Organizations Agree On Top Sharps Safety Recommendations & Best Practices

November 19, 2018

By: Adeline Yi, Anzen™ Product Manager

Sharps safety is one of the most important topics when it comes to occupational hazards in the healthcare workplace. This is especially so for surgical sharps safety, as data shows sharps injuries in the operating room continues to be a problem.

While different facilities may approach sharps safety initiatives from varying perspectives, we recently compared what key industry organizations have to say about sharps safety best practices in the surgical setting.  We looked at the recommendations of the following industry associations: American College of Surgeons (ACS), Association of PeriOperative Registered Nurses (AORN), International Sharps Injury Prevention Society (ISIP), Occupational Safety and Health Administration (OSHA), National Institute for Occupational Safety and Health (NIOSH).

Across the board, four common themes reverberate throughout their recommendations. They are:

  1. The use of a sharps safety device where possible
  2. The utilization of a Neutral/Hands-Free zone for passing sharp instruments, blades and needles
  3. The adoption of blunt suture needles
  4. The implementation of work practice controls and training

Upon closer look, each organization had similar recommendations.

  1. Use of a Sharps Safety Device Where Possible

American College of Surgeons (ACS) – The use of ESIP devices as an adjunctive safety measure to reduce sharps injuries during surgery except in situations where it may compromise the safe conduct of the operation or safety of the patient.

Association of PeriOperative Registered Nurses (AORN) – Safety scalpel devices should be used when clinically feasible.

International Sharps Injury Prevention Society (ISIP) – The EU Sharps Directive was introduced as a way to prevent injuries and blood-borne infections to healthcare workers from sharp instruments. They also cite that many clinicians in the U.S. believe the mandatory use of safety-engineered devices can help decrease the incidence of injury.

Occupational Safety and Health Administration (OSHA) – Use safer needle devices and needleless devices to decrease needlestick or other sharps exposures.

National Institute for Occupational Safety and Health (NIOSH) – Use devices with safety features.

  1. Utilization of a Neutral/Hands-Free Zone

American College of Surgeons (ACS) – The use of Hands-free technique (HFT) as an adjunctive safety measure to reduce sharps injuries during a surgical procedure except in situations where it may compromise the safe conduct of the operation, in which case a partial HFT may be used.

Association of PeriOperative Registered Nurses (AORN) – Use of a neutral zone or hands-free technique for passing sharp instruments, blades, and needles.

International Sharps Injury Prevention Society (ISIP) – The EU Sharps Directive was introduced as a way to prevent injuries and blood-borne infections to healthcare workers from sharp instruments. They also cite that many clinicians in the U.S. believe neutral passing zones provide the most beneficial results.

Occupational Safety and Health Administration (OSHA) – 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 documented in the Exposure Control Plan (ECP).

  1. Adoption of Blunt Suture Needles

American College of Surgeons (ACS) – The universal adoption of blunt-tip suture needles for the closure of fascia and muscle in order to reduce needlestick injuries in surgeons and OR personnel.

Association of PeriOperative Registered Nurses (AORN) – Blunt suture needles should be used unless clinically contraindicated.

Occupational Safety and Health Administration (OSHA) – Use safer needle devices and needleless devices to decrease needlestick or other sharps exposures.

National Institute for Occupational Safety and Health (NIOSH) – Use devices with safety features.

  1. Implementation of Work Practice Controls and Training

American College of Surgeons (ACS) – Use of structured evaluation and user-based criteria that include performance standards, task analysis, simulation, and training programs for devices intended to reduce sharps injuries in the OR.

Association of PeriOperative Registered Nurses (AORN) – All sharps must be handled and disposed of safely.

International Sharps Injury Prevention Society (ISIP) – The EU Sharps Directive sets framework in place includes measures for how to address risk assessment, risk prevention, training and information, awareness raising and monitoring and response and follow-up procedures in relation to sharp injuries. They also cite that many clinicians in the U.S. believe training and awareness for those at risk provides the most beneficial results.

Occupational Safety and Health Administration (OSHA) – 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 documented in the Exposure Control Plan (ECP).

National Institute for Occupational Safety and Health (NIOSH) – Promote education and safe work practices for handling needles and related systems

Industry Recommendations Are Backed By Research

When framing their recommendations for sharps safety, the industry organizations cite the following research findings:

American College of Surgeons (ACS) – No study published to date demonstrates the clinical effectiveness of ESIP devices. The design and quality of Engineered Sharps Injury Prevention (ESIP) devices has been variable and their acceptance among surgeons is limited. Nevertheless, these devices may contribute to minimizing sharps injuries in the OR.

International Sharps Injury Prevention Society (ISIP) An estimated 1 million needlestick injuries occur in Europe each year, not taking into the account the number of unreported events.

It also goes without saying that needlestick injuries, in addition to being expensive, cause severe distress for affected healthcare workers and their families. In the UK, it is estimated that needlestick injuries cause costs of approximately 500,000 GBP per year for each NHS Trust.

Percutaneous injury was the most commonly reported type of exposure [78% (1,664/2,140)], with nursing related professions representing 45% (962/2,140) of the initial reports and medical professionals (doctors and dentists) accounting for 37% (793/2,140). If this is compared to the numbers of nurses and doctors practising, it suggests that within their professional group, there are a greater number of reported injuries among doctors.

Occupational Safety and Health Administration (OSHA)

OSHA estimates that 5.6 million workers in the healthcare industry and related occupations are at risk of occupational exposure to bloodborne pathogens.  According to the Centers for Disease Control and Prevention (CDC), about 385,000 sharps injuries occur annually to hospital employees. The Centers for Disease Control and Prevention (CDC) estimated in March of 2000 that 62 to 88 percent of sharps injuries in the hospital setting could be preventing by using safer medical devices.

National Institute for Occupational Safety and Health (NIOSH)

The primary route of exposure to bloodborne pathogens is accidental percutaneous injury caused by needlesticks (puncturing of the skin by a needle or similar sharp object). In the United States, approximately 800,000 needlestick injuries occur in hospitals annually—an average of one injury every 10 seconds. Studies have shown that many of these injuries occur after a sharp (needle or other sharp object) is used; as many as one-third of all sharps injuries have been reported to have occurred during disposal activities. Occupational transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) has been well documented. The risk of infection with HIV following one needlestick exposure is approximately .3% and ranges from 6% to 30% for HBV and from 5% to 10% for HCV.

While there may be varying perspectives on sharps safety initiatives based on the setting, organizations across the industry agree that these four best practices will provide the most effective outcomes in workplace safety for healthcare employees, especially in the operating room.