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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 2006: 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 devices involved in the injuries; how the injuries occurred; type of sharps devices in use at time of injuries; worksite controls; and safety engineered sharps protection status of devices involved in the injuries.

Aggregate reports of contaminated sharps injuries in Texas may be accessed at: Contaminated Sharps Injuries Reports

This 2006 report also includes information concerning reports of risk among non-hospital based nurses, winged steel needles, and suture needles. Recommendations for a safe worksite practices are included at end of report.

Where Injuries Occurred

Contaminated sharps injuries are reported in by Public Health Service Regions: Texas Public Health Service Regions
The greatest number of injuries was reported in Region 6 (figure 1).

Table 1 reflects the diverse types of governmental entity reporting sharps injuries, table 2 further defines the location within governmental entities, and table 3 lists specific work sites of injuries.

As may be noted in table 3, the surgery/operating room and the patient's room are the sites of the most injuries with the emergency department reporting the third highest number.

When Injuries Occurred

There continues to be neither seasonal variation (table 4) nor a change in the time of day (figure 2) when sharps occur from previous years of Texas reporting.

Texas Health Care Worker Information

Registered Nurses and Interns/Residents reported the greatest number of injuries in Texas governmental entity facilities in 2006 although physicians were third in number of reported injuries (table 5).

Non-hospital based Registered Nurses Study

As may be noted in table 2, hospitals reported 82.1% of injuries in Texas in 2006. Thirteen percent of the 2006 Texas governmental entity Registered Nurse injuries occurred in facilities other than a hospital. A study of non-hospital based Registered Nurses conducted in other states, found the sharps injuries risk to be substantial for nurses not working in hospitals, with an estimated excess of 145,000 injuries per year.¹ According to the study, risk management strategies that can effectively reduce the risk burden include:
(1) Use of a team of frontline staff in the prevention program
(2) Effective product selection and implementation
(3) Improved reporting and post-exposure follow up and
(4) Effective bloodborne pathogen education from orientation through annual updates.¹

Demographics of Injured Workers in Texas

Females continue to suffer the majority (65% in 2006) of injuries and the worker age 25 through 34 years reported the highest number of sharps injuries (tables 6 and 7).

Ninety-five percent of the sharps injuries were sustained to the hand of injured workers (table 8).

How Sharps Injuries Occurred

Suturing, giving injections, collecting blood samples, and use of intravenous/central lines accounted for the highest number of injuries in Texas governmental entities as reported for the year of 2006 (table 9).

Table 10 displays how the injury occurred by procedure or process.

Type of Sharp

The type of sharp involved in injuries is displayed in table 11, with syringes/needles and suture needles involved in the greatest percentages of injuries. However, both IV catheter/needles and scalpels each account for over 8 percent of injuries.

Review of Winged Steel Needle Information

A survey by the International Safety Center in 58 teaching and non-teaching hospitals revealed the winged steel infusion needles to account for an incidence rate of 6.7% and the United States National Surveillance System for Health Care Workers (NASH) identified winged steel needles as responsible for 12% of needlestick injuries.² One author states that winged infusion needles are overused for phlebotomy; are more costly than other phlebotomy devices; increase the risk of hemolysis of blood; do not cause less discomfort to the patient; and can cause needlestick injuries.² An efficacy study by the University of Tokyo Hospital found safety winged steel needles reduced cases of needlestick injuries and estimated that 76.5% of safety winged needle injuries occurred because the "safety mechanism was not activated." ³ A 1,190 bed acute care hospital conducted a study of sharps injuries before and after implementation of a safety resheathable winged steel needle with results showing a winged steel needle injury rate decline from 13.41 to 6.41 per 100,000 (relative risk 0.48; 95% C.I. 0.31 to 0.73).3 Safety winged steel needle injuries occurred most often before activation of the device (39%), 32% were due to the healthcare worker not activating the device; 21% occurred after activation; and 4% were due to incorrect activation.⁴ Texas winged steel needle injuries among governmental entities (figure 3), ranged from 6.23% to 10% of total injuries per year over 6 years of injury reporting. However, in review of injuries to Registered Nurses for the year 2006, it was found that 43 (12%) of 348 RN injuries were sustained in the use of a winged steel needle (table 12). Table 13 shows seventy-five percent of the 99 Texas winged steel needles injuries in 2006, occurred with safety engineered winged steel needles. The winged steel needle (butterfly), even if safety engineered, is obviously a device with sharps injury risks.

Suture Needle Injuries

Twenty-two percent of total injuries reported in 2006 were sustained by contact with a suture needle (table 11). Table 14 depicts suture needle injuries by job title with Intern/Resident and Attending Physicians sustaining 54% of the injuries related to suture needles. Table 15 shows 73% of suture needles were NOT safety engineered.

Worksite Safety Controls

Safety engineered sharps devices, annual bloodborne pathogen education, glove use, hepatitis B vaccine series, and sharps containers placed appropriately and not overfilled, are required bloodborne pathogen regulations.

Safety Engineered Sharps Devices

As seen in table 16, forty-seven percent of injuries in 2006 occurred with devices that were not safety engineered.

Over the past 6 years, there has been a decrease in total number of sharps injuries reported. As depicted in figure 4, there has been an increase in the use of safety engineered devices. Tables 17 and 18 display the activation status of devices at the time of the sharps injury. However it must be noted that there is a high percentage of missing information (not submitted) in tables 16, 17, and 18.

Glove Use, Hepatitis B Vaccine, Annual Bloodborne Pathogen Education, and Available Sharps Container

Other worksite safety controls shown in table 19, reflect 88-93 % compliance in glove use at time of injury, hepatitis B series completed, bloodborne pathogen education, and the availability of the sharps container.

Conclusions:

1. There has been an increase in the use of safety engineered devices.
2. Injuries have continued to occur with devices that are safety engineered.
3. There has not been an increase in the use of safety engineered suture needles.

Recommendations:

1. Healthcare facility tracking and monitoring of sharps injuries related to:
   1. Winged steel needles and suture needles
   2. Safety engineered status of devices
   3. Employee correct usage/activation of safety device and the
   4. Success of quality teams work in the maintenance of a safe work climate.
2. Encouragement of employee reporting of sharps injuries in a non-punitive environment.

References:

1. Gershon, R. Quresh, K. Pogorzelska, M. Rosen, J. Gebbie, K Brandt-Rauf, P. Sherman, F. Non-hospital based Registered Nurses and the risk of bloodborne exposure. Industrial Health: 2007, 45, 697-704
2. Allen, George. Preventing needlestick injuries in blood collection: Focus on winged infusion needles. Infection Control Resource: Vol. 4 No. 3; 2007
3. Suzuki R, Kimura S, Shintani Y, Uchida M, Morisawa Y, Okuzumi K, et al. The efficacy of safety winged steel needles on needlestick injuries. Retrieved 5/14/2008 from www.ncbi.nlm.nih.gov/pubmed/1651923
4. Mendelson M, Ying L, Solomon R, Bailey E, Kogan G, Goldbold J. Evaluation of safety resheathable winged steel needle for prevention of percutaneous injuries associated with intravascular-access procedures among healthcare workers. Infection Control and Hospital Epidemiology. 2003, vol. 24, 2, 105-112.

Submitted by:

Gary Heseltine MD MPH 
Bloodborne Pathogen Nurse Consultant
Texas Department of State Health Services
Infectious Disease Control Unit
Gary.Heseltine@dshs.state.tx.us
(512) 776-7676 Ext. 6352 (512) 458-7616 FAX

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