infection prevention
By Amber Hogan Mitchell , DrPH , MPH , CPH
Sharps Injuries in 2020 : The Year to Learn from the Past , Draw from the Present , and Improve the Future of Worker Safety in Healthcare
Reprinted with permission from ORsafe . org
November 2020 marked 20 years since the passage of the
Needlestick Safety and Prevention Act ( NSPA ). The Act required the Occupational Safety and Health Administration ( OSHA ) to update its 1991 Bloodborne Pathogens Standard to include new protections for workers facing exposures to blood , body fluids , and other potentially infectious materials .
At the time , advocates for worker health and safety and preventing sharps injuries and needlesticks were so aligned that champions from multiple disciplines and backgrounds came together seamlessly to fight for stricter policies that addressed safer conditions in healthcare . The Act was passed unanimously by Congress Nov . 6 , 2020 . Clinicians affected by injuries , worker safety and health advocates , manufacturers , unions , law makers , and regulators came together to improve the coverage the standard offered to workers .
At a high level , this meant inclusion of more specific requirements for :
● The evaluation and use of engineering controls , including safer medical devices like needleless systems and “ sharps with engineered sharps injury protections ” ( devices with sharps injury prevention features ).
● The inclusion of frontline non-managerial employees in the identification , evaluation , and selection of engineering controls and work practices .
● Establishing and maintaining a sharps injury log ( beyond what is required by the OSHA Recordkeeping Rule ).
On a more facility-specific level , this meant then and still means now that employers – despite being faced with competing safety and quality initiatives -- do not lose sight of identifying where injuries are occurring , during what procedures , and with what devices or practices . This includes using the Sharps Injury Log as an evergreen tool to direct campaigns and controls that prevent future injuries and learn from past ones .
Over the 20 years when incident data is compared at the facility-level to the national or regional levels , data tracks true to bigger surveillance systems that collect and report sharps injuries to the public , including the Exposure Prevention Information Network ( EPINet ®) from the International Safety Center and the Sharps Injury Surveillance System ( SISS ) from the Massachusetts Department of Public Health ( MA DPH ). As a nation , we saw great strides for decreasing incidence of injuries from blood collection devices , IV catheters , and lancets . Technologies got better , safer and more intuitive and the tide changed for the benefit of exposure prevention .
Today , however , reported incidents of injuries from hypodermic syringes , suture needles , and scalpel blades continue to be unacceptably high . In fact , according to both EPINet and MA SISS , these three device categories represent the highest numbers of injuries compared to all other device types in recent reporting years . They remain the devices that need greater attention relative to identifying and selecting better , safer alternatives and effective work practice controls like “ safety ” feature activation , no hands passing , and safe disposal .
Top 5 Sharps Injury Device Types
% Injuries |
Hypodermic Syringe / Needle |
Suture Needle |
Scalpel Blade ( disposable or reusable ) |
Blood Collection : Winged Steel or Vacuum Tube |
IV Catheter Stylet / Line Procedures + |
EPINet 24.1 24.8 5.5 7 4.4
MA DPH SISS * 34 22 7 11 11
+ MA DPH SISS does not list “ IV access ” or “ IV catheters ” per EPINet , but does list “ line procedures ”, so these were compared .