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TEXAS CONTAMINATED SHARPS INJURIES: 2006

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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 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).

Figure 1. Contaminated Sharps Injuries by Health Service Regions Figure 1.  Sharps Injuries by Health Service Regions

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.

Table 1. Injuries by Type of Governmental Entity

Governmental Entity

Number

Percent

Hospitals/Medical/Health Centers

780

53.0%

Colleges/Universities

493

33.5%

City/County Services

99

6.7%

State Facilities

75

5.1%

Schools

15

1.0%

Home Health

8

0.5%

Long Term Care

2

0.1%

Other

1

0.1%

Total

1473

100.0%


Table 2. Injuries by Type of Facility

Location/facility

Number

Percent

Hospital

1210

82.1%

Clinic/Outpatient/Amb Surgery

91

6.2%

Correctional Facility

69

4.7%

EMS/Fire/Police

23

1.6%

School/College

21

1.4%

Residential Facility

17

1.2%

Dental Facility

11

0.7%

Home Health

9

0.6%

Medical Examiner Office/Morgue

8

0.5%

Laboratory (freestanding)

6

0.4%

Other

3

0.2%

Blood Bank/Center/Mobile

3

0.2%

Recycling Center

2

0.1%

Total

1473

100.00%




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.

Table 3. Work Area Where Injury Occurred

Work Area

Number

Percent

Surgery/Operating Room

377

25.6%

Patient/Resident Room

260

17.7%

Emergency Department

160

10.9%

Medical/Outpatient Clinic

114

7.7%

Critical Care Unit

87

5.9%

Laboratory

68

4.6%

Procedure/Med Room

68

4.6%

L&D/Gynecology Unit

67

4.5%

Dental Clinic

40

2.7%

Medical/Surgery Unit

36

2.4%

Other/Unknown/Missing

32

2.2%

Radiology Department

27

1.8%

Autopsy/Pathology

16

1.1%

Ambulance

12

0.8%

Nursery

12

0.8%

Floor, not Patient Room

12

0.8%

Service/Utility Area

11

0.7%

Blood Bank/Dialysis

11

0.7%

Infirmary/School Clinic

10

0.7%

Pediatrics

9

0.6%

Field (non EMS)

9

0.6%

Pre-op or PACU

8

0.5%

Central Supply/Sterile Prep

7

0.5%

Home

6

0.4%

Jail Unit

6

0.4%

Classroom

5

0.3%

Restroom

3

0.2%

Total

1473

100.00%



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.

Table 4. Sharps Injuries per Month

Month of Injury

Number

Percent

January

144

9.8%

February

126

8.6%

March

142

9.6%

April

129

8.8%

May

113

7.7%

June

118

8.0%

July

99

6.7%

August

120

8.1%

September

103

7.0%

Octpber

139

9.4%

November

116

7.9%

December

124

8.4%

Total

1473

100.00%


Figure 2. Time of Sharps Injuries

Figure 2.  Time of Sharps Injuries

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).


Table 5. Sharps Injuries By Job Classification

Job Classification

Number

Percent

Registered Nurses

348

23.6%

Intern/Residents

246

16.7%

MD/DO/Fellows

157

10.7%

Licensed Vocational Nurses

121

8.2%

OR/Surgical Techs

106

7.2%

Lab Tech/Phlebotomist/IV Team

91

6.2%

Aide (CNA, HHA, Orderly)

57

3.9%

Medical Students

51

3.5%

Other/Unknown

49

3.3%

Housekeeper/Laundry

42

2.9%

Dentist/Hygienist/Tech

30

2.0%

First Responders

29

2.0%

Physician Assistant

22

1.5%

Other Techs

20

1.4%

School Personnel/Research

15

1.0%

Radiology/Radiologic Techs

15

1.0%

Other Students

12

0.8%

Dental Students

12

0.8%

Respioratory Therapist/Techs

10

0.7%

CRNA/NP/Nurse Midwife

10

0.7%

Nursing Students

7

0.5%

Maintenance/Safety Security

5

0.3%

ER Techs

5

0.3%

Morgue Tech/Autopsy Techs

4

0.3%

Physical Therapist

4

0.3%

Central Supply/Sterile Process

3

0.2%

Hemodialysis Techs

2

0.1%

Total

1473

100.00%


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).

Table 6. Gender of Injured Worker

Gender of Worker

Number

Percent

Female

956

64.9%

Male

475

32.2%

Unknown/Missing

42

2.9%

Total

1473

100.0%


Table 7. Age of Injured Worker

Age

Number

Percent

Less than 18 years

10

0.7%

18 thru 24

143

9.7%

25 thru 34

575

39.0%

35 thru 44

306

20.8%

45 thru 54

198

13.4%

55 thru 64

82

5.6%

65 thru 79

16

1.1%

Missing

143

9.7%

Total

1858

100.0%


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

 

Table 8. Area of Body Injured

Body Area

Number

Percent

Hand

1396

94.8%

Arm

35

2.4%

Leg/foot

18

1.2%

Unknown

16

1.1%

Torso

5

0.3%

Face/Neck

3

0.2%

Total

1473

100.0%


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 9. Use of Sharp At Time of Injury

Original Intended Use

Number

Percent

Injection, SC/ID/IM

342

23.2%

Suturing Skin

187

12.7%

Draw Venous Blood Sample

183

12.4%

Start/Use IV/Central Line

149

10.1%

Cutting

128

8.7%

Unknown/Not Applicable

109

7.4%

Suturing Deep

105

7.1%

Surgery/Surgical Procedure

62

4.2%

Obtain Body Fluid/Tissue Sample

45

3.1%

Draw Arterial Blood Sample

42

2.9%

Dental Procedure

28

1.9%

Other Suturing

22

1.5%

Finger Stick/Heel Stick

21

1.4%

Contain Specimen

19

1.3%

Drilling

7

0.5%

Electrocautery

6

0.4%

Wiring

5

0.3%

Shaving

5

0.3%

Dialysis

4

0.3%

Tattoo

4

0.3%

Total

1473

100.00%


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

Table 10. Procedure or Process Involved in Injury

How Exposed

Number

Percent

Between Steps Of A Multi-step Procedure

274

18.6%

Suturing

172

11.7%

Patient Moved During The Procedure

137

9.3%

Use Of Sharps Container

111

7.5%

Found In An Inappropriate Place

101

6.9%

Unsafe Practice

96

6.5%

Other/Unknown

88

6.0%

Interaction With Another Person

85

5.8%

Activating Safety Device

64

4.3%

Disassembling Device Or Equipment

63

4.3%

Laboratory Procedure/Process

57

3.9%

Recapping

52

3.5%

Use Of IV/Central Line

48

3.3%

Surgery

32

2.2%

Preparation For Reuse Of Instrument

22

1.5%

Procedure/Environment

20

1.4%

Device Malfunctioned

17

1.2%

Blade Scalpel Use

17

1.2%

Stuck Self

9

0.6%

Dental Process

8

0.5%

Total

1473

100.00%


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.

Table 11. Type of Sharp Involved in Injury

Type of Sharp

Number

Percent

Disposable Syringe/Needle

395

26.8%

Suture Needle

325

22.1%

IV Catheter/Needles

128

8.7%

Scalpel

123

8.4%

Winged Steel Needle

99

6.7%

Insulin Syringe/Pen

85

5.8%

Other Surgical Instruments

83

5.6%

Other/Unknown

61

4.1%

Blood Tube Holder/Needle

50

3.4%

Tuberculin Syringe

29

2.0%

Pre-filled Cartridge Syringe/p>

20

1.4%

Lancet

15

1.0%

Dental Instruments/Other

15

1.0%

Blood Gas Syringe

14

1.0%

Biopsy/Other Needles

11

0.7%

Razor

10

0.7%

Test Tubes/Other Glass

7

0.5%

Huber Needle

3

0.2%

Total

1473

100.00%


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.

Figure 3. Winged Steel Needles Involved In Sharps Injuries in Texas Figure 3.  Winged Steel Needles Involved In Sharps Injuries in Texas


Table 12. Winged Steel Needle Injuries 2006 by Job

Job Classification

Number

Percent

Registered Nurse

43

43.4%

Lab Tech/Phlebotomist/IV Team

22

22.2%

ER, OR, Rad, Resp Techs

9

9.1%

Aide (CNA, HHA, Orderly)

8

8.1%

LVN

6

6.1%

Other/Unknown

4

4.0%

Housekeeper/Laundry

3

3.0%

CRNA/NP

1

1.0%

MD/DO

1

1.0%

Physical Therapist

1

1.0%

School Personnel (not nurse)

1

1.0%

Total

99

100.00%


Table 13. . Safety Engineered Status of Winged Steel Needles

Safety Engineered

Number

Percent

Yes

74

74.7%

No

18

18.2%

Unknown

7

7.1%

Total

99

100.00%


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.


Table 14. Suture Needle Injuries by Job Title

Job Classification

Number

Percent

Intern/Resident

116

35.7%

Attending Physician (MD/DO)

57

17.5%

OR/Surgical Tech

55

16.9%

Medical Student

31

9.5%

RN

20

6.2%

Other/Unknown

14

4.3%

Physician Assistant

11

3.4%

Other Tech

5

1.5%

Other Student

5

1.5%

Dental

4

1.2%

LVN

4

1.2%

Fellow

3

0.9%

Total

325

100%


Table 15. Safety Engineered Status of Suture Needles

Safety Engineered

Number

Percent

Yes

8

2.5%

No

238

73.2%

Unknown

79

24.3%

Total

325

100%

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.

Table 16. Texas Sharps Injuries 2006

Was Device Safety Engineered?

Number

Percent

No

692

47.0%

Yes

439

29.8%

Unknown/Missing

342

23.3%

Total

1473

100.00%

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.

 

Figure 4. . Number of Safety Engineered Sharps Over Six Years Figure 4.  Number of Safety Engineered Sharps Over Six Years


Table 17. Protective Device Activation 2006

Protective Mechanism Activated

Number

Percent

Missing/Unknown information

874

59.3%

No

471

32.0%

Yes, Partially

66

4.5%

Yes, Fully

62

4.2%

Total

1473

100.00%



Table 18. Phase of Device Activation

At what phase of device activation did injury occur?

Number

Percent

Unknown

1034

70.2%

Before

234

15.9%

During

123

8.6%

After

79

5.4%

Total

1473

100.00%

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.

Table 19. Worksite Safety Controls

Compliance with Worksite Safety Controls

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

1289

87.5

11320

89.6

1370

93.0

1374

93.3

No

162

11.0

67

4.5

53

3.6

49

3.3

Unknown

22

1.5

86

5.8

50

3.4

50

3.4

 

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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Last updated April 16, 2012