Safer Sharps

More than half or 55% of needlestick injuries occur while the needle is not actively in use during a procedure. Most injuries associated with needles arise during the recapping, passing/handling, transport, clean-up, disposal, and post-disposal [Figure 1]. The use of thoughtful planning, efficient work area layouts, clear communication, and careful movements during these activities can reduce the risk of injury from needles and sharps. 

The following are some basic work practices to keep in mind:

• Keep your workspace clear and well organized, so your needles and sharps are always in plain sight.  Clutter can hide sharps hazards.
• Always keep a sharps container/needle box within arm’s reach, so you can dispose of your used sharps device without getting up. If needed, reposition the container before you commence work
• Do not use your fingers to hold loose razor blades while cutting or scraping, always install the blade in a handle or box cutter designed for the blade.
• Never walk around with an unsheathed sharp or needle. 
• Do not leave blades or sharp tools unsecured. Any device being saved for later use needs to be secured to prevent accidental contact (e.g. stored in a puncture-resistant container)
• Never recap a sharp. Please contact UPenn Biosafety for an evaluation if an exception to this rule is required.
• Consider using a tool (e.g. pliers or hemostat) to uncap needles
• Never use your fingers to pick up sharps or needles, always use another tool that maintains distance between yourself and the hazard
• Never attempt to catch falling tools or materials in the lab or clinic setting

These are not the only practices and controls that can mitigate the risk of sharps injuries. Please contact your UPenn Biosafety Team—biosafety@lists.upenn.edu to request an evaluation of your situation and help identify opportunities for improvement.

[Figure 1. Circumstances/actions associated with needle stick injuries]

Source: Centers for Disease Control & Prevention. 2008. Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program. 

Think about whether needles and other sharps are always necessary for your work. The excessive use of sharps will expose you to greater risk, especially if you are already working with high-risk materials (e.g. material with high probability of containing a pathogen). 

Here are examples of how sharps can be eliminated in the workplace:

• Transfer frequently used liquids from a vial with septum to a screw-top tube where they can be accessed with plastic pipettes
• For tissue/cell disruption protocols that require a needle and syringe, consider using a blunt-tip needles instead of sharp beveled-tip needles
• Blunt tip needles may also be useful for filling syringes when you will subsequently remove the needle and attach the syringe to another device
• Swap your glass pipettes for plastic ones. If a finer tip is needed for aspirating, try adding a micro-pipette tip on the end of your plastic serological pipette. This can be replaced between samples to help prevent cross-contamination.
• Try using lab tape instead of pinning with needles when securing specimens on dissection boards
   

If you find that you still need to use sharps and needles, there are a wide array of products on the market that incorporate safety features or guarding to prevent or reduce the risk of injury. 

Here are examples of substitutions using Safer Sharps device or a device that incorporates engineering controls:

• Razor blades used for opening packages à Safety cutters with protected blade
• Razor blades used for cutting tissue à Retractable safety scalpel
• Standard needles à Needles with built-in safety covers
• Glass capillary tubes à Plastic or mylar-wrapped capillary tubes (warning: not all products will indicate if they are glass)

For situation specific or device specific guidance on Safer Sharps substitutions or engineering controls, please see the various job aids listed under Resources and Links, at the bottom of this Safer Sharps page.  The relevant job aids include "Stop Needlesticks", "Cut Out Razor Blades", and "Get Glass Sharps Out of the Lab".

If the Safer Sharps devices are insufficient or do not address your situation, you may wish to consider other engineering controls such tools for handling sharps (e.g. hemostat or forceps), or even Personal Protective Equipment (PPE), that could reduce your risk of injury. Please contact your UPenn Biosafety Team—biosafety@lists.upenn.edu for an evaluation if these other options could be helpful for your situation.
 

Please help us understand the factors that contribute to sharps and needlestick injuries, so that we can better advise the UPenn community on how to reduce and avoid further injuries. Please use the UPenn EHRS reporting form to let us know about an incident or injury.
 

The most common route for transmission of bloodborne infections in the workplace is via percutaneous injuries from needles or other sharps resulting in a body fluid exposure. This concern is heightened because some bloodborne infections transmissible via such injuries lack reliable treatment options [Table 1].

Among sharp devices, needles are the most common source of sharps injuries [Figure 2], so our priority is to assess whether there are alternatives to the use of needles in the occupational setting. However, if a needle is required for the task, we should explore whether we can use a safer sharps device, incorporating features that can prevent or reduce the risk of injury.

[Figure 2. Types of Sharps Device Involved in Percutaneous Injuries]

Source: Centers for Disease Control & Prevention. 2008. Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program. 

OSHA's Bloodborne Pathogen standard states that "engineering and work practice controls shall be used to eliminate or minimize employee exposure" [29 CFR 1910.1030(d)(2)(i)]. This means that if an effective and situation-appropriate control exists, such as a safety-engineered sharp capable of isolating or remove the bloodborne pathogen hazard from the workplace, an OSHA-covered employer is obligated to consider the implementation of that control. For more information regarding this answer please see the relevant OSHA page under Resources and Links, at bottom of this Safer Sharps page.

Eliminating sharps, substituting a safer device, or purchasing sharps devices with built-in engineering controls are some of the most effective controls to reduce the risk of sharps and needlestick injuries. We can help you identify controls that could reduce the risk from sharps. For common sharps use situations and devices, we have developed job aids that can be found under Resources and Links, at the bottom of this Safer Sharps page. The relevant job aids include "Stop Needlesticks", "Cut Out Razor Blades", and "Get Glass Sharps Out of the Lab".

If you can’t find any existing guidance for your specific situation, we can also offer evaluations, consultations, or training tailored for your occupational setting. Please contact the EHRS Biosafety Team—biosafety@lists.upenn.edu to discuss if there are ways for us to help.

Despite there only being a limited number of users of these machines, microtomes and cryostats are frequently involved in sharps injury incidents. The improper use of this equipment can lead to severe injuries, including amputation. Many injuries to users could have been avoided through training and using appropriate techniques, tools, and supplies (including PPE). 

UPenn Biosafety has developed advice to help users of this equipment minimize the risk of injury. See the job aid titled "Microtomes & Cryostats Safety" found under Resources and Links, at the bottom of this Safer Sharps page. If you require more information, or want to discuss your situation and PPE needs, please contact the EHRS Biosafety Team: biosafety@lists.upenn.edu

If your workplace is not covered by Penn EHRS, you can contact your Infection Control or Clinical Education professional for assistance with safer sharps.

Yes, please submit a report for all sharps/needlestick incidents. Federal OSHA regulations mandate that the employer “must record all work-related needlestick injuries and cuts from sharp objects that are contaminated with another person's blood or other potentially infectious material”. Submitting reports regarding your incidents in a timely manner allows us to fulfill this obligation. Reporting injuries and near misses also helps us identify injury trends or hazards that may require additional attention. To protect the employee's privacy, the employee's name is NOT included on the required logs submitted to federal OSHA.

For occupational settings in Pennsylvania, any used sharps and any unused hypodermic needles or syringes are considered regulated medical waste (or infectious waste), which means that these may not be disposed of in municipal waste. Furthermore, regulated medical waste can only be picked up or delivered commercially in Pennsylvania by an infectious waste transporter licensed by the Pennsylvania Department Of Environmental Protection. To learn how to comply with these requirements please visit the Biohazardous Waste | PennEHRS page, where you can find comprehensive guides and convenient charts for categorizing regulated medical/infectious waste and how each type of biomedical waste must be disposed.

Please note that the disposal of sharps and needles associated with personal use may not be covered by the above regulations and your employer is not required to provide waste containers for this purpose. For more information, please see the Resources and Links at bottom of this Safer Sharps page, where you can find the guide from the City of Philadelphia on disposal of personal sharps/needles and links to the Pennsylvania Code for the most up to date regulations.

Job Aids:

• Microtome & Cryostat Safety [HANDOUT]
• Stop Needlesticks [HANDOUT]
• Cut Out Razor Blades [HANDOUT]
• Get Glass Sharps Out of the Lab [HANDOUT]
• Don't Get Stuck: Tools for Handling or Pickup [HANDOUT, forthcoming]
• PPE for Sharps Users [HANDOUT, contact EHRS Biosafety directly]
   
• UPenn Safer Sharps Program [POSTER]
• CDC Use Sharps With Safety Features [POSTER]

Resources from Penn EHRS:

• Bloodborne Pathogens Policy | PennEHRS
• Incident Reporting Forms | PennEHRS
• Biohazardous Waste | PennEHRS

• Bloodborne Pathogens - Evaluating and Controlling Exposure | Occupational Safety and Health Administration
• Personal Use Safe Sharps Disposal | Department of Public Health | City of Philadelphia
• PA Regulations: 25 Pa. Code § 273.511. Processed regulated medical waste disposal.
• PA Regulations: 25 Pa. Code Chapter 271. Municipal Waste Management— General Provisions