Percutaneous injury prevention

June 1, 2003
Percutaneous injuries (PI) pose the greatest risk for occupational exposure to bloodborne pathogens. The most serious exposures include hepatitis B, hepatitis C, and HIV.

Charles John Palenik, MS, PhD

Percutaneous injuries (PI) pose the greatest risk for occupational exposure to bloodborne pathogens. The most serious exposures include hepatitis B, hepatitis C, and HIV. PI can result from contact with contaminated needles, burs, scalpels, instruments, or other sharps that can penetrate, abrade, or cut skin. Unfortunately, sharps — especially needles — can easily penetrate most types of personal protective equipment.

It is estimated that 800,000 PI occur each year among 5.6 million health care workers and others that handle used sharps. About two percent or 16,000 of these involve items contaminated with HIV. Needlestick injuries account for up to 80 percent of accidental exposures to blood. About a third of all PI reported occur during disposal of contaminated sharps.

On November 6, 2000, Congress passed the Needlestick Safety and Prevention Act. It directed OSHA to revise the Bloodborne Pathogens Standard to describe in greater detail its requirement for employers to identify and make use of effective and safer medical devices. The Act requires employers to update their response in four areas - addition of new/changed definitions, exposure control plan revisions, solicitation of input from employees, and changes in sharps injury reporting.

New terms include sharps with engineered sharps injury protection (SESIP) and needleless systems. SESIP are needles and other sharps with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident. Needleless systems are devices that do not use needles for the collection or withdrawal of bodily fluids or for the administration of fluids or medications. The term "engineering controls" has been amended to include all control measures that isolate or remove a bloodborne pathogen hazard in the workplace. The change specifies that self-sheathing needles and safer medical devices, such as SESIP and needleless systems, be considered examples of engineering controls.

Employers must now review their exposure control plans annually to reflect changes in technology that will help eliminate or reduce exposure to bloodborne pathogens. This must include documentation of the employer's consideration and implementation of appropriate, commercially available and effective safer devices.

Employers must solicit input from nonmanagerial employees about the identification, evaluation, and selection of engineering controls, including safer medical devices. Employees selected should be directly involved with patient care and be representative of the entire work force.

Employers with 11 or more employees who are required to keep records by current recordkeeping standards must now maintain a sharps injury log. For each incident, the type and brand of device involved must be listed. Also, the location of the occurrence and a description of the event should be noted.

Prevention of PI — including needle sticks — involves several elements. Employers must provide training and monitoring of compliance. Safer work practices and appropriate engineering controls must be applied. Employers also must test potentially useful materials and provide those that prove effective. Employees must be prepared. This involves knowledge of and acclimation to any new medical devices. Routine wearing of appropriate personal protective equipment can prevent some PI. Awareness of risk must be introduced and reinforced regularly to all employees.

The Organization for Safety and Asepsis Procedures (OSAP) is the leading source for infection control and safety information in dentistry. More information is available on the OSAP Web site,

Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters and monographs, and is the co-author of the popular Infection Control and Management of Hazardous Materials for the Dental Team. He serves on the Executive Board of OSAP, dentistry's resource for infection control and safety.Questions about this article or any infection control issue may be directed to [email protected].

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