Conclusions documented in the EXPO-S.T.O.P. 2016 and
2017 report include:
The significant rise in SI incidence with the 2016
and 2017 surveys indicates that current strategies have
not been successful in reducing national SI rates.
There is an urgent need to adopt more aggressive
exposure-reduction strategies.
Large exposure databases, detailed databases of
SI mechanisms, and research on SI mechanisms, SED
effectiveness, and effective training are required, as
well as continued publication of strategies proven to
reduce exposure incidence.
Complacency about sharps injuries and occupational
exposures could explain these trends, as could the overall
busyness of clinicians that can eclipse prevention strategies.
“Injuries among physicians have been on the rise the
last several years, specifically when performing suturing
procedures,” Mitchell says. “It is important that surgical
teams identify when injuries are occurring, so that they can
evaluate safer options – devices with sharps injury prevention
features and/or eliminate sutures/needles where they can.
Some examples would be evaluating alternate devices for
skin closure (staples, zipper closures, adhesives, etc.) and
evaluating the use of blunt-tip suture needles for internal
fascia where acceptable.”
Mitchell continues, “Among nurses, since injuries with
disposable hypodermic needles are the most frequent, it is
important that users are evaluating devices and implementing
ones that they have deemed the most effective. It is also
critical that they activate the safety mechanisms immediately
after use and dispose of that device into a sharps container.
According to EPINet data, the largest numbers of syringe
injuries are occurring when using needles for insulin or
vaccinations. Evaluating safer devices for these procedures,
especially since they occur so frequently, is essential. Data
shows that more than 65 percent of SIP mechanisms are not
activated when an injury occurs. Since about one-quarter
of all injuries occur to non-users, activating SIP mechanisms
protects not only the clinical user, but also anyone that may
come into contact with it downstream (EVS, waste haulers,
laundry personnel, SPD, etc.).”
Overall numbers of injuries are increasing no matter the
device type used, Mitchell emphasizes.
“As mentioned, in 2018 35 percent of all employees
reporting injuries through EPINet are using devices with SIP
features; 65.7 percent of those are from devices where the
SIP feature has not been activated. Though the purchase
of devices with SIP features may be increasing year over
year, compliance dictates that frontline, non-managerial
employees are evaluating, considering, and implementing
safer devices on an annual basis; that those SIP features are
activated; and that the device is disposed of immediately into
a sharps containers. To compare this to infection prevention
strategies, consider it a ‘sharps safety bundle’ approach that
mimics the industrial hygiene hierarchy of controls.”
Laramie has seen first-hand the data coming out of
healthcare facilities and notes that a few practice areas of
the hospital are still problematic for occupational exposures
and SIs.
www.healthcarehygienemagazine.com • march 2020
“Operating and procedure rooms continue to be the work
area where the greatest number of reported sharps injuries are
occurring,” Laramie says. “In Massachusetts, operating and
procedure rooms consistently account for the greatest number
of reported sharps injuries, with 44 percent of sharps injuries
in 2015 occurring in operating or procedure rooms. Inpatient
units, excluding the ICU, have consistently accounted for at least
one fifth of sharps injuries over time with 20 percent occurring
on inpatient units in 2015. In large hospitals, the most sharps
injuries occur in operating and procedure rooms (47 percent),
while in small and medium sized hospitals, injuries occur most
frequently on inpatient units, excluding the ICU (25 percent).”
Laramie continues, “Operating and procedure rooms
present particular risks, from passing and handling of surgical
instruments often lacking sharps injury prevention features, to
working in crowded or low-light environments. Use of devices
with sharps injury prevention features, including blunt suture
needles and scalpels with protective covers will minimize risk
of injury. Work practice controls such as hands-free passing,
verbal cueing and use of the neutral zone, as well as double
gloving, and making sure that sharps disposal containers
are of adequate size and appropriately located will also
minimize risk of injury among workers. Similarly, on inpatient
units, increased use of devices with engineered sharps injury
prevention features, along with an adequate number of sharps
Infection preventionists can
play a critical role as they support
and assist staff to guard against
complacency around injuries.
— Karen Daley
containers that are within reach of the point of use and are
not more than three-quarters full will minimize risk of injury. In
both settings, eliminating the use of sharps by using alternative
methods for medication delivery or wound closure would also
minimize risk of injury.”
Given the immense opportunity to educate around
mitigating sharps injuries, Infection preventionists can play a
critical role in preventing occupational exposures.
“Given the preventable nature of a great majority of
workplace exposures and SIs, the importance of the role of
infection prevention staff cannot be overstated,” says Karen
Daley, former president of the American Nurses Association and
a nationally recognized expert on sharps safety. “Keeping staff
safe from bloodborne pathogen exposures requires vigilance,
open communication and promotion of practices that are
known to contribute to sharps safety in patient care settings.”
Daley continues, “Vigilance against trends contributing to
injuries is always an important part of prevention. Infection
preventionists can play a critical role as they support and assist
staff to guard against complacency around injuries. There is
a also need for transparency and communication between
infection preventionists and direct care staff as root cause
and data trend analyses are conducted following injuries.
One example of an identifiable trend amenable to mitigation
strategies is staff failure to properly activate sharps safety
mechanisms. Periodic data analysis may also identify unsafe
work practices that contribute to injuries. Injury trends as well
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