The acquired immunodeficiency syndrome epidemic of the 1980s heightened awareness of the risk of blood-borne pathogen (BBP) transmission and the role of percutaneous injuries in this transmission.
Studies describe health care worker (HCW) risks and routes of exposure to the BBPs of human immunodeficiency virus and hepatitides B and C.1,2 Based on this collective evidence (and the anxiety of HCWs and other stakeholders), much action ensued. In US laws, regulations and guidelines direct the policy, procedures, and practices of BBP safety in health care facilities.
The Occupational Safety and Health Administration (OSHA) is the federal agency responsible for ensuring safe, healthy workplaces in the United States. The OSHA developed the Blood Borne Pathogen Standard of 1991.3 Blood-borne pathogen standard violation has been a frequently cited OSHA deficiency in US health care facilities. The BBP standard gained increased compliance in US health care institutions with the passage of the Needlestick Safety and Prevention Act of 2000.4
Many organizations, including the American Hospital Association, the Centers for Disease Control and Prevention, and the Joint Commission, have published guidance on BBP safety.5 There are common themes throughout these regulations and guidance documents. The categories of emphasis include blood-borne pathogen education programs. hepatitis B vaccination programs. use of safety-protected medical devices. proper sharps disposal equipment and practices, and appropriate follow-up of sharps injuries.
Throughout the United States, a culture of BBP safety is well developed and supported. I believe few US Infection Prevention and Control Professionals contemplate a career in the settings so vividly illustrated by Hassan and Wahsheh in this issue of the Infectious Diseases in Clinical Practice. "Occupational Exposure to Sharp Injuries among Jordanian Healthcare Workers" describes health care settings where proper needle disposal options are limited and sharp devices with engineered sharps injury protection are rare. It is sobering to consider the minimal level of protection against BBP exposure afforded to these Jordanian HCWs. Hassan and Wahsheh provide thought-provoking survey results. These results allow one to compare and contrast the United States and Jordanian experiences.
The volume of sharp injuries provides the most striking contrast. This Jordanian study recorded 2069 sharp injuries among 1026 HCWs in 1 year. In 2008, a hospital in Ohio (United States) recorded 97 sharp injuries among 3133 HCWs (unpublished data). Therefore, the Jordanian experience can be seen as 2 sharp injuries for every HCW, whereas the Ohio experience was 1 sharp injury for every 32 HCWs. The Ohio hospital has a mean daily census of 500 patients. This represents a rate of 19.4 sharp injuries per 100 occupied beds. Is this hospital experience comparable to others in the United States?
The Exposure Prevention Information Network (EPINet) supports more than 1500 hospitals in the United States. It provides a standardized method for recording sharp injuries and comparing the information. The EPINet collected data from 33 US health care facilities and prepared the EPINet Summary Report for Needlestick and Sharp Object Injuries, 2006.6 This summary recorded a rate of 33.4 sharp injuries per 100 occupied beds for teaching hospitals and 16.9 sharp injuries per 100 occupied beds for nonteaching hospitals.
Hassan and Wahsheh have noted the need for BBP education. An understanding of the prevalence of BBPs and the risk of transmission via sharps injury is essential to development of safe procedures. Hollow bore needles that access veins and arteries are very high risk. The authors emphasize the importance of adopting safety protected devices for intravenous catheters and winged steel needles. Sharps disposal containers need to be available and used properly. In any setting, commitment and resources are required when seeking sharps safety.
1. Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med
2. Jagger J, DeCarli G, Perry J, et al. Occupational exposure to bloodborne pathogens: epidemiology and prevention. In: Wenzel RP, ed. Prevention and Control of Nosocomial Infections
. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:430-465.
3. Occupational Safety and Health Administration. 29 CFR:1910.1030. Occupational exposure to bloodborne pathogens. Federal Register
4. Needlestick Safety and Prevention Act of 2000. Public Law 106-430, US Statutes at Large 1901 (2000):114.
5. Pugliese G, Salahuddin M, ed. Sharps Injury Prevention Program: A Step-by-Step Guide
. Chicago, IL: American Hospital Association; 1999.
6. Perry J, Parker G, Jagger J. EPINet Report: 2006 Percutaneous Injury Rates. International Healthcare Worker Safety Center, January 2009. Available at: http://www.virginia.edu/internet/epinet
. Accessed February 25, 2009.