Needlestick Injuries in the United States

Backgrounder

The Occupational Safety and Health Administration (OSHA) estimates that 8 million healthcare workers are at risk of occupational exposure to bloodborne pathogens. And, according to the CDC in March 2000, more than 385,000 percutaneous injuries occur among healthcare workers from needles and other sharps used in the healthcare setting. Published studies have noted that the actual number could be as much as 70 percent higher. Data collected by hospitals that participate in EPINet indicate that the average hospital has approximately 30 needlestick and sharp-object injuries per 100 beds each year. Further, industry analysts estimate that 80 percent of these cases could be prevented with the use of safer sharps devices such as safety syringes and needleless IV systems.

Profile of a Needlestick

According to EPINet, the number one device causing 35% of the needlestick injuries reported in 2002 is the disposable syringe and data indicate:

• 40 percent of needlestick injuries occur during use
• 40 percent of needlestick injuries occur after use and before disposal
• 10 to 15 percent of injuries are related to disposal of the device

The type of syringe and how it is used impact needlestick incidents. For example, a pre-filled cartridge syringe that has to be disassembled after use poses a risk. Recapping of needles following use can account for as much as five percent of all needlesticks. In addition, needlesticks occur through improper disposal or the use of overfilled sharps disposal containers.

Serious, bloodborne infections can be transmitted to healthcare professionals through needlesticks, including:

• Hepatitis C, the most frequent infection from needlesticks
• Human Immunodeficiency Virus (HIV) disease
• Hepatitis B
• Tuberculosis
• Syphilis
• Malaria
• Herpes

Physical, Financial and Emotional Costs
The precise cost of needlestick injuries is difficult to quantify because it can include the inestimable pain and suffering of the injured healthcare worker. The worker’s emotional trauma, as well as the impact on family and friends can be devastating. In the case of Hepatitis C, a silent epidemic that can lead to liver failure, many healthcare workers are unaware they have the infection and as many as 85 percent can become chronic carriers.

According to the American Hospital Association, one case of serious infection by bloodborne pathogens can add up to $1 million or more in expenses for testing, lost work time and disability payments. Even when no infection occurs, the cost to institutions is estimated to be more than $3,000 per injury. These estimates are in sharp contrast to the cost of safety syringes, which average 28 cents more than traditional syringes.

Regulatory Actions and Requirements
The epidemic proportions and severe impact of needlestick incidents prompted U.S. Congressional action and the Needlestick Safety and Prevention Act became law in 2000. This law revised the 1991 Bloodborne Pathogen Standard to require the use of safe medical devices when there is a risk of exposure to bloodborne pathogens.

In early 2001, the Occupational Safety and Health Administration (OSHA) published its revised bloodborne standard that required hospitals and other healthcare facilities to:

• Implement the safer medical devices that are appropriate, commercially available, and effective
• Document consideration and implementation of safer medical devices annually
• Obtain input for these devices from those responsible for direct patient care; this input must be documented
• Train employees to use new devices and/or procedures and document training
• Maintain a log of injuries from contaminated sharps

Outside the United States, similar legislation is being passed. Several Canadian provinces and European regulatory authorities are working to require the use of safety devices. Healthcare workers in these and other countries may benefit from new products — such as manually retractable safety syringes — recently made widely available in North America.

Current Technology
The Needlestick Safety and Prevention Act and subsequent revisions in OSHA’s enforcement procedures have led to a dramatic increase in the use of safety syringes. In acute care settings, the use of safety syringes has grown from an estimated 46 percent in 2002 to 79 percent in 2005. At alternate healthcare sites, usage has increased from an estimated 35 percent in 2002 to 45 percent in 2005. Since the law was enacted, studies have shown that syringes with safety features significantly reduce the frequency of needlestick injuries.

However, safety syringes do not completely eliminate the risk of needlestick injuries and reasons may include:

• Clinician fails to activate the safety feature
• Clinician bypasses the safety feature
• Safety feature fails

To date, the growing U.S. demand for safety syringes has been met primarily by traditional devices that are retro-fitted with add-on pieces, such as sheaths, shields or caps. While these syringes meet the legislation’s requirements, they can place the clinician’s fingers dangerously close to the exposed needle and, therefore, are considered unsatisfactory by many end-users.

The solution may be a syringe engineered with the safety feature integral to the design, yet it looks and functions like a traditional device and is easy to use. Such an innovation will further help healthcare organizations protect employees, comply with industry regulations, and reduce the potential risk and costs associated with needlesticks.

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