The Occupational Safety and Health Administration (OSHA) estimates that more than 5.6 million workers in health care and related occupations are at risk of occupational exposure to bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and other potentially infectious agents.1 Occupational transmission of bloodborne pathogens (including HBV, HCV, and HIV) has been well documented.2-11 Ongoing surveillance of needlestick injuries (NSIs) and other sharps-related injuries indicate that occupational bloodborne pathogen exposure remains an important public health concern.
The primary route of occupational exposure to bloodborne pathogens is percutaneous injury (i.e., NSI). Health care workers (HCWs) handle sharp devices and equipment such as hypodermic and suture needles, intravenous blood collection devices, phlebotomy devices, and scalpels.
As many as 800,000 NSIs are estimated to occur in the hospital setting annually.12,13 However, the true incidence of sharps injuries is unknown because many injuries go unreported in both health care and public safety settings. Centers for Disease Control and Prevention (CDC) studies have estimated that the rate of seroconversion following occupational parenteral exposure to infected blood is approximately 6% to 30% for HBV exposures, 5% to 10% for HCV exposures,3-5 and 0.3% for HIV exposures.9,14 Other CDC surveillance data on NSIs indicate that 86% of reported occupational HIV exposures result from hollow-bore needles.14
NSIs occur most often to HCWs with the greatest involvement in direct patient care. Nursing staff and phlebotomists sustain the highest percentage of reported injuries.15-20 Other HCWs are at risk of injury from specific types of sharps—for example, surgeons (scalpels and suture needles), dental workers (dental burs), and housekeepers and laundry workers (discarded or lost needles in waste and laundry). The use of safer needle-bearing products and other measures for preventing sharps injuries should be part of an overall strategy to prevent NSIs.21,22 Compliance with standard precautions for prevention of exposure to bloodborne pathogens should be part of this over all strategy.23 Moreover, surveillance of NSIs is an integral part of sharps injury prevention and control. Accurate assessment of the frequency and circumstances of these injuries is necessary to direct prevention efforts.
Hospital NSI studies have shown that many of these injuries occur after the device is used and during disposal activities.15,16,24 As many as one-third of all sharps injuries have been estimated to be related to the disposal process. These injuries have most often been related to a number of factors, including inappropriate sharps disposal practices by the user, inadequate sharps disposal container design, inappropriate sharps disposal container placement,* and overfilling of sharps disposal containers.
The correct and consistent use of rigid sharps disposal containers in the health care environment has been demonstrated to reduce the number of NSIs.25 Studies indicate that placement of disposal boxes in all patient and treatment rooms decreases the frequency of sharps injury.15,16,18,25 Investigators have concluded that appropriately placed sharps disposal containers reduce NSIs related to recapping of sharps by as much as 80%.18 Cost-benefit studies show that when the increased costs of materials management are compared with the decrease in injury compensation costs, sharps disposal containers are cost effective—even when both direct and indirect costs (medical evaluation and followup, treatment costs, and lost workdays) of injury reduction are considered.24
In addition to engineering controls such as the use of rigid sharps disposal containers, organizational controls are a vital part of an overall prevention strategy. These include the elimination of unnecessary sharps, changes in device-handling procedures, worker education and training, and placement of sharps disposal containers where sharps are used.
The purpose of this document is to provide a frame work for selecting sharps disposal containers and evaluating their efficacy as part of an overall NSI prevention plan. Both disposable and reusable sharps disposal containers are included. The plan is in tended for use by infection control practitioners, purchasers, and others who are responsible for the selection process.