NIOSH Issues Alert to Prevent Needlestick Injuries in Health Care Settings
On Nov. 5, the Occupational Health and Safety Administration (OSHA) released new directives to guide compliance officers in enforcing the bloodborne pathogens standard to ensure consistent inspection procedures are followed. The OSHA directive reflects the availability of improved devices, better treatment following exposure and OSHA policy interpretations.
"Today's health care workforce faces a multitude of risks," said NIOSH Director Linda Rosenstock, M.D., M.P.H. "We know that needleless devices and safe needle devices can save lives. We must do everything we can to protect the health care workers who have devoted their lives to keeping America healthy."
Between 600,000 to 800,000 occupational needlestick injuries are estimated to occur every year and can lead to serious or potentially fatal infections with bloodborne pathogens such as hepatitis B virus, hepatitis C virus, or human immunodeficiency virus (HIV). The precise number of injuries is not known because needlesticks often go unreported. The risk of a bloodborne infection may not be immediately recognized, and symptoms may not become apparent until weeks or months after the needlestick.
NIOSH recommendations for work-related needlestick injuries are outlined in a new bulletin, "NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings." Developed in collaboration with other Centers for Disease Control and Prevention (CDC) centers and with extensive outside scientific review by diverse industry, labor, and public health organizations, the alert provides detailed guidance and assistance to employers, workers, and others in reducing needlestick injuries.
"Building on the success that some institutions have achieved in reducing such injuries by as much as 88 percent, these suggestions offer achievable, practical guidance for protecting the Nation's growing workforce of health care employees," said Rosenstock.
NIOSH recommends that the use of needles be eliminated where possible. If safe and effective alternatives to needles are not available, devices with safety features such as shields and sheaths should be used. Devices should be selected, used, and evaluated as part of a comprehensive program in which safe work practices, such as prohibiting recapping, are established under written procedures, and workers are trained in those practices. Each health care setting should have its own carefully tailored program, developed with front line worker input and review.
Hollow-bore needles such as those used in syringes present the greatest risk for needlestick, but potential for injury exists whenever any sharp device is used, the NIOSH Alert reports. Most reported needlesticks involve nurses, but laboratory staff, doctors, housekeepers, and other health care workers are also injured.
The alert suggests examples of devices that may reduce the risk of needlesticks, but advises that no one device will be appropriate or effective for every workplace. Examples of such devices include but are not limited to:
- Needleless devices, such as connectors for intravenous delivery systems that use blunt or valved ends rather than needles for attaching one length of IV tubing to another.
- Devices in which safety features are an integral part of the design, such as sheaths and shields over needles.
- Devices that operate passively without requiring user activation, such as an IV connector with a permanent rigid housing over the needle.
- Devices designed so that the user can tell easily whether the safety feature is activated, such as a visually obvious needle cover or the audible sound of a protective sheath being engaged.
- Devices in which the safety features cannot be deactivated and remains protective through disposal.
- Devices that perform reliably, are easy to use and practical, and are safe and effective for patient care.
The alert offers a number of steps both employers and workers can take to promote the safe use of needles in the workplace. Employers of health care workers should:
- Eliminate the use of needles where safe and effective alternatives are available.
- Implement the use of devices with safety features and evaluate their use to determine which are most effective and acceptable.
- Incorporate improved engineering controls into a comprehensive program involving workers. Employers should implement the following program elements:
- Analyze needlestick and other sharps-related injuries in your workplace to identify hazards and injury trends.
- Set priorities and strategies for prevention by examining local and national information about risk factors for needlestick injuries and successful intervention efforts.
- Ensure that health care workers are properly trained in the safe use and disposal of needles.
- Modify work practices that pose a needlestick injury hazard to make them safer.
- Promote safety awareness in the work environment.
- Establish procedures for and encourage the reporting and timely follow-up of all needlestick and other sharps-related injuries.
- Evaluate the effectiveness of prevention efforts and provide feedback on performance.
NIOSH recommends that health care workers take the following steps to protect themselves and their fellow workers from needlestick injuries:
- Avoid the use of needles where safe and effective alternatives are available.
- Help your employer select and evaluate devices with safety features.
- Use devices with safety features provided by your employer.
- Avoid recapping needles.
- Plan for safe handling and disposal before beginning any procedure using needles.
- Dispose of used needles promptly in appropriate sharps disposal containers.
- Report all needlestick and other sharps-related injuries promptly to ensure that you receive appropriate follow-up care.
- Tell your employer about hazards from needles that you observe in your work environment.
- Participate in bloodborne pathogen training and follow recommended infection prevention practices, including hepatitis B vaccination.
CDC is working with health care industry groups, employers, workers, unions, the public health community, and others to disseminate its guidance and recommendations. Copies of "NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings," HHS (NIOSH) Publication No. 2000-108, are available at no charge from the NIOSH toll-free information number, 1-800-35-NIOSH (1-800-356-4674). The document is also available on the Internet at http://www.cdc.gov/niosh.