• Bloodborne Pathogens
• Needlestick Injuries

• Other Sharps Injury
• Safer Needle Devices

Exposure to blood and OPIM from contaminated sharps injuries.

Follow the requirements of the Bloodborne Pathogens Standard and implement engineering and work practice controls to minimize exposure to blood and bloodborne pathogens.

• Engineering and Work Practice Controls must be the primary means used to eliminate or minimize exposure to bloodborne pathogens. Where engineering controls will reduce employee exposure either by removing, eliminating, or isolating the hazard, they must be used, and changes to the Exposure Control Plan (ECP) must include these engineering controls [29 CFR 1910.1030(c)(1)(iv), 29 CFR 1910.1030(d)(2)(i), OSHA Directive CPL 02-02-069 [CPL 2-2.69].
  
  
  • Engineering Controls are measures (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace [29 CFR 1910.1030(b)].
    
    
    • NOTE: The exposure control plan must document consideration and implementation of appropriate commercially available and effective engineering controls designed to eliminate or minimize exposure [OSHA Directive OSHA Directive CPL 02-02-069 [CPL 2-2.69]], and revised Standard Exposure Control Plan [29 CFR 1910.1030(c)(1)(iv)(B)].
    
    
  • Work Practice Controls are measures that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique).
  
  
• The revised Bloodborne Pathogens and NeedleStick Prevention Standard requirements (effective date April 18, 2001) include:
  
  
  • Employers must implement the safer medical devices that are appropriate, commercially available, and effective [29 CFR 1910.1030(c)(1)(iv)(B)] and document consideration and implementation of safer medical devices annually.
    
    
    • Employers must get input for these devices from those responsible for direct patient care in [29 CFR 1910.1030(c)(1)(v)]. This input must be documented.
      
      
    • Employers must train employees to use new devices and/or procedures and document training in the Exposure Control Plan.
    
    
  • Employers must maintain a log of injuries from contaminated sharps 29 CFR 1910.1030(h)(5)(i).
  
  
• The new Record keeping Standard 29 CFR 1904.8 also requires needlestick injuries to be recorded on the OSHA 300 Log. This includes all work related needlestick injuries and cuts from sharp objects that are contaminated with another person's blood or other potentially infectious materials (OPIM).
  
  
  • If this recorded employee injury is later diagnosed with an infectious bloodborne disease the OSHA 300 log must be updated.

Other Bloodborne Pathogens Standard requirements include:

• Compliance with Universal Precautions (an infection control principle that treats all human blood and other potentially infectious materials (OPIM) as infectious) [29 CFR 1910.1030(d)(1)].
  
  
• Personal Protective Equipment (PPE). Engineering and work practice controls shall be used to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls, PPE shall also be used [29 CFR 1910.1030(d)(2)(i)].
  
  
• Worker training in appropriate engineering controls and work practices, to eliminate or minimize worker exposure. [29 CFR 1910.1030(g)(2)].
  
  
• Proper handling and containerization of sharps.
  
  
• Post-exposure evaluation and follow-up, including post-exposure prophylaxis when appropriate [29 CFR 1910.1030(f)(3)].

For additional information, see Healthcare Wide Hazards - Bloodborne Pathogens.

• Exposure Prevention Information Network (EPINET). International Healthcare Worker Safety Center, U.Va. Health System. Conducts epidemiological research on needlesticks and blood exposures, advocates for a safer health care workplace and provides resources:
  • Fact Sheet: Percutaneous Injuries From Suture Needles. (2006, June), 83 KB PDF, 1 page. Identifies suture needles are the main source of needlesticks to OR personnel, causing 51% of all sharps injuries in surgical settings.
  • Checklist for Sharps Injury Prevention. 23 KB PDF, 2 pages.
  • CDC Releases National Needlestick Estimates. Reports CDC’s estimate of 384,325 percutaneous injuries (PIs) annually.
• Occupational safety: selected cost and benefit implications of needlestick prevention devices for hospitals. United States General Accounting Office, Publication GAO-01-60R, (2000, November), 191 KB PDF, 18 pages.
  

Exposure to blood and other potentially infectious materials (OPIM) because of:

• Unsafe needle devices.
  
  
• Improper handling and disposal of needles.

• Use safer needle devices and needleless devices to decrease needlestick or other sharps exposures. See Safer Needle Devices Section.
  
  
• Properly handle and dispose of needles and other sharps according to the Bloodborne Pathogens Standard.
  
  
  • Handling Needles/Sharps:
    
    
    • Do not bend, recap, or remove contaminated needles and other sharps unless such an act is required by a specific procedure or has no feasible alternative [29 CFR 1910.1030(d)(2)(vii)].
      
      
    • Do not shear or break contaminated sharps. (OSHA defines contaminated as the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface) [29 CFR 1910.1030(d)(2)(vii)].
    
    
  • Containerization:
    
    
    • Have needle containers available near areas where needles may be found. [29 CFR 1910.1030(d)(4)(iii)(A)(2)].
      
      
    • Discard contaminated sharps immediately [29 CFR 1910.1030(d)(4)(iii)(A)(1)] or as soon as feasible into appropriate containers.

Appropriate containers [29 CFR 1910.1030(d)(4)(iii)(A)(1)], must be: Closable, puncture-resistant, and leak-proof on sides and bottom. Accessible, maintained upright, and not allowed to overfill. Labeled or color coded according to 29 CFR 1910.1030(g)(1)(i) Colored red or labeled with the biohazard symbol. Labeled in fluorescent orange or orange-red, with lettering and symbols in a contrasting color [29 CFR 1910.1030(g)(1)(i)(C)]. Red bags or containers may be substituted for labels [29 CFR 1910.1030(g)(1)(i)(E)].

For additional information, see Healthcare Wide Hazards - Bloodborne Pathogens.

Exposure to blood and other potentially infectious materials (OPIM), from contaminated sharps for example:

• Glass Capillary Tubes that may break when used and if handled incorrectly may result in a penetrating wound of employee.
  
  
• Used Disposable Razors that could be contaminated with blood.
  
  
• I.V. Connector Systems that use needles to connect I.V. setups.

Follow the requirements of the Bloodborne Pathogens Standard 1910.1030 and implement engineering and work practice controls to help prevent needlesticks or other sharps exposures.

• Glass Capillary Tubes:
  
  
  • Do not pick up broken glassware, such as capillary tubes directly with the hands [29 CFR 1910.1030(d)(4)(ii)(D)].
    
    
  • Dispose of regulated wastes including capillary tubes properly [29 CFR 1910.1030(d)(4)(iii)].
    
    
  • Wear gloves when among other things, handling or touching contaminated items or surfaces, such as capillary tubes [29 CFR 1910.1030(d)(3)(ix)].
    
    
  • In their joint document (Glass Capillary Tubes: Joint Safety Advisory About Potential Risks, (1999, February)), OSHA, Food and Drug Administration (FDA) and National Institute for Occupational Safety and Health (NIOSH) warn healthcare workers about the hazards from breakage of glass capillary tubes and recommend using:
    
    
    • Capillary tubes that are not made of glass.
      
      
    • Glass capillary tubes wrapped in puncture-resistant film.
      
      
    • Products that use a method of sealing that does not require manually pushing one end of the tube into putty to form a plug.
  
  
• Used Disposable Razors should be considered contaminated waste and disposed of properly in appropriate sharps containers.
  
  
• I.V. connector systems: Use needleless connector systems with I.V. setups to minimize occupational exposure to needles and bloodborne pathogens. Avoid using needles where safe and effective alternatives are available.

(Figure 1) Needleless I.V. Connector

The FDA urges using needleless systems, or recessed needle systems to reduce the risk of needlestick injuries. These connectors use devices other than needles to connect one I.V. to another. This example shows the plunger-type system.

According to the revised Bloodborne Pathogens Standard, employers with the help of employees, must select safer needle devices to use in work environments.

• There are different types of safety features that are available for safer needle devices such as:
  
  
  • Passive safety features: remain in effect before, during and after use.
    
    
  • Active devices: require the worker to activate the safety mechanism.
    
    
  • Integrated safety design: have a safety feature that is built in as an integral part of the device and cannot be removed. This design feature is usually preferred.
    
    
  • Accessory safety devices: have safety features that are external to the device and must be carried to, or be temporarily or permanently fixed to, the point of use. This design is dependent on employee compliance and according to some researchers, is less desirable.
     
• Desirable Characteristics of Safety Devices include:
  
  
  • The device is needleless.
    
    
  • The safety feature is an integral part of the device.
    
    
  • The device is easy to use and practical.
    
    
  • The device performs reliably.
    
    
  • The safety feature cannot be deactivated and remains protective through disposal.
    
    
  • The devices work effectively and reliably, and are acceptable to the healthcare worker, and do not adversely affect patient care.
    
    
  • The Food and Drug administration (FDA) is responsible for clearing medical devices for marketing in the US It recommends safer needle devices with a fixed safety feature that:
    
    
    • Provides a barrier between the hands and the needle after use; the safety feature should allow or require the worker's hands to remain behind the needle at all times.
      
      
    • Is an integral part of the device and not an accessory.
      
      
    • Is in effect before disassembly and remains in effect after disposal to protect users and trash handlers, and for environmental safety.
      
      
    • Is as simple as possible, and requires little or no training to use effectively.
  
  
• Examples of Safety Device Designs

There are many types of safety devices. Some examples of safety device designs include:

• Needleless Connector Systems: Needleless connectors for IV delivery systems (e.g., blunt cannula for use with prepierced ports and valved connectors that accept tapered or luer ends of IV tubing), (Figure 1).
  
  
• Self-Sheathing Safety Feature: Sliding needle shields attached to disposable syringes and vacuum tube holders (Figure 2A and 2B).
  
  
  • Disposable scalpels with safety features such as a sliding blade shield (Figure 6).
  
  
• Retractable Technology: Needles or sharps that retract into a syringe, vacuum tube holder, or back into the device.
  
  
  • Syringe with a retractable needle (Figure 3).
    
    
  • Retractable finger/heel-stick lancets (Figure 8).
  
  
• Self Blunting Technology: Self-blunting phlebotomy and winged-steel "butterfly" needles (a blunt cannula seated inside the phlebotomy needle is advanced beyond the needle tip before the needle is withdrawn from the vein (Figure 4), (Figure 5).
  
  
• Add-on Safety Feature: Hinged or sliding shields attached to phlebotomy needles, winged steel needles, and blood gas needles, (Figure 7).

Example Devices with Safety Features
(Figure 2A) Self Re-sheathing Needles. Before Use. (Figure 2B) Self Re-sheathing Needles. After Use. *Please note these safety devices lock in place and do not reset in actual use situations. The animation resets for viewer convenience only.	Self Re-sheathing Needles Initially, the sleeve is located over the barrel of the syringe with the needle exposed for use. After the device is used, the user slides the sleeve forward over the needle where it locks in place and provides a guard around the used needle.
*(Figure 3) Syringe with Retractable Needles. The used needle retracts into the barrel of the syringe. *Please note these safety devices lock in place and do not reset in actual use situations. The animation resets for viewer convenience only.	Syringe with Retractable Needles After the needle is used, an extra push on the plunger retracts the needle into the syringe, removing the hazard of needle exposure.
*(Figure 4) Blunt-Tipped Blood Drawing Needles. Blood collection tube and blood drawing syringe. *Please note these safety devices lock in place and do not reset in actual use situations. The animation resets for viewer convenience only.	Blunt-Tipped Blood Drawing Needles After blood is drawn, a push on the collection tube moves the blunt tip needle forward through the needle and past the sharp needle point. The blunt point tip of this needle can be activated before it is removed from the vein or artery.
*(Figure 5) Winged Steel Needles. Blunt-tipped winged steel needle. *Please note these safety devices lock in place and do not reset in actual use situations. The animation resets for viewer convenience only.	Winged Steel Needles After placement, the third wing is rotated to flat position which blunts the needle point before it is removed from the patient.
*(Figure 6) Re-sheathing Disposable Scalpels. Re-sheathing scalpel. *Please note these safety devices lock in place and do not reset in actual use situations. The animation resets for viewer convenience only.	Re-sheathing Disposable Scalpels Single-use disposable scalpels have a shield that is advanced forward over the blade after use, containing and removing the hazard.
*(Figure 7) "Add on" Safety Feature. "Add on" sliding shield. *Please note these safety devices lock in place and do not reset in actual use situations. The animation resets for viewer convenience only.	"Add on" Safety Feature Hinged or sliding shields attached to phlebotomy needles, winged steel needles, and blood gas needles,
*(Figure 8) Retracting Finger Prick Lancets. Retracting Finger Lancet *Please note these safety devices lock in place and do not reset in actual use situations. The animation resets for viewer convenience only.	Retracting Finger Prick Lancets This single use lancet automatically retracts after use, containing and removing the hazard.