Despite healthcare facilities being overwhelmed with COVID-19 in 2020, the overall rates of sharps injuries and mucocutaneous exposures to healthcare workers remained relatively stable, the International Safety Center reports.
“That doesn’t mean there weren’t important differences,” says Amber Mitchell, DrPH, MPH, CPH, president and executive director of the center, which has tracked needlesticks and occupational exposures to healthcare workers for years with its EPINet surveillance system. She compared data from the 2019 report to the 2020 report.
For example, while there was more surgical mask use during reported incidents — 3% in 2019 to 26% 2020 — there was only a slight increase in eye protection use — 4% in 2019 to 5% in 2020. This, despite 81% of all exposures happening to the face or head.1
“These are extremely high-risk exposures to not only bloodborne pathogens, but infectious microorganisms like coronavirus,” Mitchell says. “This indicates that workers are gravely under-protected year to year, so we need to remain diligent about not only providing face PPE [personal protective equipment] — eye protection, respirators, masks, face shields — but making it immediately accessible when needed.”
As it relates to sharps injuries and needlesticks, there were no notable differences pre- and peri-pandemic, but many procedures were cancelled or delayed, including elective surgeries.
“With the increasing epidemic of obesity and the increasing diagnosis of type II diabetes, the largest frequency of injuries occurring from injection are from insulin syringes,” Mitchell notes.
Another concerning finding is that use of engineering controls — like devices with sharps injury protection features — remain lower than acceptable, Mitchell says. In 2019, 52% of needlesticks were associated with a sharps safety device, although in 71% of the incidents the safety device was not activated. In 2020, 37% of needlesticks occurred with a safety device, with 67% of injuries occurring with the safety feature not activated.1
“This could mean that fewer people are being injured by devices with these protective features, but it could equally mean that there was less focus on sharps injury prevention during the pandemic and, as such, safer device use declined,” Mitchell says. “This is exactly what we don’t want — a shift away from occupational health during a global public health crisis — when keeping health workers safe should be our top priority.”
Risk to Worker and Patient
Mitchell spoke more about the 2020 report and preventing needlesticks in a recent podcast recorded by the Association of Occupational Health Professionals in Healthcare.2 Suture injuries in the operating room remained at 24% for both 2019 and 2020, and there is a need for progress in this arena, she emphasized. Although suture needles are not hollow bore like injection needles, an injury during a surgical procedure can carry the additional risk of exposing the patient to the healthcare worker’s blood.
“The highest risk in the operating room is if an injury happens with a suture needle or a scalpel blade inside the operative site of the patient, which means there’s an opportunity for potential transmission between patient and worker or worker and patient,” Mitchell explained. “These are extremely high-risk liability issues for healthcare institutions.”
Alternatives to suture needles are the blunt-type needles, adhesives, and staples.
“Sometimes, there’s an even better aesthetic effect or plastic surgery effect for skin closure using these alternates vs. sutures,” she said. “[There are also] scalpel blades that have a sheath that go over them. There are still injuries from blunt-tip sutures, of course, but that example is used as an engineering control in the OSHA Bloodborne Pathogens Standard.”
Although it will not prevent injury, the practice of double-gloving in surgery can reduce the volume of blood that enters the surgeon or patient, Mitchell added.
Needlesticks Activating Safety Device
In the aforementioned needlesticks involving syringes with a safety device, 30% of the healthcare workers were injured trying to activate the protective feature. This type of “activation” injury with safety needles rose to 32% in 2020.
“A user may have to activate either a hinged sheath or has to depress the plunger a little bit further to have the needle retract into the barrel of the syringe, so there’s something that the user has to actively do,” Mitchell said. “Another thing that we’ve seen is that even though people are using devices that have safety mechanisms or sharps injury prevention mechanisms, they’re getting injured before they have the opportunity to activate that safety feature.”
This underscores another OSHA requirement: that frontline employees participate in the evaluation of safety devices to determine if better options are on the market.
“A lot of medical device manufacturers are trying to move toward passive-type of technology, which could be more of a failsafe,” Mitchell says. “The user doesn’t have to do any activation of a safety feature. For example, say a lancet that’s used to take a finger prick sample, you depress the plunger or you put pressure on the skin and the needle pops in and pops out. There’s nothing that the user has to do to get the sharp [back] into the barrel of that lancet.”
Safety devices used for blood collection have been the biggest success story, “reducing injuries by leaps and bounds over the years,” Mitchell said. “Those are traditionally the highest risk because you have a blood-filled hollow bore needle that is being used, but [they have been greatly reduced] by advances in technology for blood collection, greater use of [safety] needles, button technologies, and retractable needles.”
Similarly, intravenous catheters that enter a vein or artery are almost completely enclosed now. “There’s been a lot of advances in IV insertion that have resulted in less injuries,” Mitchell said.
The constant is to continually look for ways to eliminate needles wherever possible. Until then, the process of preventing a needlestick or sharps injury is multifactorial, and many questions must be addressed.
“Is the right device in place? Is the safety feature obvious? Does the safety feature decrease a potential injury by activation? Is the sharps container in the right spot to reduce any movement across a room or over a patient?” Mitchell asked. “All of these things come into play.”
REFERENCES
- International Safety Center. EPINet sharps injury and blood and body fluid data reports.
- Association of Occupational Health Professionals in Healthcare. AOHP Caring for Healthcare Professionals podcast — Episode 17: Needlestick/sharps injury and blood/body fluid exposure prevention. Aug. 19, 2021.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content