Needlestick Tracking: Results of the first 2 years of the

California Sharps Injury Surveillance Registry

California Department of Health Services

University of California, San FranciscoPresented at Health Care Workers Conference, July 2002

Project Staff

Marion Gillen, RN, MPH, PhD, Principal Investigator Martha Davis, MPH, EMT, Project Coordinator, 1998-2000 Jennifer McNary, CIH, MPH, Industrial Hygienist Alisa Boyd, MPH, Research Assistant Julieann Lewis, MPH, Research Assistant/Health Educator Chris Curran, MS, Research Assistant Mary Schuller, BS, Research Assistant James Cone, MD, MPH, Contract Officer and Chief, OHB Florence Reinisch, MPH – Project coordinator, 2002-

Project Aims

• Mandated by CA Senate Bill 2005;• Pilot study to determine the feasibility of

establishing a Sharps Injury Registry;• Overlapped passage of CA Assembly

Bill 1208 which mandated emergency changes to the Bloodborne Pathogens Standard.

Overview of Sharps Injury Surveillance Program

California the first state in the U.S. to develop a voluntary sharps injury registry

Collects data from acute care hospitals, home health agencies, and skilled nursing facilities.

Collected 1940 reports from 442 facilities (Jan. 98-Jan 30, 2000).

Response Rate

Overall response rate - 18%• Acute care facilities – 106/477 (22%)• Home health agencies – 120/872 (13%)• Skilled nursing facilities – 216/1177 (18%)

Average daily expenses in participating hospitals higher than non-participating hospitals (t = 2.55, p = 0.01)

Overall Project Aims

Conduct 2-year sharps injury surveillance study (injury registry)

Compile list of safety device studies Educate the public regarding sharps

injuries and Bloodborne pathogens Compile a list of available devices with

sharps injury prevention features

Research Methods

Developed injury log form for reporting Sent survey letter to 2550 California

acute care hospitals, skilled nursing facilities and home health care agencies requesting data

Sent follow up post card; second mailing Data coding, entry, cleaning and analyses

Study Parameters

Data was collected before and after effective date of revisions to California Bloodborne Pathogens standard

Sharps Injury Surveillance ProgramJanuary 1, 1998-December 31, 1999

Revisions to Bloodborne Pathogens Standard

Effective July 1999

Inclusion Criteria

Only includes injuries from sharp objects (not splashes, bites, or exposure to mucous membranes)

Only injuries from contaminated sharps Injuries to employees (not patients or

visitors)

Study Limitations

Participation was voluntary; data accepted in any format

Necessary to re-code data• Initial instructions not provided for log• Brand and model often unknown • Missing data in all data fields• Variability among facilities with regard to

data collection efforts considerable

Sharps Injury Log Form

Description of the Exposure Incident Job Classification Department or work area Procedure How the incident occurred

Sharps Injury Log Based on Cal-OSHA BBP Standard

Protective mechanism activated? Body part injured Employee’s opinion whether a safety

device or other controls could have prevented injury

Type, brand, model http://www.dhs.cahwnet.gov/ohb/SHARPS/Default.htm

Percent of All Reported Injuries by Facility Type

Other1%

HHA3%SNF

4%

HOSP92%

Sharps Injuries by Gender(n = 696)

Female77%

Male23%

Sharps Injuries by Shift Worked(n = 821)

Nights16%

Evenings28%

Days57%

Sharps Injuries by Job Class(n = 1344)

Nurse 49Technol/Therapist 12

MD 10

Phlebotomist/Lab 8

Housekeeper 7

CNA/HHA/Orderly 6

Student 2

Sharps Injuries by Location(n = 1455)

Location Percent

Patient Room 25

Operating Room 19

Emergency Dept. 10

ICU / CCU / NICU 8

Clinical Lab/Phlebotomy 7

Procedure room 7

Sharps Injuries by Procedure(n = 1327)

Procedure % of Injuries

Injection 22

Drawing venous blood 20

Suturing 11

Start IV/ DC IV 10

Procedure/Biopsy 10

Manipulating IV/port 8

Sharps Injuries by Secondary Procedures (n = 494)

Procedure %

Assisting w/ procedure 24

Equipment cleaning 21

Contact with trash 12

Room cleaning 11

Sharps protruding from SDC 8

Patient assistance 6

Sharps Injury by Work Process(n = 1345)

During use of sharp 30

After use/before disposal 23

Sharps left 16

While putting 11

During cleaning 7

Recapping 6

Sharps Injuries by Body Part(n = 983)

Hand13%

Other6%

Finger81%

Devices Associated With Injuries

Disposable Needle/Syringe 32% Needle, Not sure what kind 14% I.V. Catheter (Stylet) 9% Suture Needle 8% Winged steel needle/blood draw 7%

Scalpel 6% Vacuum tube blood needle 5%

Injuries from Traditional vs. Devices with E.S.I.P. (n = 832)

Traditional Devices 70% Devices with Engineered 20% Sharps

Injury Protection Didn’t know 9%

Age of Injured Workers (n = 411)

Mean age 38.48 years Minimum 18 years Maximum 72 years Housekeepers/laundry personnel

significantly older (mean=46 years) than phlebotomists, CNA/HHAs, therapists & technologists and others.

Size of Needle (n = 363)

Mean 23 gauge Minimum 30 gauge Maximum 14 gauge Mode 28 gauge

Time of Injury (n = 631)

Time of injury

240022002000180016001400120010008006004002000

Frequency

60

50

40

30

20

10

0

Other findings noted in text fields (n = 336)

Other circumstances contributing to injury event:• Patient moved 26%• Stuck by someone else 24%• Safety device related 17%• Sharps contained design or 10%

placement• Stuck by needle in sharps box 10%

Employee opinions regarding sharps with ESIP (n = 491)

yes67%

Text explanations = 191 Safety device could/would

have prevented injury (62%) SD could not have

prevented injury (8%) SD needs better design (7%) In stock, but not used (5%)

Employee opinions regarding sharps with ESIP (n = 491)

yes67%

Device was a safety device, but it was not activated (5%)

Safety device on order/on trial/unavailable (5%)

Thought there was no SD on marker for procedure (3%)

Employee thought SD would hinder procedure (3%)

Employee opinions regarding other work controls (n = 474)

yes74%

Text explanations = 311 Human factors including

slowing down (41%) Proper sharps disposal (20%) SDC design, placement, or

container too full (8%) Revised procedures or

improved protocols (7%)

Employee opinions regarding other work controls (n = 474)

yes74%

Improved staffing/training (6%) Other design feature; better

design of non-sharps tools or PPE; availability (6%)

Avoidance of recapping (5%) Have someone help (3%) Revised pt. care protocols (2%)

Employee opinions regarding other work controls (n = 474)

Work practice controls 73% Administrative controls 15% Engineering controls 10% Of note, many of the circumstances would

have benefited from engineering controls as a primary means or injury prevention. Most of the human factors explanations involved self-blame.

Facility Type and Injury Circumstances (n = 1258)

Circumstances Hospitals(%)

SNF & HHA(%)

During use 32 20

After use 23 30

While putting 12 7

Sharps left 17 25

2 = 10.69. P = 0.03

Job Classification and Injury Circumstances (n = 1125)

MD (%) Lab (%) Nurse(%)

CNA(%)

During use 79 35 31 20

After use 12 30 32 25

While putting 2 22 12 10

Sharps left 0 4 8 33

2 = 464, p = <.001

Job Classification and Procedure (n = 1100)

MD (%) Nurse(%)

Tech(%)

Others(%)

Draw blood 5 20 13 43

Injection 24 30 7 13Start IV 1 15 4 8Suture/assist 46 11 49 14Finger stick 0 4 1 6Other 24 19 26 16

2 = 275, p = <.001

Job Classification and Secondary Procedure (n = 446)

Hskpr(%)

CNA(%)

Nurse(%)

Tech(%)

Other(%)

Assisting 0 10 27 47 30

Rm/pt cleaning 29 58 19 9 15Equip cleaning 1 25 18 28 25Trash 60 2 3 5 6SDC-related 10 4 18 6 15

2 = 284, p = <.001

Injury Circumstance and Procedure (n = 1075)

Duringuse

Afteruse

Whileputting

Sharpsleft

Other

Draw blood 21 27 42 12 9

Injection 16 37 30 12 32Start IV 8 14 4 21 4Suture/assist 28 8 8 22 29Fingerstick 2 2 1 16 7Other 26 11 15 18 22

2 = 232, p = <.001

Injury Circumstance and Type of Device (n = 1239)

Duringuse(%)

Afteruse(%)

Whileputting

(%)

Sharpsleft(%)

Other(%)

Syringe 37 50 41 23 40IV needles 10 14 2 14 5Winged steel 11 18 31 6 4Lancet 2 2 1 10 5Suture 18 3 4 10 4

2 = 255, p = <.001

Department Location and Procedure (n = 1201)

Room(%)

OR(%)

ICU (%)

ED(%)

Other(%)

Draw blood 24 2 33 40 29

Injection 32 10 21 13 25Start IV 15 2 20 15 7Suture/assist 2 63 7 14 17Other 26 23 20 18 23

2 = 433, p = <.001

Device Type and Injury Circumstance (n = 1239)

Syringe(%)

IVneedle

(%)

Wingedsteel(%)

Lancet(%)

Suture(%)

During use 28 32 28 14 68

After use 33 35 35 16 10While putting 11 2 25 2 5Sharps left 10 23 8 43 10Other 18 9 6 25 8

2 = 255, p = <.001

Why Sharps Injury Surveillance?

Benefits of aggregated data Identify devices that continue to result in

injuries Serve as early warning for device or

design-related injuries Identify job class., procedures, work

activities, that continue to be at risk for sharps injuries.

Future Plans/Recommendations

Continue to collect sharps injury logs.

Encourage use of standard reporting format

Change voluntary nature of reporting

Develop recommendations based on injury circumstance and device type