RAFAEL VALLE
8th Medical Brigade
Staten Island, New York

In my 24 years of working in the Army medical field, I’ve seen some pretty incredible things involving needlesticks. A needlestick injury is defined as a mishap which occurs when the skin is accidentally punctured by a used needle. These injuries can transmit several blood-borne diseases, including human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) just to name a few. Some people, such as healthcare workers, are at increased risk of needlestick injuries — due mostly to careless actions. Fortunately, following some guidelines from the Occupational Safety and Health Administration can help keep these workers safe.

While on active duty in Germany, I witnessed a medic attempt to recap a needle after she gave a flu shot to a Soldier in our unit. The recapping did not go well. She missed and accidentally stuck her finger with the used needle. As soon as I noticed what happened, I checked to see if she’d pierced her own skin. She had. I immediately referenced our standard operating procedure because it explained what to do in the event of a needlestick.

The SOP called for my medic to document what happened and for anyone that witnessed the accidental needlestick to corroborate on a standard witness statement form. The purpose of documentation was to maintain a record of the injury and possible exposure to blood-borne pathogens. Per the SOP, my medic and the Soldier that was vaccinated had to undergo a series of blood tests immediately — and every month thereafter for six months — to ensure blood-borne diseases were ruled out. This process, although time consuming, was necessary to identify any blood-borne pathogens and treat the affected medic as soon as possible. Fortunately, the medic was safe this time.

This accident happened in Germany in 1990. At that time we were not very well versed with the Code of Federal Regulation – Title 29 and were going by past experiences. Today, OSHA 1904.8(a) states that the basic requirement for work-related needlestick injuries and cuts from sharp objects that are contaminated with another person's blood or other potentially infectious material will be recorded as defined by 29 CFR 1910.1030, the blood-borne pathogens standard. The following work practices are provided by OSHA to help employers decrease their workers’ chances of contracting blood-borne diseases when handling contaminated needles.

Safer medical devices
Employers are required to consider and use safer medical devices whenever possible. These devices include those that are needleless or have built-in protection to guard workers against contact with the contaminated sharp. In addition, employers must ask non-managerial patient care workers who could be exposed to contaminated sharps injuries for their input in identifying, evaluating and selecting effective work practice and engineering controls, including safer medical devices. The employer must document consideration and implementation of these devices, and the solicitation of worker input, in the Exposure Control Plan.

Prompt disposal
Employers must also ensure contaminated sharps are disposed of in sharps disposal containers immediately, or as soon as feasible, after use. Sharps disposal containers must be readily accessible and located as close as feasible to the area where sharps will be used. In some cases, they may be placed on carts to prevent patients, such as psychiatric patients or children, from accessing the sharps. Containers also must be available wherever sharps may be found, such as in laundries.

Contaminated sharps must never be sheared or broken. Recapping, bending or removing needles is permissible only if there is no feasible alternative or if such actions are required for a specific medical or dental procedure. If recapping, bending or removal is necessary, employers must ensure workers use either a mechanical device or a one-handed technique. The cap must not be held in one hand while guiding the sharp into it or placing it over the sharp. A one-handed "scoop" technique uses the needle itself to pick up the cap, and then the cap is pushed against a hard surface to ensure a tight fit onto the device. Also, the cap may be held with tongs or forceps and placed over the needle. Contaminated broken glass must not be picked up by hand, but must be cleaned up using mechanical means, such as a brush and dust pan, tongs or forceps.

Sharps containers
Containers for contaminated sharps must be puncture-resistant. The sides and the bottom must be leak-proof. They must be appropriately labeled or color-coded red to warn everyone that the contents are hazardous. Containers for disposable sharps must be closable (that is, have a lid, flap, door or other means of closing the container), and they must be kept upright to prevent the sharps and any liquids from spilling out of the container.

The containers must be replaced routinely and not be overfilled, which can increase the risk of needlesticks or cuts. Sharps disposal containers that are reusable must not be opened, emptied or cleaned manually or in any other manner that would expose workers to the risk of sharps injury. Employers also must ensure reusable sharps that are contaminated are not stored or processed in a manner that requires workers to reach by hand into the containers where these sharps have been placed.

Handling containers
Before sharps disposal containers are removed or replaced, they must be closed to prevent spilling the contents. If there is a chance of leakage from the disposal container, the employer must ensure that it is placed in a secondary container that is closable, appropriately labeled or color-coded red and constructed to contain all contents and prevent leakage during handling, storage, transport or shipping.

Conclusion
Needlestick accidents are dangerous and should be treated as medical emergencies, especially if skin is broken and fluids are exchanged. Careful handling of contaminated needles can prevent injury and reduce the risk of infection when performing critical job requirements like blood draws and immunizations. Remember to maintain and update unit SOPs so personnel know what procedures to follow in the event of a needlestick injury. Visit OSHA’s Bloodborne Pathogens and Needlestick Prevention Safety and Health Topics webpage at https://www.osha.gov/SLTC/bloodbornepathogens/index.html for more information.