NIOSH recommendations to protect healthcare workers

CDC, NIOSH today recommended that employers adopt strategic measures to protect the Nation's 8 million health care workers from job-related injuries caused by needles in syringes, intravenous delivery systems, and related medical devices.

"Today's health care workforce faces a multitude of risks," said NIOSH Director Linda Rosenstock, M.D., M.P.H. "We know that needle-less devices and safe needle devices can save lives. We must do everything we can to protect the health care workers who have devoted their lives to keeping America healthy."

Every year 600,000 to 800,000 occupational needlestick injuries are estimated to occur and can lead to serious or potentially fatal infections with bloodborne pathogens such as hepatitis B virus, hepatitis C virus, or human immunodeficiency virus (HIV). The precise number of injuries is not known because needlesticks often go unreported. The risk of a bloodborne infection may not be immediately recognized, and symptoms may not become apparent until weeks or months after the needlestick.

NIOSH recommendations for work-related needlestick injuries are outlined in a new bulletin, "NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings." Developed in collaboration with other CDC centers and with extensive outside scientific review by diverse industry, labor, and public health organizations, the Alert provides detailed guidance and assistance to employers, workers, and others in reducing needlestick injuries.

"Building on the success that some institutions have achieved in reducing such injuries by as much as 88 percent, these suggestions offer achievable, practical guidance for protecting the Nation's growing workforce of health care employees," said Rosenstock.

NIOSH recommends that the use of needles be eliminated where possible. If safe and effective alternatives to needles are not available, devices with safety features such as shields and sheaths should be used. Devices should be selected, used, and evaluated as part of a comprehensive program in which safe work practices, such as prohibiting recapping, are established under written procedures, and workers are trained in those practices. Each health care setting should have its own carefully tailored program, developed with front line worker input and review.

Hollow-bore needles such as those used in syringes present the greatest risk for needlestick, but potential for injury exists whenever any sharp device is used, the NIOSH Alert reports. Most reported needlesticks involve nurses, but laboratory staff, doctors, housekeepers, and other health care workers are also injured.

The Alert suggests examples of devices that may reduce the risk of needlesticks, but advises that no one device will be appropriate or effective for every workplace. Examples of such devices include but are not limited to:

• Needle-less devices, such as connectors for intravenous delivery systems that use blunt or valved ends rather than needles for attaching one length of IV tubing to another.
• Devices in which safety features are an integral part of the design, such as sheaths and shields over needles.
• Devices that operate passively without requiring user activation, such as an IV connector with a permanent rigid housing over the needle.
• Devices designed so that the user can tell easily whether the safety feature is activated, such as a visually obvious needle cover or the audible sound of a protective sheath being engaged.
• Devices in which the safety feature cannot be deactivated and remains protective through disposal.
• Devices that perform reliably, are easy to use and practical, and are safe and effective for patient care.

CDC is working with health care industry groups, employers, workers, unions, the public health community, and others to disseminate its guidance and recommendations. Copies of "NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings," HHS (NIOSH) Publication No. 2000-108, are available at no charge from the NIOSH toll free information number, 1-800-35-NIOSH (1-800-356-4674). The document is also available online at www.cdc.gov/niosh.