Staying Sharp about Using Sharps Safely

June 23, 2023
Healthcare industry looks to maintain decline in sharps-related injuries with continued awareness.

At the height of their occurrences, sharps-related injuries were a daily event, with needlestick events increased by the frenzied situations in which sharps were being used. The result of many of these common, yet accidental, injuries was an increase in disease and infection transmission for unfortunate staff members. However, with heightened awareness and improved sharps usage protocols—along with enhancements in sharps devices and designs—needlestick injuries have been declining for years. Today, industry professionals are looking to continue the decline in sharps-related injuries by way of implementation and maintenance of best practices for use.

Safety policies and sharps practices 

According to Cara Simaga, senior director of Regulatory Affairs at Stericycle, needlestick injuries have been declining for over 30 years. “According to incident data from the International Safety Center Exposure Information Network, needlestick injuries have declined since the 1990s. While some of this is attributed to advances in safety for disposal syringes and winged steel needles, we can’t underestimate the role of key safety policies and practices within the care environment to help clinicians and caregivers safely dispose of sharps. The Occupational Safety and Health Administration (OSHA) recommends safe disposal as a core safety practice.” 

She added, “It is worth noting though that while needlestick injuries have declined, injuries from sutures and scalpel blades—especially among physicians—remain high. To that end, it is important that healthcare organizations continue training staff on proper usage and disposal of all sharps to ensure a compliant and safe environment for healthcare workers.” 

In agreement with Simaga is Marie Moss, RN, MPH, CIC, an infection preventionist who is a member of the Communications Committee at the Association for Professionals in Infection Control and Epidemiology (APIC). 

“In my opinion, sharps-related injuries have declined. This, I believe, is related to improvements in device design, i.e., needle-less IV tubing, self-sheathing or retracting needles and guidewires, and increased use of blunt-fill needles.” 

Also touting the effectiveness of implemented standards for sharps use is Certified Surgical Technologist (CST) and Clinical Consultant at IQVIA/Ansell, Katie Karus. She pointed out, “I think sharps-related injuries have declined in recent years. I have been in surgery for over 20 years, and I have not only seen changes in standards for double gloving, which can help reduce sharps injuries, but also for creating neutral zones while handing sharps. I think the addition of standards by the Association of periOperative Registered Nurses (AORN) and facility-specific changes including education on their policies for their staff, as well as the introduction of new products, has been instrumental in the decline of sharps-related injuries.” 

Safety protocols and proven success 

With increased requirements for safer medical devices, new protocols and new product designs have proven successful in reducing sharps-related injuries. Stericycle’s Simaga said, “The Department of Transportation (DOT) oversees how sharps waste is transported. At Stericycle we look to minimize interaction between our sharps containers and our team members. We train and empower all of our team members on Stop Work Authority (SWA) to be used if they see an issue with a container or any other practice that impacts safety. Sharps containers are stored on carts to minimize interaction with the drivers.” 

She added, “Stericycle team members also wear appropriate Personal Protective Equipment (PPE), such as eye protection and puncture-resistant gloves, while handling the containers. At our processing facilities, we utilize automated processes including lid removal, dumping of containers, and washing. We are also always looking for ways to improve our automated process such as increased investments in robots and automated pre-washing to decrease interaction points.” 

Regarding sharps containers, Simaga continued, “OSHA mandates that sharps containers must be closable, puncture-resistant, leak-proof on the sides and bottom, and properly labeled. Stericycle’s sharps containers are designed to satisfy this mandate and reduce the risk of sharps injuries. The lids allow for an easy vertical drop, allowing the sharp to land safely in the container. In addition, the containers are see-through and have a max fill line on the label to help prevent potential overflow. To be compliant, containers are labeled with the universal biohazard symbol, the word ‘biohazard,’ and color-coded red to warn everyone that the contents are hazardous.” 

At Viscot Medical, marketing associate Nina Morales, reported, “Clinicians have told us that a standardized and unified effort is key in terms of protocol. If everyone is on the same page and is ‘speaking the same language’ it makes errors less likely to occur. OSHA, CDC, AST, AORN, etc. all have recommendations and requirements around sharps safety but the final implementation of how those recommendations  carried out is up to the facility.” 

She continued, “For example, a neutral zone for sharps is recommended and several products exist to help enforce the neutral zone recommendations. It’s up to the facilities to standardize that neutral zone so it looks the same in every OR and no clinician is left guessing where to put their sharps when in use.” 

Also citing the importance of a neutral zone is Ansell’s Karus, who pointed out, “One of the biggest changes has been to create the neutral zone on our mayo stands for all sharps, as well as getting staff and surgeons to comply with and to utilize the same area. There are some great products out on the market to help facilitate these zones. 

Rushing increases risk of injury 

When considering the most common reasons and situations where sharps-related injuries occur, it appears the frenetic pace of healthcare is most to blame, along with a certain amount of user mishandling of sharps and related instruments. 

Ansell’s Karus asserted, “In my experience, one of the most common reasons for sharps-related injuries is rushing and distraction. Often procedures just become second nature, and the best way to reduce injuries for staff is making a policy change and requiring ongoing training. I have seen that implementing a policy change to require the use of a neutral zone can significantly reduce the number of sharps-related injuries within the sterile field. 

Nurse Consultant Judith Seltzer, MS, BSN, RN, CNOR, for Global & US Marketing-Gloves at Mölnlycke, reported that a Center for Disease Control (CDC) analysis showed that the most prevalent causes of injuries as a result of a needlestick incident were manipulating a needle in a patient (27 percent), improper disposal/disposal-related (22 percent), cleanup (11 percent), handling/passing a device during or after use (10 percent). 

As a preventative measure for sharps-related injuries, double-gloving has become a popular practice to avoid accidental needlesticks; however, not all injuries are noticed at the time they occur – both in patient care and surgical situations. 

Seltzer said, “More and more researchers continue to balance how surgical gloves play a critical role in minimizing sharps injuries to healthcare workers. AORN has identified PPE as being a primary element under the Sharps Safety Guideline.” 

She continued, citing the findings of a recent SERMO survey of over 500 practicing surgeons, “Implementing double-gloving into everyday practice can provide staff and patient safety. Double-gloving is proven to reduce the exposure to bloodborne infections by 71 percent. On average, only 10 percent of glove punctures are noticed during surgery, putting operating staff and patients at risk of exposure. Each incident costs up to $4,838 to manage.” 

Arguably, the operating room and surgical environment have the highest potential for sharps injuries because sharp instruments, scalpels and sutures are handled frequently and passed back and forth amongst the surgical staff. As such, Seltzer asserted there are several approaches to avoiding sharps injuries that healthcare workers can take including “the initial personal protective step to double-glove in all procedures as a preventive strategy.” 

Safety continues in sharps containers 

At Medegen Medical Products, Senior Director of Marketing & International Sales, Roy Prybella pointed out that the commonly seen red sharps containers are not just limited to certain areas of hospitals and healthcare facilities anymore. 

“We are seeing sharps used in more locations within the hospitals to make the containers more convenient to use. Awareness and sensitivity to reducing exposure both for needlesticks and also biological contamination has driven sharps container availability in each patient’s room, limiting the distance traveled with the needle,” Prybella said. 

He added, “There was also a complicating factor where sharps containers only fit into a certain manufacturers cabinets and brackets limiting choice and managing inventories. New products are being designed to fit into multiple cabinets. For example, the leading sharps container is a 5-quart or 5.4-quart sharps from two different suppliers, and the sharps would not fit into each other’s cabinet. We have a new design that provides the 5.4-quart volume, and it fits into both cabinets simplifying supply by reducing the number of SKUs.” 

Prybella also reported that sharps containers are being seen more frequently in locations outside of hospitals and healthcare facilities, both for convenience and safety reasons. 

He said, “Alternate care is the fastest-growing segment of the healthcare industry including home healthcare. Medication is administered in those settings by both licensed professionals and family members. [The] practice is changing from using empty coffee cans and plastic milk containers to dispose of needles. There are more options available that are safer and approved for use and proper disposal. There is also a higher awareness in public spaces to retain and dispose of needles.” 

As an example of sharps disposal convenience, Prybella noted that Medegen has introduced a “small, personal sharps container that can be easily carried and used while limiting the distance traveled with the potentially dangerous sharps.” The portable container is designed for medical and personal daily use. 

Forecasting the future of the sharps market, Prybella opined, “I believe the sharps market will expand with smaller, more portable models and less with large, centrally located units. Large units will still be used in more industrial locations like lab testing facilities. There will also be more awareness of bloodborne pathogens.” 

In a scenario that embraces technology to potentially eliminate almost all sharps injuries, APIC’s Moss suggested, “In the future, I think a large number, if not all, surgeries and sharps procedures will be performed robotically. Phlebotomy and IV insertions could also be performed by robotic devices, and laboratory tests could become more of a scanning procedure than the actual collection of blood. Ultimately, humans would have minimal or no role in the performance of sharps-related activities in healthcare.”