Increase in Sharps Injuries in Surgical Settings Versus Nonsurgical Settings after Passage of National Needlestick Legislation

Journal of the American College of Surgeons (Impact Factor: 5.12). 04/2010; 210(4):496-502. DOI: 10.1016/j.jamcollsurg.2009.12.018


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.

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.

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.

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Available from: Janine Jagger, May 09, 2014
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    • "Contract staff suffering sharps injury may be required to report incidents through their own management structures, under-representing the incidence of trust-wide disposal errors and injury unless coordinated universal reporting is enshrined within contract terms. Engineered sharps safety devices, introduced under the European Union Council Directive 2010/32/EU, are delivering substantial reduction in sharps injuries among sharps users (Elder and Paterson, 2006; Jagger et al, 2010), but disposal-related errors may be largely unchanged. Under this directive, obligations fall upon employers to develop policies and procedures for safe sharps use and disposal, to implement effective training and audit, to investigate sharps incidents and, where appropriate, to implement necessary corrective actions. "
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    ABSTRACT: Engineered sharps safety devices have delivered a substantial reduction in sharps injuries to healthcare professionals but disposal-related errors and subsequent injury to ancillary and support staff have remained largely unchanged. Obligations placed on employers by existing health and safety legislation, and more recently by the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, are welcome developments for healthcare professionals though the protection for subcontracted support staff and agency workers may be less than adequate. Outsourcing ancillary services creates unforeseen problems. Remarkably, the sharps injury rate for support staff, when measured against employment statistics, greatly exceeds that for frontline healthcare professionals. Though the business model of outsourced NHS support services has been successful, subcontracted hourly paid, sessional and casual support workers will receive neither sharps safety training nor the support of an effective occupational health service. Working dice-by-side with a trust staff, and at risk of being stuck by the same needles, this creates a two-tier system for sharps incident management, investigation and follow-up, that may be difficult to defend. A common programme of tailored sharps safety training, incident reporting, and investigation, and shared access to the specialist urgent care facilities necessary in the event of sharps injury, will ensure that both trusts and their subcontractors can address their obligations to sharps safety for all of those working in their hospitals, in full compliance with the requirements of The Sharps Directive and more general health and safety legislation.
    Full-text · Article · Sep 2014 · British Journal of Health Care Management
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    • "Regulatory requirements to adopt the use of SEMDs have a primary objective to reduce the incidence of needlestick injuries among healthcare workers and the majority of studies that have examined safer needle regulation have focused on the prevention of needlestick injuries [10-12]. One consistent finding is that injuries associated with conventional sharps and SEMDs continue to occur. "
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    ABSTRACT: Background Implementation effectiveness models have identified important factors that can promote the successful implementation of an innovation; however, these models have been examined within contexts where innovations are adopted voluntarily and often ignore the socio-political and environmental context. In the field of occupational health and safety, there are circumstances where organizations must adopt innovations to comply with a regulatory standard. Examining how the external environment can facilitate or challenge an organization’s change process may add to our understanding of implementation effectiveness. The objective of this study is to describe implementation facilitators and barriers in the context of a regulation designed to promote the uptake of safer engineered medical devices in healthcare. Methods The proposed study will focus on Ontario’s safer needle regulation (2007) which requires healthcare organizations to transition to the use of safer engineered medical devices for the prevention of needlestick injuries. A collective case study design will be used to learn from the experiences of three acute care hospitals in the province of Ontario, Canada. Interviews with management and front-line healthcare workers and analysis of supporting documents will be used to describe the implementation experience and examine issues associated with the integration of these devices. The data collection and analysis process will be influenced by a conceptual framework that draws from implementation science and the occupational health and safety literature. Discussion The focus of this study in addition to the methodology creates a unique opportunity to contribute to the field of implementation science. First, the study will explore implementation experiences under circumstances where regulatory pressures are influencing the organization's change process. Second, the timing of this study provides an opportunity to focus on issues that arise during later stages of implementation, a phase during the implementation cycle that has been understudied. This study also provides the opportunity to examine the relevance and utility of current implementation science models in the field of occupational health where the adoption of an innovation is meant to enhance the health and safety of workers. Previous work has tended to focus almost exclusively on innovations that are designed to enhance an organization’s productivity or competitive advantage.
    Full-text · Article · Jan 2013 · Implementation Science
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    • "Sustaining sharps' injuries might engender the belief that injuries are an occupational hazard; alternatively, acceptance of hazard might lead to suboptimal compliance. Four of six nurses interviewed alleged that their injuries resulted from actions of others, usually surgeons when passing instruments or leaving sharps in inappropriate places, as in other work (Jagger et al., 2010). Careless disposal of sharps has contributed to injury in ancillary staff (HPA, 2005) and this requires further research. "
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    ABSTRACT: Occupational acquisition of blood-borne infections has been reported following exposure to blood or body fluids. Consistent adherence to standard precautions will reduce the risk of infection. To identify: the frequency of self-reported adverse exposure to blood and body fluids among surgeons and scrub nurses during surgical procedures; contributory factors to such injuries; the extent of compliance with standard precautions; and factors influencing compliance with precautions. A multi-site mixed methods study incorporating a cross-sectional survey and interviews. Six NHS trusts in Wales between January 2006 and August 2008. Surgeons and scrub nurses and Senior Infection Control Nurses. A postal survey to all surgeons and scrub nurses, who engaged in exposure prone procedures, followed by face to face interviews with surgeons and scrub nurses, and telephone interviews with Infection Control Nurses. Response rate was 51.47% (315/612). Most 219/315 (69.5%) respondents reported sustaining an inoculation injury in the last five years: 183/315 (58.1%) reported sharps' injuries and 40/315 (12.7%) splashes. Being a surgeon and believing injuries to be an occupational hazard were significantly associated with increased risk of sharps' injuries (adjusted odds ratio 1.73, 95% confidence interval 1.04-2.88 and adjusted odds ratio 2.0, 1.11-3.5, respectively). Compliance was incomplete: 31/315 (10%) respondents always complied with all available precautions, 1/315 (0.003%) claimed never to comply with any precautions; 64/293 (21.8%) always used safety devices, 141/310 (45.5%) eye protection, 72 (23.2%) double gloves, and 259/307 (84.4%) avoided passing sharps from hand to hand. Others selected precautions according to their own assessment of risk. Surgeons were less likely to adopt eye protection (adjusted odds ratio 0.28, 0.11-0.71) and to attend training sessions (odds ratio 0.111, 0.061-0.19). The professions viewed the risks associated with their roles differently, with nurses being more willing to follow protocols. Inter-professional differences in experiencing adverse exposures must be addressed to improve safety and reduce infection risks. This requires new training initiatives to alter risk perception and promote compliance with policies and procedures.
    Full-text · Article · Mar 2012 · International journal of nursing studies
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