Anytime a member of your hospital staff starts an IV, injects medication, or participates in a surgical procedure, he or she can be at risk for a skin puncture, cut, or scratch by a needle or other sharp device. Needlesticks and sharps injuries remain a part of every healthcare provider’s risk profile. A recent industry study of 32 hospitals found the following:
- The sharps injury rate for all hospitals was 19.46 per 100 beds per year.
- The sharps injury rate for teaching hospitals was 20.73 per 100 beds per year.
- The sharps injury rate for nonteaching hospitals was 16.51 per 100 beds per year.
- Personnel other than the original user of the device, such as clinicians, housekeepers, and laundry and waste management staff, sustained 30 percent of sharps injuries.
As these statistics indicate, more work needs to be done to prevent sharps injuries.
Key Steps to a Prevention Program
The National Institute for Occupational Safety and Health has outlined the following five-step plan for developing a sharps injury prevention program:
- Form a sharps injury prevention team.
- Identify priorities.
- Identify and screen safer medical devices.
- Evaluate safer medical devices.
- Implement and monitor the use of the new devices.
While many healthcare organizations generally execute each step of the plan, monitoring the effectiveness of the prevention program can be challenging. A successful monitoring and accountability system should include three types of metrics:
- Outcome Metrics
Outcome metrics are a set of measurements that describe what is being produced, achieved, or obtained through your sharps program. A key metric to track is how often sharps injuries occur. You can further measure the outcome of your program by setting goals by individual departments, job titles, types of sharps, or devices used.
Since a significant portion of injuries are sustained by “secondary” employees, such as laundry staff, your metrics should also include the number of sharps found in other areas.
- Process Metrics
Your process metrics should include observations of whether safety devices are being used according to their recommended procedures and whether injury prevention program steps are being followed.
Have the observations made by someone who can reinforce proper behaviors and correct improper techniques. Be sure to document and share the observations with all stakeholders.
- Progress Metrics
Improvements start from a baseline and have a definable point in time where change or improvement occurs. Set up a system for continuous improvement by communicating incremental changes in injury rates. Let everyone know how the program’s progress stacks up against the original goals you set. To maintain continuous improvement in your program, analyze every sharps injury and consider the following factors and questions:
- Job title of the injured person and where injury occurred
- Type of device used
- Did the device have a protective mechanism for the needle?
- Procedure being performed when injury occurred
- Point in the procedure when injury occurred (e.g., after use/before disposal)
- Patient assessment (e.g., was the patient cooperative, agitated?)
- Issues related to staff training or competency (e.g., inadequate training)
- Was it a safe device? Could a safe device have prevented the injury?
- Issues related to the work environment (e.g., availability and fullness of sharps containers, placement of supplies, sufficient lighting, crowding, sense of urgency to complete the procedure)
- Worker factors involved (e.g., fatigue)
- Do adequate policies and procedures exist to prevent this type of injury?
Take the Long View
Reducing your sharps injury rate requires a long-term effort. All stakeholders in every location your organization operates must commit to a system of continuous improvement that seeks to lower your injury rate. By implementing a prevention program that’s supported by education, training, and communication, you’ll help improve worker and patient safety.
 2011 EPINet Report: Needlestick and Sharp-Object Injuries, International Healthcare Worker, Safety Center University of Virginia, Jan. 1, 2011 to Dec. 31, 2011.