Needlesticks and blood exposures appear to be increasing, threatening healthcare workers with bloodborne infections and the attendant mental anguish of awaiting test results for themselves or source patients, researchers report.
After years of incremental gains, hard-fought adoption of needle safety devices and passage of federal regulations requiring their use in 2001, a survey of members of the Association of Occupational Health Professionals in Healthcare (AOHP) reveals a troubling trend.1
AOHP members from 157 hospitals in 32 states participated in EXPO-S.T.O.P. 2012, a survey to determine the incidence of sharps injuries and mucocutaneous blood exposures among healthcare workers in U.S. hospitals. The survey shows a sharps injury (SI) rate of 28.2 per 100 occupied beds, or 2.2 per 100 full-time equivalent staff. That incidence of SI is significantly higher than the prior AOHP survey, which found an overall SI incidence rate of 24 per 100 beds. In addition, the incidence of 28.2 exposures per 100 occupied beds is higher than the 22.2 rate found among 58 hospitals in the EPINet surveillance system in 2001. The disappointing conclusion is that little reduction in SI rates has occurred in the last decade, the researchers report. The results indicate that mandating the use of safety engineered devices through the Needlestick Safety and Prevention Act of 2001 has not — as many apparently assumed — eliminated a longstanding problem.
“It is disturbing to find that our assumption that we are increasing safety and decreasing injuries is wrong,” says Linda Good, PhD, RN, COHN-S, co-author of the study and director of employee occupational services at Scripps Health in San Diego. “The assumption that recognizing a danger will automatically result in changes in behavior is not proving to be true. It’s also disturbing that there still seems to be an acceptance among some that a certain number of [sharps] injuries are to be expected [and are in] the nature of the work.’”
Extrapolation of the survey results indicates that healthcare workers are suffering some 322,000 SIs and 119,000 mucosal blood exposures annually. While the aggregate data are of concern, the survey did identify hospitals with highly successful programs that have reduced sharps injuries dramatically.
“Hospitals with low exposure injuries take a very proactive approach,” Good says. “They make ‘zero’ their only acceptable rate. They hold everyone accountable.”
These hospitals have established safety cultures that include such traits as:
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Data-driven communication
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Immediate root cause investigation of all exposures
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Adoption of safer safety-engineered devices
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Engagement of staff on all levels
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Acceptance by staff that safety is their responsibility
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Prevention through education
A host of variables
The AOHP survey results are subject to a host of variables, but the authors noted some possible explanations for the higher rates. For example, the findings may reflect a surveillance artifact caused by respondents reporting more of their injuries and exposures. Likewise, previous comparative data may have reflected region-specific low incidence in states with early adopters of safety engineered devices. In addition, databases and surveys from hospitals not collecting non-employee exposure data will always show incidence rates below the true incidence for the facility, the authors reported. In addition, some 40% of respondents were teaching hospitals, which typically have higher sharps injury rates due to procedure intensity and the trainee “learning curve.”
Among the specific findings, AOHP found that 44% of sharps injuries are occurring during surgical procedures.
“It is not surprising that the OR has the highest incidence — with procedures done with very sharp objects in close quarters — and most procedures have no clinically acceptable, safety-engineered option available,” Good says. “Blunt suture needles do not seem to have caught on. Some progress has been noted with use of ‘neutral zones’ to eliminate direct passing of sharps.”
Clinicians comfortable with established methods may be reluctant to change practices and adopt a differently designed safety device. For example, Good recalls a situation years ago when a facility adopted safety-engineered IV start devices.
“The change was met with resistance from the anesthesiologists,” she says. “They wanted to stay with devices with which they were comfortable, confident — recognizing that they were often called upon in emergency situations where it was crucial that they get the line in immediately. They did not want to go through the inevitable learning curve — and the initial possibility of failure — associated with a new device.”
The assumption is that as next-generation surgeons, anesthesiologists, and other practitioners learn with next-generation devices, the comfort level and acceptance of safety devices will improve, she adds.
It would certainly seem that a lot of the exposures could be to blood containing HCV, particularly from baby boomer patients who have collectively been advised they are a risk group and need to be tested for the virus. There are treatments for HCV now that carry an exorbitant price tag, raising the possibility that hospitals may be more motivated to fund sharps safety programs rather than pay out expensive occupational infection claims.
However, though there are likely HCV occupational infections that are not reported, those that are identified suggest HCV seroconversion after a needlestick is certainly possible but exceedingly rare. With post-exposure prophylaxis for HIV and an available vaccine for HBV, the risk for bloodborne infections of any stripe is real but rare.
“Though bloodborne pathogen exposures are potentially devastating, they rarely even rise above a ‘first aid’ designation on injury reports,” Good says. “This keeps them off the radar — and when off the radar it is easy to assume they have gone away. They haven’t.”
The 15-item AOHP electronic survey pertaining to 2012 calendar-year will be conducted annually, with information for EXPO-S.T.O.P. 2013 & 2014 currently being analyzed after being collected in the spring of 2015. The findings should continue to shed light on the nature of exposures and injuries while identifying best practices in hospitals with low incidence rates.
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Grimmond T, Good L. EXPO-S.T.O.P.: A national survey and estimate of sharps injuries and mucocutaneous blood exposures among healthcare workers in USA. J Assoc Occ Health Prof2013;33(4):31-36.
