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Safer Needle Devices: Protecting Health Care Workers

October 1997


Acknowledgment: This document was developed by the Office of Occupational Health Nursing, with significant contributions from Susan Elliott, ARNP, MSN, MPH, OSHA Nurse Intern, and Digna Walker, RN, B.S.N., OSHA Nurse Intern.

Acronyms and Abbreviations

CDC Centers for Disease Control and Prevention
CSHO Compliance Safety and Health Officer
FDA Food and Drug Administration
HBV Hepatitis B Virus
HCV Hepatitis C Virus
HIV Human Immunodeficiency Virus
IM Intramuscular
IV Intravenous
MMWR Morbidity and Mortality Weekly Report
NCID National Center for Infectious Diseases
OPIM Other potentially infectious materials
OSHA Occupational Safety and Health Administration

Purpose of this Packet

Q. What is the purpose of this packet?

A. The purpose of this packet is to:

  • Update OSHA staff's knowledge of current statistical data on exposure risk, prevalence, and incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) in health care workers.
  • Provide technical assistance to OSHA staff in understanding the role of safer needle devices in preventing needlestick injuries.
  • Give guidance on the process of selecting safer devices.

Q. What are some questions that may be asked about safer needle devices and needlestick prevention programs?

A. Although OSHA does not review, approve, license, or endorse products, OSHA staff may receive questions about safer needle devices and therefore have an excellent opportunity to educate the public about the role of these devices in preventing needlestick injuries. Questions that may be asked include:

  • What are the current risks to health care workers who sustain a needlestick injury?
  • What is the definition of a safer needle device?
  • Why do we need safer needle devices?
  • Does OSHA require us to use these devices?
  • What features make a safer needle device an effective engineering control?
  • How can a health care facility develop a program to implement safer needle devices?
This guide will provide answers to these questions.

Epidemiology of Needlestick Injuries

Q. What is the epidemiology of needlestick injuries?

A. Five primary activities are associated with the majority of needlestick injuries. They are:

  • Disposing of needles, including collection and disposal of materials used during patient care procedures
  • Administering injections
  • Drawing blood
  • Recapping needles (not allowed under the Bloodborne Pathogens Standard)
  • Handling trash and dirty linens (termed "downstream injuries", these usually affect the housekeeping department (Chiarello, 1992).
Since 1992, the International Health Care Worker Safety Center has gathered data on needlestick injuries from 63 cooperating hospitals around the country. The results of the data analysis provide us with a useful picture of the pattern of needlestick injuries leading to occupational exposure to bloodborne pathogens.
  • Participating hospitals reported an overall rate for sharp-object injuries of 27.0 per 100 occupied beds per year.
  • Most exposure incidents occurred in patient rooms (37%), the operating room (16%), the emergency department (7%) or the critical care units (6%). (Figure 1)
  • Nurses report the most frequent exposures (49.7%), while physicians rank second at 12.6%. Nursing assistants and housekeeper/laundry workers account for 5.3% and 5.1% of exposures respectively. (Table 1)
  • Hollow-bore needles are the cause of injury in 68.5% of cases. Hollow-bore needles (the type of needle used for giving injections or drawing blood) also are implicated as the devices most often associated with the transmission of bloodborne pathogen infections, because the blood remaining inside the bore of the needle after use contains a larger volume of virus than the relatively small amount of blood remaining on the outside of a solid core needle (e.g., a suture needle). The amount of blood the health care worker is exposed to during the exposure event is one of the risk factors assessed to determine the type of post-exposure prophylaxis needed. (Figure 2)
Figure 1
Locations Where Percutaneous Injuries and Mucocutaneous Blood Exposures Occurred,
U.S. EPINet, 1995
63 hospitals, 3,552 total incidents
(Source: Ippolito, 1997)

Table 1
Health Care Workers Reporting Percutaneous and Mucocutaneous Blood Exposures, by Occupation, U.S. EPINet, 1995
(63 hospitals, 3,552 total exposures)
  Reported percutaneous and mucocutaneous blood exposures
Job Category No. %
Nurse RN/LPN 1,764 49.7%
M.D. (attending/resident) 446 12.6%
Attendant (non-surgical)/PCA/CNA 189 5.3%
Housekeeper/laundry worker/central supply 180 5.1%
Technologist (non-lab) 165 4.6%
Phlebotomist/venipuncture 160 4.5%
Clinical lab worker (non-phlebotomist) 143 4.0%
Surgery attendant/surgical technician 132 3.7%
Student 91 2.6%
Respiratory therapist 56 1.6%
Dental personnel 28 0.8%
Paramedic 17 0.5%
I.V. team 5 0.1%
Dialysis 4 0.1%
Other 172 4.8%
Total 3,552 100.0%
(Source: Ippolito, 1997)

Figure 2
Items Most Frequently Causing Sharp-Object Injuries, U.S. EPINet, 1995

63 hospitals, cases = 3,003
(Source: Ippolito, 1997)

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