LabNotes - Volume 16, No. 3, 2006

USE OF SAFETY DEVICES
Reduces Exposure of Healthcare Workers to Bloodborne Pathogens

Healthcare worker (HCW) safety is an important aspect of infection control. HCWs are at risk of occupational exposure to pathogens present in blood and body fluids. Although the use of universal precautions has significantly reduced this risk, accidental puncture of skin by needles, other instruments, or broken glass (“sharps”) still remains an important source of HCW acquired infections and necessitates further action in order to achieve the desired level of HCW safety.

Although more than 20 different infectious agents have been shown to be transmissible by exposure to blood and body fluids,¹ most of the attention is currently focused on prevention of viral infections caused by human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Traditionally, the average transmission rates of infection following a needlestick injury from an infected patient are: 0.3% for HIV, 30 (23-62)% for HBV, and 1.8% for HCV.^{2, 3} The major population at risk for percutaneous injuries (PI) are nurses.

It was estimated that the total US annual rate of HCW injuries involving contaminated sharps is close to 650,000.⁴ This estimate took into consideration the rate of PI underreporting, which can in certain settings be as high as 73%.⁵ Seventy-five percent of needlesticks that occur annually in hospital settings are preventable either by: eliminating unnecessary use (25%), using needles with safety features (29%), or using safer work practices (21%).³ Using these three approaches, 65 infections with HBV and 42 infections with HCV can be prevented; however, the number of HIV infections that would be avoided could not be validly estimated.³

A great impact on HCW safety can be achieved through the replacement of conventional devices with safety-engineered products (e.g., shielded, retracted, or self-blunting conventional and winged set needles, plastic blood collection vacuum tubes, round-tipped scalpel blades, retracting-blade or shielded-blade scalpels, etc.). Data from the EPINetTM Multihospital Sharps Injury database showed that although conversion to safety devices was not proportional across different device categories, it resulted in a 51% decline of PIs (from 19.5 to 9.6 PIs per 100 occupied beds).⁶

Legislation has significantly increased the rate of conversion to safety devices. In the United States, the Needlestick Safety and Prevention Act of 2000 made the use of safety devices mandatory as of July 2001. As a result of that, healthcare employers in the United States must document annually in their exposure control plan that they have evaluated and implemented “safer medical devices designed to eliminate or minimize occupational exposure” to bloodborne diseases and have taken into consideration changes in sharps safety technology. During this process, input from nonmanagerial HCW is mandatory, as well as maintenance of a sharps injury log.

However, in order to achieve maximum effect, the safety features of the devices have to be engaged appropriately. When analyzing the injuries that occurred during the use of safety devices, it was shown that injuries occurred frequently either before the activation of the device (in 56.9% of cases) or during the activation (in 26.3% of cases).⁷ Because of that, use of passive needles that automatically allow engagement of safety features as soon as the needle is out of the blood vessel and in-vein activation devices will further reduce the number of PIs. BD (Becton, Dickinson and Company) released the first passive needle for blood collection in the spring of 2005, and the
BD Vacutainer® Push Button Blood Collection Set was also released in 2005.

In recent years, major improvements have been made in the area of HCW safety. New and innovative safety devices, combined with effective HCW training, have ensured continued reduction of PI injuries and occupational exposure to pathogens, thus successfully lowering rates of HCW acquired infections. Conversion to passive safety devices, safety legislation, and discontinuation of unnecessary use of sharps will move this process even further.

References

1. Collins C.H. and Kennedy D.A. Microbiological hazards of occupational needlestick and “sharps” injuries. Journal of Applied Bacteriology 62:385-402, 1987.
   
2. Centers for Disease Control and Prevention. Updated U.S. Public Health Guidelines for management of occupational exposures to HBV, HCV and HIV and recommendations for postexposure prophylaxis. MMWR 50(RR11): 1-42, 2001.
   
3. United States General Accounting Office. Needlestick prevention, GAO 01 60R, 1-18, 2000.
   
4. Perry J, Jagger J. Healthcare worker blood exposure risks: correcting some outdated statistics. Advances in Exposure Prevention 6:28-31, 2003.
   
5. Alvarado F, Panlilio A, Cardo D. NaSH Surveillance Group. Percutaneous injury reporting in U.S. hospitals, 1998 (abstract). Infection Control and Hospital Epidemiology 21:106, 2000.
   
6. Jagger J, Perry J. Marked decline in needlestick injury rates. Advances in Exposure Prevention 6:25-27, 2003.
   
7. Perry J, Parker G, Jagger J. EPINet report: 2001 percutaneous injury rates. Advances in Exposure Prevention 6:32-36, 2003.

Epinet is a trademark of the University of Virginia Patent Foundation