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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 (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

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

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

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.

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

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.

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 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.

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).

How Sharps Injuries Occurred

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.

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.

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.

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.

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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