Steps to Prevent Injuries

• A local union health and safety committee can be an effective vehicle for coordinating efforts to identify needlestick and sharps hazards, and safer equipment. The union’s committee can work with management where there is a cooperative relationship with the employer.

  Protecting workers from needlesticks requires that:

  • Hazards are identified and documented (determine who has been stuck or is at risk of getting injured and why). 
    
    
  • Safer equipment (engineering controls) and work practices are used to prevent incidents. 
    
    
  • Workers understand and use their rights to have safe equipment and work practices. 
    
    
  • Workers receive training on the use of safe equipment and work practices.

  Identifying and documenting needlesticks and other hazards caused by sharps

  Sharps injuries log

  The Needlestick Safety and Prevention Act of 2000 directed OSHA to revise the Bloodborne Pathogens Standard to require that employers keep track of needlesticks. OSHA requires that covered employers:

  shall establish and maintain a sharps injury log [emphasis added] for the recording of percutaneous injuries from contaminated sharps . . . The information in the sharps injury log shall contain, at a minimum —

  1.  
     1. the type and brand of device involved in the incident, 
     2. the department or work area where the exposure incident occurred, and 
     3. an explanation of how the incident occurred. 
  • Figure: Sample sharps injury log (PDF)
    

  Incident reports, workers compensation and other records

  Committee members should review all records relating to needlesticks and sharps injuries. Challenge incident reports or other records that describe an injury as an accident caused by a careless worker that failed to follow procedures. Look beyond this excuse to see what equipment was used, staffing levels and other conditions at the time.

  Workers' and union representatives’ rights to information

  Workers and employee representatives have important rights under OSHA standard 1910.1020, access to employee exposure and medical records. Workers and their designated representatives have the right to review and obtain copies of medical records and other information about exposure to hazards in the workplace.

  Certain medical and other records contain confidential information. Union representatives have a right to this information provided they get written authorization from the worker(s).

  Sample letter to release medical records

  I, ______________________________, (full name of worker/patient) hereby authorize _________________________ (individual or organization holding the medical records) to release to ___________________________ (individual or organization authorized  to receive the medical information), the following medical information from my personal medical records: ____________________________________________________________________ ____________________________________________________________________ (Describe generally the information desired to be released). I give my permission for this medical information to be used for the following purpose: ____________________________________________________________________ ____________________________________________________________________ but I do not give permission for any other use or re-disclosure of this information. ______________________________________________ (signature and date)

  Finding needlestick and sharps hazards in the workplace

  Inspect the workplace

  Needlestick and sharps hazards can be identified by:

  • Talking to workers, 
    
    
  • Looking at what type of equipment is being used for various procedures, 
    
    
  • Observing other working conditions that are causing or increasing the chances of needlesticks.

  Surveys

  Employers' records are often incomplete and/or inaccurate. Surveys can provide additional information. Here is a sample survey that can be used to get a more complete record of needlestick hazards.

  HAVE YOU BEEN STUCK? Please answer the following questions if you have been stuck by a needle or injured by another sharp device. Name (optional)_____________________________________________________________________ Telephone (optional) Work __________________ Home_________________________________ Job title ____________________________________________________________________________ 1. What unit were you working in at time of the incident? _____________________________ 2. What time did the incident occur?__________________________________________________ 3. What type of device caused the injury?_____________________________________________ 4. What is the name of the device? ___________________________________________________ 5. Who is the manufacturer of the device? ____________________________________________ 6. What were you doing when the injury occurred? ____________________________________________________________________________________ ____________________________________________________________________________________ 7. Describe your workload and staffing level at the time of your injury. ____________________________________________________________________________________ ____________________________________________________________________________________ 8. Was the device equipped with a safety feature? _____________________________________ 9. Were you able to activate the safety feature? ________________________________________ 10. Did the safety feature malfunction? _______________________________________________ 11. If yes, please explain. ____________________________________________________________________________________ ____________________________________________________________________________________ 12. If you were not able to activate the safety feature, why not? ____________________________________________________________________________________ ____________________________________________________________________________________ 13. In your opinion, is there a safer and/or easier to operate device on the market that would have prevented this injury? ____________________________________________________________________________________ ____________________________________________________________________________________

  Selecting safer equipment — engineering controls

  The most effective way to prevent needlesticks is to use equipment that eliminates or greatly reduces the chances of injuries. Engineering controls include needleless systems and sharps with Engineered Sharps Injury Protections (ESIP). OSHA defines a sharp with ESIP as a nonneedle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

  Equipment evaluation — safer devices are not all created equal

  Sharps evaluation committees need to compare different devices under the conditions they will be used in a facility. The Needlestick Safety and Prevention Act of 2000 also changed the OSHA Bloodborne Pathogens Standard to require the involvement of workers in the selection of equipment. OSHA requires that employers

  solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls . . .

  
  There are many products available with various safety features. It is critically important that these products are evaluated by those who will use them to know if they offer effective protection. Appendix A includes checklists that committees can use to evaluate and select equipment.

  Design features of safety devices

  Safety syringes — the spring-loaded  needle is pulled into the barrel of the  syringe after the injection is given.

  The following list includes examples of design features that can greatly reduce the risk of a needlestick or other sharps injury.

  • There is a barrier between the hands and the needle after use. 
    
    
  • The worker’s hands remain behind the needle at all times. 
    
    
  • The safety features are part of the device itself rather than being an accessory. 
    
    
  • The safety mechanism is in effect before the device is taken apart and remains in effect after disposal to protect other staff such as housekeepers and laundry workers. 
    
    
  • The device is simple and easy to operate with little training. 
    
    
  • The safety features do not interfere with the delivery of care. 

  "Passive" vs. "active" safety features

  An integrated safety design means that the safety feature is built in as an integral part of the device and cannot be removed. In general, passive features are more effective in preventing needlesticks than devices that rely on an active safety design.

  • A passive safety feature does not require the worker to activate the safety mechanism. For example, a safety IV access device automatically covers the needle following access into the vein. Such a device is completely passive because the worker does not have to take any additional steps to activate the safety mechanism. Devices that have passive safety features remain in effect during and after use. 
    
    
  • An active device requires the worker to activate the safety mechanism. Failure to do so leaves the worker unprotected. A syringe that utilizes a protective sheath to cover the needle is an example of an active device. The worker must slide a plastic sheath over the needle of a syringe and lock it in place after the injection is given. 

  Examples of safety devices

  Type of Device	Safety Features
  Syringes and Injection Systems	Needleless injection – the solution is injected under the skin without using a needle. Retractable needle – the needle is spring-loaded and is pulled into the barrel of the syringe after the injection is given. (See photo on previous page.)  Protective sheath – after giving an injection, the worker slides a plastic barrel over the needle and locks it in place.
  IV Access	IV Access Retractable – the spring-loaded needle is pulled into the needle holder after use.  Passive – a safety clip covers the needle as it is withdrawn. Shielded IV. catheters (midline and peripheral) – a protective shield slides over the exposed needle.  Hemodialysis safety fistula sets (butterfly) – a protective shield slides over the needle as it is withdrawn
  Blood-collection	Retractable needle – the spring-loaded needle is pulled into the needle holder after use.  Shielded butterfly needle – a protective shield slides over the needle after use. Self-blunting needle – after use, the needle is blunted while still in the patient. Plastic blood collection tubes to replace glass tubes.
  Suture	Blunted suture needles
  Lancets	Retracting lancet – following skin puncture, the sharp automatically retracts back into the device.
  Surgical Instruments	Retracting scalpel – after use, the blade is withdrawn back into the body of the scalpel.  Quick-release scalpel blade handles – a lever is activated that allows for a “touchless” attachment of the blade to the handle and releases it after use.

   The technology is continually changing. Hundreds of patents have already been issued for various designs of needles and other sharps. Appendix D contains a list of resources to get more information on devices.

  Safer devices save lives and money

  Employers frequently use the excuse that they cannot afford to purchase protective equipment such as safer needles. In fact, safety designed syringes and other needle devices save money even though they are generally more expensive than conventional non-safety devices. Using safety needles eliminates the following costs related to a needlestick.

  • Initial and periodic testing to detect infection.

  • Counseling the affected worker about the risks and precautions to take to prevent infecting others.

  • The medications that are taken after an exposure to prevent infection with HIV (prophylaxis) or to slow the progression of HIV.

  • The average annual cost for treating a person with HIV has been estimated at tens of thousands of dollars.

  • A liver transplant due to hepatitis C costs hundreds of thousands dollars.

  • Other costs such as workers compensation, overtime, and expenses related to recruitment and training of staff to replace a worker who becomes ill. 

  Work practices that can prevent needlesticks

  In addition to using more protective devices, the following safer work practices (administrative controls) can reduce needlesticks.

  • No recapping of needles.

  • Planning for the safe handling and disposal of needles before beginning any procedure.

  • Disposing of used needle devices promptly in appropriate sharps disposal containers.

  • Reporting all needlesticks and other sharps-related injuries promptly and evaluating how they occurred and what could have prevented the injuries.

  • Reporting needlestick hazards to the employer.

  • Training workers on the use of safer equipment and work practices.