Sharps Injury Prevention Training Program
Sharps Injury Prevention Training Program
Sharps injury prevention training is an aspect of bloodborne pathogen (BBP) training mandated by the Occupational Safety and Health Administration (OSHA) BBP standard. ECRI Institute recommends presenting sharps
injury prevention training as part of the required annual BBPs training because material from each training
program overlaps. OSHA regulations require that healthcare workers with occupational exposure must receive
BBP training every 12 months (i.e., no more than 12 months may elapse before the next training session). Additional training must be provided when tasks or procedures change or when new procedures are introduced that
affect healthcare workers’ occupational exposure. This type of training only needs to address new or different
exposures.
ECRI Institute has developed this training packet to support compliance with the OSHA requirements imposed
by revisions to the BBP standard. This training satisfies the requirements of the BBP standard when used in conjunction with the BBP training program provided elsewhere on the CD-ROM accompanying this guide. OSHA
requires that BBP training sessions provide attendees with interaction with a live instructor who is knowledgeable
about BBPs and the workplace. OSHA does allow video or distance training, but employees still must have access
to a “live” person (even if by phone or electronically) to answer questions. This packet provides the trainer with
the materials needed to coordinate, develop, and conduct interactive sharps injury prevention training sessions. It
includes the following:
 A teaching plan
 Sample slides that can be used to develop a facility-specific training program
 A sample posttraining quiz that can be used to ensure understanding and retention of the information
presented
Feel free to copy, modify, or adapt any of the above materials for use within your practice to meet your needs.
PRACTICE-SPECIFIC INFORMATION
These training materials must be supplemented with facility-specific information. The OSHA standard requires
that training cover the practice’s own exposure control plan (ECP) and the engineering controls (e.g., needlestick
prevention devices) used at the practice, not just provide generic information. The trainer should feel free to copy,
modify, or adapt any of these materials to meet the practice’s needs. In the sample visuals, blank spaces and directions to the individuals preparing the training will help them fill in the required practice-specific information.
TEACHING PLAN
Pretraining Preparation
In preparing for and conducting sharps injury prevention training, some or all of the following activities
may apply:
 Review OSHA’s BBP standard.
Additional Materials Available
The following items can be adapted to meet individual
practice needs:

Sample Memo to announce a training session

Attendance Sheet to verify attendance at the
training session

Evaluation Form to gather input from trainees
on the quality of the training presentation and
suggestions for improvement

PowerPoint presentation
 Assess current practices to evaluate compliance
and to note any areas in need of improvement and
that could be stressed during training.
 Review sharps injury records to determine which
sharps are most frequently involved in injuries.
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Sharps Injury Prevention Training Program
 Consult with healthcare workers who have occupational exposure to used/contaminated sharps (e.g., nurses,
physicians, housekeeping staff, laboratory personnel) to identify areas to focus on during training.
 Review the processes for injury reporting and postexposure treatment.
 Review state and local disposal practices and disposal regulations for needleless systems.
 Set a training schedule that meets the needs of the groups that must receive training.
 Provide advance notice of scheduled training sessions with informational posters and memos to remind pro-
viders, managers, and staff of dates and times.
 Develop visual aids.
 Prepare and copy any handout materials, attendance sheets, and written quizzes.
 Plan to keep a training record, noting the date of the training program, instructor’s name, and names of staff
who attended the program.
Depending on the practice’s needs, different training sessions may be created for different audiences. For
example, the information presented to nurses may be more complex and detailed than that prepared for housekeeping staff. ECRI Institute recommends using the training materials in this packet as the core information to
create audience specific training sessions. When adding or deleting visuals for specific training sessions, trainers
should ensure that all the required elements are still covered.
TRAINING TOPICS
According to the revised OSHA standard, annual BBPs training must include an explanation of the following:
 The OSHA standard
 The ECP
 Appropriate methods for recognizing tasks that may involve exposure to used/contaminated sharps
 Methods that will prevent or reduce exposure, including engineering controls and work practice controls
 The procedure to follow if an exposure incident occurs
 Prohibited work practices
Training must also include information on the types, use, and disposal of engineered sharps devices; actions
to take and people to contact in an emergency involving blood or other potentially infectious material; and the
postexposure evaluation and follow-up that the employer is required to provide to healthcare workers who have
experienced an exposure incident.
SAMPLE SLIDES
 The first five sample slides introduce the topic of sharps injury prevention with a review of the learning objec-
tives and a discussion about the risks from sharps injuries. Slide 5 emphasizes the importance of a culture of
safety in which healthcare providers and staff are encouraged to report injuries and hazards. About half of all
sharps injuries go unreported, raising the possibility that postexposure prophylaxis is not provided and that
existing hazards are not eliminated.
 Slide 6 identifies sharps that can cause injuries. The lists of exposure-prone jobs and procedures provided
in slides 7 and 8 are merely examples and should be tailored to the audience. Slide 9 provides details on the
specific injury history at the facility. Providing this information is not required by the regulations but will
personalize the training for attendees. Slide 10 prompts the trainer to provide information that applies to the
group being trained.
 Slide 11 reviews the sharps-related aspects of standard precautions mandated by OSHA regulations. Slides
12 through 14 cover the ECP. If this training is conducted as a part of BBP training and the details of the ECP
are covered elsewhere, these visuals may be omitted. If this training session is conducted separately, it may
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be helpful to review the relevant aspects of the ECP. One of the most important points to emphasize is the
requirement to solicit input from healthcare workers who are exposed to sharps regarding the evaluation and
purchase of needlestick prevention devices and other engineered sharps.
 Slide 15 reviews methods to reduce the possibility of sharps injuries and occupational exposure to a BBP.
Remember that the training does not address all measures for reducing occupational exposures required by
OSHA’s BBP training requirements. Slide 16 reviews standard precautions. Slides 17 through 19 introduce
work practice and engineering controls. Slide 20 defines protective devices to protect healthcare workers from
accidental needlesticks and other sharps injuries. Trainers may want to emphasize that not all safety features
afford an equal level of protection.
 Slides 21 through 23 describe the two major classes of needlestick prevention devices. Slides 24 through 26 use
pictures to show how a few engineering controls work. These pictures are available from the OSHA Web site.
As indicated by slide 27, ECRI Institute recommends having some devices available, if possible, so that trainees
can examine them in a nonexposure situation. Slides 28 and 29 describe the hazards of glass capillary tubes and
some possible controls to reduce or eliminate the hazards. These visuals may be omitted if glass capillary tubes
are not used in the facility or if the audience (e.g., housekeeping staff) does not use or have exposure to them.
 Slides 30 through 31 address disposal issues. Facility-specific information regarding the disposal of sharps must
be provided to the audience. Slide 32 covers the OSHA requirements for sharps container handling and use.
 Slide 33 prompts a reminder to staff to report any risky work practices or hazards that might cause sharps injuries.
 Slide 34 defines sharps exposure incidents. Information on facility-specific reporting requirements should be
added to slide 35. Some facilities track near-miss incidents, in which no injury occurs, as well as confirmed
injuries. Slide 36 and 37 provide general information about postexposure treatment. Practices can tailor the
information to be consistent with their policies. Some of this information could also be covered in a more general training program on BBPs.
 Slide 38 provides a review of sharps injury prevention strategies, and slide 39 prompts the trainer to open the
training program for questions.
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Sharps Injury Prevention Training Program
[Insert facility name here.]
Sharps
Injury Prevention
Training Program
Learning Objectives
¾ Identify risks posed by needles and other sharps.
¾ Recall safe practices for needles and other sharps.
¾ Recognize sharps that have engineered sharps injury
protection.
¾ Recall safe practices for sharps container handling.
¾ Know how to report an exposure incident.
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Educational materials from ECRI Institute, (610) 825-6000
Needles and Sharps Pose Risks
¾ Any needle or other sharp poses the risk of
transmitting bloodborne pathogens to someone
injured by the sharp.
¾ Between 600,000 and 800,000 sharps injuries occur
among healthcare
h lth
workers
k
annually,
ll says th
the
National Institute for Occupational Safety and Health.
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Bloodborne Pathogen Transmission
¾ Sharps injuries can be associated with occupational
transmission of more than 20 bloodborne pathogens.
¾ Most commonly transmitted pathogens:
¾ Hepatitis B virus (HBV)
¾ Hepatitis C virus (HCV)
¾ Human immunodeficiency virus (HIV)
¾ Sharps injuries can lead to serious or fatal infections.
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Educational materials from ECRI Institute, (610) 825-6000
Culture of Safety
¾ About half of all sharps injuries go unreported.
¾ This office supports a culture of safety for providers,
staff members, and patients.
¾ Promote reporting of injuries and hazards.
¾ Support involvement of staff in selection of sharps
injury prevention devices.
¾ Provide education and training on sharps injury
prevention.
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Educational materials from ECRI Institute, (610) 825-6000
Sharps That Frequently Cause Injuries
¾ Hypodermic needles
¾ Blood collection needles
¾ Suture needles
¾ Needles used in intravenous ((IV)) delivery
y systems
y
¾ Glass capillary tubes
¾ Used disposable razors
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Who’s at Risk?
¾ Physicians
¾ Nurses
¾ Lab technicians
¾ Phlebotomists
¾ Mid-level providers
¾ Housekeepers
¾ Laundry personnel
¾ And others
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Educational materials from ECRI Institute, (610) 825-6000
Procedures Linked to Sharps Injuries
¾ Phlebotomy
¾ Intramuscular injection
¾ IV access
¾ Suturing
g
¾ Handling laundry
¾ Collecting filled sharps containers
¾ And more
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Educational materials from ECRI Institute, (610) 825-6000
Sharps Injury History
¾ (Provide data about facility-specific sharps injuries)
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Exposure-Prone Jobs and Procedures
¾ (Fill in information specific to the duties of the
trainees to help them distinguish the potential for
exposure during their tasks)
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Educational materials from ECRI Institute, (610) 825-6000
OSHA Requirements
¾ Occupational Exposure to Bloodborne Pathogens (29
CFR § 1910.1030)
¾ Originally published in December 1991; revised in
January 2001
¾ Covers all occupational exposure to blood and
other potentially infectious material (OPIM)
¾ Available at U.S. Occupational Safety and Health
Administration (OSHA) Web site: www.osha.gov
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Educational materials from ECRI Institute, (610) 825-6000
Bloodborne Pathogen Standard
¾ OSHA requirements:
¾ Healthcare facilities must develop and periodically
review an exposure control plan.
¾ Employers must offer safer medical devices to
reduce or eliminate exposure incidents.
¾ Employers must seek employee input in selection
of safer medical devices and implementation of
work practice controls.
¾ Employers must offer vaccine for HBV to workers.
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Exposure Control Plan
¾ OSHA requires healthcare providers to:
¾ Identify jobs and tasks in which occupational
exposure to blood or other potentially infectious
material occurs.
¾ Consider and implement safer medical devices.
¾ Seek input from healthcare workers in
identification, evaluation, and selection of safer
medical devices and work practice controls.
¾ Update plan annually—at least.
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Educational materials from ECRI Institute, (610) 825-6000
Our Exposure Control Plan
¾ (Insert specific information about the practice’s
exposure control plan, such as where to obtain a
copy of the plan)
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Educational materials from ECRI Institute, (610) 825-6000
Methods to Reduce Exposure
¾ OSHA’s bloodborne pathogen standard requires
healthcare providers to:
¾ Follow standard precautions.
¾ Use engineering and work practice controls.
¾ Wear personal protective equipment.
¾ Avoid recapping, bending, or breaking of needles
and sharps.
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Standard Precautions
¾ Standard precautions as recommended by the
Centers for Disease Control and Prevention (CDC)
assume all blood and body fluids are infectious.
¾ Every patient is treated as potentially infected with a
bl db
bloodborne
pathogen.
th
¾ All healthcare workers must use standard
precautions whenever there is a chance of exposure
to blood or other potentially infectious material.
¾ Workers must follow infection prevention practices;
hand hygiene is key!
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Educational materials from ECRI Institute, (610) 825-6000
Work Practice Controls
¾ Standard operating procedures
¾ Training programs
¾ Signs and labels
¾ Facilityy rules and regulations
g
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Educational materials from ECRI Institute, (610) 825-6000
Follow These Safe Practices
¾ Avoid recapping, bending, or breaking of needles and
sharps.
¾ If medical procedure requires recapping, use a onehand technique.
¾ Place used sharps immediately into punctureresistant containers.
¾ Carry sealed specimen containers in an outer
container.
¾ Avoid touching contaminated broken glass with bare
hands.
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Engineering Controls
¾ Controls that isolate or remove the bloodborne
pathogen hazard from the workplace
¾ Safer medical devices
¾ Plastic capillary tubes
¾ Sharps disposal containers
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Educational materials from ECRI Institute, (610) 825-6000
Safer Medical Devices
¾ A protective device is any product that can be used to
protect healthcare workers from accidental
needlesticks and other sharps injuries
¾ Protective devices generally take the same form and
are used
d ffor th
the same application
li ti as th
their
i ttraditional
diti
l
(nonsafety) counterparts, EXCEPT:
¾ Protective devices include a design characteristic
to help prevent personnel from coming into
contact with an exposed needle or other sharp
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Educational materials from ECRI Institute, (610) 825-6000
Two Types of Safer Medical Devices
¾ Needleless systems, such as needleless IV line
connectors
¾ Sharps with engineered sharps injury protection,
such as self-sheathing needles on syringes
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Needleless Systems
¾ Device that does not use a needle for
¾ Collection of body fluids;
¾ Administration of medication/fluids; or
¾ Anyy other p
procedure with p
potential p
percutaneous
exposure to a contaminated sharp.
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Educational materials from ECRI Institute, (610) 825-6000
Engineered Sharps Injury Protection
¾ Nonneedle sharps or needle devices with built-in
safety features or mechanisms that reduce the risk of
exposure incidents
¾ Uses
¾ Withdrawing body fluids
¾ Accessing a vein or artery
¾ Administering medications or other fluids
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Educational materials from ECRI Institute, (610) 825-6000
Examples
¾ Hypodermic syringe with “retractable technology”
safety feature
Retracted protected position
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Examples
¾ Phlebotomy needle with “self-blunting” safety feature
Blunted protected position
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Educational materials from ECRI Institute, (610) 825-6000
Examples
¾ Needleguard safety feature
Attached to syringe
Attached to blood tube holder
26
Educational materials from ECRI Institute, (610) 825-6000
Protective Devices Available Here
¾ (Insert specific information about protective devices
available at the practice)
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Educational materials from ECRI Institute, (610) 825-6000
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Glass Capillary Tubes
¾ Used to collect blood
¾ Break when inserted into putty
¾ Break during centrifugation
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Educational materials from ECRI Institute, (610) 825-6000
Alternatives for Glass Capillary Tubes
¾ Tubes that are not made of glass
¾ Glass tubes wrapped in puncture-resistant film
¾ Products that do not require manually pushing the
tubes into putty to form a plug
¾ Products that allow the blood hematocrit to be
measured without centrifugation
29
Educational materials from ECRI Institute, (610) 825-6000
Disposal of Needleless Devices
¾ All contaminated sharps must be discarded in a
suitable sharps container, says OSHA
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Sharps Disposal Containers
¾ Place used sharps in a sharps disposal container
immediately after use.
¾ (If applicable to the practice, add information on how
reusable sharps such as scalpels are handled.)
¾ Do not overfill sharps containers.
¾ (Add information on how to remove or who to call to
remove full sharps containers.)
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Educational materials from ECRI Institute, (610) 825-6000
Sharps Container Handling
¾ Always hold a sharps container by the handles.
¾ Always mount sharps containers securely in visible,
accessible places.
¾ Do not shake a container to make more room.
¾ Do not stick fingers into the opening.
¾ Do not wipe or clean sharps containers.
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Educational materials from ECRI Institute, (610) 825-6000
Report Hazards
¾ Report any sharps injury hazards – contact (names)
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Exposure Incident
¾ An exposure incident has occurred if
¾ Blood or other potentially infectious material (not
your own) has come into direct contact with your
eyes, mouth, mucous membranes, or open
wounds;
d or
¾ You have punctured your skin with a
contaminated sharp object.
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Educational materials from ECRI Institute, (610) 825-6000
Reporting an Exposure Incident
¾ Report all exposures to: (specify practice contact)
¾ (Specify practice contact) will provide you with the
necessary paperwork and will help document the
exposure.
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Educational materials from ECRI Institute, (610) 825-6000
After an Exposure Incident
¾ You will be sent for a free medical evaluation.
¾ You will be provided any necessary counseling free
of charge.
¾ You will be provided any necessary free of charge.
¾ Any test results, medical recommendations, or other
information will be shared with you.
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Educational materials from ECRI Institute, (610) 825-6000
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Sharps Injury Prevention Training Program
Postexposure Follow-Up
¾ Medical evaluation.
¾ HBV vaccination is recommended for any exposure if
you have not been vaccinated.
¾ Postexposure prophylaxis (PEP), if clinically
indicated.
¾ If PEP for HIV is indicated, treatment should be
started as soon as possible after exposure—
within hours.
¾ Physician’s written opinion.
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Educational materials from ECRI Institute, (610) 825-6000
Review
¾ Use devices with safety features.
¾ Never recap needles.
¾ Always dispose of used and contaminated sharps
immediately.
¾ Be aware of the hazards of nonneedle sharps.
¾ Broken glass, scalpels, and other sharps objects
contaminated with blood
¾ Report all needlestick and sharps-related injuries
promptly.
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Educational materials from ECRI Institute, (610) 825-6000
Questions?
39
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Sharps Injury Prevention Training Program
POSTTRAINING QUIZ
1. All of the following are commonly involved with sharps injuries except . . .
a. Phlebotomy needles
b. Hypodermic needles
c. Tongue blades
d. Glass capillary tubes
2. Only some sharps injuries are serious and must be reported.
a. True
b. False
3. Shearing or breaking contaminated sharps is completely prohibited by Occupational Safety and Health
Administration (OSHA) regulations.
a. True
b. False
4. When a sharps container appears to be full, it is acceptable to shake it to make more room inside.
a. True
b. False
5. _____ controls reduce or eliminate exposures by removing the hazard or isolating the healthcare worker from
the hazard.
a. Administrative
b. Standard
c. Work practice
d. Engineering
6. Sharps injuries can result in fatal infections in healthcare workers.
a. True
b. False
7. OSHA requires healthcare facilities to gather input from nonmanagerial healthcare workers about the types of
engineered sharps to evaluate and purchase.
a. True
b. False
8. An example of a safer medical device with engineered sharps injury protection is the disposable syringe.
a. True
b. False
9. Healthcare workers who sustain a sharps injury are entitled to the following:
a. A confidential, free medical examination
b. Free counseling
c. Free postexposure treatment medications
d. All of the above
10. An employee whose skin is accidentally punctured by the needle attached to a syringe used on a patient must
immediately report the incident to the U.S. Food and Drug Administration.
a. True
b. False
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Sharps Injury Prevention Training Program
Answers
1. c
2. b
3. a
4. b
5. d
6. a
7. a
8. a
9. d
10. b
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