New Organization Pushes No Needle, No Stick Primary Prevention of Sharps Injuries

Edition: July 2001 - Vol 9 Number 07
Article#: 1000
Author: Brad Poulos

For patients, hypodermic needles, lancets, suture needles, and scalpels are life-giving devices. For nurses and physicians, such implements can be life threatening. Every day, an average of more than 2,000 health care workers suffer accidental injuries from used needles or other medical sharps. Many of these objects carry bloodborne pathogens, and the consequences are sometimes catastrophic. For instance, nearly 2,500 health care workers annually are infected with hepatitis C, hepatitis B, or HIV from sharps injuries.

Recently, a new organization arose to address this problem. Comprised of medical device makers, health organizations, professional associations, and individual clinicians, the National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI) promotes technologies and practices that reduce or eliminate the need for sharp implements in the health care workplace. This strategy, known as primary prevention, is summarized quite simply by NAPPSI: Eliminate the needle and you eliminate the risk.

Sales representatives have an opportunity to educate and provide information on sharps injury prevention devices. Clinicians will be looking at the marketplace to discover what technologies are available. With primary prevention being the ultimate solution because it reduces the number of sharps used in the health care workplace, sales people need to stay current on what primary-prevention technology is available.

To better understand primary prevention, consider catheter securement devices. These products replace the need to use suturing for catheter securement. Not only is the initial suture needle use avoided, but also potentially dangerous catheter restarts are reduced, helping to protect the health care worker from bloodborne infection. NAPPSI acknowledges the importance of secondary prevention such as retractable scalpel blades, as well, but focuses its efforts on primary approaches, which maximize risk reduction.

NAPPSI Activities

Based in South Jordan, UT, NAPPSI educates the public on primary prevention and the safety benefits of its members' products, services, and expertise through communications to the media, its Web site ( and other outreach. It also encourages federal and state efforts to promote primary prevention and seeks support for its goals from organizations and professional associations involved with sharps injury prevention. NAPPSI uses its various activities to highlight new developments that help eliminate medical sharps, as opposed to merely making sharps safer. Through these various efforts, NAPPSI hopes to change medical practices and minimize health are workers' exposure to accidental infection from sharps injuries.

NAPPSI also seeks to extend its reach by expanding its membership. Candidates include manufacturers that make, or are developing, primary preventions products and services; professional associations; health care organizations; and individual health care professionals and experts. The organization is overseen by a volunteer board of directors. Clinicians can join NAPSI as individual members.

The Impact of Needlestick and other Sharps Injuries

In an era where potentially fatal diseases like AIDS can result from the most casual medical accident, the health care community should be particularly alarmed about the widespread incidence of sharps injuries. These injuries also have a substantial financial impact on the health care economy. An estimated 800,000 health care workers – mainly nurses – will suffer these injuries each year, with an average treatment cost between $2,234 and $3,032. Two health care workers per week will die from needlestick injuries, according to figures from the Service Employees International Union (SEIU).

Action to remedy the situation is taking place in many different areas:

Products. From both a primary and secondary prevention perspective, manufacturers are introducing an increasing number of innovative products, with more in development.

Regulations. The Occupational Safety and Health Administration (OSHA) has written new regulations, tightened enforcement of existing regulations, and alerted health care facilities with high rates of sharps injuries about tougher oversight, including inspections and possible fines.

Legislation. The Needlestick Safety and Prevention Act, which went into effect in July, places more stringent requirements on employers in the health care workplace.

Practices. On their own initiative, many health care facilities are instituting sharps injuries prevention programs and embracing preventive products as they emerge.

For all the progress that has recently been made, sharps injury prevention remains in a developmental phase, with most health care facilities yet to adopt a comprehensive response to the issue. Changes in regulations and legislation, however, suggest that it will not be prudent for them to neglect the problem much longer.

A Closer Look at the Legal Front

Not surprisingly, the threat of accidental exposure to HIV and AIDS inspired the nation's first successful needlestick safety legislation. SEIU, which represents thousands of nurses, had long lobbied for stricter needlestick safety laws and regulations. The union joined with nursing organizations, manufacturers of safety devices, and other safety advocates in 1998 to support a tough new sharps-safety bill.

The California Healthcare Association, which represents hospitals' interests, initially geared up to fight the bill to protect its members from what it feared would be substantial costs for new safety devices. But as the bill gathered bipartisan support, the association backed off and the bill became the nation's first needlestick safety law in late 1998.

The next step forward in sharps injury protection took place when the California Occupational Safety and Health Program (Cal/OSHA) began debating regulations to implement the new law. The case for primary prevention was sufficiently made that Cal/OSHA granted equal status with secondary methods for catheter securement devices, a primary prevention technology.

In this more favorable climate for needlestick safety in general and primary prevention in particular, more than 15 states went on to pass their own versions of California's groundbreaking law. Meanwhile, OSHA was soliciting comments on how to improve needlestick safety regulations at the national level. It received over 400 responses, from both individuals and organizations. Soon, it was putting its own tougher national regulations in place.

A revised compliance directive, issued by OSHA in November 1999, put muscle behind OSHA inspectors' responsibility to monitor healthcare facilities. The inspectors now had authority to ensure that health care employers comply with regulations in several new ways. Employers were required to replace obsolete devices and practices with improved ones that further minimized needle stick risks. They were to assess new devices as they emerged in the marketplace so they were always aware of, and adopting, the best technology available. They had to train employees in using the new safety devices and otherwise closely follow agency guidelines regarding various safety procedures. And they had to document that they had put and exposure control plan in operation.

The regulations did remain flexible on one point: Although employers had to adopt safety products and practices, no specific products and practices were dictated. Individual employers could select the devices and practices that best suited their needs, as long as they were medically appropriate and, in the case of devices, available in the commercial market.

Needlestick safety had by now become such a popular issue that the federal bill passed both houses of Congress unanimously and was signed into law last fall by President Clinton. The new law beefs up existing regulations in several areas:

• Employers are required to record all sharps injuries in detail.

• The bloodborne pathogens standard has been revised to included emerging, safer technologies as good examples of appropriated risk reduction devices – for instance, primary prevention technology such as catheter securement devices.

• Employees who use medical devices are required to be included in the evaluation and selection of new technology.

Secondary prevention methods will continue to have a prominent place in the prevention of sharps injuries. But thanks to NAPPSI, clinicians, purchasers of health care devices and government regulators are also coming to see the advantage of implementing primary prevention wherever possible. By reducing or even eliminating the need to introduce sharps into the healthcare workplace, primary prevention can make a substantial contribution to protect healthcare workers and their employers from the costs and dangers associated with sharps injuries.

ABOUT THE AUTHOR: Brad Poulos is Deputy Director of NAPPSI. He can be reached at