Two Decades Later, Are We Safer? Revisiting Sharps Injury Prevention in U.S. Healthcare

As the EPINet data shows, perioperative team members are among those clinicians for whom sharps injuries are on the rise. During an interview with HPN, Emily Jones, PhD, RN, CNOR, EBP-C, senior perioperative practice specialist, Association of periOperative Registered Nurses (AORN), commented on sharps injuries in the operating room (OR), stating:

“Sharps safety is critically important for every member of the surgical team, as the risk of injury affects everyone. Despite ongoing efforts, data shows that sharps injuries continue to occur in the operating room. In fact, one study found that nearly half of all reported sharps injuries took place in the perioperative setting.”

The tip of the iceberg

Because sharps injuries often go unreported, the EPINet data is only the tip of the iceberg when assessing real-world risk to healthcare workers and the actual number of injuries sustained each year in the U.S. 

This was evidenced by landmark study led by current U.S. Food and Drug Administration (FDA) Commissioner Martin A. Makary, M.D., M.P.H. and published in the New England Journal of Medicine (NEJM).² Entitled “Needlestick injuries among surgeons in training,” the study surveyed surgeons in training at 17 medical centers about previous needlestick injuries.

The survey had a 95% response rate, with 699 participants questioned about whether their most recent needlestick injury was reported to an employee health service or involved a “high-risk” patient (e.g., one with a history of infection with HIV, hepatitis B or hepatitis C, or injection-drug use).

The survey revealed:

• 83% of residents experienced at least one needlestick injury during training.
• The mean number of needlestick injuries increased with each postgraduate year (PGY):
  • PGY-1: 1.5 injuries
  • PGY-2: 3.7 injuries
  • PGY-3: 4.1 injuries
  • PGY-4: 5.3 injuries
  • PGY-5: 7.7 injuries
• By their final year, 99% of residents had experienced a needlestick injury; 53% of those injuries involved a high-risk patient.
• 51% of the most recent injuries incurred (297 of 578) were not reported to an employee health service, and 16% of those involving high-risk patients (15 of 91) were not reported.

Primary reasons for underreporting

Among the surgeons in training surveyed by Dr. Makary and his team of researchers, 42% cited “lack of time” as their reason for not reporting their injury, with this being the most common reason cited (126 of 297 respondents).

While Dr. Makary’s research was published 18 years ago, the findings still hold true nearly two decades later. In his interview with HPN, Scott Roberts, MD, medical director, Infection Prevention for Yale New Haven Health and assistant professor, Infectious Diseases for Yale School of Medicine, shared both anecdotal stories and research findings demonstrating how sharps injuries remain an underreported and underestimated risk in healthcare. 

“I've had surgical residents tell me they had a needlestick injury on a Saturday night when they're the only resident on call and the health system doesn’t have occupational health services available after hours on weekends,” said Dr. Roberts. “While the emergency department (ED) has needlestick injury protocols, the residents don’t want to wait in the ED for hours to get post exposure prophylaxis.”

A recent study, “National Survey of Sharps Injuries Incidence Amongst Healthcare Workers in the United States,” published in the April 2023 edition of the International Journal of General Medicine, found the top three reasons for not reporting sharps injuries are:³

1. Healthcare workers perceiving low infection risk based on patient medical history;
2. Fear of peer perception; and
3. Belief of lack of reporting utility or that reporting is inconsequential.

It is this first reason that Dr. Roberts highlighted in his co-authored case report, “Blood exposure to Babesia microti through sharps injury,” which was published in the October 2024 edition of Infection Control & Hospital Epidemiology. It described how a physician sustained a sharps injury from a scalpel contaminated with blood by a patient later confirmed to have Babesia microti (B. microti) infection.

B. microti is a parasitic blood-borne piroplasm commonly transmitted to humans by deer tick bites, but it can also be spread by exposure to infected blood products through transfusion or organ transplantation. Babesiosis, an infectious disease caused by B. microti, ranges in severity from “asymptomatic infection in about a fifth of adults to severe disease requiring hospital admission.”

While still rare, babesiosis has been described as “an unseen epidemic, with rates increasing in the U.S. by 9% per year from 2015 to 2022.”^4,5 As Dr. Roberts and his colleague wrote in their case report, “A sharps exposure to B. microti has never been reported, and no guidance exists for managing exposed healthcare workers.” 

“In general, healthcare workers do not have an accurate knowledge base of what defines a bloodborne pathogen,” Dr. Roberts explained. “They order patient testing for Hep B, Hep C, and HIV, and when all that comes back negative, they think, ‘OK, we are good to go.’ They don’t explore other diseases transmitted through bloodborne means that could put them at risk if a sharps injury occurs.”

Recommendations for maintaining awareness and reducing risk

A good first step in combatting complacency around sharps injury risks among healthcare workers is promoting awareness – both dangerous pathogens that can be transmitted through contact with a patient’s blood and factors that increase or decrease the risk for injury. 

“My team is working to educate the healthcare workforce that there are many other things that can be transmitted, such as Syphilis, Cytomegalovirus (CMV), and B. microti,” he continued. “We need to broaden patient evaluation and testing to reduce healthcare workers’ risk for exposure and harm.”

In the case report, Dr. Roberts and his colleague recommend the bloodborne transmission potential of babesiosis be taught to healthcare workers in endemic regions, which today include the Northeastern and Northern Midwestern regions of the U.S.”⁶

Dr. Roberts also highlighted the importance of raising awareness for activities that increase healthcare workers’ risk for injury, along with positive behaviors that can help enhance safety. 

“There's been some recent epidemiological data indicating suturing on closure is a high-risk activity compared with non-suturing-based activities,” he stated. “Additionally, research has shown that a stable team can improve safety. If a surgical team doesn’t change team members every day but rather has the same team in place for six months, safety incidents decrease.”^7,8

According to Dr. Jones, organizations can strengthen their commitment to sharps safety by renewing efforts to develop and maintain a comprehensive sharps safety program that involves every team member. 

“Experts emphasize that institutions have a responsibility to actively foster a culture of sharps safety,” she stated. “Leadership plays a key role by promoting a non-punitive environment, which helps create psychological safety and encourages more accurate and consistent reporting of sharps injuries. With consistent reporting of sharps injuries, we can follow the trends in injuries and identify ways we can continue to improve.”

Dr. Jones pointed to the AORN Guideline for Sharps Safety as a valuable resource, which features evidence-based recommendations, such as applying a bundled approach when structuring a sharps safety program.⁹ 

“One quality improvement initiative described in the literature demonstrated a decrease in sharps injuries after implementing a comprehensive bundle,” said Dr. Jones. “This included consistent use of a neutral zone, clear verbal communication when passing sharps, adoption of devices with engineered sharps injury prevention features, and routine double gloving.”

To effectively implement the updated AORN Guideline for Sharps Safety, Dr. Jones recommends the following best practices:

Review your current program: Begin by reviewing your organization’s existing sharps safety program to identify current practices, gaps, and areas for improvement.

Establish an interdisciplinary leadership team: Form a team with the authority and responsibility to develop and lead implementation efforts. This team should include:

Perioperative leaders and perioperative RNs

Surgeons and surgical technologists

Anesthesia professionals and perianesthesia RNs

Occupational health professionals, quality professionals, and risk managers

Additional representation may come from executive leadership, infection prevention, materials management, and nurse informatics

Develop a comprehensive sharps safety program that includes:

An exposure control plan

A process to evaluate and select devices that help reduce the risk of sharps injury

Implementation of safe sharps handling practices

Consistent use of personal protective equipment (PPE)

A user-friendly sharps injury reporting system

A robust quality improvement process

Role-specific education on sharps injury prevention 

The future of sharps injury reporting

Since its introduction in 1992, EPINet has served as the only multi-state data source for occupational needlesticks, contaminated sharps injuries, and high-risk mucocutaneous exposure incidents.¹⁰ 

On July 10, 2025, the Association of Occupational and Environmental Clinics (AOEC) announced that ISC, the home of EPINet, is closing at the end of this year and EPINet data is being transitioned to AOEC’s domain (www.aoec.org/epinet).¹¹

The announcement read, “EPINet data remains publicly available. Everyone is encouraged to delve deeper into EPINet findings to actively contribute to AOEC and its initiatives and join as a member of AOEC. Continued collaboration, adoption of evidence-based strategies, and improved surveillance will be essential for upholding safety standards and protecting workers in the healthcare sector.”

Commenting on the transition, Dr. Jones stated:

“With the ISC closure and EPINet data transition over to the Association of Occupational and Environmental Clinics, AORN continues to support perioperative teams with evidence-based recommendations for creating a comprehensive organizational sharps safety program to cultivate a culture of safety that promotes sharps injury prevention, supports consistent PPE use, and encourages sharps injury reporting.”