Site Details

Needle and Sharps Safety

During FY 2010, there were several incidents of needle sticks reported to the Occupational Medicine Clinic. One involved uncapping of a tightly fitting needle cap, another involved a needle dangling from an experimental apparatus and two involved work with rodents.

What are needle stick injuries?

Needle stick injuries are wounds caused by needles that accidentally puncture the skin. Needle stick injuries are a hazard for people who work with hypodermic syringes and other needle equipment. These injuries can occur at any time when people use, disassemble, or dispose of needles. When not disposed of properly, needles can become concealed and injure other workers who encounter them unexpectedly.

What are the hazards of needle stick injuries?

Accidental punctures by contaminated needles can inject hazardous and/or radioactive fluids into the body through the skin. There is potential for injection of hazardous drugs, but injection of infectious fluids, especially blood, is by far the greatest concern. Even small amounts of infectious fluid can spread certain diseases effectively.

How do needle stick injuries occur ?

A needle stick injury is the result of an accident with a needle. Several studies show that needles cause injuries at every stage of their use, disassembly, or disposal. But there is disagreement as to why the accidents are so common among health care workers or why simple solutions fail to solve the problem.

Laboratory staff usually experience 90 percent of all injuries during animal and research procedures. Equipment design, nature of the procedure, condition of work, staff experience, recapping/uncapping, and disposal have all been mentioned as factors that influence this occurrence.

Nature of Procedure

Critical situations during laboratory procedures include:

Withdrawing a needle from a the animal.
Attempting to perform a tail vein injection on a live unrestrained animal
Pulling a needle out of the rubber stopper of a vacuum tube which can jab the hand in a rebound reflex.

Injuries commonly occur when workers try to do several things at the same time, especially while disassembling or disposing of needles.

Staff Experience

New staff or students tend to have more needle stick injuries than experienced staff.

Recapping and Uncapping

Recapping and uncapping can account for 25 to 30 percent of all needle stick injuries of laboratory staff. Often, it is the single most common cause.

It is extremely dangerous to hold a needle in one hand and attempt to cover it with a small cap held in the other hand. Injuries occur three different ways:

the needle misses the cap and accidentally enters the hand holding it.
the needle pierces the cap and enters the hand holding it.
the poorly fitting cap slips off of a recapped needle and the needle stabs the hand.
Tight fitting caps require additional force to remove. Once removed, the “cap hand” makes contact with the needle on a rebound reflex.

Several agencies have recommended that workers avoid recapping needles before disassembly or disposal. Despite this, some health care workers have continued the practice even when informed of the dangers. In some cases, inappropriate training or force of habit may be responsible.

Guidelines from OSHA recommend that workers do not recap (or bend or cut) needles but dispose of them directly into approved, puncture-proof containers.

If recapping is necessary and uncapping becomes more difficult, safety devices are available. Contact Bea Pyatt or Bob Colichio for additional information.

Disposal

Needle stick injuries commonly occur when workers dispose of needles. They occur when staff use special containers for needles and sharps. They also occur when needles are disposed of improperly in regular garbage or lost in the workplace.

Special Containers

Up to 30 percent of needle stick injuries of nursing and laboratory staff occur when workers attempt to dispose of needles using sharps containers. Accidents occur at every step:

while carrying the needle to the disposal container, especially when the needle is uncapped and mixed with other trash.
while placing the needle into the disposal container, especially if the container is overfilled.
while emptying disposal containers instead of sealing them for disposal.

Virtually all needle stick injuries of maintenance and custodial staff are from needles that have either been lost in the workplace or thrown into regular garbage. Janitors and garbage handlers can also experience needle stick injuries or cuts from "sharps" when handling trash that contains needles or scalpels.

How can needle stick injuries be prevented?

Preventing needle stick injuries is the most effective way to protect workers from the infectious diseases that needle stick accidents transmit. A comprehensive needle stick injury prevention program would include:

Needle Substitution

If, in fact hypodermic needles are not a necessity for the work you are doing, please refrain from using them. For example, I’ve witnessed several individuals in the past that use hypodermic needles (sans the syringe) as dissection pins. “T-Handle” dissection pins offer great control and the blunter and wider needle point is more forgiving in case of accidents.

Equipment Design

Safer innovative devices using protected needle devices or needle-free systems with self-sealing ports would alleviate many of these injuries. There is accumulating evidence suggesting that syringes with safety features reduce needle stick injuries.

Employee Training

To reduce needle stick injuries, an effective program must include employee training. Workers need to know how to properly use, assemble, disassemble, and dispose of needles. Workers need to understand the risks associated with needlestick injuries and know the proper means to prevent them. Specifically, the training programs should address:

Risk of injury.
Potential hazards.
Recommended precautions for use and disposal of needles.
Proper reporting of injuries.
The importance of tetanus vaccinations where appropriate.

Recommended Guidelines

The following guidelines deal specifically with needle safety:

Needles, scalpel blades and other sharp instruments--workers should consider these as potentially infectious or contaminated and handle them with care to prevent accidental injuries
Disposable needles and syringes, scalpel blades, and other sharp items--workers should place these in puncture-resistant containers located near the area of use. They should avoid overfilling the containers because accidental needlestick injuries may occur.
Recapping--Workers should not recap needles by hand or purposely bend, break, or remove them from disposable syringes or otherwise manipulate them by hand

Recommended Guidelines

In situations where recapping is considered necessary, develop safe approaches which workers can follow. Workers should never move an exposed needle tip towards an unprotected hand.

Single-Handed Scooping

Recapping can be safe when people lay the cap on a flat surface and scoop it onto the tip of a syringe held in one hand. They must keep the free hand away from the sheath and well behind the exposed needle.

Recapping/Uncapping Devices

Several devices are available for recapping needles safely. Some devices permit single-handed recapping by parking a needle cap on a flat surface. Other devices are designed to protect the hand that holds the cap during two-handed recapping procedures. As yet, most products have not received independent testing and the two-handed recapping process remains a cause for concern. Recapping devices require further investigation. They may provide a practical solution for situations where recapping is considered necessary.

Article >>

Last Modified: December 22, 2010
Please forward all questions about this site to: Denise Monteleone