sharps injuries among massachusetts hospital workers · 2018-05-02 · sharps injuries among...

Sharps Injuries

among

Massachusetts Hospital Workers

Angela Laramie, MPH, Devan Hawkins, MS, Letitia Davis, ScD

Occupational Health Surveillance Program

Massachusetts Department of Public Health

Funded in part by CDC/NIOSH

Findings from the

Massachusetts

Sharps Injuries

Surveillance

System

Background

384,325 needlestick injuries occur annually among

hospital workers in the U.S. (CDC estimates)

Risk of infection from a known positive source for:

HBV 6% to 30% (for those not immune to HBV)

HCV 1.8% (range 0% to 7%)

HIV 0.3%

Costs of exposures to can range from $71 to $4,838 (O’Malley, et al., ICHE, 2007)

ILLINOIS

http://www.dph.illinois.gov/sites/default/files/publications/publicationsohp-illinoishivintegratedplan2017-2021.pdf

http://www.dph.illinois.gov/sites/default/files/publications/publicationsdoil-opioid-data-report.pdf

Hepatitis C HIV

IOWA

https://idph.iowa.gov/Portals/1/userfiles/40/State%20of%20Iowa%202016%20End-of-

Year%20HIV%20Disease%20Surveillance%20Report%20-%20FINAL%20%281%29.pdf

http://idph.iowa.gov/Portals/1/userfiles/40/Iowa%20Hepatitis%20C%20Epidemiological

%20Profile%20%20Feb%202017%20Version%20-FINAL.pdf

Hepatitis C HIV

OSHA Bloodborne Pathogens Standard

29 CFR 1910.1030

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS

&p_id=10051

https://www.osha.gov/OshDoc/Directive_pdf/CPL_02-02-069.pdf


29 CFR 1910.1030

https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf

• Establish an exposure control plan

• Review annually

• Implement universal precautions

• Identify and use engineering controls

• SESIPs – Sharps with Engineered Sharps

Injury Protections

• Involve front line workers in device selection

http://www.osha.gov/SLTC/etools/hospital/hazards/sharps/sharps.html#bluntingneedles

RETRACTING NEEDLE

SLIDING SHEATH

HINGED ARM /

SNAP DOWN


29 CFR 1910.1030

• Identify and ensure use of work practice controls

• Provide PPE (i.e., gloves, gowns, eye protection,

masks)

• Make disposal containers available

• Closable, puncture resistant, leakproof, labeled,

• At point of use, upright, replaced routinely

• Make HBV vaccination available to all with

occupational exposure


29 CFR 1910.1030

• Post-exposure evaluation and follow-up after any

exposure incident

• Use labels and signs to communicate hazards

• Provide information and training to workers

• Maintain medical and training records

Top 10 OSHA Violations - 2017 Bloodborne Pathogens - Healthcare Industry

1910.1030

1. (c)(1)(i)

Exposure Control Plan - written

2. (g)(2)(i)

Information and Training – at no cost, during work

hours, to all employees with occupational exposure

3. (d)(2)(i)

Engineering and Work practice Controls

4. (c)(1)(iv)

Exposure Control Plan – reviewed and updated

annually or when new/modified tasks

5. (f)(2)(iv) &

(h)(5)(i)

HBV vaccination – signed declination

Sharps Log

Top 10 OSHA Violations - 2017 Bloodborne Pathogens - Healthcare Industry

1910.1030

6. (f)(2)(i) &

(g)(2)(ii)(A)

HBV vaccination – after training and within 10 working

days of assignment

Information and Training – at time of initial assignment

7. (c)(1)(iv)(B)

Exposure Control Plan – document review and

implementation of safer devices

8. (f)(1)(i) &

(f)(3)

HBV Vaccination –

Post-Exposure Evaluation & Follow-up – immediately

available; source testing; baseline and periodic testing;

counseling; confidential

9. (g)(2)(ii)(B)

Information & Training – annually

10 . (g)(2)(vii)(N)

Information & Training – opportunity for interactive

questions/answers

“Therefore, an

employer’s failure to use

rapid HIV antibody

testing when testing as

required by paragraph

1910.1030(f)(3)(ii)(A)

would usually be

considered a violation of

that provision.”

“While video training

programs are

certainly appropriate

for use as and aid in

training, they must

be supplemented

with the required site

specific information,

and a person must

be accessible for

interaction.”

https://www.cdc.gov/nhsn/PDFs/NaSH/Na

SH-Report-6-2011.pdf

https://www.cdc.gov/niosh/

topics/ohsn/default.html

https://internationa

lsafetycenter.org/

Under-reporting of Sharps Injuries

Reasons for not Reporting Sharps

Injuries

I didn’t feel the patient/injury was

high risk

57%

Reporting takes too long 47%

I was embarrassed 27%

Didn’t want to disclose injury to

manager or peers

22%

Nurse manager reprimands nurses

who don’t use sharps devices

correctly

7%

Didn’t want to disclose that I didn’t

use the safety devices

0%

Boden et al. (2014) AJIM

ANA/InviroMedical survey 2008

Sharper images: Despite needlestick law, nonsafe sharps practices still go unchecked

By Ed Frauenheim February 12, 2001 Nurse Week

Photo: Courtesy of the White House

Timeline of Regulations

December 1998 Legislation filed by Massachusetts Nurses Association

August 2000 An Act Relative to Needlestick Injury Prevention (MA)

November 2000 Needlestick Safety and Prevention Act (Federal)

January 2001 Revised OSHA Bloodborne Pathogen standard published

April 2001 Massachusetts Dept of Public Health regulations published

MDPH Sharps Injury Prevention Regulations

105 CMR 130.1001 et seq.

Requires hospitals to:

• Incorporate the use of safe needle / sharps devices into

engineering and work practice controls

• Maintain a written exposure control plan

– with procedures for selecting safe devices

• Maintain a Sharps Injury Log

• Use data for continuous quality improvement

• Report to MPDH annually (Annual Summary)

Requires MDPH to:

• Establish an Advisory Committee

• Develop a list of needleless systems

Objectives of the Sharps Injury

Surveillance System

• Document magnitude of the problem and trends in sharps

injuries among hospital workers overtime

• Identify departments, occupations, procedures, and

hospitals where intervention is needed

• Identify devices associated with sharps injuries

• Facilitate sharing information among hospitals about

successful programs and practices

Massachusetts Sharps Injury

Surveillance System 105 CMR 130.1001 et seq.

• Population under surveillance:

All health care workers in Massachusetts hospitals licensed by MDPH

• Reportable exposure incident:

BBP exposure that is the result of events that pierce the skin or mucous membranes

• Reporting period:

January 1 – December 31

• Data elements: - Date of exposure - Was it a safety device (SESIP)?

- Unique exposure ID - What is the mechanism?

- Employment status - Is it part of a prepackaged kit?

- Occupation - Manufacturer / Brand / Model

- Department - Purpose or procedure for which device was used

- Device - How the injury occurred

- Who was holding the device

http://www.mass.gov/eohhs/provider/reporting-to-state/diseases-and-conditions/

workplace-reporting/occupational-disease-and-injury-mandated-reporting.html

(scroll to bottom of page for links)

Sharps Injuries among Massachusetts Hospital

Workers, 2002-2016*

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016*

# of hospitals 101 99 99 99 99 99 99 99 98 98 98 96 95 94 93

compliance w/

reporting

requirement

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

100%

100%

# of injuries

reported

3,413 3,327 3,279 3,265 3,133 3,068 3,145 2,889 2,947 2,892 3,019 2,947 2,946 2,866 2,908

% injuries in

acute care

hospitals

97% 97% 97% 98% 98% 98% 97% 97% 98% 97% 97% 97% 98% 98% 98%

% injuries in

teaching

hospitals

40% 58% 59% 62% 65% 63% 65% 65% 67% 61% 63% 63% 62% 62% 62%

Data Source: MDPH Annual Summary of Sharps Injuries, 2002-2016

*Preliminary data not to be duplicated, cited, quoted or published.

0

5

10

15

20

25

30

35

0

500

1,000

1,500

2,000

2,500

3,000

3,500

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Number of Sharps Injuries Annual Rate in MA Hospitals

Num

ber

of S

harp

s Inju

ries

SIs

per 1

00 b

eds

2002-2010: APC = -2.5, p<0.001

2010-2016: APC = 0.1, p=0.802



Sharps Injuries among Hospital Workers,

Massachusetts (all hospitals), 2002-2016,

N=46,049*

Sharps Injuries among Employees of Acute

Care Hospitals, Massachusetts, 2002-2016,

N=38,529*

0

5

10

15

20

25

30

35

0

500

1,000

1,500

2,000

2,500

3,000

3,500

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Number of Sharps Injuries Annual Rate in MA Hospitals

Num

ber

of S

harp

s Inju

ries

SIs

per 1

,000 F

TE

s

2002-2008: APC = -4.64, p<0.001

2008-2016: APC = -1.14, p=0.003



Rates • Some useful denominators for sharps injury rates

are:

– Employee-hours at work (full-time equivalents)

– Number of occupied beds (or licensed beds) in a hospital

– Number of patients (average census, or annual total hospital

admissions)

– Number of medical procedures performed

– Number of procedures involving a sharp

– Number of sharps used

– Number of operations (for Operating Room)

– Number of patient visits (for Emergency Room)

• There is no ideal denominator!

Sharps Injuries among Hospital

Workers, 2010-2015

EPINet MDPH

0

5

10

15

20

25

30

35

0

500

1,000

1,500

2,000

2,500

3,000

3,500

Nu

mb

er o

f sh

arp

s in

juri

es

Number of Sharps Injuries Sharps Injury Rate

Sh

arps in

juries p

er 100 licensed

bed

s

0

5

10

15

20

25

30

35

0

500

1,000

1,500

2,000

2,500

3,000

3,500

Nu

mb

er o

f sh

arp

s in

juri

es

Number of Sharps Injuries Sharps Injury Rate

Sh

arps in

juries p

er average d

aily censu

s

Sharps Injuries among Hospital Workers by

Occupation, Massachusetts, 2015, N=2,866

Nurse 38%

Physician 38%

Technician 17%

Support Services

3%

Other Medical Staff 2%

Dental Staff <1%

Other / Not answered

2%


.

Sharps Injury Rates among Employees of Acute

Care Hospitals by Occupation, Massachusetts,

2002-2016, N=27,392*

0

10

20

30

40

50

60

70

80

90

100

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Sh

arp

s I

nju

rie

s p

er

1,0

00

FT

Es

Physicians (APC 2002-2016 = 0.5%*)

Nurses (APC 2002-2009 = -6.3%*, APC 2009-2016 = -0.5%)



Sharps Injuries Between Physician Groups

by Academic Quarter, 2002-2016*, n=13,607

0

500

1000

1500

2000

2500

Jul-Sept Oct-Dec Jan-Mar Apr-Jun

Num

be

r o

f sh

arp

s in

juri

es

Quarters during Academic Year

Medical trainees Attending physicians

Fourteen complete academic years were presented in this figure.

The first two quarters of 2002 and the last two quarters of 2016 were dropped because of incomplete academic year




Department, Massachusetts, 2015, N=2,866

OR and Procedure

Rooms 44%

Inpatient Units 20%

ED 10%

ICU 8%

Outpatient Areas

8%

Laboratories 4%

Other Areas and Unknown / Not Answered

6%


Sharps Injuries in the OR by How and When

the Injury Occurred, 2002-2016*, N=14,850

0 1000 2000 3000

During sharps disposal

Improper disposal

Activating safety

Recap needle

During clean-up

Collision with worker or sharp

Handle/Pass equipment

Patient moved and jarred device

Handle/Pass equipment

Manipilate needle in patient

Collision with worker or sharp

Suturing

During use

(n=7,891)

After use,

before disposal

(n=4,289)

During or after

disposal

(n=992)



Sharps Injuries in the Operating Room

as a Percentage of Sharps Injuries

Hospital Wide

0

10

20

30

40

50

60

70

80

90

100

2010 2011 2012 2013 2014 2015

EPINet

MDPH

Perc

enta

ge o

f In

juries

Sharps Injuries in the OR among

Nurses and Physicians by Who was

Holding the Device, 2010-2015 Sharps Injuries among Nurses in the OR

0

10

20

30

40

50

60

70

80

90

100

Injuried HCW Other person No one Unknown/Not

answered

EPINet MDPH

%

Sharps Injuries among Physicians in the OR

0

10

20

30

40

50

60

70

80

90

100

Injuried HCW Other person No one Unknown/Not

answered

EPINet MDPH

%

Recommendations for

prevention:

- Convene multidisciplinary

team

- Modify work practices to

avoid:

- Recapping

- Hand to hand passing

- Convert devices

- Use blunt suture needles

“…If, during surgical

procedures, as your letter

specifies, physician

specialists or other

healthcare personnel are

using medical instruments

supplied in pre-packaged

kits, those packages must

include engineering

controls appropriate for the

specific procedures being

performed…”

“The hospital is responsible

under the OSH Act for

affording the protections of the

bloodborne pathogens

standard to its employees,

regardless of the independent

practitioners performing

surgery in its operating rooms.

It may not absolve itself of

these responsibilities…

Hospitals have the right to

make a practitioner's

adherence to the hospital's

procedures a condition of staff

privileges.”


Device, Massachusetts, 2015, N=2,866

Hypodermic Needle/Syringe

32%

Winged Steel Needle

7%

IV Stylet 5%

Vacuum Tube Collection Set

3%

Other Hollow Bore 6%

Suture Needle 22%

Scalpel 7%

Glass 1%

Other/Unknown/Not Answered

17% 0%

Hollow

bore

needles

53%


.


Sharps with Engineered Sharps Injury

Protection, Massachusetts, 2015

non-SESIP 50%

SESIP 44%

Unknown/Not Answered

5%

non-SESIP 37%

SESIP 57%

Unknown/Not Answered

6%

N=2,238 N=2,866

All devices Excluding suture needles


Sharps Injury Rates among Employees of Acute

Care Hospitals by SESIP and non-SESIP,

Massachusetts, 2002-2016*, N=35,382

0

2

4

6

8

10

12

14

16

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Non-SESIP SESIP

SIs

per

1,0

00 F

TE

s

-11.0% APC*

-2.4% APC*

0.9% APC*



Rate of Sharps Injury with Winged Steel

Needles & Percent Due To SESIPs,

Massachusetts, 2002-2016*

0

1

2

3

4

5

6

7

8

9

10

0

10

20

30

40

50

60

70

80

90

100Non-SESIP SESIP

Perc

ent

of S

Is b

y S

ES

IP

SIs

per 1

,000 F

TE

s



Rate of Sharps Injury with Hypodermic

Needles/Syringes & Proportion of Injuries with

SESIPs v. non-SESIPs, 2002-2016, N=11,885

0

1

2

3

4

5

6

7

8

9

10

0

10

20

30

40

50

60

70

80

90

100Non-SESIP SESIP

Perc

ent

of S

Is b

y S

ES

IP S

Is p

er 1

,000 F

TE

s



scalpel

25 G x 1”

22 G x 1-1/2”

18 G x 1-1/2”

25 G x 1”

SESIP non-SESIP

Sharps Injuries involving Devices in

Prepackaged Kits, 2006-2016 n=6,595

0

20

40

60

80

100

HypodermicNeedle /Syringen=2,186

Suture Needlen=1,048

Scalpel n=617 IV Stylet n=551 Winged SteelNeedle n= 458

Vacuum TubeCollection Set

n=208

Other /Unknownn=1,527

Perc

enta

ge o

f In

juries

Device

No sharps injury prevention feature Sharps injury prevention feature Unknown




Procedure or Purpose for which Device was Used,

Massachusetts, 2015, N=2,866

Injection 28%

Suturing 22%

Blood Procedures

12%

Line Procedures 10%

Making the incision

10%

To obtain body fluid or tissue

sample 2%

Other / Unknown/Not

answered 15%


.

Sharps Injuries among Massachusetts

Hospital Workers by Procedure,

2002-2016*, N=46,025

0

2,000

4,000

6,000

8,000

10,000

12,000

Injection Suturing Bloodprocedures

Lineprocedures

Making theincision

Other Unknown/Notanswered

Injection, unspecified / Other injection

21%

Intramuscular injection

14%

Subcutaneous injection

65%



Injection related Sharps Injuries and Sharps

Injury Prevention Devices, Massachusetts,

2002-2016*, N=11,460

Sharps Injury

Protection devices (SIP) 66%

non-SIP 30%

Unknown/Not

Answered 4%



Injection related Sharps Injuries among

Massachusetts Hospital workers by When

the Injury Occurred, 2002-2016*, N=11,460

0

20

40

60

80

100

Before or During Use /Unknown

After use, Beforedisposal

During or After Disposal

64%



Injection related Injuries among Hospital

Workers occurring After Use by How the Injury

Occurred for non-SIP devices, Massachusetts,

2002-2016*, N=2,183

0

100

200

300

400

500

600

Recappingneedle

Duringdisposal

Handle/passequipment

Collision withsharp

Improperdisposal

During clean-up

Other

Num

ber

of In

juries



97% of

sharps

injuries occur

among

workers at

acute care

hospitals

Illinois Health & Hospital Association

Illinois Compensation Trust,

Claims by Type,2013-2017, N=6,963

Blood & Body Fluid

Exposures

(including MRSA exposures)

Sharps Injuries

(Needles &

Medical Instruments)

# $ # $

Incident

Only

621 0 1,142 0

Medical

Only

1,196 738,933 3,980 1,863,227

Lost

Time

6 111,625 18 423,239

Total 1,823 $ 850,557 5,140 $ 2,286,465

Nurse 52%

Technician

26%

Support Services

6%

Physician 6%

Other Medical

Staff 2%

Other 3%

Nonclassifiable 3%

Not Answered

2% Nurse 37%

Technician

21% Physician

8%

Support Services

4%

Other Medical

Staff 3%

Other 3%

Nonclassifiable 1%

Not Answered

23%

Illinois Health & Hospital Association,

Illinois Compensation Trust,

Claims by Occupation, 2013-2017, N=6,963 Blood & Body Fluid Exposures

(including MRSA exposures)

Sharps Injuries

(Needles & Medical Instruments)

N=1,823 N=1,823

Prevention

&

Resources

Product feedback

Report information to: – FDA

– Device manufacturer

When should you report? – Serious injury or illness to patient

or worker

– Device malfunction

Where can I find feedback from others? – FDA MAUDE

(Manufacturer and User Facility Device Experience)

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cf

- FDA Medwatch

https://www.fda.gov/Safety/MedWatch/

https://www.uml.edu/docs/Med

Watch%20for%20Sharps%200

52215_tcm18-187544.pdf

Evaluating Devices

Device specific evaluation forms

www.tdict.org

Factors to consider:

• One-handed activation

• Hand remains behind the needle

• Audible or visual cue of complete

activation

• Feature remains in place after

disposal & can’t be undone

Passive

Easy

Simple

Throughout

https://www.uml.edu/docs/Selecting%20Medical%20Sharps

%20052215_tcm18-187542.pdf

UMass Lowell –

Sustainable Hospitals

https://www.uml.edu/Research/

SHCH/Sustainable-Hospitals/

www.isips.org/safety_products.php

http://www.aorn.org/Clinical_Practice/ToolKits/

Sharps_Tool_Kit/Sharps_Safety_Tool_Kit.aspx AORN

www.cdc.gov/niosh/docs/2008-101/pdfs/2008-101.pdf

http://www.aorn.org/Clinical_Practice/ToolKits/

Sharps_Tool_Kit/Sharps_Safety_Tool_Kit.aspx

www.osha.gov/SLTC/etools/hospital/hazards/bbp/bbp.html

https://www.osha.gov/SLTC/etools/hospital/surgical/surgical.html

www.cdc.gov/sharpssafety

https://www.cdc.gov/sharpssafety/pdf/sharpssafety_poster3.pdf

http://www.jstor.org/stable/pdf/10.1086/672271.p

df?refreqid=excelsior:22a9548ee7cd081d4401ad

c850171bfd

Post-Exposure Follow-up

https://www.cdc.gov/mmwr/preview/mmwrh

tml/rr5011a1.htm

Illinois Injury Prevention Center

http://illinoisinjuryprevention.org/

NIOSH ERC

http://publichealth.uic.edu/illinois-erc

Iowa Department of Public Health

Occupational Health & Safety Surveillance

Program

https://idph.iowa.gov/lpp/occupational-health

NIOSH ERC

https://www.public-

health.uiowa.edu/heartland/

Occupational Health

Surveillance Program

• Massachusetts Sharps Injury Surveillance System

• [email protected]

• www.mass.gov/dph/ohsp

Angela Laramie, MPH

Devan Hawkins, MS

Letitia Davis, ScD

Special thanks to all Infection Control and Employee Health staff at Massachusetts hospitals who collect and submit data annually to MDPH.

sharps injuries among massachusetts hospital workers · 2018-05-02 · sharps injuries among...

Documents