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Sharps Safety & Occupational Exposure:
20th Anniversary of the Needlestick Safety and
Prevention Act Reminds Us Progress Still Necessary
By Kelly M. Pyrek
T
wenty years ago, the federal Needlestick Safety &
Prevention Act (NSPA) of 2000 was signed into law with
the hope that it could bring new awareness to the dangers
of occupational exposures and percutaneous injuries in the
healthcare environment.
“Since the NSPA of 2000 was signed into law the
issue has received greater focus from occupational health
and infection prevention staff,” says Angela Laramie, an
epidemiologist with the Massachusetts Department of Public
Health. “Hospitals are continuing to convert to using devices
with sharps injury prevention features across the hospital,
including devices in pre-packaged kits. In Massachusetts,
after seeing an initial decrease in sharps injury rates in MDPH
licensed hospitals from 2002
to 2010 that was statistically
significant, sharps injury rates
between 2010 and 2015 have
We have
spent the plateaued.”
To review, the NSPA revised
better part the Occupational Safety and
of two decades educating Health Administration (OSHA)’s
standard regulating occupa-
hospitals and enforcing
tional exposure to bloodborne
regulations that require
pathogens and sought to fur-
use of devices with
ther reduce healthcare workers’
sharps injury prevention exposure by imposing additional
requirements upon employers
features.
regarding their sharps-related
— Angela Laramie procedures. OSHA’s regulations
modified the definition of
“engineering controls” and added definitions for the
terms “sharps with engineered sharps injury protection”
and “needleless systems;” required employers to consider
and implement new technologies when they update their
exposure control plan; required employers to solicit employee
input with respect to appropriate engineering controls; and
required employers to maintain a sharps injury log.
“It is important to note that the NSPA in and of itself is
not enforceable in healthcare facilities,” emphasizes Amber
Hogan Mitchell, DrPH, MPH, CPH, president and executive
director of the International Safety Center. “Rather, it
required OSHA to incorporate additional requirements
in its Bloodborne Pathogens Standard, including more
specific requirements for the use of devices with sharps
injury prevention (SIP) features, annual frontline employee
evaluation and selection of those devices, and maintaining a
sharps injury log. After 2000, we saw reductions in injuries
overall, but in the last several years, injuries have started to
26
increase, especially among physicians using suture needles
and nurses using disposable syringes. These are two areas are
where we must remain diligent about capturing injury data,
evaluating safer devices and work practices, and reducing
the numbers of injuries.”
For one commonwealth, at least, there has been an
increase in the percentage of injuries reported involving
devices with engineered sharps injury prevention features over
time. “In 2002 in Massachusetts, 26 percent of all injuries
occurred with devices with sharps injury prevention features.
Excluding suture needles, the percentage is 32 percent,”
Laramie says. “In 2015, 45 percent of injuries occurred with
devices with sharps injury prevention features. If we exclude
suture needles, that figure increases to 57 percent. This may
be seen as a proxy for use of such devices, in which case it is
appropriate that we are seeing an increase in the proportion
of injuries with these devices. The goal is to eliminate use of
devices without sharps injury prevention features, in which
case all injuries would occur with devices with sharps injury
prevention features.”
Laramie continues, “What we need to address is the efficacy
of the devices with sharps injury prevention features. Not all
mechanisms are equally effective at reducing risk of injury.
We have spent the better part of two decades educating
hospitals and enforcing regulations that require use of devices
with sharps injury prevention features. The next step is to
make sure that the devices being used are the ones that most
effectively minimize the risk of exposure.”
Last year, the Association of Occupational Health Pro-
fessionals in Healthcare (AOHP) released the findings of the
EXPO-S.T.O.P. (EXPOsure Survey of Trends in Occupational
Practice) 2016 and 2017 surveys in the AOHP Journal (Vol.
39, No. 1). AOHP’s EXPO-S.T.O.P. is an electronic survey
designed to ascertain the incidence of sharps injuries and
mucocutaneous blood exposures among healthcare workers
in U.S. healthcare facilities.
The 2016 and 2017 overall results for all hospitals
participating in the survey document a significant increase
in blood exposure incidence over the 2011 results.
“It is alarming that data from the last three surveys have
shown a year-by-year significant increase in sharps injuries (SI),
and that the 2017 rate is almost back to the 2001 rate,” said
survey co-author Terry Grimmond of Grimmond & Associates
Microbiology Consultants, in a statement released at the
time the survey results were announced, “These increasing
rates validate that the significant decrease in sharps injuries
in the years immediately following the Needlestick Safety
and Prevention Act has not been sustained.”
march 2020 • www.healthcarehygienemagazine.com