Safety: Debunking Sharps Injury Myths

The truth about five commonly misunderstood areas.

Avoiding dangerous and preventable sharps injuries often comes down to debunking the common myths about these issues. Setting the record straight allows facilities to put proven processes and protocols in place. This includes the use of Sharps Injury Prevention (SIP) devices as well as the safe activation of those SIP features and proper disposal of sharps. We asked Amber Hogan Mitchell, DrPH, MPH, CPH, president and executive director of the International Safety Center, to provide some clarity and perspective on the truth behind the common misconceptions.

MYTH: Most sharps injuries get reported.
Truth: Despite what some staff believe, safety experts know this is far from the truth. “While underreporting of sharps injuries, needlesticks and mucocutaneous exposure incidents varies greatly from department to department and facility to facility based on climate and culture of safety, experts in occupational infection prevention and control estimate that injuries are only reported about 50-60% of the time,” says Dr. Mitchell. Many in surgical practice feel that splashes and splatters causing mucocutaneous exposure incidents are just “part of the job.” While it’s true surgical environments create exposures to large volumes of blood and bodily fluids, these hazards can largely be prevented by wearing face protection, including not just surgical masks, but face shields and/or eye protection, as well as gloves and long sleeve garments or gowns. If a worker experiences a splash to unprotected eyes, nose, mouth or non-intact skin, post-exposure follow-up needs to be done as soon as possible to determine next steps to prevent any seroconversion. This includes not just to the person in the surgical field, but also to the patient if an exposure happens inside of the surgical site, especially if an injury to the surgical team member includes a suture or scalpel blade injury. “Suture and scalpel injuries continue to be two of the top three sharps injury types,” she says.

MYTH: Those who suffer a needlestick or sharps injury are not at a high risk of occupational exposure to bloodborne pathogens.
Truth: It’s not that simple. Although Dr. Mitchell notes that the risk of seroconverting to a bloodborne disease like HIV or the hepatitis C virus (HCV) is lower now than ever before because of timely source testing and drug prophylaxis, she reminds clinicians that HIV and HCV and co-infection with both continues to warrant the public health focus of the CDC, NIOSH, OSHA, the Public Health Service and the WHO. In fact, HCV is the most prevalent bloodborne infection in most countries around the world. Up to 40% of the individuals who have it do not know, making occupational exposures to blood important to report to occupational/employee health and infection prevention and control. “In fact, sharps injuries inside of the surgical site can also result in patient exposure to worker bloodborne pathogens and can result in high-risk legal and liability incidents in any facility,” says Dr. Mitchell. 

MYTH: Needlestick injuries among healthcare workers aren’t that common.
Truth: Dr. Mitchell debunks this one with an eye-opening statistic: “Given that the Exposure Prevention Information Network (EPINet) has been in use since the mid-1990s, users of the program share that nearly every single healthcare provider, especially those working in surgical environments, reports at least one contaminated needlestick or sharp injury in their career, especially early on.” What’s more, some workers report multiple injuries in a single year and, the more frequent those injuries are, the less likely staff are to report them for fear of retaliation or judgment. Then there’s the COVID effect. Percentages of injuries have actually increased over the three years of the pandemic, notes Dr. Mitchell, citing EPINet data. “In 2019, there were 26 injuries per 100 average daily census (ADC),” she says. “In 2020, there were 27 and in 2021, there were 31 injuries per 100 ADC.”

MYTH: Most physicians use engineering controls that reduce sharps injuries like scalpels with retracting blades or zipper skin closures that prevent injury. 
Truth: These devices may improve safety, but there’s still a reluctance among clinicians to use them. Case in point: According to a 2019 survey conducted by Outpatient Surgery Magazine, when readers were asked how frequently their surgeons use safety scalpels, 40% said never and only 19% said always. Readers were also asked to share the reasons why they do not use safety scalpels at their facility, and over 62% said it is because their surgeons refuse to use them. This is problematic when you consider they are the ones who bear the consequences of this refusal. “Physicians sustain the largest numbers of injuries from both suture and scalpel blades and the majority of those are from devices without sharps injury prevention or safety features,” says Dr. Mitchell, citing 2021 EPINet data.

MYTH: Double-gloving will not protect you from a needlestick injury.
Truth: “Double-gloving will prevent exposure to larger volumes of blood or bodily fluids if a needle or sharp device were to penetrate either the outer or inner glove or both,” says Dr. Mitchell. Likelihood of seroconversion tends to depend on the volume of blood, which in turn impacts the viral load of that bloodborne pathogen in the blood or bodily fluid. AORN’s double-gloving guidance now recommends providers use a perforation indicator glove under the second glove to increase awareness that a glove perforation has occurred. In fact, a new systematic review of randomized controlled trials on double-gloving by Mischke et al cited in the update found that glove perforations were reduced by 71% when wearing two pairs of gloves compared to wearing only one.

Clearing up these myths makes it much easier for facility leaders to focus on preventive controls, practices and technologies that keep your OR teams safe and injury-free. OSM