AmericanNurseToday.com February 2017 American Nurse Today 23

NEEDLESTICKS and other sharps-related expo-sures to bloodborne pathogens (including HIV,hepatitis B virus [HBV] and hepatitis C virus)continue to pose a significant occupational riskfor healthcare workers. Largely preventable,these injuries are all-too-common events thatcreate a significant burden for exposed workers,even if they don’t lead to infection. Over the last few decades, regulatory and

legislative measures have been enacted to pro-tect U.S. healthcare workers from bloodbornepathogens, including the Bloodborne PathogenStandard, which established requirements forengineering controls, HBV vaccination, and useof personal protective equipment. In 2000, Con-gress unanimously passed the Needlestick Safe-ty and Prevention Act (NSPA), which updatedthe Bloodborne Pathogen Standard andstrengthened federal requirements for the useof sharps with engineered sharps injury protec-tion (SESIP). Between 2002 and 2007, we saw measurable

progress in injury reduction linked to conversionto SESIPs. But since 2010, previously declininginjury rates have consistently leveled off. Ongo-ing national injury surveillance ended in 2007,so we can’t identify nationwide trends or deter-mine what factors might be contributing to thisleveling off.

What we know about the current state ofsharps injuriesHealthcare workers continue to bear the burdenof potentially life-changing sharps-related expo-sures. To reduce preventable injuries, nurses

and other healthcare workers need to take ac-tion based on what we know about the currentstate of these injuries. We know nurses and physicians are the most

frequently affected healthcare workers, becausethey use sharps more often than others. Thehighest proportion of sharps injuries occurs inoperating rooms, followed by inpatient units.Hollow-bore needles and syringes used for in-jection account for the greatest number of in-juries. Suture needles consistently rank second. We also know that up to one-third of sharps

injuries occur between the time the sharp isused and when it’s disposed of—even thougheffectively designed and fully activated SESIPsshould virtually eliminate exposure risk. Efficacy of a particular SESIP is measured by

ease of use, level of training needed, and de-vice dependability and acceptance. Unfortu-nately, some users don’t activate SESIP safetyfeatures. In one study, researchers concludedthat nonactivated SESIPs posed as much dan-ger as conventional devices. An unacceptablyhigh proportion of injuries continues to occurwith devices lacking SESIP features, despitedecades-long availability of appropriate alterna-tives designed to improve safety.

Injury-prevention strategiesWhile SESIPs remain a primary line of defensefor preventing sharps injuries, the most effectiveprevention programs involve a comprehensiveapproach that includes:• annual evaluation of the effectiveness of vari-ous SESIPs

Sharps injuries: Where we stand today We can’t afford to be complacentabout sharps safety.By Karen A. Daley, PhD, RN, FAAN

24 American Nurse Today Volume 12, Number 2 AmericanNurseToday.com

• proper training• engaging direct users in device evaluationand selection

• implementing evidence-based work controlpractices

• conducting ongoing real-time root-causeanalysis of injuries whenever they occur.

Embrace sharps safety and injurypreventionBoth experts and clinical staff continue to iden-tify sharps injuries as ongoing threats to worker

health and safety. We can’t afford to be compla-cent about sharps safety. All of us need to stayvigilant in our efforts to keep ourselves and ourpatients safe. s

Karen Daley is a past president of the AmericanNurses Association and a nationally recognizedleader and advocate for sharps injury prevention.Visit AmericanNurseToday.com/?p=24734 for a list of selected references.

Sponsored by an unrestricted educational grant from CM&F Group, Inc.

What you can do to preventsharps injuriesUse these strategies to help prevent sharps injuries.

4Get involved in evaluating and selectingsharps devices. The law mandates that asdirect users, nurses must have an opportunity to be involved in evaluating and selectingSESIPs, to help ensure the most appropriateand effective devices are integrated into patient-care settings.

4 Implement effective work control practices.Best practices for injury prevention includetotal elimination of sharps recapping andhand-to-hand passing of contaminated sharpsin procedure or operating rooms.

4Make sure to get training on new SESIPs.As a rule of thumb, if a device requires hoursof training, it’s not a good device. The mosteffective devices are easy and intuitive to use.

4 Eliminate conventional devices where SESIPsare available and appropriate. Injuries fromusing devices without SESIP features wheresafer alternatives exist are still unacceptablyhigh.

4 Fully activate SESIP features. Failure to fullyactivate safety features increases your injuryrisk.

4 Report all injuries. If you sustain a sharpsinjury, don’t conduct your own risk assessment.Not only could self-assessment deprive you ofneeded care, but it could also contribute tounderestimation of injury rates in your caresetting. We can’t learn from sharps injuries thataren’t acknowledged.

Sharps injuries: Facts and figures

Why preventable sharps-related blood exposuresoccur:

• failure to convert to sharps with engineered sharpsinjury protection (SESIPs) where appropriate

• poorly designed SESIPs• inadequate training• rushed care• staff shortages• unanticipated patient movement• failure to properly activate SESIP features• improper disposal of contaminated sharps• failure to adopt evidence-based work controlpractices, such as avoiding hand-to-hand pass-ing of contaminated sharps in operating rooms.

* This estimate doesn’t take into account injuries in nonhospital set-tings, where as many as 40% of U.S. registered nurses work.

Source: Centers for Disease Control and Prevention

385,000 Estimated number of hospital- based worker exposures each year*

50% Estimated percentage of sharps injuries that go unreported

Estimated direct cost of each sharps injury

64% Percentage of sharps-related blood exposures that are preventable

$500 to $5,000