It’s no secret that healthcare workers are at an increased risk for needle stick or sharps injuries, especially nursing staff, doctors, and lab workers. The Centers for Disease Control and Prevention estimates that 600,000 to 800,000 needle stick injuries occur each year, many going unreported. They remind us that without appropriate follow-up or post-exposure prophylaxis (PEP) care, these injuries can lead to serious or fatal infections, such as Hepatitis A, C, and HIV. CAP’s Risk Management and Patient Safety Specialists recommend the following:
1. Follow the Centers for Disease Control and Prevention’s guidelines for needle stick injury and post-exposure prophylaxis treatment. Call the CDC’s Clinician’s Post Exposure Prophylaxis Hotline at 1-888-448-4911 or visit https://www.cdc.gov/niosh/topics/bbp/emergnedl.html.
2. Contact your workers' compensation insurance carrier. If you do not have a policy or you obtained a policy through CAP Physicians Insurance Agency and cannot recall the name of your carrier, please call 800-819-0061.
3. Record the injury and investigate the incident to determine the root cause. Ask “why and how did the needle stick injury occur?” Here are some questions to consider:
a. Are disposable syringes with safety features available to staff?
b. Is the sharps disposal container within reach of staff for immediate disposal of a contaminated syringe?
c. Was there adequate room in the container to safely dispose of the contaminated needle?
d. Was staff properly trained in the safe use and disposal of needles?
e. Did staff deviate from safety standards and protocols?
f. Did staff feel comfortable reporting a needle stick injury?
4. Report to Cal/OSHA on Form 300, as required by law (see below). You can find the form at https://www.dir.ca.gov/dosh/etools/recordkeeping/CAStandard/CalStandard.htm
5. Under California Code of Regulations, Title 8, Section 14300.8 (a) Basic requirement. You must record all work-related needle stick injuries and cuts from sharp objects that are contaminated with another person's blood or other potentially infectious material (as defined by Title 8, Section 5193). You must enter the case on the Cal/OSHA Form 300 as an injury. To protect the employee's privacy, you may not enter the employee's name on the Cal/OSHA Form 300.
6. A patient may need viral serology testing for HIV, Hepatitis B, and Hepatitis C if their status is unknown. Take steps to ensure that the patient does not incur any out-of-pocket expenses associated with the incident.
7. Provide staff training and resources to reduce the risk of a needle and sharps injury. Consider these options:
a. E-Volve e-Learning Solutions: Web-based compliance courses for employees on topics like HIPAA, Medicare Fraud and Abuse, Medical OSHA, Bloodborne Pathogens, ICD-10 Billing and Coding, and more. Discount on all available courses with the discount code cap10off at
b. Centers for Disease Control and Prevention (CDC) and The National Institutes for Occupational Safety and Health (NIOSH) offers a variety of articles, practice guidelines and standards, and training material on needle stick prevention. Visit https://www.cdc.gov/niosh/topics/bbp/sharps.html.
c. Cal/OSHA publications and training resources can be found at https://www.dir.ca.gov/dosh/dosh_publications/bbpfct.pdf, and https://www.osha.gov/SLTC/bloodbornepathogens/index.html.
There’s a wise old saying, “An ounce of prevention is worth a pound of cure.” It is much easier to prevent a needle stick injury than to deal with its medical, emotional, and regulatory fallout. With proper training and the use of safe equipment and systems, you and your medical staff can minimize risk of exposure to a contaminated needle or sharp. But most importantly, knowing what to do in the aftermath of an unfortunate needle stick injury will minimize the chance of acquiring a life-threatening disease.
Amy McLain is a Senior Risk Management and Patient Safety Specialist for CAP. Questions or comments related to this article may be directed to amclain@CAPphysicians.com