Contents

• Acronyms and Abbreviations
• Purpose of this Packet
• Epidemiology of Needlestick Injuries
• Occupational Risk of Needlestick Injuries
  • Occupational Risk of Hepatitis B
  • Occupational Risk of Hepatitis C
  • Occupational Risk of HIV
• Definition of a Safer Needle Device
• Efficacy of Safer Needle Devices
• Characteristics of Safer Needle Devices
• Evaluation and Selection of Safer Needle Devices
• OSHA's Position on Safer Needle Devices
• References
• Appendix A: FDA Safety Alert
• Appendix B: Sample Evaluation Form
• Appendix C: Additional Resources
• List of Illustrations
  • Figure 1 - Locations Where Percutaneous Injuries and Mucocutaneous Blood Exposures Occurred, U.S. EPINet, 1995
  • Figure 2 - Items Most Frequently Causing Sharp-Object Injuries, U.S. EPINet, 1995
  • Figure 3 - Health Care Workers with Occupationally Acquired AIDS/HIV Infection, Cumulative Cases, 1987 through 1996
  • Table 1 - Health Care Workers Reporting Percutaneous and Mucocutaneous Blood Exposures, by Occupation, U.S. EPINet, 1995
  • Table 2 - Health care workers with documented and possible occupationally acquired AIDS/HIV infection, by occupation, reported through December 1998, United States

Acknowledgment: This document was developed by the Office of Occupational Health Nursing, with significant contributions from Susan Elliott, ARNP, MSN, MPH, OSHA Nurse Intern, and Digna Walker, RN, B.S.N., OSHA Nurse Intern.

Acronyms and Abbreviations

CDC	Centers for Disease Control and Prevention
CSHO	Compliance Safety and Health Officer
FDA	Food and Drug Administration
HBV	Hepatitis B Virus
HCV	Hepatitis C Virus
HIV	Human Immunodeficiency Virus
IM	Intramuscular
IV	Intravenous
MMWR	Morbidity and Mortality Weekly Report
NCID	National Center for Infectious Diseases
OPIM	Other potentially infectious materials
OSHA	Occupational Safety and Health Administration

Purpose of this Packet

Q. What is the purpose of this packet?

A. The purpose of this packet is to:

• Update OSHA staff's knowledge of current statistical data on exposure risk, prevalence, and incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) in health care workers.
• Provide technical assistance to OSHA staff in understanding the role of safer needle devices in preventing needlestick injuries.
• Give guidance on the process of selecting safer devices.

Q. What are some questions that may be asked about safer needle devices and needlestick prevention programs?

A. Although OSHA does not review, approve, license, or endorse products, OSHA staff may receive questions about safer needle devices and therefore have an excellent opportunity to educate the public about the role of these devices in preventing needlestick injuries. Questions that may be asked include:

• What are the current risks to health care workers who sustain a needlestick injury?
• What is the definition of a safer needle device?
• Why do we need safer needle devices?
• Does OSHA require us to use these devices?
• What features make a safer needle device an effective engineering control?
• How can a health care facility develop a program to implement safer needle devices?

This guide will provide answers to these questions.

Epidemiology of Needlestick Injuries

Q. What is the epidemiology of needlestick injuries?

A. Five primary activities are associated with the majority of needlestick injuries. They are:

• Disposing of needles, including collection and disposal of materials used during patient care procedures
• Administering injections
• Drawing blood
• Recapping needles (not allowed under the Bloodborne Pathogens Standard)
• Handling trash and dirty linens (termed "downstream injuries", these usually affect the housekeeping department (Chiarello, 1992).

Since 1992, the International Health Care Worker Safety Center has gathered data on needlestick injuries from 63 cooperating hospitals around the country. The results of the data analysis provide us with a useful picture of the pattern of needlestick injuries leading to occupational exposure to bloodborne pathogens.

• Participating hospitals reported an overall rate for sharp-object injuries of 27.0 per 100 occupied beds per year.
• Most exposure incidents occurred in patient rooms (37%), the operating room (16%), the emergency department (7%) or the critical care units (6%). (Figure 1)
• Nurses report the most frequent exposures (49.7%), while physicians rank second at 12.6%. Nursing assistants and housekeeper/laundry workers account for 5.3% and 5.1% of exposures respectively. (Table 1)
• Hollow-bore needles are the cause of injury in 68.5% of cases. Hollow-bore needles (the type of needle used for giving injections or drawing blood) also are implicated as the devices most often associated with the transmission of bloodborne pathogen infections, because the blood remaining inside the bore of the needle after use contains a larger volume of virus than the relatively small amount of blood remaining on the outside of a solid core needle (e.g., a suture needle). The amount of blood the health care worker is exposed to during the exposure event is one of the risk factors assessed to determine the type of post-exposure prophylaxis needed. (Figure 2)