Amber Hogan Mitchell, DrPH, MPH, CPH, Sharps Injuries in 2020

Sharps Injuries in 2020; The Year to Learn from the Past, Draw from the Present, and Improve the Future of Worker Safety in Healthcare

Amber Hogan Mitchell, DrPH, MPH, CPH

November marks 20 years since the passage of the Needlestick Safety and Prevention Act (NSPA).  The Act required the Occupational Safety and Health Administration (OSHA) to update its 1991 Bloodborne Pathogens Standard to include new protections for workers facing exposures to blood, body fluids, and other potentially infectious materials.

At the time, advocates for worker health and safety and preventing sharps injuries and needlesticks were so aligned that champions from multiple disciplines and backgrounds came together seamlessly to fight for stricter policies that addressed safer conditions in healthcare.  The Act was passed unanimously by Congress November 6, 2020.  Clinicians affected by injuries, worker safety and health advocates, manufacturers, unions, law makers, and regulators came together to improve the coverage the standard offered to workers.

At a high level, this meant inclusion of more specific requirements for:

  • The evaluation and use of engineering controls, including safer medical devices like needleless systems and “sharps with engineered sharps injury protections” (devices with sharps injury prevention features).
  • The inclusion of frontline non-managerial employees in the identification, evaluation, and selection of engineering controls and work practices.
  • Establishing and maintaining a Sharps Injury Log (beyond what is required by the OSHA Recordkeeping Rule).

On a more facility-specific level, this meant then and still means now that employers – despite being faced with competing safety and quality initiatives - do not lose sight of identifying where injuries are occurring, during what procedures, and with what devices or practices.  This includes using the Sharps Injury Log as an evergreen tool to direct campaigns and controls that prevent future injuries and learn from past ones.

Over the 20 years when incident data is compared at the facility-level to the national or regional levels, data tracks true to bigger surveillance systems that collect and report sharps injuries to the public, including the Exposure Prevention Information Network (EPINet®) from the International Safety Center and the Sharps Injury Surveillance System (SISS) from the Massachusetts Department of Public Health (MA DPH).  As a nation, we saw great strides for decreasing incidence of injuries from blood collection devices, IV catheters, and lancets.  Technologies got better, safer, and more intuitive and the tide changed for the benefit of exposure prevention.

Today, however, reported incidents of injuries from hypodermic syringes, suture needles, and scalpel blades continue to be unacceptably high.  In fact, according to both EPINet and MA SISS, these three device categories represent the highest numbers of injuries compared to all other device types in recent reporting years.  They remain the devices that need greater attention relative to identifying and selecting better, safer alternatives and effective work practice controls like “safety” feature activation, no hands passing, and safe disposal.

Top 5 Sharps Injury Device Types

%   Injuries   
Hypodermic Syringe/Needle   
Suture Needle   
Scalpel Blade (disposable or reusable)   
Blood Collection: Winged Steel or   Vacuum Tube    
IV Catheter Stylet/Line Procedures+   

*MA DPH SISS reports data through 2018, EPINet reports data through 2019, but to stay consistent in reporting years, 2018 was used.

+MA DPH SISS does not list “IV access” or “IV catheters” per EPINet, but does list “line procedures”, so these were compared.

Key Questions Looking Forward

In 2021, will we see percentages ofdevice types change because of the pandemic? If we don’t manage the delivery of SARS-CoV-2 vaccines using deviceswith sharps injury prevention features will we see a drastic increase ofinjuries from hypodermic needles?

How might these reported incidentschange in a pandemic age where there is more focus on keeping adequate stock ofpersonal protective equipment like respirators and less on engineering controlsfor sharps injury prevention?  

Given overcrowding and carefulmanagement of capacity avaailable for patients suffering with COVID-19 or fluand protecting workers from airborne infectious disease, might focus onpreventing exposures to bloodborne pathogens falter?

Given more focus than ever onworker health and safety in healthcare due to the global pandemic are we atcontinued risk of compromising worker safety for patient safety or will thetide change?  Will we continue tosacrifice, overwork, and under-resource our healthcare workforce or will thepandemic improve conditions?

2020 Reflection

Yes, it has been 20 years since the passage of the NSPA and we celebrate that momentous occasion and yes, we are working through a global pandemic and we hope to see the light at the end of the tunnel in the coming months.  2020 has been wrought with ups and downs, challenges and opportunities, successes and failures and we must use what we have learned to make healthcare better and safer for those who work in it and those who access it.

Focus on COVID must not mean that we lose focus on sharps injuries that we can see and know how to prevent.  Focus on PPE to prevent infectious disease exposures must not mean that we ignore what we know about the industrial hygiene hierarchy of controls and lose focus on the effectiveness of engineering controls and safe work practices. These include not only the use of devices with sharps injury prevention features like retracting needles and blades and suture-alternatives for skin closure, but safety feature activation, and responsible and safe disposal.  This also includes shining a light on facilities, advocates, and manufacturers that get it right, work together, stay the course, and collaborate on developing and using the best devices to ensure the highest quality outcomes for workers and patients alike.

Amber Hogan Mitchell, DrPH, MPH, CPH

Dr. Mitchell's career has been focused on public health and occupational safety and health related to preventing infectious disease. She is currently President and Executive Director of the International Safety Center and is the Immediate Past Chair of the Occupational Health and Safety section of the American Public Health Association (APHA). She is also a Senior Science Adviser for the NIEHS Worker Training Program for COVID-19 response. Dr. Mitchell holds an adjunct faculty position at the University of Maryland School of Medicine Department of Environmental and Occupational Medicine.

Dr. Mitchell began her career as the first OSHA National Blood borne Pathogens Coordinator and has received several Secretary of Labor Excellence awards for her work on bioterrorism and public preparedness. She holds a Doctor of Public Health (DrPH) degree from the University of Texas School of Public Health and a Master’s in Public Health from The George Washington University. She is certified in Public Health as a member of the very first CPH cohort offered by the National Board of Public Health Examiners. She has a new book available now called Preventing Occupational Exposure to Infectious Disease in Health Care: A Practical Guide.

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