

0.18%

Counselor/Social Worker

3

0.18%

Correctional

3

0.18%

Clerical/Administrative

3

0.18%

Pathology

2

0.12%

Occupational Therapy

2

0.12%

Medical Student

2

0.12%

Emergency Room Tech

1

0.06%

Dietary

1

0.06%

Total

1686

100.00%




Table 11. Gender of Injured Worker (n=1686)

Gender

Number

Percent

Female

1071

63.52%

Male

578

34.28%

Missing

37

2.19%

Total

1686

100.00%




Table 12. Age Distribution of Injured Workers (n=1686)

Age Group

Number

Percent

Less than 18

5

0.30%

18 through 24

167

9.91%

25 through 34

652

38.67%

35 through 44

387

22.95%

45 through 54

251

14.89%

55 through 64

100

5.93%

65 through 76

10

0.59%

Missing

114

6.76%

Total

1686

100.00%




Table 13. Area of Body Injured (n=1686)

Body Part

Number

Percent

Hand

1590

94.53%

Arm

35

2.08%

Leg/Foot

25

1.49%

Unknown

32

1.90%

Face/Head/Neck

12

0.71%

Torso

3

0.18%

Total

1686

100.00%

How Sharps Injuries Occurred

A review of the stated reason for the injury, the device involved, and the original intended use of the sharps device provides a broad review of how sharps injures occurred.

Table 14. Procedure or Process Involved in Injuries (n=1686)

Reason

Count

Percent

Suturing

293

17.38%

Found In An Inappropriate Place

185

10.97%

Use Of Sharps Container

159

> 9.43%

Between Steps Of A Multi Step Procedure

145

8.60%

Laboratory Procedures/Process

142

8.42%

Patient Moved During Procedure

125

7.41%

Use Of IV/Central Line

97

5.75%

Disassembling Device Or Equipment

90

5.34%

Blade/Scalpel Use

86

5.10%

Interaction With Another Person

64

3.80%

Other/Unknown

59

3.50%

Surgery

50

2.97%

Recapping

53

3.14%

Activating Safety Device

35

2.08%

Unsafe Practice

34

2.02%

Device Malfunctioned

25

1.48%

Preparation For Reuse Of Instrument

25

1.48%

Procedure/Environment

12

0.71%

Dental

5

0.30%

Tattoo

2

0.12%

Total

1686

100.00%

Four years comparison of the reason for sharps injuries reveals a 1% decrease in injuries due to device being found in an inappropriate place and due to suturing. In comparison, use of the sharps container injuries has decreased by 5%.

Table 15. Four Years Comparison of the Stated Reason for Sharps Injuries

YEAR

FOUND IN AN
INAPPROPRIATE PLACE

SUTURING

USE OF SHARPS CONTAINER

2001

12%

18%

14%

2002

11%

18%

13%

2003

11%

18%

12%

2004

11%

17%

9%

A sum all needles and syringes (excluding iv needles/catheters) was 42% of the injuries. Suture needles and surgical instruments comprised 39% of the injuries.

Table 16. Type of Sharp Involved in Injuries (n=1686)

Type of Sharp

Count

Percent

Suture Needle

386

22.89%

Disposable Syringe

240

14.23%

Other Syringe With Needle

185

10.97%

Scalpel

130

7.71%

Other Surgical Instrument

111

6.58%

Winged Steel Needle

105

6.23%

Disposable Syringe Insulin

68

4.03%

IV Catheter, Loose

66

3.91%

Other Non Suture Needle

63

3.74%

Vacuum Tube Collection

56

3.32%

Lancet

46

2.73%

Needle On IV Line

27

1.60%

Unknown

24

1.42%

Disposable Syringe Tuberculin

23

1.36%

Blood Gas Syringe

20

1.19%

Needle Factory - Attached

17

1.01%

Other

16

0.95%

Wire

12

0.71%

Blood Tube

10

0.59%

Staples

8

0.47%

Arterial Catheter Introducer

8

0.47%

Prefilled Cartridge Syringe

8

0.47%

Huber Needle

7

0.42%

Other Glass

6

0.36%

Unattached Hypodermic Needle

5

0.30%

Spinal Needle

4

0.24%

Dental Instrument

4

0.24%

Tattoo Pin

4

0.24%

Syringe, Other

4

0.24%

Pipette

4

0.24%

Biopsy Needle

3

0.18%

Drill Bit

3

0.18%

Central Line Catheter Needle

3

0.18%

Scissors

3

0.18%

Other Vascular Catheter Needle

3

0.18%

Retractor

3

0.18%

Razor

3

0.18%

Microtome Blade

2

0.12%

Total

1686

100.00%




Table 17. Use of Sharp At Time of Injury (n=1686)

Original use

Number

Percent

Injection, SC/ID/IM

317

18.80%

Suture Skin

235

13.94%

Draw Venous Sample

199

11.80%

Suture Deep

165

9.79%

Cutting

154

9.13%

Unknown/Not Applicable

114

6.76%

Start IV Or Set Up Heparin Lock

104

6.17%

Obtain Body Fluid/Tissue Sample

88

5.22%

Injection/Aspiration IV

50

2.97%

Finger Stick/Heel Stick

45

2.67%

Draw Arterial Sample

42

2.49%

Other

31

1.84%

Contain Specimen/Pharmaceutical

26

1.54%

Place Central Line

17

1.01%

Retraction

17

1.01%

Dental

15

0.89%

Wiring

13

0.77%

Heparin Or Saline Flush

10

0.59%

Drilling

9

0.53%

Electrocautery

6

0.36%

Remove Central Line/PORTA Catheter

6

0.36%

Tattoo

5

0.30%

Dialysis

4

0.24%

Surgery/Surgical Procedure

3

0.18%

Suture Removal

3

0.18%

Shave

3

0.18%

Fetal Monitor

2

0.12%

Staples Removal

1

0.06%

Total

1686

100.00%

Worksite Safety Control

Tables 18 and 19 show the compliance or lack of compliance in the use of safety engineered sharps and whether the safety mechanism was activated. In comparison, table 20 shows a high rate of compliance with glove use, Hepatitis B vaccination, bloodborne pathogen education, and availability of the sharps container.

Table 18. Was Device Safety Engineered? (n=1686)

Safety Sharp

Number

Percent

No

982

58.66%

Yes

370

22.10%

Unknown

334

19.95%

Total

1686

100.00%




Table 19. Was Safety Feature Activated? (n=1686)

Protective mechanism activated

Number

Percent

Not Applicable

1049

62.22%

Unknown

288

17.08%

No

243

14.41%

Yes Partial

75

4.45%

Yes Fully

31

1.84%

Total

1686

100.00%




Table 20. Worksite Safety Controls (n=1686)

Compliance With Worksite Safety Controls At Time Of Injury

Glove Use At Time Of Injury

Hepatitis B Vaccine Series Completed

Received Bloodborne Pathogen Education In Past 12 Months

Availability Of Sharps Container

 

Number

(%)

Number

(%)

Number

(%)

Number

(%)

Yes

1482

88.37

1531

91.29

1563

93.20

1577

94.04

No

172

10.26

106

6.32

83

4.95

62

3.70

Unknown

18

1.07

40

2.39

31

1.85

38

2.27

Not Applicable

5

0.30

 

 

 

 

 

 

Safer Devices and Practices in the Healthcare Field

U.S. Laws and Directives

In 1955, Roehr Products introduced a plastic disposal syringe. 7 Plastic disposal syringes replaced the reusable glass syringes thus reducing the potential of contaminates in a reused syringe and needle as well as eliminating the risk of breakage. Disposable plastic syringes were designed initially without safety features. The Federal Bloodborne Pathogen standard issued in 1991, required work place Bloodborne Pathogen Exposure Control Plans that described how the site would implement sharps containers, safety engineered devices, and bloodborne pathogen education. In 2001, the Federal Needlestick Safety and Prevention Act and Texas Bloodborne Pathogen Law as well as other state’s bloodborne pathogen laws required health care facilities to establish a team of direct care staff to screen, test, and recommend implementation of appropriate syringes and other devices that are safety designed.

Federal directives over time have addressed specific bloodborne pathogen risk issues. Occupational Safety Health Agency (OSHA) requires employers to substitute non-glass products (e.g., plastic) when available such as blood tubes and slides. 8 A joint FDA/NIOSH/OSHA advisory in February 1999 provided an alert as to the potential risk of use of glass capillary tubes and recommended that the users consider capillary tubes that are not made of glass, products that use a method of sealing that does not require manually pushing one end of the capillary tube, and products that allow the blood Hematocrit to be measured without centrifugation. 9 OSHA clarified its policy on the prohibition of removing contaminated needles from blood tube holders: “Removing contaminated needles and reusing blood tube holders can expose workers to multiple hazards”. 10 Blood tube holder reuse is a potential hazard also for the patient, clinical studies have shown a 50-80% contamination of the blood tube holder after one usage. 11 CDC reported the transmission of Hepatitis B Virus in three long term care facilities was attributed to shared devices (blood glucose monitors, multi dose vials of insulin, and lancets), and other breaks in infection control practices related to blood glucose monitoring. 12 Thus, single patient/resident dedicated glucose monitors, insulin vials, and lancets are the preferred infection control approach.

World Health Organization Study Considers the Global Burden of Disease Attributable to Contaminated Injections in Health Care Settings

As a part of the 2000 Global Burden of Disease study by the World Health Organization, the death and disability from injection-associated infections with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) were quantified. The model based the study on the fraction of the annual number of infections attributable to injections, the proportion of infections resulting with reused equipment, the probability of infections resulting from percutaneous exposure, the prevalence of active infection, the prevalence of immunity and total incidence. 13 These infections were converted into disability-adjusted life years (DALYS) in 2000-2030. 13 During 2000, in Ten Global Burden of Disease regions, where persons received an average of 3.4 injections per year, 39.3% of the injections were given with reused equipment. 13 Thus contaminated injections were anticipated to cause an estimated 21 million HBV infections, two million HCV infections, and 260,000 HIV infections resulting in a new infection burden of 9,177,679 DALYS between the years 2000 and 2030. 13 The study demonstrated the need for policies and plans for safe and appropriate use of injections to reduce the burden of disability and death in countries with poor injection practices. 13

Recommendations:

  1. Healthcare administration support and monitoring of worksite safety in relation to safety sharps selection and usage.
  2. Annual update of worksite Bloodborne Pathogen Exposure Control Plans including policies and procedures to prevent sharps injuries and manage Post Exposure Prophylaxis
  3. Continued encouragement of employees to report sharps injuries.
  4. Conduct worksite tracking of sharps injuries in relationship to specific devices and work processes.
  5. Revise worksite procedures for processes that have higher incidence of injuries.

References:

1 Adler, M W. ABC of AIDS development of the epidemic. BMJ. May 19, 2001 322 (7296)
   1226-1229. Retrieved 1/23/06 from
     http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

2 Klevens, RM and Neal, JJ. Update: AIDS United States, 2000. CDC MMWR Weekly. July 12,
   2002/51(27); 592-595 Retrieved 1/23/2006 from
     http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5127a2.htm

3 Espinoza, L. et al. Trends in HIV/AIDS diagnosis---33 states, 2001-2004. CDC MMWR
  Weekly.
November 18, 2005/54 (45); 1149-1153. Retrieved 1/31/2006 from:
     http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5445a1.htm

4 Puro, V. and Shouval, D. Conclusions of the meeting of the Viral Hepatitis Prevention Board    Meeting on Hepatitis B, hepatitis C, and other bloodborne infections in health care
   workers. Rome, Italy, March 17-18, 2005. Viral Hepatitis. November 2005 14 (1) 1-16.

5 Department of Health and Human Services Centers for Disease Control and Prevention.
   Surveillance of healthcare personnel with HIV/AIDS, as of December 2002. Retrieved
   2/10/2006 from:
     http://www.cdc.gov/ncidod/dhqp/bp_hiv_hp_with.html

6 Title 25. Health Services Part 1. Texas Department of State Health Services Chapter
   96. Bloodborne Pathogen Control.
     http://www.dshs.state.tx.us/idcu/health/infection_control/bloodborne_pathogens/reporting

7 Who Invented the Hypodermic Needle or Syringe. Retrieved 2/17/06:
     http://inventors.about.com/libaray/inventors/blsyringe.htm

8 U.S. Department of Labor Occupational Safety And Health Administration Memorandum from    Cindy A. Coe. June 4, 2002 Bloodborne Pathogens Interpretation Request.

9 Joint FDA/NIOSH/OSHA Advisory on: Glass Capillary Tubes: Joint Safety Advisory About    Potential Risks. February 1999. Retrieved 3/8/2004 from:
     http://www.cdc.gov/niosh/capssa9.html

10 OSHA Trade News Release, U.S. Department of Labor, Office of Public Affairs, Trade News    Release, Wednesday, June 12, 2002. OSHA clarifies position on the removal of contaminated    needles.

11 Perry, J. and Jagger, J. Reuse of blood tube holders, redux. Preventing Occupational Exposures to Bloodborne Pathogens. Articles from Advances in Exposure Prevention, 1994-2003 Vol.6, no.4, 2003; 230-231. The Safety Institute, Premier Inc. 2004.

12 Webb, R. et al. Transmission of Hepatitis B Virus among persons undergoing glucose    monitoring in long-term care facilities Mississippi, North Carolina, and Los Angeles, California,    2003-2004. CDC MMWR Weekly March 11, 2005/54(09); 220-223. Retrieved 2/17/2006 from:
     http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a2.htm

13 Hauri AM, Armstrong, GL, Hutin YF. The global burden of disease attributable to    contaminated injections given in health care settings. Int J STD AIDS. January 2004 15 (1)    7-16.


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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Last updated April 16, 2012