Preventing Needlestick INJURIES PartI.ppt

NEEDLE STICK INJURIES

1. Part I:
Background
Preventing Needlesticks
and Other Sharps
Injuries…
Everything You Need to Know

2. •Part I: Background
•Part II: Safer Sharps Devices
•Part III: Safe Work Practices

3. The Problem
•CDC estimates ~385,000 sharps injuries
annually among hospital-based healthcare
personnel (>1,000 injuries/day)
–Many more in other healthcare settings (e.g., emergency
services, home care, nursing homes)
•Increased risk for bloodborne virus transmission
•Costly to personnel and healthcare system

4. Risks of Seroconversion due to Sharps Injury
from a known positive source
Virus
HBV
HCV
HIV
Risk (Range)
6-30%*
~ 2%
0.3%
(*Risk for HBV applies if not HB vaccinated)

5. What is the Risk for HIV Alone?
•Percutaneous 0.3%
•Mucous membrane 0.1%
•Non-intact skin <0.1%

6. Occupational HIV Transmission among U.S.
Healthcare Personnel, 1985-2004
•57 documented cases
–i.e., HIV negative at time of exposure and
became HIV positive during follow-up period
•137 other cases
–i.e., No documented exposure and no
known risk factor for HIV infection

7. Occupational HIV Transmission
Documented Cases (n=57)
•50 (88%) involved percutaneous exposures
45 caused by hollow-bore needles, half of
which were used in a vein or artery
•5 mucocutaneous exposures
•2 exposure route unknown

8. Costs of Sharps Injuries
•Baseline and follow-up laboratory testing
•Treatment of exposed personnel
–$71-~$5,000 depending on treatment provided
•Lost productivity
•Time to complete paperwork
•Loss of income / loss of career
•Emotional costs
•Societal costs
O’Malley, et. al. Costs of Management of Occupational Exposure to Blood and Body Fluids.
ICHE, July 2007, v 28, No. 7.

9. Preventing
Sharps Injuries
is Our Goal!

10. How Do Sharps Injuries Happen?
•Who gets injured?
•Where do they happen?
•When do injuries occur?
•What devices are involved?
•How can they be prevented?

11. Who Gets Injured?
Nurse
43%
Technician
15%
Student
4%
Dental
1%
Housekeeping/
Maintenance
3%
Clerical /
Admin
1%
Other
5%
Physician
28%
Occupational Groups
of Healthcare
Personnel Exposed to
Blood/Body Fluids,
NaSH June 1995—
December 2003
(n=23,197)

12. Where Do Sharps Injuries Occur?
•Patient Room 39%
(Inpatient: Medical – ICUs )
•Operating Room 27%
•Outpatient 8%
•ER 8%
•Laboratory 5%
•Other 13%
Source: NaSH, June 1995—December 2003

13. When Do Sharps Injuries Occur?
•During use 41%
•After use/before disposal 40%
•During and after disposal 15%
•Other 4%
Source: NaSH, June 1995—December 2003

14. What Devices are Involved in Sharps Injuries?
Six Devices Account for 78% of All Injuries
•Disposable Syringes 30%
•Suture Needles 20%
•Winged-Steel Needles 12%
•Intravenous Catheter Stylets 5%
•Phlebotomy Needles 3%
•Scalpels 8%
Source: NaSH, June 1995—December 2003

15. 0
5
10
15
20
25
30
35
40
Disposable
Syringe
Cartridge
Syringe
ButterflyIV StyletPhlebotomy
Needle
IV Tubing
Needle
Percentage of injuriesRate/100K devices purchased
Jagger, et al. Rates of needle-stick injury caused by various devices in a university hospital.
NEJM. 1988;319.
Devices that Require Manipulation after Use
are Associated with an Increased Rate of Injury

16. How Do Injuries Occur With Hollow-Bore Needles?
During Sharps
Disposal
13%
During Clean Up
9%
In Transit to
Disposal
4%
Handle/Pass
Equipment
6%
Improper
Disposal
9%
Access IV Line
5%
Transfer/Process
Specimens
5%
Recap Needle
6%
Collision
W/Worker or
Sharp
10%
Manipulate
Needle in Patient
28%
Other
5%
Circumstances Associated with Hollow-Bore Needle
Injuries NaSH June 1995—December 2003 (n=10,239)
Disposal
Related:
35%

17. Sharps Injuries Are Preventable
Preventable
64%
Nonpreventabl
e
18%
Undetermined
18%
Preventability of Needlesticks in 78 NaSH Hospitals,
June 1995--December 2004 (n=11,625)

18. Sharps Injuries at ______Hospital ( period of time)
•Last year _____ sharps injuries were reported by our
employees/staff
•The occupations most affected were _____
•The devices most commonly involved were _____
•The most common ways sharps injuries occurred were
_____

19. What are Strategies to Eliminate Sharps Injuries?
•Eliminate or reduce the use of needles and
other sharps
•Use devices with safety features to isolate
sharps
•Use safer practices to minimize risk for
remaining hazards

20. •Part II: Safer Sharps Devices
•Part III: Safe Work Practices