By Casey Czarnowski, Clinical Educator, HSPA
Unprotected sharp devices that enter the decontamination area of the sterile processing department (SPD) – or sharps waste placed in an inappropriate container, such as a garbage bag – jeopardize the safety of those who handle the items. This article addresses the risks of sharps injuries in the SPD, as well as regulatory considerations and prevention strategies.
Sharps handled by sterile processing (SP) professionals may be contaminated with blood or other potentially infectious materials (OPIM). SP professionals are also sometimes tasked with handling waste from the operating room. When sharps are improperly disposed of, they can pierce a bag and create a puncture wound in the employee. In the decontamination area, single-use saw blades, drill bits and scalpel blades that arrive still attached to instruments may go unnoticed, injuring the technician. Most healthcare facilities have policies that require sharps to be removed at the point of use; therefore, SP professionals may not notice occasional lapses. All sharp injuries in the decontamination area are considered potentially infectious and must be treated as such, resulting in additional testing costs, lost productivity and emotional distress for the worker.
Healthcare sharps safety is regulated by the Occupational Safety and Health Administration (OSHA), and the bloodborne pathogens (BBP) standard aims to protect employees – including those responsible for SP functions – from occupational exposure to blood and other potentially infectious pathogens. Specifically, regarding sharps safety, the standard addresses how devices must be disposed of and transported. It also contains sections on exposure control and compliance methods for transport containers, engineering controls, and personal protective equipment (PPE).
Strategies to cut the risks
To mitigate sharps injuries, healthcare organizations should implement engineering and administrative controls, policies and targeted education. OSHA’s BPP is an essential tool for creating hospital policies to prevent and manage sharps-related injuries and other occupational hazards. Additionally, the National Institute for Occupational Safety and Health (NIOSH) has developed a beneficial tool called the hierarchy of protection.
According to the NIOSH hierarchy, eliminating sharps or substituting devices redesigned without sharp edges are the top two effective ways to protect workers from injury. The tool places engineering controls that help isolate employees from a hazard third in the hierarchy, followed by administrative controls that address specific work practices. Engineering and administrative controls are essential because eliminating sharps from practice or substituting a non-sharp device is often unrealistic or infeasible.
Engineering controls can include the following examples:
- Using approved containers for transporting sharps safely
- Using commercially available tip protectors for sterilized instruments
- Installing calibrated sinks and automated chemistry dispensers for the SPD decontamination area; these can help prevent cloudy water, making devices easier to see in the sink for safer cleaning and handling.
- Administrative controls can include:
- Robust, updated policies based on the OSHA BBP standard
- Regular documented training, such as reinforcing the practice of properly managing disposable sharps at the point of use and securing and protecting reusable sharps to prevent injuries
- Clear and regular communication for all employees about sharps safety and steps to take when policy noncompliance or injuries occur
Equally important, healthcare executives and departmental leaders must establish a culture of transparency and trust to encourage, document and track reporting of sharps injuries.
Conclusion
Most sharps injuries are preventable, and their occurrence can be reduced further through ongoing education, standards-based policies and procedures, and the adoption and implementation of engineering and administrative controls. Healthcare workers at every level must be aware of and actively help prevent sharps-related injuries. Employees must understand and follow policies and procedures, remind co-workers when they are engaging in unsafe practices, exercise caution when handling all devices – such as never rushing steps or reaching into a cloudy sink containing sharp instruments – and promptly report injuries when they occur.
References
www.cdc.gov/niosh/hierarchy-of-controls/about/index.html.
www.ecfr.gov/current/title-29/part-1910/section-1910.1030
Healthcare Sterile Processing Association. Sterile Processing Leadership Manual, Fourth ed. 2024.
