Preventing and Responding to Needle Stick Injuries

Executive Summary 

As needle stick injuries in healthcare settings increase, it’s important that providers understand their obligations to prevent such injuries. Organizations must take the necessary steps to protect their employees and appropriately respond when needle stick injuries do occur.    

Recommended Actions 

• Maintain an up-to-date needle stick injury protocol.
• Ensure that your organization has needle stick injury reporting guidelines in place.
• Ensure that all employees are appropriately trained regarding this reporting process. 

Needle Stick Prevention Guidelines 

Needle sticks are one of the most common worker’s compensation injuries in a healthcare organization, and it’s important that such organizations have controls in place to prevent them. Controls can include environmental safeguards as well as policies and procedures, such as:

• Providing easily accessible sharps disposal containers with clear indications when they’re full 
• Supplying healthcare workers with safe needle and sharps devices that provide protection via sheathing or needle retraction actions
• Maintaining and educating staff on the organization’s exposure control plan and safety strategies to best minimize potential injuries 

Most needle stick injuries occur when (1) passing off or disposing of a needle, (2) cleaning up after using a needle and (3) improperly closing a needle safety cap. To help prevent such incidents, organizations should implement the following practices:

• Always replace the sharps disposal container when the full line is reached to prevent injury when disposing of used needles
• Periodically review proper handling methods (place needles on a tray instead of directly handing them off and recommend no-recapping) with healthcare staff
• Ensure that used needles are clearly visible prior to clean up (do not cover with tissue, gauze or other materials, for example) 

Needle Stick Injury Protocols 

If a needle stick occurs, there are steps you can take to minimize the potential injury.  

For injured employees:

1. Treat: First, treat the sharps injury by immediately washing the cut or puncture with soap and water. Note: if exposure occurs via splash to nose, mouth, skin or eyes, immediately flush and irrigate with clean water or saline.
2. Report: Second, report the incident to your supervisor. 

Needle Stick Reporting Policies

1. Treat: Consider the potential disease exposure (e.g., HIV, HBV or HCV) and whether any additional immediate treatment is needed, such as post-exposure prophylactics.
2. Test: Perform baseline testing after exposure on both the source person (if status unknown) and the exposed employee, including rapid HIV, HCV Ab, and HBV surface antigen if not immunized.
3. Report: Record all work-related needle stick injuries involving potentially infectious material in your sharps injury log (or OSHA 300 Log for Hospitals). If the exposed employee is later diagnosed with an infectious disease, update the sharps injury log and reclassify it as an illness. Note: if an employee is exposed via splash, compared to a puncture, report as “illness only” if diagnosis of infectious disease occurs. Needle stick injuries should also be reported to your organization’s workers’ compensation carrier.
4. Retest: Finally, follow up with an HIV test at 6 weeks, 3 months, and 6 months if the source person tested positive. For HCV, perform an HCV RNA test 1-2 weeks after exposure. If results are positive for infection, refer to a specialist for treatment. 

Additional Resources

• American Nurses Association - ANA Needlestick Prevention Guide'
• Center of Disease Control - Emergency Sharps Information
• OSHA – Needlestick Reporting Requirements 

Lessons Learned 

• Ensure that your healthcare organization is regularly training all employees regarding needle stick injury prevention and proper needle handling methods.

• Maintain documentation of all needle stick injuries that occur. 

• Ensure that management has followed up with any employee who has incurred such an injury to ensure that the employee has been properly treated.  

Potential Damages 

Healthcare organizations that fail to take the necessary steps to prevent needle stick injuries or that inappropriately respond to such an injury could face a costly and time-consuming workers’ compensation lawsuit. Needle stick injuries are a relatively common workplace injury and the costs of a workers’ compensation lawsuit add up quickly.