Course 181 Healthcare: Sharps Safety

Safety guides and audits to make your job as a safety professional easier

Sharps and Container Safety

Needlestick Safety and Prevention Act (2000)

Recent changes in federal legislation have helped prevent sharps injuries in healthcare facilities. Congress passed the federal Needlestick Safety and Prevention Act in 2000. This legislation mandated the revision of the 1991 Bloodborne Pathogens Standard to require engineered sharps injury prevention devices whenever possible. The Act also requires employers to maintain a Sharps Injury Log that records the type and brand of device involved in an incident, the work area where the injury occurred, and an explanation for how the injury happened. Employers must also develop a written Exposure Control Plan.

Exposure Control Plan

Exposure Control Plan
A written ECP outlines the strategies necessary to eliminate or minimize employee occupational exposure to bloodborne pathogens.

A healthcare worker's risk of infection following a needlestick exposure depends on the pathogen involved, the worker's immune status, the severity of the needlestick injury, and the availability and use of appropriate post-exposure prophylaxis. An employer exposure control plan (ECP) is a requirement of 29 CFR 1910.1030(c) of the Bloodborne Pathogens Standard established by the Occupational Safety and Health Administration (OSHA). The purpose of the ECP is to establish procedures to eliminate or minimize employee exposure to bloodborne pathogens.

A written ECP outlines the strategies necessary to eliminate or minimize employee occupational exposure to bloodborne pathogens. This site-specific plan identifies all employee classifications with occupational exposure to bloodborne pathogens and other potentially infectious materials. Additional components of an ECP include engineering and work practice controls, personal protective equipment, housekeeping, and containment and labeling of potentially infectious materials.

The written ECP must be accessible to all employees. It must be reviewed and updated annually or when alterations in procedures create the possibility of new occupational exposures. Additionally, non-managerial employees who provide direct patient care must be asked to provide input in identifying, evaluating, and selecting effective controls to isolate or remove bloodborne pathogens from the workplace.

An employer's ECP must identify all specific procedures an employee performs which may expose them to bloodborne pathogens.

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1. According to the Needlestick Safety and Prevention Act, management must evaluate an exposure control plan _____.

a. daily
b. weekly
c. monthly
d. annually

Case Reports

The following case report describes the experience of two health care workers who developed severe infections after occupational exposures to bloodborne pathogens. This case illustrates several preventable hazardous conditions and practices that can lead to needlestick injuries.

A hospitalized patient with AIDS became agitated and tried to remove the intravenous (IV) catheters in his arm. Several hospital staff members struggled to restrain the patient. An IV infusion line was pulled during the struggle, exposing the connector needle inserted into the IV catheter's access port. A nurse at the scene recovered the connector needle at the end of the IV line. She tried to reinsert it when the patient kicked her arm, pushing the needle into the hand of a second nurse. The nurse who sustained the needlestick injury tested negative for HIV that day. However, the injured nurse tested HIV positive several months later.

Sharps Injuries
Sharps injuries can occur anywhere within the medical environment.

Although sharp devices can cause injuries anywhere within the healthcare environment, most (40%) occur in inpatient units, such as medical floors, intensive care units, and operating rooms. Sharp-related injuries generally occur after use and before disposal of the sharp device (41%), while the sharp device is being used on a patient (39%), and during or after removal (16%).

Preventing Injuries

Be Prepared

  • Organize your work area with appropriate sharps disposal containers within reach.
  • Work in well-lit areas.
  • Receive training on how to use sharps safety devices.
  • Before handling sharps, assess any hazards – get help if needed.

Be Aware

  • Keep the exposed sharp in view.
  • Be aware of the people around you.
  • Stop if you feel rushed or distracted.
  • Focus on your task.
  • Avoid hand-passing sharps and use verbal alerts when moving sharps.
  • Watch for sharps in linen, beds, on the floor, or in waste containers.

Dispose of Sharps with Care

  • Be responsible for the device you use.
  • Activate safety features after use.
  • Dispose of devices in rigid sharps containers; do not overfill containers.
  • Keep fingers away from the opening of sharps containers.

It is essential to report all sharps injuries and all sharp hazards you observe to your employer. You may help prevent someone else from being injured.

2. Where do most sharps injuries occur in a healthcare setting?

a. Inpatient units
b. Outpatient clinics
c. Doctors office
d. Emergency room

Activities Associated with Injuries

Sharps injuries can happen before, during, or after the use of a sharp. The following are some examples of high-risk activities in a healthcare setting.

During patient care:

  • inserting or withdrawing a needle
  • inserting needles into IV lines
  • handling or passing sharps

Immediately after sharp use:

Sharps Injuries
In hospitals, 80% of sharps injuries are due to the use of these instruments.
  • recapping a used needle
  • transferring or processing specimens
  • during and after sharp disposal
  • disposing of sharps into proper containers
  • cleaning up after a procedure
  • sharps left on floors and tables or found in linen, beds, or waste containers

In hospitals, 80% (4 in 5) of sharps injuries are due to the use of:

  • hypodermic needles/syringes (32%)
  • suture needles (19%)
  • winged-steel (butterfly-type) needles (12%)
  • blood collection needles (3%)
  • scalpels (7%)
  • IV stylets 6%

3. Accidental exposure to sharps injuries happens _____.

a. when unwrapping a packaged needle
b. when a patient stabs you
c. when using a needle for your personal use
d. when recapping a used needle

Sharps Safety Devices

sharps safety devices
There are many different types of safety devices to protect yourself from a potential needlestick injury, including a sharps disposal container.
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You can use many different types of sharps safety devices to protect yourself. Here are a few options:

  • needle-free IV systems
  • sheathed, blunting, or retractable needles
  • blood transfer adapters
  • non-breakable plastic vacuum and capillary tubes
  • sharps disposal containers

Employers are required to involve frontline workers in selecting devices with safety features. It is important to choose devices that:

  • come attached with safety features that cannot be removed
  • are easy to use and have clear instructions
  • do not interfere with patient care
  • can be engaged with one hand
  • enable hands to remain behind the exposed sharp
  • are visibly different when activated

4. Employers need to choose safety devices that ______.

a. interfere with patient care
b. need two hands to work properly
c. are easy to use and have clear instructions
d. come attached with safety features that can be removed

OSHA Requirements

OSHA recommends implementing work practice and engineering controls to help prevent exposure to sharps.
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It is necessary to implement work practice and engineering controls to help prevent exposure to sharps. OSHA requires sharps must be appropriately disposed of immediately or as soon as feasible into the appropriate containers. [29 CFR 1910.1030(d)(4)(iii)(A)(1)]

Handling Sharps Containers

Disposal of Sharps Containers

Employees should be trained in the proper handling and disposal of sharps and containers. When moving containers of contaminated sharps from an area of use, the containers shall be:

  • Closed immediately before removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping.
  • Placed in a secondary container, if leakage is possible. The secondary container must meet the requirements of 29 CFR 1910.1030(d)(4)(A)(3)(ii).
  • Disposed of in accordance with EPA, state, territorial, and local regulations [29 CFR 1910.1030(d)(4)(iii)(C)].

Reusable Sharps Containers

  • Reusable sharps containers must not be opened, emptied, or cleaned manually or in any other manner that would expose employees to the risk of percutaneous injury.
  • Employers must maintain a log of injuries from contaminated sharps. [29 CFR 1910.1030(h)(5)(i)].

5. When should sharps be appropriately disposed of into the appropriate containers?

a. Immediately
b. At the end of the work shift
c. Before a new work crew starts their shift
d. When it is convenient

Cost of Needlestick Injuries

The risks and costs associated with blood exposure are serious and real in a healthcare setting. Direct costs associated with exposure include the initial and follow-up treatment of exposed healthcare personnel. These can range from $500 to $3,000, depending on the treatment provided. Indirect costs include lost employee productivity and healthcare provider time to evaluate and treat the employee and evaluate and test the exposure source.

Costs that are harder to quantify include the emotional toll associated with fear and anxiety from worrying about the possible consequences of exposure and the cost of any associated litigation.

Hierarchy of Controls

hierarchy of controls
NIOSH recommends that employers use the hierarchy of controls to prevent sharps injuries.
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The National Institute for Occupational Safety and Health (NIOSH) recommends that employers use the hierarchy of controls to prevent sharps injuries. When applying the hierarchy of controls, employers must select the most effective control strategy or method to eliminate or reduce exposure to the hazard. In healthcare, engineering, work practice, and PPE controls are generally the most widely used methods to protect employees from exposure.

Elimination and Substitution

While most effective at eliminating or reducing hazards, the elimination and substitution methods can be challenging to implement. These control methods are designed to eliminate a hazard by removing exposure entirely or substituting less hazardous materials. In the healthcare setting, it may not be possible to eliminate exposure to a hazard. Similarly, it may not be possible to substitute a less hazardous material to achieve the same objective. Despite these hurdles, the elimination and substitution methods should be considered when evaluating how to reduce exposure to hazards.

6. When applying the hierarchy of controls, what must employers select?

a. The most expensive control strategy
b. The most effective control strategy
c. The least expensive control strategy
d. Whichever control strategy they prefer

Engineering Controls

Engineering controls focus on eliminating or reducing the actual source of the hazard. The basic concept behind engineering controls is that the work environment and the job itself should be designed to eliminate or minimize risks. Engineering controls are measures that isolate or remove the workplace's hazard.

Examples of engineering controls include:

  • sharps disposal containers
  • self-sheathing needles
  • safer medical devices, such as sharps injury protections and needleless systems

Sharps Disposal Container

Sharps disposal containers are considered an engineering control for sharps injury prevention. These come in various sizes, shapes, and options and should be selected based on the need in each area. Location is key to success, and research shows the closer the container is to the point of use, the lower risk for sharps injuries. Although these containers effectively prevent sharps penetration through the sidewall, overfilling them can provide injury opportunities and, therefore, should be avoided.

safer medical devices
There are many different types of safer medical devices to help prevent sharps injuries.

Self-sheathing Needles

These safer needle devices allow a sleeve to slide forward over the needle, locking the guard in place and providing a mechanical barrier around the used needle.

Safer Medical Devices

There are many types of safer medical devices. Some examples of these safety devices include:

  • Needleless connector systems
  • Retractable needles and sharps
  • Self-blunting needles
  • Hinged or sliding shields

7. Why is the sharps disposal container location important?

a. the closer the container, the lower the risk for sharps injuries
b. more sharps can be stuffed into the container
c. location is not important since staff should use the sharps container regardless
d. a closer container means other safety devices don’t need to be used

Work Practice Controls

Substitute endoscopic surgery for open surgery when possible.
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Work practice controls reduce the likelihood of exposure by altering how a task is performed. The recapping of needles using a one-handed technique is an example of a work practice control. Similarly, passing a needle or other sharps device indirectly to another person would be another example of a work practice control.

Operating room work practice controls should include:

  • Use instruments, rather than fingers, to grasp needles, retract tissue, and load/unload needles and scalpels.
  • Give verbal announcements when passing sharps.
  • Avoid hand-to-hand passage of sharp instruments by using a basin or neutral zone.
  • Use alternative cutting methods such as blunt electrocautery and laser devices when appropriate.
  • Substitute endoscopic surgery for open surgery when possible.
  • Use round-tipped scalpel blades instead of sharp-tipped blades.

Administrative Controls

Administrative controls are policies established and frequently used with existing processes where hazards are not particularly well controlled. Administrative control programs may be relatively inexpensive to establish but, over the long term, can be very costly to sustain. These methods for protecting workers have also proven to be less effective than other measures, requiring consistent employee adherence and management monitoring.

Policies that prohibit hazardous sharps handling activities should be implemented and required. Examples of hazardous sharps activities include:

  • bending needles
  • removing contaminated needles
  • breaking or shearing contaminated sharps

8. _____ are measures that reduce the likelihood of exposure by changing how a task is performed.

a. Substitution
b. Work practice controls
c. Hazard assessment
d. Engineering controls

Employer Recommendations

Employers can reduce the risk of needlestick injuries by providing needles with safety features.
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To protect healthcare workers from needlestick injuries, employers must provide a safe working environment that includes safer needle devices and effective safety programs. It is necessary to train healthcare workers in the safe use and disposal of needles and sharps.

As we have already discussed, many types of needle devices are associated with needlestick injuries. These injuries can occur in many ways. Therefore, employers must consider a combination of prevention strategies. Employers should take the following steps to implement a program to reduce needlestick injuries and involve workers in this effort.

Employers should implement the use of improved engineering controls to reduce needlestick injuries. For example:

  • Eliminate the use of needle devices where safe and effective alternatives are available.
  • Implement needle devices with safety features and evaluate their use to figure out which are most effective and acceptable.

Employers must also modify work practices that pose a needlestick injury hazard to make them safer. They can help eliminate dangers by changing work practices, which include the following:

  • injuries due to recapping
  • failing to dispose of a needle device properly
  • directly passing or transferring such a device
  • transferring blood or body fluids from a device into a specimen container

9. To protect healthcare workers from needlestick injuries, _____ must provide a safe working environment.

a. patients
b. co-workers
c. family members
d. employers

Worker Recommendations

Dispose of used needle devices promptly in appropriate sharps disposal containers.
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To protect themselves and their co-workers, healthcare workers should be aware of the hazards posed by needlestick injuries. They should use safety devices and improved work practices as follows:

  1. Avoid the use of needles where safe and effective alternatives are available.
  2. Help your employer select and evaluate devices with safety features.
  3. Use devices with safety features provided by your employer.
  4. Avoid recapping needles.
  5. Plan safe handling and disposal before beginning any procedure using needles.
  6. Dispose of used needle devices promptly in appropriate sharps disposal containers.
  7. Report all needlestick and other sharps-related injuries promptly to ensure that you receive appropriate follow-up care.
  8. Tell your employer about hazards from needles that you observe in your work environment.
  9. Participate in bloodborne pathogen training and follow recommended infection prevention practices, including hepatitis B vaccination.

10. When should you plan for safe handling and disposal when using needles?

a. Before beginning procedure
b. At the end of the procedure
c. During the procedure
d. At the end of the work shift

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