The Definition of Needlestick Injury

Definition of Needlestick Injury

A needlestick injury is a puncture of the skin by a needle or other sharp object that may be contaminated with blood or other potentially infectious materials. The term is often used broadly for all sharps injuries, including cuts from scalpels, lancets, broken glass and other contaminated sharp items.

The main concern with a needlestick injury is exposure to bloodborne pathogens, especially hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The risk of infection depends on the pathogen, the type of needle, how deep the injury is and how much blood was involved.

Needlestick injuries are most common in healthcare, but they also happen in laboratories, waste handling and recycling, janitorial work, laundry services, law enforcement, corrections, parks and landscaping, and anywhere workers may find discarded needles.

Regulations Covering Needlestick Injuries

In the United States, OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030, applies to all employees who could reasonably be expected to contact blood or other potentially infectious materials as part of their job. The Needlestick Safety and Prevention Act of 2000 updated the standard to strengthen requirements for safer devices. Key requirements include:

• Exposure control plan: a written plan that identifies exposed jobs and tasks and describes controls. It must be reviewed and updated at least once a year.
• Safer medical devices: employers must evaluate and use devices with engineered sharps injury protection, such as retractable needles and needleless systems, and involve frontline workers in choosing them.
• Sharps injury log: employers who must keep OSHA injury records must also keep a log of contaminated sharps injuries, while protecting the injured worker's privacy.
• Hepatitis B vaccination: offered at no cost to exposed workers.
• Post-exposure evaluation: confidential medical evaluation and follow-up at no cost after an exposure incident.
• Training: provided at the start of assignment and every year after.

Under OSHA recordkeeping, a needlestick or cut from a sharp contaminated with another person's blood or infectious material is a recordable incident.

Preventing Needlestick Injuries

• Eliminate needles where possible: use needleless IV connectors and alternative drug delivery methods.
• Use safety-engineered devices: such as retractable syringes, self-blunting needles and shielded blood collection devices. See engineering controls.
• Never recap used needles by hand. If recapping is unavoidable, use a one-handed scoop method or a mechanical device.
• Dispose of sharps immediately in puncture-resistant, labeled sharps containers placed close to where sharps are used, and replace containers before they are overfilled.
• Handle waste carefully: do not compress trash bags with hands or feet, and carry bags away from the body.
• Train non-healthcare workers to pick up discarded needles with tongs or tools and never with their hands.
• Wear appropriate PPE: puncture-resistant gloves may be needed for some tasks, though standard gloves do not stop needles.

What to Do After a Needlestick Injury

1. Wash the wound with soap and water. Do not squeeze or scrub it, and do not use bleach. Flush splashes to the eyes, nose or mouth with water.
2. Report the injury to a supervisor right away.
3. Seek medical evaluation immediately. If HIV post-exposure treatment is recommended, it works best when started within hours.
4. Identify the source of the needle, if possible, so it can be tested with consent.
5. Complete the sharps injury log and an incident investigation to find out how the injury happened and how to prevent it.

Example of Needlestick Injury

A custodian at a public library was emptying a restroom trash bin and pressed down the contents with his hand to make room. A discarded syringe punctured his palm. He told his supervisor, who sent him straight to the occupational health clinic, where he received an evaluation, baseline blood tests and counseling on post-exposure treatment.

The library's review found that custodians had never received bloodborne pathogens training and that no sharps containers were installed in public restrooms. The library added wall-mounted sharps disposal boxes in each restroom, provided tongs and puncture-resistant gloves, trained all custodial staff and changed its procedure so that trash is never compacted by hand.

Frequently Asked Questions: Needlestick Injury

Is a needlestick injury an OSHA recordable?

Yes. A needlestick or cut from a sharp contaminated with another person's blood or other potentially infectious material must be recorded on the OSHA 300 log, with privacy protections.

What is the risk of infection from a needlestick?

It varies by pathogen. The risk is highest for hepatitis B in workers who are not vaccinated, lower for hepatitis C and lowest for HIV. Prompt medical care reduces the risk further.

Does the bloodborne pathogens standard apply outside healthcare?

Yes. It applies to any employee who can reasonably be expected to contact blood or infectious materials at work, including first aid responders, custodians and some waste workers.