Sharps Injuries among Employees of Acute Care Hospitals in Massachusetts, 2002-2007

Massachusetts Department of Public Health Occupational Health Surveillance Program, Boston, Massachusetts 02108, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 06/2011; 32(6):538-44. DOI: 10.1086/660012
Source: PubMed


Sharps with engineered sharps injury protections (SESIPs) have been found to reduce risk of sharps injuries (SIs). We examined trends in SI rates among employees of acute care hospitals in Massachusetts, including the impact of SESIPs on SI trends during 2002-2007.
Prospective surveillance.
Seventy-six acute care hospitals licensed by the Massachusetts Department of Public Health.
Employees of acute care hospitals who reported SIs to their employers.
Data on SIs in acute care hospitals collected by the Massachusetts Sharps Injury Surveillance System were used to examine trends in SI rates over time by occupation, hospital size, and device. Negative binomial regression was used to assess trends.
During 2002-2007, 16,158 SIs among employees of 76 acute care hospitals were reported to the surveillance system. The annual SI rate decreased by 22%, with an annual decline of 4.7% (P < .001). Rates declined significantly among nurses (-7.2% per year; P < .001) but not among physicians (-0.9% per year; P = .553). SI rates associated with winged steel needles and hypodermic needles and syringes also declined significantly as the proportion of injuries involving devices with sharps injury prevention features increased during the same time period.
SI rates involving devices for which SESIPs are widely available and appear to be increasingly used have declined. The continued use of devices lacking SI protections for which SESIPs are available needs to be addressed. The extent to which injuries involving SESIPs are due to flaws in design or lack of experience and training must be examined.

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    ABSTRACT: Background: Despite their overwhelming efficacy, safety-engineered sharp devices (SESDs) cause a residual fraction of injuries. Although the fraction of injuries from SESDs is less than that reported for nonsafety devices, it remains a "preventable fraction" and is a sizable target for further advances. Methods: A retrospective review of 3,297 percutaneous injuries from hollow bore safety-engineered devices occurring between 2001 and 2009 was conducted examining the Exposure Prevention Information Network (EPINet) needlestick surveillance data. Results: Nurses sustain 64.6% of all SESD injuries. 42.9% Of SESD injuries occur after device use and are likely preventable through consistent and effective use of safety-engineered technology. Excluding injuries that occurred during device use or between procedural steps, 71.8% (n/N = 28/39) of physician injuries, 58.2% (n/N = 645/1,109) of injuries to nurses, and 45.8% (n/N = 88/192) of injuries to phlebotomists occurred when an available SESD was not fully activated. Conclusion: Passive devices that do not require action on the part of the end user to engage a safety feature currently represent a small portion of the SESD market. Wider dissemination of a broader array of passive SESDs coupled with continual education of end users is essential to an effective sharps injury prevention program.
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    ABSTRACT: Sharps injury among health professionals is a devastating event, risking severe stress and debilitating post-traumatic anxiety, even in the absence of seroconversion. Effective prevention requires comprehensive training and education of all staff, who must comply with evidence-based policies and procedures based on detailed risk assessment. Safer working is supported by safety engineered sharps devices, now mandated by specific sharps safety legislation unless retention of an older non-safety device is demonstrably unavoidable. Costs may be high and some trusts provide only the cheapest sharps safety devices, claiming overwhelming cost pressures. However, safety performance when using lower cost active safety devices may be less than with the fully automated passive devices that require no user intervention to default to a safe condition. Carefully crafted sharps policies and procedures should shape and be supported by comprehensive training and periodic audit. Detailed investigation must be undertaken in relation to any incidents and near misses, including those occurring as wastes pass from the clinical area, along the disposal chain, in the hands of porters and ancillary staff, waste handlers and laundry workers.
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