1. Sharps Injury
Surveillance and Prevention
in Massachusetts
Angela K. Laramie, MPH
Massachusetts Sharps Injury Surveillance System
Occupational Health Surveillance Program
MNA
June 2007
2. Background
• Risk of being exposed to HBV, HCV, and HIV
• Risk of infection for:
HBV 6% to 30%
(for those not immune to HBV)
HCV 1.8% (range 0% to 7%)
HIV 0.3%
3. Costs of sharps injuries
• Direct costs
– includes cost of EH personnel, lab tests, HBV
immune globulin, HBV vaccine
• ranges from $110 - $1,232
– Includes medical care after seroconversion
• ranges from $32,000 - $500,000
• Indirect costs - difficult to quantify
4. Sharper images: Despite needlestick law, nonsafe sharps practices still go unchecked
By Ed Frauenheim February 12, 2001 Nurse Week
Photo: Courtesy of the White House
5. Timeline of Regulations
December 1998 Legislation filed by Massachusetts Nurses
Association
August 2000 An Act Relative to Needlestick Injury Prevention
(Massachusetts)
November 2000 Needlestick Safety and Prevention Act
(Federal)
January 2001 OSHA revised Bloodborne pathogen standard
April 2001 MDPH regulations (included in hospital licensure
regulations)
6. States with sharps legislation:
1998 2000 Ohio
California West Virginia Massachusetts
Minnesota New York
1999 Maine
Tennessee Georgia 2001
Maryland Iowa Arkansas
Texas New Hampshire Missouri
New Jersey Alaska Rhode Island
Connecticut Pennsylvania
As of June 2002
Oklahoma
7. MDPH Sharps Injury Prevention
Regulations
105 CMR 130.1001 et seq.
Requires hospitals to:
• Incorporate the use of safe needle / sharps
devices into engineering and work practice
controls
• Maintain a written exposure control plan
– with procedures for selecting safe devices
8. MDPH Sharps Injury Prevention
Regulations
105 CMR 130.1001 et seq.
Requires hospitals to:
• Maintain a Sharps Injury Log
• Use data for continuous quality improvement
• Report to MPDH annually (Annual Summary)
Requires MDPH to:
• Establish an Advisory Committee
• Develop a list of needleless systems
9. MDPH Sharps Injury Prevention
Advisory Committee
• Mass Nurses Assoc.
• Mass Hospital Assoc.
• Mass Medical Society
• UMass: Sustainable
Hospitals Project
• NECOEM
• Consumer Advocate
MDPH
• Occupational Health
Surveillance
• Bureau of Communicable
Disease Control
• Division of Health Care
Quality
10. Objectives of the Sharps Injury
Surveillance System
• Document magnitude of the problem and trends in sharps
injuries among hospital workers overtime
• Identify departments, occupations, procedures, and
hospitals where intervention is needed
• Identify devices associated with sharps injuries
• Facilitate sharing information among hospitals about
successful programs and practices
11. Methods
• Population under surveillance: All health care workers in
Massachusetts hospitals (acute and non-acute care)
licensed by MDPH
• Reportable exposure incident: BBP exposure that is the
result of events that pierce the skin or mucous
membranes
• Reporting period: January 1 – December 31
• Coding structure is based on the CDC NaSH system
12. Annual Summary of Sharps Injuries Hospital:
Massachusetts Department of Public Health License Number:
Occupational Health Surveillance Program Hospital Contact:
Phone number:
Year:
Use of the attached lists is encouraged when completing this form.
*Required data elements for reporting to MDPH.
*
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13. Sharps Injuries among Massachusetts
Hospital Workers, 2002 -2004
2002 2003 2004
# of hospitals 101 99 99
% compliance 100% 100% 100%
# of injuries reported 3,413 3,327 3,276
Range of # of injuries reported 0 – 431 0 - 312 1-317
% injuries in acute care hospitals 97% 97% 97%
% injuries in teaching hospitals 40% 58% 59%
14. Sharps Injuries among Hospital Workers by Occupation,
Massachusetts, 2002-2004, N=10,016
Nurse
40%
Other / Not
answered
3%
Physician
32%
Technician
19%
Other Medical
Staff
1%
Support
Services
4%
Dental Staff
1%
15. Sharps Injuries among Massachusetts
Hospital Workers, 2002-2004
top 4 occupations
0
5
10
15
20
25
30
35
40
45
50
Nurse Physician Technician Support
Services
2002
N=3,413
2003
N=3,327
2004
N=3,276
Percentage
of
injuries
16. Sharps Injuries among Massachusetts
Hospital Workers, 2002-2004
top 4 occupations
0
200
400
600
800
1000
1200
1400
Nurse Physician Technician Support
Services
2002
N=3,413
2003
N=3,327
2004
N=3,276
#
of
injuries
17. Sharps Injuries among Hospital Workers by
Department, Massachusetts, 2002-2004, N=10,016
OR and
Procedure
Rooms
42%
Inpatient Units
23%
ED
8%
ICU
8%
Laboratories
5%
Outpatient Areas
4%
Other Areas and
Unknown / Not
Answered
10%
18. Sharps Injuries among Massachusetts
Hospital Workers, 2002-2004
top 4 departments
0
5
10
15
20
25
30
35
40
45
50
OR Inpatient
Units
ED ICU
2002
N=3,413
2003
N=3,327
2004
N=3,276
Percentage
of
injuries
19. Sharps Injuries among Hospital Workers by Procedure or
Purpose for which Device was Used, Massachusetts,
2002-2004, N=10,016
Unknown/ Not
Answered
7%
Other
11%
To obtain body
fluid or tissue
sample
2%
Line Procedures
9%
Making the
incision
8%
Blood
Procedures
19%
Injection
23%
Suturing
21%
23. Sharps Injuries among Hospital Workers by Device Involved
in the Injury, Massachusetts, 2002-2004, N=10,016
0
500
1000
1500
2000
2500
3000
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Number
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Injuries
Unknown/Not answered
Safety Device
Conventional Device
25. Sharps Injuries among Hospital Workers by Department
where Injury Occurred, Massachusetts, 2002-2004, N=10,016
0
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Injuries
Unknown/Not answered
Safety Device
Conventional Device
26. Sharps Injuries among Hospital Workers with Hypodermic
Needles by Procedure - Standard v Safety Device,
Massachusetts, 2002-2004, n=2,984
0
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800
1200
1600
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2400
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27. Sharps Injuries among Hospital Workers with Hypodermic
Needles by Procedure – Conventional v Safety Device,
Massachusetts, 2002-2004, n=942
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28. Sharps Injuries among Hospital Workers in the OR
by Device, Massachusetts, 2002, n=935
Vacuum tube
collection holder
/ needle
1%
Hypodermic
needle
12%
Other hollow-
bore needle
9%
Suture Needle
48%
Scalpel
11%
Other
17%
Unknown/Not
Answered
1% Butterfly
1%
Hollow
bore
needles
23%
29. Sharps Injuries among Hospital Workers in the OR by Device:
Conventional v. Safety, Massachusetts, 2002, n=935
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30. Strengths of Massachusetts
Program
• Census of hospitals
• Not biased by voluntary reporting
• Concordance with federal requirements
• Used by hospitals for continuous quality improvement
• Provides a mechanism for sharing information among
hospitals
• Provides a model to be used in other settings
31. Annual Summary of Sharps Injuries Hospital:
Massachusetts Department of Public Health License Number:
Occupational Health Surveillance Program Hospital Contact:
Use of the attached lists is encouraged when completing this form. Phone number:
*Required data elements for reporting to MDPH. Year:
*
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32. Data Limitations
• Rate of underreporting is unknown and likely
varies by hospital/occupation
– Underestimates magnitude
– Limits comparison among hospitals
• Limitations of denominator data
• Statewide data on specific devices is difficult to
interpret without market share information
33. # of devices w/ safety features
purchased
#
of
sharps
injuries
Response rate for device
evaluations
Timeliness of PEM
Level of under reporting
34. Conclusions
• Need to look beyond summary data
• Need better information about under-reporting
• Conversions:
conventional → safety
→ first generation ↔ second…fourth generation
35. Conclusions
• Patterns are similar to those found in NaSH and
EPINet
• Many standard devices are still in use; e.g.
hypodermic needles
• Approximately half of injuries occur after use of
the device; e.g. disposal issues and use of
safety features
• Rate of participation may be driven by the ability
to comply with multiple regulations at one time
36. Prevention
Elimination
Substitution
· suturing glues
· injection with needles
alternative delivery of medications
Engineering controls
· IV systems needleless IV
· conventional needles SESIPs
(retractable, blunting, shielding, plastic)
37. Prevention
Administrative controls
· neutral zones in OR
· placement of sharps disposal containers
· purchasing policies
· reporting procedures
Personal Protective Equipment
· gloves, mask, gowns, goggles
38. Progress by Hospitals:
• Written inventory of devices
• Increased conversion to safety devices
• Review of safety devices
• Committee to look at sharps related injuries
• Committee to look at new devices
• Involvement of staff in decision making
• Centralized purchasing process
• Improved post exposure management
• Use of data in decision making
• Reporting of near misses
39. Acknowledgements:
Phil Adamo, Evie Bain, Helene Bednarsh, Al DeMaria,
Karen Daley, Tish Davis, Natalia Firsova, Catherine
Galligan, Anuj Goel, Liz O’Connor, Gail Palmeri, Laurie
Robert, Margaret Quinn, and Jim Ryan
This presentation is dedicated to Dr. James
Ryan, for his passionate work to protect the
health and safety of workers, particularly
those in the healthcare field.
40. Massachusetts Department of
Public Health
Occupational Health
Surveillance Program
Angela Laramie, MPH
Sharps Injury Surveillance and Prevention
Sharps.Injury@state.ma.us
www.mass.gov/dph/ohsp
