How to Keep Sharps Safety a Cut Above

Occupational risk of sharps injuries transcends health care from local and community settings to a global stage. Although often preventable, sharps injuries occur in high-income countries at an alarming rate, and low- and middle-income countries (LMICs) with higher endemic rates of blood-borne pathogens and/or limited resources pose a setting of increased risk for this professional hazard. In response to this often unrecognized or underreported issue, the International Sharps Injury Prevention Society (ISIPS) has designated the month of December as International Sharps Injury Prevention Awareness Month. This calendar designation offers recognition of sharps safety as a global health issue.

The World Health Organization (WHO) highlights the importance of this global perspective of occupational risk by offering data sets that disclose 1.5 million new cases of HIV, hepatitis B, and hepatitis C from 2019 to2020. Coupled with this data, the WHO data sets also identified disruption to health care services for prevention, detection, and treatment of HIV and hepatitis in the setting of the COVID-19 pandemic.¹

Although rates of HIV have slowly trended down in the United States over the past decade, rates have increased in LMICs. This offers an acute demonstration of disparities in health care access and resources.

Global politics compound the problem of health care inequities and occupational risk of sharps injury. Mass migration and civil unrest hinders access to health care as well as accurate current communicable disease trends. HIV and hepatitis can easily escape detection in this population, and receiving countries may struggle with availability of sharps safety products for vaccination at border crossings.

The ISIPS website offers an extensive listing of available sharps safety products and manufacturers.2 Unfortunately, health care disparities may prevent the use of the identified safety-engineered products. However, not all products are created equal.

The International Safety Center EPINet data unveils that 30.2% of 975 sharps injuries occurred with use of a sharps safety device. The safety mechanism was properly activated in approximately 10% of 290 cases.³

This same report identifies that needle stick injuries (NSIs) with use of disposable syringes account for 27% of sharps injuries, and that it is nurses who incur the highest occupational risk in this category. Additional data in this report identifies intramuscular and subcutaneous injections as the primary source of NSIs. The data set predated the COVID-19 pandemic, which potentiated an increased risk of NSIs with mass vaccination in unfamiliar and nontraditional settings, such as tents or large arenas.

Needle-Phobic Clientele

Future considerations in safe injection practices for mass vaccination during a pandemic might include dissolvable micro-needle dermal patches. A method of vaccine administration such as this may improve vaccination rates among needle-phobic clientele. In addition, vaccination efforts could be enhanced in LMICs with fewer required resources for large volume transport and storage.⁴

No health care worker is immune from the dangers of handling sharps. Physicians hold a rate just under that of nurses, mostly related to use of scalpels, but are less likely to report these injuries. The actual number of all sharps injuries for all health care professionals may easily be double that of which is reported.

Exposure Control

In the United States, the Needlestick Safety and Prevention Act was borne from the Safe Needles Save Lives campaign, launched by the American Nurses Association, and was enacted in November 2020. This law mandated that the Occupational Safety and Health Administration (OSHA) revise the OSHA blood-borne pathogens standard to include safety-engineered sharp devices. The revision also included the requirement that hospitals develop a blood-borne pathogen exposure control plan with annual updates and a requirement for a sharps injury log to track and trend occurrences to identify contributing factors. This standard offers a global model of prevention to also include use of personal protective equipment and work practice controls.⁵

The Centers for Disease Control and Prevention contributes to a global model of sharps injury prevention with a comprehensive workbook to guide design, implementation, and evaluation of a sharpsinjury prevention program. Federal and state regulatory guidelines are presented as well as the cost of sharps injuries. The workbook user is offered operational guidance to include a multidisciplinary approach to selection of safety-engineered needles and other sharp devices. Embedded tool kits guide the user through the steps of operations, with the goal of establishing a culture of safety. Data analytics for assessing sharp injury prevention interventions are presented methodically, offering uncomplicated learnings to even the novice learner.⁶

Environmental factors, such as lighting and noise, predispose the health care providerto these injuries. Even nondirect patient care employees, such as environmental or food service personnel, may be at risk when a direct care provider does not properly dispose used sharps. It is essential to assess the downstream effect of sharps handling when developing a sharps safety program.

Sharps safety is not limited to just health care settings or health care workers. Persons in the community may require the use of lancets or needles and syringes for monitoring and treatment of diabetes or other medical conditions. Municipal workers in waste management and/or recycling may also beat risk for sharps injuries. Children and other community members might incur a sharps injury when devices are not properly disposed.

External Supports Required

It is critical that home care patients are educated about proper disposal of lancets and needles in sharps containers that are approved by the Food and Drug Administration and that community regulations are followed for disposal of container at the fill level. Other countries may have similar designated sharps containers as determined by regulatory authorities. In resource-limited countries or communities, external supports are required to safely manage sharps. Nations that align with WHO may serve as external resources.

The designated International Sharps Injury Prevention Awareness Month of December coincides with closure to the calendar year, and for many health care and political organizations, marks the end of a fiscal year. This offers an opportune time to assess local, national, and international resources and engage health care and political stakeholders in sharps injury prevention measures for the coming year. Finally, raising awareness on the importance of global health care equity is of paramount importance in reducing sharps injuries.

JENNY HAYES, MSN, RN, CIC, CAIP, CASSPT, has 15 years of experience as an infection preventionist, serving both in-patient and ambulatory care populations in multidisciplinary settings. She is an infection preventionist at the Hospital of the University of Pennsylvania.

References:

1. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. World Health Organization. July 15, 2021. Accessed October 30, 2021. https://www.who.int/publications/i/item/9789240027077
2. Safety products categories. International Sharps Injury Prevention Society. Accessed October 29, 2021. http://isips.org/safety-products/safety-product-categories/
3. EPINet Report for needlestick and sharp object injuries. International Safety Center. July 19, 2017. Accessed November 1, 2021. https://internationalsafetycenter.org/wp-content/uploads/2018/06/Official-2016-NeedleSummary.pdf
4. O’Shea J, Prausnitz MR, Rouphael N. Dissolvable microneedle patches to enable increased access to vaccines against SARS-CoV-2 and future pandemic outbreaks. Vaccines (Basel). 2021;9(4):320. doi:10.3390/vaccines9040320
5. Needlestick Safety and Prevention Act, HR 5178, 106th Congress (2000) Accessed October 28, 2021. https://www.cdc.gov/sharpssafety/pdf/Neelestick%20Saftety%20and%20Prevention%20Act.pdf
6. Sharps safety for healthcare settings. Centers for Disease Control and Prevention. February 11, 2015. Accessed October 27, 2021. https://www.cdc.gov/sharpssafety/index.html