News

about healthcare worker safety, needlestick prevention & occupational exposure prevention

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Center news:

  • March 2012: Center releases Consensus Statement and Call to Action on Sharps Safety, endorsed by 20 healthcare and nursing organizations. Read the joint press release from the Center and the American Nurses Association.
  • November 2010: Center-sponsored national conference on Nov. 5-6, "Tenth Anniversary of the Needlestick Safety and Prevention Act: Mapping Progress, Charting a Future Path," features keynote address by John Howard, director of National Institute for Occupational Safety and Health. Conference program, video of keynote address, photos, and speaker presentations are available here.
  • September 2010: Center receives official designation as a World Health Organization (WHO) Collaborating Center for Occupational Health. More here. Information on Collaborating Centers in Occupational Health available here.
  • April 2010: Article in April issue of the Journal of the American College of Surgeons on sharps injuries in surgical settings, demonstrating disparity in impact of Needlestick Safety and Prevention Act on OR versus non-OR injury rates, receives extensive attention in medical press (read abstract here). BNA interviewed co-author Ramon Berguer about the JACS article -- read it here (go to p. 332).
  • January 2010:  Following the earthquake in Haiti last January, PAHO invited experts in occupational safety and health, including IHWSC staff members, to participate in a conference call on a "Haiti Emergency Deployment Kit"--essential items to provide to relief workers to protect them from occupational hazards such as bloodborne pathogen exposures. The Center's suggestions for the list of supplies being gathered for transport to Haiti included a variety of personal protective equipment, hepatitis B vaccine, and  safety devices.
  • Jane Perry interviewed in OR Manager article on "Blunting sharps injuries." More.
  • News archives here.

Center's quarterly newsletters:

U.S. & international news:

May 2012:

December 2010:

  • NIOSH seeks comment on proposed list of diseases that may pose bloodborne or airborne transmission risks for emergency responders. More.

November 2010:

October 2010:

  • European Biosafety Network publishes Implementation Guidance for the EU Framework Agreement, Council Directive and Associated National Legislation. More.

May 2010:

April 2010:

March 2010:

The European Council approves a directive on the prevention of sharp injuries in healthcare settings which will make use of safety devices a legal requirement in EU countries. Press:

February 2010:

  • In a 2/5/10 article and video report from Voice of America, Johns Hopkins surgeon Martin Makary discusses sharps injuy risk to medical students and surgeons-in-training, and recommends use of blunt suture needles. To read article, click here; to view video, scroll down page to the video box.
  • SHEA releases updated guidelines on management of infected healthcare workers. More.
  • News archives here .

Upcoming conferences:

  • Association of periOperative Registered Nurses (AORN) 58th Annual Congress.
    Philadelphia, PA; March 18-24, 2011. Information.

  • Society of Healthcare Epidemiologists of America (SHEA) 2011 Annual Scientific Meeting. Dallas, TX; April 1-4, 2011. Information.

  • American Association of Occupational Health Nurses (AAOHN) 2011 National Conference: Health and Safety of Workers at Home and Around the World. Atlanta, GA; April 29-May 5, 2011.  Information.

  • Association of Professionals in Infection Control and Epidemiology (APIC) Annual Conference. Baltimore, MD; June 27-29, 2011. Information.

  • First International Conference on Prevention and Infection Control (ICPIC). Geneva, Switzerland; June 29-July 2, 2011. Abstract submission deadline: March 4, 2011. Information.

  • Association of Occupational Health Professionals in Health Care (AOHP) Annual Meeting. Minneapolis, MN; September 14-17, 2011. Information.

  • National Occupational Injury Research Symposium (NOIRS) 2011. Morgantown, WV; October 18-20, 2011. Information.

  • Fifth International Congress of Asia Pacific Society of Infection Control (hosted by Victoria Infection Control Professionals Association). November 8-11, 2011; Melbourne, Australia. Information.

To add your conference, contact us here.

Publications

Center publications - recent:

  • Jagger J, Berguer R, Phillips EK, Parker G, Gomaa AE. Increase in sharps injuries in surgical settings versus non-surgical settings after passage of national needlestick legislation. Journal of the American College of Surgeons 2010 (April);210(4):496-502.
    ABSTRACT: The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings. Study design: We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members. Results: Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others. Conclusions: Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers.
  • Boal WL, Leiss JK, Ratcliffe JM, Sousa S, Lyden JT, Li J, Jagger J. The national study to prevent blood exposure in paramedics: rates of exposure to blood. Int Arch Occup Environ Health 2010 83:191-9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19437031?dopt=Abstract.
    OBJECTIVE: The purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers. METHODS: A survey on blood exposure was mailed in 2002-2003 to a national sample of paramedics. Results for California paramedics were analyzed with the national sample and also separately. RESULTS: The incidence rate for needlestick/lancet injuries was 100/1,000 employee-years [95% confidence interval (CI), 40-159] among the national sample and 26/1,000 employee-years (95% CI, 15-38) for the California sample. The highest exposure rate was for non-intact skin, 230/1,000 employee-years (95% CI, 130-329). The rate for all exposures was 465/1,000 employee-years (95% CI, 293-637). California needlestick/lancet rates, but not national, were substantially lower than rates in earlier studies of paramedics. Rates for all percutaneous injuries among paramedics were similar to the mid to high range of rates reported for most hospital-based healthcare workers. CONCLUSIONS: Paramedics in the United States are experiencing percutaneous injury rates at least as high as, and possibly substantially higher than, most hospital-based healthcare workers, as well as substantially higher rates of exposure to blood on non-intact skin.

  • Perry J. Safety scalpels and sutures have come a long way. Outpatient Surgery Magazine 2009 (May);10(5):48-51. Available at: http://www.outpatientsurgery.net/2009/05/safety_scalpels_and_sutures_have_come_a_long_way.php.

  • Perry J, Gomaa AE, Jagger J. Progress in preventing sharps injuries in the United States. Chapter in: Charney W, ed. Handbook of Modern Hospital Safety (2nd ed). CRC Press, Inc.;2009.
    Traces progress in preventing sharps injuries in the U.S., while also addressing some of the important issues and challenges associated with full implementation of the revised bloodborne pathogens standard.

  • Shiao JSC, McLaws ML, Lin MS, Jagger J, Chen CJ. Chinese EPINet and recall rates for percutaneous injuries: an epidemic proportion of underreporting in the Taiwan healthcare system. Journal of Occupational Health 2009;51(2):132-6. Available at:
    http://www.jstage.jst.go.jp/article/joh/51/2/51_132/_article.
    OBJECTIVE: As an occupational injury, percutaneous injury (PI) can result in chronic morbidity and death for healthcare workers (HCWs). A pilot surveillance system for PIs using the Chinese version of Exposure Prevention Information Network (EPINet) was introduced in Taiwan in 2003. We compared data from EPINet and recall of PIs using a cross-sectional survey for rates to establish the reliability of the new system. METHODS: HCWs from hospitals that had implemented EPINet for > or =12 months completed a survey for recall of contaminated PIs sustained between October 2004 and September 2005, type of item involved, and reasons for reporting or not reporting the PI. Comparative data from EPINet for the same period were analyzed. RESULTS: The EPINet rate, 36.1/1,000 HCW (95%CI 31.8-41.1) was almost 5 times lower (p<0.0001) than the PI recall rate for 2,464 HCWs of 170/1,000 HCWs (95%CI 155.4-185.5). Approximately 2.5 PIs were recalled for every 1,000 bed-days of care. The recall rate by physicians was 268.3/1,000, 188.5/1,000 for nurses, 88.9/1,000 for medical technologists and 81.3/1,000 for support staff. Hollow-bore needle items most commonly recorded on EPINet includ, disposable needles and syringes were underreported by 81%, vacuum tube holder/needles by 67%, and arterial blood gas needles by 75%. Nearly 63% of the reasons for underreporting were related to the complexity of the reporting process, while 37% were associated with incorrect knowledge about the risks associated with PIs. CONCLUSIONS: EPINet data underestimates a commonplace occupational injury with nearly four in five PIs not reported. Addressing the real barriers to reporting must begin with hospital administrators impressing on HCWs that reporting is essential for designing appropriate safety interventions.

  • De Carli G, Puro V, Jagger J. Needlestick-prevention devices: we should already be there [letter]. Journal of Hospital Infection 2009;71(2):183-4 (Epub 2008 Dec 4).
    Click here to view.
    Occupational exposure data from Italy's Studio Italiano Rischio Occupazionale da HIV (SIROH) group supports the efficacy of needlestick-prevention devices (NPDs) in reducing sharps injury risk to healthcare workers. Data from 16 hospitals (2003-2006) in which NPDs were implemented indicated that injury rates for NPDs were, on average, 80% lower than for conventional devices. During the same period, in hospitals that had not implemented NPDs 12 cases of occupational hepatitis C infection were reported, and one case of occupationally acquired HIV. Eleven of the 13 injuries that resulted in infection involved devices for which safety alternatives were available.

  • Jagger J, Perry J, Gomaa A, Phillips EK. The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: the critical role of safety-engineered devices. Journal of Infection and Public Health 2008 (Dec);1(2):62-71. Available at: http://www.sciencedirect.com/science/journal/18760341.
    In the United States (U.S.), federal legislation requiring the use of safety-engineered sharp devices, along with an array of other protective measures, has played a critical role in reducing healthcare workers' (HCWs) risk of occupational exposure to bloodborne pathogens over the last 20 years. We present the history of U.S. regulatory and legislative actions regarding occupational blood exposures, and review evidence of the impact of these actions. In one large network of U.S. hospitals using the Exposure Prevention Information Network (EPINet) sharps injury surveillance program, overall injury rates for hollow-bore needles declined by 34%, with a 51% decline for nurses. The U.S. experience demonstrates the effectiveness of safety-engineered devices in reducing sharps injuries, and the importance of national-level regulations (accompanied by active enforcement) in ensuring wide-scale availability and implementation of protective devices to decrease healthcareworker risk.

Other recent articles of interest:

  • Ongoing use of conventional devices and safety device activation rates in hospitals in Ontario, Canada. Authors: Stringer B, Haines T. In: Journal of Occupational and Environmental Hygiene 2011 Mar;8(3):154-60.
    ABSTRACT: This study assessed voluntary compliance with the use of sharp safety devices in lieu of conventional ones and the activation status of these safety devices: VanishPoint syringes, Terumo Surshield butterflies, and Insyte Autoguard IV catheters. Sharps disposal containers from various wards in three private, not-for profit, university-affiliated Ontario hospitals were audited during 9 days in August 2007. In the 149 audited sharps containers, 55% of all syringes found were conventional compared with 45% that were safety syringes. In the three hospitals, the percentages of conventional (non-safety) vs. safety syringes found in used sharps containers were as follows, respectively: (i) 72% conventional and 28% safety, (ii) 55% conventional and 45% safety, and (iii) 65% conventional and 35% safety. In addition, it was found that 77% of 2131 Terumo butterflies, 97% of 1117 Insyte Autoguard IV catheters, and 87% of 4897 VanishPoint syringes in the containers had been activated. This study, carried out approximately 1 year before it was legally required to use safety instead of sharp conventional devices, found that most devices in use were conventional ones. It was also found that only the activation rate for the safety IV device was acceptable. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file containing tables outlining safety syringes and conventional syringes by ward and hospital and hospital-wide and ward activation rates by category of device.].

  • The EPINet data of four Indian hospitals on incidence of exposure of healthcare workers to blood and body fluid: a multicentric prospective analysis. Authors: Chakravarthy M, Singh S, Arora A, Sengupta S, Munshi N. In: Indian Journal of Medical Science 2010 (Dec);64(12):540-48.
    BACKGROUND: Sharps injury (SI) and blood and body fluid exposure are occupational hazards to healthcare workers (HCWs). Although data from the developed countries have shown the enormity of the problem, data from developing countries, such as India, arelacking. Purpose : The purpose of this study was to cumulate data from fourmajor hospitals in India and analyze the incidence of SI and blood and body fluid exposure in HCWs. MATERIALS AND METHODS: Four Indian hospitals (hospital A, B, C and D) from major cities of India participated in this multicentric study. Data ranging from 6 to 26 months were collected from these hospitals using Exposure Prevention Information network (EPINet) which is the database created by International Healthcare Worker Safety Research and Resource Center, University of Virginia. RESULTS: Two hundred and forty-three sharp injuries and 22 incidents of blood or body fluid exposure were encountered in the cumulated 50 months of our study. The incidence of SIswas thehighestamong nurses (55%) of allthe HCWs, akin to the global data. An injury rate of nearly 20% among housekeeping staff seems to be specific to the Indian data. Patient's room followed by operation theater appeared to be common locations of injury in our study. The source of the injury was identified in majority (64%) of the injuries. A major part of the group was not the primary users of the sharp (38%). Disposable needles caused nearly half of the injuries. Suture needles contributed to a reasonable number of injuries in one of the hospitals. CONCLUSIONS: The incidence of SI is the highest among nurses and the housekeeping staff (>30% each). A substantial number of injuries are avoidable.

  • Core components for infection prevention and control programs: a World Health Organization network report. Authors: Seto WH, Otaíza F, Pessoa-Silva CL; World Health Organization Infection Prevention and Control Network. Published in: Infection Control and Hospital Epidemiology, 2010 Sep;31(9):948-50.
    Summary: Under the leadership of the World Health Organization (WHO), the core components necessary for national and local infection prevention and control programs are identified. These components were determined by a network of international experts who are representatives from WHO regional offices and relevant WHO programs. The respective roles of the national authorities and the local healthcare facilities are delineated.

  • Needlestick injury rates according to different types of safety-engineered devices: results of a French multicenter study. Authors: Tosini W, Ciotti C, Goyer F, Lolom I, L'Hériteau F, Abiteboul D, Pellissier G, Bouvet E. Published in: Infection Control and Hospital Epidemiology, 2010;31(April):402-7.)
    Summary: To evaluate the incidence of needlestick injuries (NSIs) among different models of safety-engineered devices (SEDs) (automatic, semiautomatic, and manually activated safety) in healthcare settings. DESIGN: This multicenter survey, conducted from January 2005 through December 2006, examined all prospectively documented SED-related NSIs reported by healthcare workers to their occupational medicine departments. Participating hospitals were asked retrospectively to report the types, brands, and number of SEDs purchased, in order to estimate SED-specific rates of NSI. Setting. Sixty-one hospitals in France. RESULTS: More than 22 million SEDs were purchased during the study period, and a total of 453 SED-related NSIs were documented. The mean overall frequency of NSIs was 2.05 injuries per 100,000 SEDs purchased. Device-specific NSI rates were compared using Poisson approximation. The 95% confidence interval was used to define statistical significance. Passive (fully automatic) devices were associated with the lowest NSI incidence rate. Among active devices, those with a semiautomatic safety feature were significantly more effective than those with a manually activated toppling shield, which in turn were significantly more effective than those with a manually activated sliding shield (P < .001, chi(2) test). The same gradient of SED efficacy was observed when the type of healthcare procedure was taken into account. CONCLUSIONS: Passive SEDs are most effective for NSI prevention. Further studies are needed to determine whether their higher cost may be offset by savings related to fewer NSIs and to a reduced need for user training.

  • Occupational injury history and universal precautions awareness: a survey in Kabul hospital staff.
    Authors: Salehi AS, Garner P. Published in: BMC Infectious Diseases 2010; 10:19 doi:10.1186/1471-2334-10-19.
    Summary: Health staff in Afghanistan may be at high risk of needle stick injury and occupational infection with blood borne pathogens, but we have not found any published or unpublished data. Methods: Our aim was to measure the percentage of healthcare staff reporting sharps injuries in the preceding 12 months, and to explore what they knew about universal precautions. In five randomly selected government hospitals in Kabul a total of 950 staff participated in the study. Data were analyzed with Epi Info 3. Results: Seventy three percent of staff (72.6%, 491/676) reported sharps injury in the preceding 12 months, with remarkably similar levels between hospitals and staff cadres in the 676 (71.1%) people responding. Most at risk were gynaecologist/obstetricians (96.1%) followed by surgeons (91.1%), nurses (80.2%), dentists (75.4%), midwives (62.0%), technicians (50.0%), and internist/paediatricians (47.5%). Of the injuries reported, the commonest were from hollow-bore needles (46.3 %, n=361/780), usually during recapping. Almost a quarter (27.9%) of respondents had not been vaccinated against hepatitis B. Basic knowledge about universal precautions were found insufficient across all hospitals and cadres. Conclusion: Occupational health policies for universal precautions need to be implemented in Afghani hospitals. Staff vaccination against hepatitis B is recommended.
  • Needlestick injury rates according to different types of safety-engineered devices: results of a French multicenter study. Authors: Tosini W, Ciotti C, Goyer F, Lolom I, L'Hériteau F, Abiteboul D, Pellissier G, Bouvet E. Published in: Infection Control and Hospital Epidemiology, 2010;31(April):402-7.)
    Summary: To evaluate the incidence of needlestick injuries (NSIs) among different models of safety-engineered devices (SEDs) (automatic, semiautomatic, and manually activated safety) in healthcare settings. DESIGN: This multicenter survey, conducted from January 2005 through December 2006, examined all prospectively documented SED-related NSIs reported by healthcare workers to their occupational medicine departments. Participating hospitals were asked retrospectively to report the types, brands, and number of SEDs purchased, in order to estimate SED-specific rates of NSI. Setting. Sixty-one hospitals in France. RESULTS: More than 22 million SEDs were purchased during the study period, and a total of 453 SED-related NSIs were documented. The mean overall frequency of NSIs was 2.05 injuries per 100,000 SEDs purchased. Device-specific NSI rates were compared using Poisson approximation. The 95% confidence interval was used to define statistical significance. Passive (fully automatic) devices were associated with the lowest NSI incidence rate. Among active devices, those with a semiautomatic safety feature were significantly more effective than those with a manually activated toppling shield, which in turn were significantly more effective than those with a manually activated sliding shield (P < .001, chi(2) test). The same gradient of SED efficacy was observed when the type of healthcare procedure was taken into account. CONCLUSIONS: Passive SEDs are most effective for NSI prevention. Further studies are needed to determine whether their higher cost may be offset by savings related to fewer NSIs and to a reduced need for user training.

  • Occupational injury history and universal precautions awareness: a survey in Kabul hospital staff.
    Authors: Salehi AS, Garner P. Published in: BMC Infectious Diseases 2010; 10:19 doi:10.1186/1471-2334-10-19.
    Summary: Health staff in Afghanistan may be at high risk of needle stick injury and occupational infection with blood borne pathogens, but we have not found any published or unpublished data. Methods: Our aim was to measure the percentage of healthcare staff reporting sharps injuries in the preceding 12 months, and to explore what they knew about universal precautions. In five randomly selected government hospitals in Kabul a total of 950 staff participated in the study. Data were analyzed with Epi Info 3. Results: Seventy three percent of staff (72.6%, 491/676) reported sharps injury in the preceding 12 months, with remarkably similar levels between hospitals and staff cadres in the 676 (71.1%) people responding. Most at risk were gynaecologist/obstetricians (96.1%) followed by surgeons (91.1%), nurses (80.2%), dentists (75.4%), midwives (62.0%), technicians (50.0%), and internist/paediatricians (47.5%). Of the injuries reported, the commonest were from hollow-bore needles (46.3 %, n=361/780), usually during recapping. Almost a quarter (27.9%) of respondents had not been vaccinated against hepatitis B. Basic knowledge about universal precautions were found insufficient across all hospitals and cadres. Conclusion: Occupational health policies for universal precautions need to be implemented in Afghani hospitals. Staff vaccination against hepatitis B is recommended.
EPINet data for 2010 and 2011
Consensus Statement and Call to Action on Sharps Safety released March 2012