H ow to Prevent
Needlestick Injuries
A nswers to Some
Important Q uestions
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How to Prevent Needlestick Injuries: Answers to Some
Important Questions
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U.S. Department of Labor Occupational Safety & Health
Administration 200 Constitution Avenue Washington,
DC 20210
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OSHA 3161
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The original document contains color images.
Abstract
As an employer of health care workers, you want and need to provide a safe and healthful workplace for
your employees. In 1991, OSHA published the Bloodborne Pathogens Standard, Title 29 Code of Federal
Regulations, Part 1910.1030, to protect workers from exposures to bloodborne illnesses. Because
needlestick injuries are a major cause of these exposures in the health care setting, it is important to
recognize that there are work practices and engineering controls to help reduce these exposures and
injuries. This brochure looks at the issue of safer needle devices and how they can help employers like
you create a safer workplace to protect your workers.
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UU
Introduction
As an employer of health care workers, you want
and need to provide a safe and healthful workplace
for your employees. In 1991, OSHA published the
Bloodborne Pathogens Standard, Title 29 Code of
Federal Regulations, Part 1910.1030, to protect work¬
ers from exposures to bloodborne illnesses. Because
needlestick injuries are a major cause of these
exposures in the health care setting, it is important
to recognize that there are work practices and
engineering controls to help reduce these exposures
and injuries. This brochure looks at the issue of
safer needle devices and how they can help em¬
ployers like you create a safer workplace to protect
your workers.
W hy Do I N eed If you're an employer of
to Worry A bout health care workers who are
M ppH I pd-1 r k- c? potentially exposed to blood
and contaminated needles,
you should know that there
are an estimated 800,000 needlesticks each year in
the U.S. About 2 percent, or 16,000, of these are
likely to be contaminated with the Human Immu¬
nodeficiency Virus (HIV). Needlestick injuries
account for up to 80 percent of accidental exposures
to blood. Nurses in hospitals are the most fre¬
quently injured.
When M ight
My Employees
Be Injured
By a
Needlestick?
Needlestick injuries may
occur when employees
dispose of needles, collect
and dispose of materials
used during patient care
procedures, administer
injections, draw blood, or handle trash or dirty
linens where needles have been inappropriately
discarded.
Isn't There Just
a Small Chance
of Such an
Injury?
Data from 63 hospitals show
that the overall rate of such
injuries is 27 per 100 occu¬
pied beds annually. Nurses
had the most frequent
exposures (49.7 percent); physicians ranked second
(12.6 percent); nursing assistants accounted
for 5.3 percent, and housekeepers, 5.1 percent. 1
Hollow-bore needles are the cause of injury
in 68.5 percent of all cases.
1 G. Ippolito; V. Puro; N. Petrosillo; G. Pugliese; B.Wispelwey; P.M. Tereskers;
N. Bentley; and J. Jagger, Prevention, Management & Chemoprophylaxis of
Occupational Exposure to HIV (Charlottesville, VA: Advances in Exposure
Prevention, International Health Care Worker Safety Center, 1997).
What Can
Happen from
a Needlestick?
More than 20 pathogens
have been reportedly trans¬
mitted from needlesticks. 2
The most serious are the
transmission of Hepatitis C
(HCV), Hepatitis B (HBV), and HIV. In fact, the risk
of acquiring HBV or HCV from a contaminated
needlestick is greater than for HIV.
Why Is the Risk
G reater from
Hepatitis B and C
Than from HIV?
The risk of acquiring an
infection has to do with the
prevalence of these diseases
in the patient population
at large. For example, an
estimated 1.25 million
people in the U.S. are chronically infected with
HBV and 6,000 die each year from HBV-related
liver disease. HCV also is a major cause of chronic
liver disease worldwide. In 1997, there were an
estimated 4 million people in the U.S. infected with
HCV. 3 As many as 85 percent of all HCV-infected
persons develop chronic hepatitis and are at
increased risk for cirrhosis and primary hepatocel¬
lular carcinoma. 4 Liver failure from Hepatitis C is
the leading reason for liver transplants in the U.S.
So, DO I Still
N eed to Worry
A bout HIV
Exposures
for Employees?
Yes. The total number of
occupationally acquired HIV
infections in health care
workers continues to in¬
crease each year. Of the 52
such cases documented
during 1996,45 were from
needlesticks or cuts. 5
Make sure that employees
use universal precautions,
engineering and work
practice controls, and per¬
sonal protective equipment
to reduce their exposure to
bloodborne pathogens, as required by OSHA's
Bloodborne Pathogens Standard. 6
How Can I
Protect Employees
A gainst Potential
Exposures?
2 L.A. Chiarello, Deborah Nagin, and Franklin Laufer, Pilot Study of
Needlestick Prevention Devices, Report to the Legislature, New York State
Department of Health, March 1992, p.16.
3 U.S. Department of Health and Human Services, National Institutes of
Health, Consensus Development Statement: Management of Hepatitis C.
Available online at odp.od.nih.gov/consensus/statements/cdc/105/
105_stmt.html.1997.
4 Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report
88(2), 1996.
5 Centers for Disease Control and Prevention, Division of HIV/AIDS
Prevention, National Center for HIV, STD, and TB Prevention, HIV/AIDS
Surveillance
Report 8(2): Atlanta, GA 1996.
6 Title 29 Code of Federal Regulations, Part 1910.1030.
C an't N eed Ies You're correct. Most
Penetrate M OSt personal protective equip-
Personal Protective ment can be easily pen-
r . , 0 etrated by needles. Most
Equipment? needlestick injuries, how-
ever, result from unsafe
needle devices rather than carelessness by health
care workers. Safer needle devices have been
shown to significantly reduce needlesticks and
exposures to potentially fatal bloodborne illnesses. 7
What's a Safer
N eedle Device?
A safer needle device has
built-in safety controls to
reduce needlestick injuries
before, during, or after use
and to make needlesticks
less likely.
Will These
Devices Prevent
N eed lestick
Injuries?
Not all needlestick injuries
are preventable, but the
number can be reduced by
using devices containing
needles with built-in safety
features or other devices that eliminate the use of
needles altogether. Using needleless IV connectors,
self re-sheathing needles, or blunted surgical
needles, for example, can help reduce the risk of
injury. In fact, almost 83 percent of injuries from
hollow bore needles are potentially preventable. 8
H 0 W Do T h ese In general, properly
D ev i ces W 0 r k ? designed devices should
(1) provide a barrier between
the hands and the needle
after use; (2) allow or require
the worker's hands to remain behind the needle
at all times; (3) have safety features integral to the
device itself rather than as accessories; (4) be in
effect before disassembly and remain in effect
after disposal to protect downstream workers;
(5) be simple and easy to operate, with little or no
training; and (6) not interfere with the delivery
of patient care.
A re There Specific Yes, that would be helpful.
Safety Featu res For example, it is good to
I |\| opH to Know know whether the feature is
A . . 9 active or passive or whether
the engineering control is
part of the device. Types of safety features include
the following:
7 Centers for Disease Control and Prevention, Division of HIV /
AIDS Prevention, National Center for HIV, STD, and TB
Prevention, HIV/AIDS Surveillance Report, 9(1): Atlanta, GA,
1997.
8 Ippolito, et al, 1997.
• Passive safety features remain in effect before,
during, and after use; workers do not have to
activate them. Passive features enhance the
safety design and are more likely to have a
greater impact on prevention. (See Figure 1.)
• Active devices require the worker to activate
the safety mechanism. Failure to do so leaves
the worker unprotected. Proper use by health
care workers is the primary factor in the
effectiveness of these devices. (See Figure 2.)
• An integrated safety design means that the
safety feature is built in as an integral part of the
device and cannot be removed. This design
feature is usually preferred. (See Figure 1.)
• An accessory safety device is a safety feature
that is external to the device and must be
carried to, or be temporarily or permanently
fixed to, the point of use. This design also is
dependent on employee compliance, and
according to some researchers, is less desirable.
These connectors use devices other than needles to connect one IV
to another. Examples of needleless connectors include 3-way
stopcocks and plunger-type systems. An example of the plunger-
type system is shown here. These devices are passive and integral
to tlte system.
Before us<
-<-
- ■ pi
| | i :
After use
u l
o=0l mi m ■ 1 1 l:(-
Figure 2. Self-Resheathing N eedle
Initially, the sleeve is located over the barrel of the syringe with
the needle exposed for use. After the device is used, the user
slides the sleeve fonvard over the needle where it locks in place
and provides a guard around the used needle.
Does 0 SH A No. OSHA does not require
Requirethe employers to institute
U se Of Specific specific devices, but it does
Devi ces? require that employers
evaluate the effectiveness of
existing controls and review
the feasibility of instituting more advanced engi¬
neering controls. Further, OSHA's Bloodborne
Pathogens Standard 9 requires that employers
establish a written exposure control plan as well as
engineering and work practice controls to eliminate
or minimize employee exposure. Additionally,
employers are required to provide post-exposure
follow-up if an employee sustains a needle punc¬
ture and to record the injury on the OSHA 200 log
in some cases.
What Steps Do
I N eed to Take
to H ave a
Comprehensive
Prevention
Program and to
Implement Safer
Needle Devices?
As an employer of health
care workers, you have the
flexibility to develop indi¬
vidual worksite-specific
needlestick prevention
programs to protect employ¬
ees. Such a program would
mean that you have a
mechanism in place to select
and evaluate safer medical
devices in a systematic manner. In evaluating safer
needlestick devices, ideally you should evaluate
your workplace and base your choices for these
types of products on the following:
• The needs of the primary users.
• The need of the patients who must continue to
receive safe, efficient, and comfortable care.
(Workers are likely to reject products that they
think will interfere with patient care in any
way.)
In addition, a comprehensive needlestick preven¬
tion program might include the following:
• Creating a multidisciplinary team to investigate
and assess needlestick incidents.
• Defining prevention priorities on the basis
of collection and analysis of an institution's
injury data.
• Developing design and performance criteria
for product selection according to needs
for patient care and health care worker safety.
• Planning and implementing an evaluation
of products in clinical settings. 10
To evaluate and select appropriate safer needle
devices, you also should review available
needlestick injury data including the personnel
involved, the devices used, and the circumstances
and frequency of needlestick events. This informa¬
tion can help in determining how employees can
maximally benefit from a product change to safer
needle devices. Although not required by OSHA,
the collection and evaluation of complete
needlestick injury data are key to identifying
injury patterns and then implementing an effective
abatement plan. (See also, the sample "Safety
Feature Evaluation Form," for help in determining
the most appropriate device for your employees.)
9 29 CFR, Part 1910.1030, (c)(l)(ii)(B) and (d)(2)(i).
10 L.A. Chiarello, "Selection of Safer Needle Devices: A Conceptual
Framework for Approaching Product Evaluation," Am ] Infection
Control 23(6):386-395,1995.
How Can I
Get M ore
Information
or A ssistance
on ThisTopic?
For OSHA assistance, you can
contact the bloodborne patho¬
gens coordinator in your
nearest regional office listed
elsewhere in this booklet. See
also Other Resources listed in
this brochure. OSHA also
provides other services and assistance, including:
• Consultation Program— This service is deliv¬
ered by state government agencies or universi¬
ties employing professional safety health and
consultants. Primarily developed for smaller
employers with more hazardous operations,
comprehensive assistance includes an onsite
appraisal of all work practices and environmen¬
tal hazards and all aspects of the employer's
present job safety and health program. Largely
funded by OSHA, the service is provided at
no cost to the employer and is available on
request to employers who want help in estab¬
lishing and maintaining a safe and healthful
workplace.
experience and expertise. For more information
on VPP, contact your VPP coordinator in your
nearest OSHA regional office.
• Publications— OSHA has many published
materials, including specific topics for small
businesses, that are available or ordered online
at www.osha.gov. Publications lists and single
copies of various OSHA materials can be ob¬
tained by sending a self-addressed label to the
OSHA Publications Office, PO. Box 3753,
Washington, DC 20013-7535, or by calling
(202) 693-1888.
OSHA regulations are contained in Title 29
of the Code of Federal Regidations, Parts 1904
(Recordkeeping), 1910 (General Industry), 1911
through 1925 (Maritime), 1926 (Construction),
and 1928 (Agriculture). All OSHA regulations
are available or can be ordered online at
www.osha.gov. Printed copies of OSHA regula¬
tions are sold by the Government Printing Office
and can be ordered online as indicated above.
• Electronic Information— Internet: OSHA
standards, interpretations, directives, interactive
software, compliance assistance materials, and
additional information are available or can be
ordered on the World Wide Web at
www.osha.gov. See in particular. Safer Needle
Devices: Protecting Health Care Workers, under
Index, Needlestick Injuries, and News Room,
Publications, on the OSHA home page.
CD-ROM: includes directives, standards,
interpretations, and other materials on CD.
Available from the U.S. Government Printing
Office, Superintendent of Documents, PO. Box
371954, Pittsburgh, PA 15250-7954 or at (202)
512-1800. Specify OSHA Regidations, Documents,
and Technical Information on CD-ROM, (ORDT),
Order No. S/N729-013-00000-5; $43 per year
and $15 per single copy. Issued quarterly.
• Grants— OSHA gives training and education
grants to various non-profit groups to develop
programs to help small businesses establish
safety and health programs.
• Mentoring— OSHA's Voluntary Protection
Programs (VPP) recognize worksites where
employers and employees work together to
achieve safety and health excellence. Small
firms can be matched with and mentored by a
VPP site that will share its safety and health
• Small Business Liaison— OSHA's liaison is
available to answer questions on small business
issues at 202-693-2317.
• State Plans— Twenty-five states and territories
operate their own federally approved occupa¬
tional safety and health programs. The states
conduct most OSHA enforcement through their
own standards, which are at least as effective as
Federal OSHA's, but may have different or
additional requirements. Many states offer
additional programs of assistance to small
businesses. For more information on state
plans, see the list of plans at the end of this
brochure or visit Outreach on OSHA's Web site
at www.osha.gov.
• Training and Education— OSHA's Training
Institute in Des Plaines, IL, and OSHA's Training
Education Centers provide basic and advanced
courses in safety and health. OSHA's area offices
offer information services, such as audiovisual
aids, technical advice, and speakers for special
engagements. For more information, contact the
Institute at 1555 Times Drive, Des Plaines, IL
60018, (847) 297-4810, or fax (874) 297-4874. A
list of courses also can be found under Outreach
on OSHA's Web site at www.osha.gov.
Emergencies— For life-threatening situations only,
call (800) 321-OSHA. Complaints will go immedi¬
ately to the nearest OSHA area or state office for
help.
Other Resources
American Hospital Association— AHA report,
December 1996, Implementing Safer Needle Devices
(Item No. 196310). Call (800) AHA-2626 to order
copies.
American Nurses Association— ANA position
papers on safer needle devices. Call (202) 652- 7130.
EPINet Program— Includes manuals and software,
data collection tools, and tracking and reporting
systems for surveillance of bloodborne exposures,
tracking device specific injuries, and evaluating the
efficacy of safer needle devices. Call EPINet Pro¬
gram (800) 528-9803.
The Service Employees International Union's
(SEIU) Guide to Preventing Needlestick Injuries—
Includes a listing of safer needle devices, checklist
for compliance with OSHA's bloodborne pathogen
standard, safe device feature evaluation checklist,
and guide for post-needlestick exposure followup.
To order, send a check for $5.00 (pre-paid orders
only) to the SEIU Mailroom, 1313 L St., NW Wash¬
ington, DC 20005.
0 ther Websites
CDC AIDS Clearinghouse -www.cdcnac.org
EPINet - www.med.virginia.edu-epinet
CDC Hepatitis Branch - www.cdc.gov/ncidod/
diseases/hepatitis/hepatitis.htm
OSHA Regional Offices - For more information,
contact the bloodborne pathogens coordinator at
the nearest OSHA Regional Office.
Region I
(CT/ MA, ME, NH, RI, VU)
JKF Federal Building
Room E-340
Boston, MA 02203
Telephone: (617) 565-9830
Region II
(NJ, NY/ PR/ VP)
201 Varick Street
Room 670
New York, NY 10014
Telephone: (212) 337-2378
Region III
(DC, DE, MD/ PA, VA/ WV)
Gateway Building, Suite 2100
3535 Market Street
Philadelphia, PA 19104
Telephone: (215) 596-1201
Region IV
(AL, FL, GA, KY/ MS, NC/ SC/ TN*)
Atlanta Federal Center
61 Forsyth Street, SW, Room 6T50
Atlanta, GA 30303
Telephone: (404) 562-2300
Region V
(IL, IN/ MI/ MN/ OH, WI)
230 South Dearborn Street
Room 3244
Chicago, IL 60604
Telephone: (312) 353-2220
Region VI
(AR, LA, NM/ OK, TX)
525 Griffin Street
Room 602
Dallas, TX 75202
Telephone: (214) 767-4731
Region VII
(IA/ KS, MO, NE)
City Center Square
1100 Main Street, Suite 800
Kansas City, MO 64105
Telephone: (816) 426-5861
Region VIII
(CO, MT, ND, SD, UT/ WY*)
1999 Broadway, Suite 1690
Denver, CO 80202-5716
Telephone: (303) 844-1600
Region IX
(American Samoa, AZ/ CA/ Guam, HI/ NV/ Trust
Territories of the Pacific)
71 Stevenson Street
Suite 420
San Francisco, CA 94105
Region X
(AK/ ID, OR*, WA*)
1111 Third Avenue
Suite 715
Seattle, WA 98101-3212
Telephone: (206) 553-5930
*These states and territories operate their own OSHA-approved job safety and health programs (Connecticut and New York
plans cover public employees only). States with approved programs must have a standard that is identiical to, or at lease as
effective as, the federal standard.
U.S. Department of Labor
Occupational Safety and Health Administration
OSHA 3161
The following is the most recent copy of the Sample “Safety Feature Evaluation Form,” devel¬
oped by the Training for Development of Innovative Control Technology Project (TDICT), Trauma
Foundation, San Francisco General Hospital, 1001 Potrero Avenue, Building 1, Room 300, San
Francisco, CA 94110. OSHA has permission to reprint this form in both traditional and electronic
publishing formats. Since the form is copyrighted, however, extensive use of the form by others
may require additional permission from the copyright holders. Other evaluation forms for different
devices also are available from TDICT.
Guidelines for the Use of
Safety Feature Evaluation Sheets
Coordinators:
Determine which products are to be evaluated and provide at least four or more test
samples for each individual evaluating the product. (Each evaluator should have enough
samples to disassemble and examine the design thoroughly.)
Set up a testing station for each type of device which allows testers to evaluate products in
a simulated patient procedure. Provide training dummies (injection pads, oranges, etc.) as
necessary.
Provide visual instructions and demonstrate proper use of each device.
Review the instructions and rating system with each evaluator.
Encourage each evaluator to comment on the sheets and prioritize the questions at the end
of the evaluation. This will provide a useful decision making tool and will help alert you to
specific areas of concern which may not have been covered by the questionnaire.
Evaluators:
Re-enact all steps of intended or possible procedures performed with the device being
tested.
Attempt to misuse the device and circumvent or disable the safety feature.
Answer each question, including the short answer section at the end. If you do not under¬
stand a question, please write comments directly on the sheets.
Note: Certain assumptions have been made in the development of these forms based on
information about currently available products. We recognize the likelihood that the ideal
product may not exist.
©June1993
Training for Development of Innovative Control Technology Project
Safety Feature Evaluation Form
SAFETY SYRINGES
Number of times used:
Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if
the question does not apply to this particular product.
During Use: agree.disagree
1. The safety feature can be activated using a one-handed technique.1 2 3 4 5 N/A
2. The safety feature does not obstruct vision of the tip of the sharp.1 2 3 4 5 N/A
3. Use of this product requires you to use the safety feature.1 2 3 4 5 N/A
4. This product does not require more time to use than a non-safety device...1 2 3 4 5 N/A
5. The safety feature works well with a wide variety of hand sizes.1 2 3 4 5 N/A
6. The device is easy to handle while wearing gloves.1 2 3 4 5 N/A
7. This device does not interfere with uses that do not require a needle.1 2 3 4 5 N/A
8. This device offers a good view of any aspirated fluid.1 2 3 4 5 N/A
9. This device will work with all required syringe and needle sizes.1 2 3 4 5 N/A
10. This device provides a better alternative to traditional recapping.1 2 3 4 5 N/A
After Use:
11. There is a clear and unmistakeable change (audible or visible) that occurs
when the safety feature is activated.1 2 3 4 5 N/A
12. The safety feature operates reliably.1 2 3 4 5 N/A
13. The exposed sharp is permanently blunted or covered after use and prior to
disposal.1 2 3 4 5 N/A.
14. This device is no more difficult to process after use than non-safety
devices.1 2 3 4 5 N/A
Training:
15. The user does not need extensive training for correct operation.1 2 3 4 5 N/A
16. The design of the device suggests proper use.1 2 3 4 5 N/A
17. It is not easy to skip a crucial step in proper use of the device.1 2 3 4 5 N/A
Of the above questions, which three are the most important to your safety when using this
product?
Are there other questions which you feel should be asked regarding the safety/ utility of this
product?
©June1993
Training for Development of Innovative Control Technology Project
