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    Infectious Disease Control Unit
    Mail Code: 1960
    PO BOX 149347 - Austin, TX 78714-9347
    1100 West 49th Street, Suite T801
    Austin, TX 78714

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TEXAS CONTAMINATED SHARPS INJURIES: 2005

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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), 76th 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 2005: 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. Comprehensive reports of contaminated sharps injuries in Texas are published at: Contaminated Sharps Injury Reports

Contaminated sharps injuries in Texas have ranged from 1622 injuries in 2001 to 1858 in 2005. Centers for Communicable Disease Control and Prevention (CDC) and other sources indicate that 50% or more of sharps injuries go unreported.1,2,3

Where Sharps Injuries Occurred in Texas

High percentages of sharps injuries in Regions 3 and 6 reflect the higher populations and greater number of health care facilities in those Health Service Regions (table 1).
Texas Regional Map

Table 1.

Region

Number

Percent

1

191

10.3%

2

109

5.9%

3

355

19.1%

4

40

2.2%

5

10

0.5%

6

579

31.2%

7

132

7.1%

8

180

9.7%

9

115

6.2%

10

93

5.0%

11

21

1.1%

Missing

33

1.8%

Total

1858

100.0%

Governmental entity hospitals, medical centers, and health centers continue to report the greatest number of injuries as shown in table 2

Table 2. Injuries by Type of Governmental Entity

Facility Type

Number

Percent

Hospitals/Medical/Health Centers

1268

63.3%

Colleges/Universities

423

22.8%

City/County Services

66

3.6%

State Facilities

64

3.4%

Schools

16

0.9%

Long Term Care

3

0.2%

Home Health

1

0.1%

Missing

17

0.9%

Total

1858

100.0%

Review of location/facility type shows hospital report the greatest number of injuries (table 3).

Table 3. Site of Injury by Location/facility

Location/facility

Number

Percent

Hospital

1514

81.5%

Clinic

120

6.5%

Correctional

58

3.1%

School/College

31

1.7%

Laboratory

29

1.6%

EMS/Fire/Police

28

1.5%

Residential Facility

16

0.9%

Dental Facility

13

0.7%

Outpatient Clinic

13

0.7%

Home Health

12

0.6%

Other

12

0.6%

Morgue

10

0.5%

Blood Bank

2

0.1%

Total

1858

100.00%




In 2001 and 2002, the highest number of injuries were reported in the patient/resident room. In contrast, reports for years 2003, 2004, and 2005 list the surgery/operating room setting for the highest number of injuries.

Table 4. Area Within Facility In Which Injury Occurred

Work Area

Number

Percent

Surgery/Operating Room

434

23.4%

Patient/Resident Room

376

20.2%

Emergency Department

181

9.7%

Procedure Room

143

7.7%

Laboratory

119

6.4%

Medical/Outpatient Clinic

110

5.9%

Critical Care Unit

87

4.7%

L&D/Gyn Unit

75

4.0%

Other/Unknown/Missing

53

2.9%

Dental Clinic

27

1.5%

Floor, not Patient Room

23

1.2%

Infirmary

20

1.1%

Service/Utility Area

20

1.1%

Medical/Surgery Unit

19

1.0%

Radiology Department

19

1.0%

Autopsy/Pathology

19

1.0%

Nursery/Pediatrics

17

0.9%

Pre-op or PACU

15

0.8%

Central Supply/Sterile Prep

15

0.8%

Ambulance

14

0.8%

Jail Unit

12

0.6%

Home

11

0.6%

Blood Bank/Dialysis

10

0.5%

Field (non EMS)

7

0.4%

Rescue Setting

6

0.3%

School

6

0.3%

Restroom

5

0.3%

Psych Unit

5

0.3%

Cath Lab

4

0.2%

Rehab Unit

3

0.2%

Medication Room

2

0.1%

Research

2

0.1%

Total

1858

100.00%




When Injuries Occurred

There continues to be no real seasonal variation in the reporting of sharps injuries (figure 1) and the time when more injuries occur are as expected during the daytime (figure 2). The reports of numbers per month and time of day have been consistent over 5 years of reporting in Texas

Figure 1.  Sharps Injuries Per Month 2005

Figure 2.  Time of Sharps Injuries

Since the critical times for injuries seems to be predominately during and after the use of the sharp (table 5), healthcare workers focus on sharp handling and the avoidance of environmental distractions could potentially help in the prevention of injuries.

Table 5. Sharps Injuries by Phase of Procedure

When

Number

Percent

After

1093

58.8%

During

638

34.3%

Unknown

106

5.7%

Before

21

1.1%

Texas Health Care Worker Information

Registered nurses and physicians have reported the highest number of injuries over four years of Texas reporting; however in 2005 the number of injuries reported by interns/residents surpassed the number of physician injuries (table 6). A study conducted by a network of facilities in 2003, reported an overall annual percutaneous injury (PI) rate of 23.87 per 100 occupied beds, for teaching hospitals in the network, the PI rate was 26.8 per 100 occupied beds, and the average PI for non–teaching hospitals in the network was 18.7 per 100 occupied beds.4 Researchers also have found that interns working during the day after having worked also during the previous night sustained 61% more needlesticks and other sharp object injuries.5 In 2003, the Accreditation Council for Graduate Medical Education introduced a maximum 30 consecutive work hours (known as the 30–hour rule) limit and a prohibition from working more than 80 hours per week (averaged over 4 weeks).6

Table 6. Sharps Injuries By Job Classification

Job Classification

Number

Percent

Registered Nurse

437

23.5%

Intern/Resident

247

13.3%

MD/DO/Fellow

227

12.2%

OR/Surgical Technician

157

8.4%

Lab Tech/Phlebotomist//IV Team

148

8.0%

Licensed Vocational Nurse

144

7.8%

Students

91

4.9%

Aide (CNA, HHA, Orderly)

75

4.0%

Housekeeper/Laundry

68

3.7%

First Responders

41

2.2%

Other/Unknown

35

1.9%

Dentist/Hygienist/Assistant

32

1.7%

Other Techs

31

1.7%

School Personnel/Research

25

1.3%

Respiratory Therapist/Technician

24

1.3%

Physician Assistant

21

1.1%

Central Supply

15

0.8%

CRNA/NP/Nurse Midwife

13

0.4%

Forensic

8

0.4%

Radiology

7

0.3%

Physical Therapist

5

0.2%

Maintenance/Safety Security

4

0.2%

Food Service

3

0.2%

Total

1858

100.00%

Table 7 depicts injuries by students with interns/residents sustaining more than 70% of the student injuries and medical students reporting the second greatest number of injuries in 2005.

Table 7. Students/Interns/Resident Injuries

Type of Student

Number

Percent

Interns/Residents

247

73.1%

Medical Students

52

15.4%

Other Students

18

5.3%

Nursing

12

3.6%

Dental

9

2.7%

Total

338

100.00%


Female healthcare workers reported the greatest number of injuries (table 8). Workers 25 through 34 years of age consistently report the highest number of injuries (table 9). Injuries to the hand occurred in 90% of reported injuries in 2005 (table 10).

Table 8. Gender of Injured Worker

Sex of Worker

Number

Percent

Female

1251

67.3%

Male

570

30.7%

Unknown/Missing

37

2.0%

Total

1858

100.0%

 

Table 9. Age Distribution of Injured Workers

Age

Number

Percent

Less than 18 years

6

0.3%

18 thru 24

176

9.5%

25 thru 34

712

38.3%

35 thru 44

410

22.1%

45 thru 54

283

15.2%

55 thru 64

102

5.5%

65 and older

8

0.4%

Total

1858

100.0%

 

Table 10. Area of Body Injured

Injured Area

Number

Percent

Hand

1745

93.9%

Arm

44

2.4%

Leg/foot

37

2.0%

Unknown

22

1.2%

Face/Head/Neck

5

0.3%

Torso

5

0.3%

Total

1858

100.0%

How Sharps Injuries Occurred

Table 11 displayed how the sharps injuries occurred. As shown, between steps of a procedure and suturing were the most frequent processes involved in injuries. Devices found in an inappropriate place and during the use of the sharps container also continue be involved in sharps injuries.
Table 11. Procedure or Process Involved in Injuries

How Exposed

Number

Percent

Between Steps Of A Multi-step Procedure

273

14.7%

Suturing

243

13.1%

Other/Unknown

175

9.4%

Found In An Inappropriate Place

154

8.3%

Use Of Sharps Container

146

7.9%

Patient Moved During The Procedure

146

7.9%

Unsafe Practice

136

7.3%

Disassembling Device Or Equipment

86

4.6%

Activating Safety Device

72

3.9%

Interaction With Another Person

71

3.8%

Laboratory Procedure/Process

70

3.8%

Recapping

60

3.2%

Use Of IV/Central Line

57

3.1%

Surgery

42

2.3%

Blade Scalpel Use

39

2.1%

Preparation For Reuse Of Instrument

34

1.8%

Device Malfunctioned

18

1.0%

Dental Process

15

0.8%

Procedure/Environment

13

0.7%

Stuck Self

8

0.4%

Total

1858

100.00%


Sharps Device Information

Disposable syringes accounted for 30% of the injuries in 2005, however if combined with insulin syringes and tuberculin syringes they then sum to 37.1 %. Suture needle injuries comprised 21% of injuries but when combined with surgical instruments and scalpels they total to 35.8% of injuries related to surgery. Winged steel needles and IV catheter needles were each involved in 8% of injuries, however when they are combined with blood tube holder/needle, lancets, blood gas syringes, and Huber needles they sum to 21.1% of injuries associated with collection of blood sample/other central lines processes.

Table 12. Type of Sharp Involved in Injuries

Type of Sharp

Number

Percent

Disposable Syringe/Needle

567

30.5%

Suture Needle

392

21.1%

Winged Steel Needle

144

7.8%

IV Catheter/Needles

144

7.8%

Other Surgical Instruments

138

7.4%

Scalpel

136

7.3%

Insulin Syringe

92

5.0%

Blood Tube Holder/Needle

58

3.1%

Other/Unknown

46

2.5%

Tuberculin Syringe

30

1.6%

Blood Gas Syringe

29

1.6%

Lancet

26

1.4%

Dental Instruments/Other

22

1.2%

Biopsy/Other Needles

16

0.9%

Test Tubes/Other Glass

10

0.5%

Huber needle

8

0.4%

Total

1858

100.00%


Original Use of Sharp

Injections and suturing (tables 13 and 14) display the highest percentages of sharps injuries with collection of a venous blood sample as the third highest percentage.

Table 13. Use of Sharp At Time of Injury

Original Use

Number

Percent

Injection, SC/ID/IM

438

23.6%

Draw Venous Sample

244

13.1%

Suture Skin

210

11.3%

Start IV or Set Up Heparin Lock

179

9.6%

Cutting

171

9.2%

Suture Deep

155

8.3%

Unknown/Not Applicable

91

4.9%

Obtain Body Fluid/Tissue Sample

81

4.4%

Surgery/Surgical Procedure

55

3.0%

Draw Arterial Blood Sample

52

2.8%

Dental

37

2.0%

Contain Specimen

30

1.6%

Finger Stick/Heel Stick

29

1.6%

Other Suturing

29

1.6%

Wiring/Stapling

19

1.0%

Place/Remove Central Line

17

0.9%

Shaving

7

0.4%

Tattoo

5

0.3%

Dialysis

4

0.2%

Fetal Monitor

3

0.2%

Autopsy

2

0.1%

Total

1858

100.00%




Table 14. Suturing Injuries

Original Use

Number

Percent

Suture Skin

210

11.3%

Suture Deep

155

8.3%

Orther Suturing

29

1.6%

Total

394

21.2%

Safety Engineered Sharps Use

Both Texas bloodborne pathogen regulations and OSHA standards require the use of safety engineered sharps devices in the healthcare setting. As may be noted in table 15, fifty percent of the sharps injuries occurred with devices that were not safety engineered. However, the 31% of injuries that were reported with safety engineered sharps is also of concern, especially the nine percent in which the safety feature was fully or partially activated (table 16). Does the occurrence of sharps injuries with safety engineered devices denote both an inadequate design of the safety engineered sharps device and inadequate education of staff prior to use of the device, or are there are reasons such as worker distraction during usage, etc? Facility tracking and investigation of the root causes of sharps injuries may provide a clearer understanding of how the injury occurred and promote prevention of injuries. Improvements in the design of sharps devices and staff education in device usage are safety steps for employee safety.

Table 15. Was Device Safety Engineered?

Safety Sharp

Number

Percent

Yes

560

30.3%

No

925

50.1%

Other/Unknown

373

20.2%

Total

1858

100.00%

 

Table 16. Was Safety Feature Activated?

Activated

Number

Percent

Unknown

1254

67.4%

Yes, Fully

69

3.7%

Yes, Partially

97

5.2%

No

438

23.5%

Total

1858

100.00%

Worksite Safety Controls

Worksite safety controls continue to reflect 88 to 95% compliance in glove use, hepatitis B vaccine series, required annual bloodborne pathogen education, and availability of the sharps container.

Table 17. Worksite Safety Controls

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

1626

88.5

1687

90.8

1723

92.7

1758

94.6

No

208

11.1

101

5.4

56

3.0

42

2.2

Unknown

24

1.2

70

3.7

79

4.2

58

3.1

 

Recommendations:

  1. Continue to screen, test and use appropriate safety devices.
  2. Track injuries that occur by type of device and procedure in an effort to determine root causes of injury.
  3. Provide staff education and follow up in the use of new safety devices at the worksite.
  4. Monitor efficacy of new devices.
  5. Institute and maintain a culture of safety supported from administration throughout facility with all staff.

 

References:

  1. 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
  2. Elmiyeh, B. Whitaker, S. James, M. J. Chahal, C. A. Galea, A. Alshafi, K. Needle-stick in the National Health Service: a culture of silence. Journal of the Royal Society of Medicine: July 2004: volume 97.
  3. Patterson, J. M. Novak, C. B. Mackinnon, S. E. Ellis, R. A. Needlestick injuries among medical students. AJIC: June 2003 31 (4) 226-230.
  4. Perry, J. Parker, G. Jagger, J. EPINET Report: 2003 Percutaneous Injury Rates. Advances in Exposure Prevention-Vol. 7, No. 4, 2005.
  5. Ayas, N.T. Barger, L.K. Cade, B.E. Extended duration work and the risk of self-reported percutaneous injuries in interns. U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. Research Activities No. 313, September 2006: 2.
  6. National studies examine excess work hours among medical interns and the risk for needlestick injuries. U.S. Department of Health and Human Services Agency for Healthcare Research and Quality Research Activities No. 313, September 2006: 1-2.

Questions or comments may be directed to:

Gary Heseltine MD MPH 
Texas Department of State Health Services
Communicable Disease Control Unit
(512) 458-7676 Ext. 6352
Gary.Heseltine@dshs.state.tx.us

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Last updated October 07, 2013