Workbook for Designing, Implementing & Evaluating a Sharps Injury Prevention Program

Introduction

Occupational exposure to bloodborne pathogens from needlesticks and other sharps injuries is a serious problem, but it is often preventable. The Centers for Disease Control and Prevention (CDC) estimates that each year 385,000 needlesticks and other sharps-related injuries are sustained by hospital-based healthcare personnel. Similar injuries occur in other healthcare settings, such as nursing homes, clinics, emergency care services, and private homes. Sharps injuries are primarily associated with occupational transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), but they they have implicated in the transmission of more than 20 other pathogens.

Overview of the program plan

An effective sharps injury prevention program includes several components that must work in concert to prevent healthcare personnel from suffering needlesticks and other sharps-related injuries. This program plan is designed to be integrated into existing performance improvement, infection control, and safety programs. It is based on a model of continuous quality improvement, an approach that successful healthcare organizations are increasingly adopting. We can describe this model in a variety of terms, but the underlying concept is that of a systematic, organization-wide approach for continually improving all processes (Processes Performance Improvement) involved in the delivery of quality products and services. The program plan also draws on concepts from the industrial hygiene profession, in which prevention interventions are prioritized based on a hierarchy of control strategies. The plan has two main components:

Organizational steps for developing and implementing a sharps injury prevention program. These include a series of administrative and organizational activities, beginning with the creation of a multidisciplinary working team. The steps are consistent with other continuous quality improvement models in that they call for conducting a baseline assessment and setting priorities for development of an action plan. An ongoing process of review evaluates the plan's effectiveness and modifies the plan as needed.

Operational processes. These activities form the backbone of the sharps injury prevention program. They include creating a culture of safety, reporting injuries, analyzing data, and selecting and evaluating devices.

Information provided

The Workbook includes several sections that describe each of the organizational steps and operational processes. A toolkit of forms and worksheets is included to help guide program developmentand implementation. The Workbook also contains:

• A comprehensive overview of the literature on the risks and prevention of sharps injuries in healthcare personnel;
• A description of devices with sharps injury prevention features, and factors to consider when selecting such devices; and
• Internet links to websites with relevant information on sharps injury prevention.

How to use the workbook

The Workbook presents a comprehensive program for sharps injury prevention. The information can be used to:

• Help healthcare organizations design, launch, and maintain a prevention program, and
• Help healthcare organizations enhance or augment current activities if a program is already in place.

The principles may also be broadly applied to the prevention of all types of blood exposures.

Target audience

The audience for this information includes healthcare administrators, program managers, and members of relevant healthcare organization committees. However, not all parts or activities will be relevant to every healthcare organization. CDC encourages healthcare organizations to use whatever they find helpful and necessary for their sharps injury prevention program. The sample forms and worksheets in the toolkit may also be adapted according to users' needs. Some sample tools (e.g., those for baseline assessment) are designed to be used only once, whereas others (e.g., healthcare worker surveys) are designed for periodic use.

Value of the workbook to healthcare organization

This Workbook contains a practical plan to help healthcare organizations prevent sharps injuries. Once implemented, the program will help improve workplace safety for healthcare personnel. At the same time, it may help healthcare facilities meet the worker safety requirements for accrediting organizations, as well as the following federal and state regulatory standards:

• Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards for surveillance of infection, environment of care, and product evaluation;
• Center for Medicare and Medicaid Services (CMS) compliance with the Conditions for Medicare and Medicaid Participation;
• Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030) and its related field directive, Inspection Procedures for the Occupational Exposure to Bloodborne Pathogens Standard (CPL 2-2.44, November 5, 1999) requiring use of engineered sharps injury prevention devices as a primary prevention strategy;
• State OSHA plans that equal or exceed federal OSHA standards for preventing transmission of bloodborne pathogens to healthcare personnel;
• State-specific legislation that also requires the use of devices with engineered sharps injury prevention features and, in some cases, specific sharps injury reporting requirements; and
• Federal Needlestick Safety and Prevention Act (PL 106-430), (November 6, 2000), which mandates revision of the 1991 OSHA Bloodborne Pathogens Standard to require the use of engineered sharps injury prevention devices.

Teaching tools