CDC Sharps Injury Prevention Workbook
CDC Centers for Disease Control and Prevention
Needlesticks and other sharps injuries to healthcare personnel (HP) have been associated with transmission of hepatitis B and C viruses and human immunodeficiency virus (HIV). CDC estimates that every day, over 1,000 hospital-based HP sustain an injury from contaminated needles and other sharp devices during the delivery of patient care; countless others occur in other healthcare settings such as nursing homes, outpatient clinics, physician offices, and emergency care services. The prevention of sharps injuries in HP is a national priority as evidenced by federal and state legislation and other regulatory initiatives, including OSHA’s Bloodborne Pathogen standard, requiring the implementation of sharps injury preventive measures.
For more than three decades, CDC has been involved in research and education related to sharps injury prevention, including analysis of injuries, surveillance and data reporting, device analysis, and education and training. Needlestick prevention activities involve a collaboration between the CDC’s Division of Healthcare Quality Promotion (DHQP) and CDC’s National Institute of Occupational Safety and Health (NIOSH). Many more of CDC’s resources for reducing occupational risk of bloodborne
pathogen, including needlestick prevention are available from
CDC Workbook for designing, implementing, and evaluating a sharps injury
Among the major tools developed by the CDC is a comprehensive, 155 page CDC workbook based on a model of continuous quality improvement intended to facilitate development of a systematic program for preventing and evaluating sharps injuries and include the following.
- Program plan: Integrates the performance improvement, infection prevention, and safety programs that already exist within healthcare facilities. It draws on concepts from the industrial hygiene profession, in which prevention interventions are prioritized based on a hierarchy of control strategies. Key elements include organizational steps for developing and implementing a sharps injury prevention program, and operational processes (activities) considered vital to the success of a sharps injury prevention program.
- Bloodborne pathogen information: Background information is provided on occupational injury statistics, transmission risk, and disease outcomes for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV).
- Tools: A variety of tools (e.g., surveys, worksheets, data collection forms) to implement the organizational steps and operational processes for a sharps injury reduction program.
An initial version of the workbook was launched and available on the CDC
website in 2004 and was revised in 2008 after a major evaluation of the workbook was completed. The workbook, a key resource for developing a program can be accessed here in a variety of ways:
Research collaboration – workbook evaluation: CDC, Premier
The CDC in collaboration with other federal and professional stakeholder organizations works to identify gaps in prevention and strategies to eliminate sharps injuries. One research initiative with support from the Premier Safety Institute® was conducting an evaluation of the first edition “Sharps Injury Prevention Workbook-2004.” Related activities included developing resources for training and education as well hosting a national stakeholders meeting to align efforts toward the goal of sharps injury prevention.
Evaluation of the CDC Workbook
Participants Eight hospitals within three healthcare systems volunteered to participate in a two-year study to evaluate specific components of the 2004 workbook. The findings from this research were presented at national professional association meetings and used to revise the 2008 workbook.
Overall summary The healthcare facilities generally agreed that the selection of safety devices and strategies to eliminate the risk of occupational needlestick injuries should be guided by input and preferences of front line workers and each institution’s data on risks. This includes at minimum, using data from the OSHA-required sharps injury log that contains information about sharps injuries, including the type and brand of device causing injury, location where incident occurred, description of events surrounding injury, such as the procedure being performed and prevention strategies found to be successful. Additional findings from the research are summarized below and followed by copies of selected research abstracts and other resources developed in conjunction with the Workbook.
Major findings – Workbook research
- Injuries still occur with the use of “sharps” with safety features. These devices include disposable syringes, butterfly needles, IV catheter stylets, vacuutainer needles, and scalpels. Factors contributing to injury include:
- Lack of activation of safety feature
- Improper technique used for activation
- Failure of device safety feature
- Lack of activation of safety features reported to be due to lack of training and awareness of importance.
- Sharp object injuries can be reduced through the use of safety devices and work practices, including blunt sutures, protective corks on surgical wires, and a neutral zone for passing sharps. Training on appropriate use of the device and activation of the safety feature is an essential component of the program to eliminate needlestick and sharps injuries.
- Availability of rapid HIV- testing of “source” patient results in fewer workers unnecessarily being started on HIV chemoprophylaxis.
- Root cause analysis is a useful tool to identify the cause of sharps injuries
- Respondents with a positive perception of the organization’s safety culture are less likely to sustain a sharps-related injury. Examples include the belief that patient safety is never sacrificed to get more work done and the organization encourages and rewards the recognition and reporting of errors and hazardous conditions.
- “Relationship Between Hospital-Based Healthcare Personnel Perceptions of Safety Culture and the Occurrence of Sharps Injuries.” Grytdal SP, Kobeski A, Kaplan C, Flanagan E, Cousin P, Lundstrom TS, Beltrami EM, Pearson ML. Presented by S. Grytdal at Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference, 2006 (oral presentation)
- “Sharps Injury Prevention Program: Root Cause Analysis of Sharps Injury or Near Miss Event at a Multi-Facility Medical Center.” Flanagan E, Semproch L, Preney K, Chevalier T, Lundstrom TS. Presented at Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference, 2006 (poster presentation)
- “Reduction of Sharps Injuries in the Operating Room Following Implementation of a CDC-Recommended Sharps Injury Prevention Program.” Berry X, Voris V, White N, Salomone J, Diaz-Granados C, Dent L, McCoy J, Feliciano D, Blumberg HM, Ray SM. Presented at Society of Healthcare Epidemiologists for America (SHEA) Annual Meeting, 2007 (poster presentation)
- “Sharps Injuries Occurring With the Use of Safety Devices: Providing Safer Devices Is Not Enough.” Walker C, Robichaux C, Desroches P, Berry X, Ribner B, Ray S, Blumberg HM, Diaz-Granados C, Steinberg, J. Presented at Society of Healthcare Epidemiologists for America (SHEA) Annual Meeting, 2007 (poster presentation)
- “Acceptance and Completion of HIV Post-exposure Prophylaxis by Healthcare Workers Following Blood and Body Fluid Exposures.” Berry X, Ray SM, White N, Voris V, Diaz-Granados C, Sanchez M, Del Rio C, Blumberg, HM. Presented at Society of Healthcare Epidemiologists for America (SHEA) Annual Meeting, 2007 (poster presentation)
CDC National stakeholders meeting
Worker training and education
- CDC Sharps safety education pamphlet for healthcare professionals.
2-page tri-fold; easy to download and print.
- Premier Safety Institute’s needlestick brochure
12-page, easy-to-read brochure for worker training for all healthcare settings.
12 – page brochure
The Stakeholders meeting, the research evaluating the CDC Workbook, dissemination of the sharps safety posters and CD-ROM was funded by the CDC Foundation with an unrestricted education grant from the Premier Safety Institute.