Sharps injuries among home healthcare workers affiliated with Massachusetts hospitals: Evidence from state based surveillance system, 2001-2004

Sharps injuries among healthcare workers remain a significant public health concern due to risk of transmitting HIV, HCV, HBV and other pathogens. However, little is known about the magnitude and circumstances of sharps injuries among home healthcare (HHC) workers, one of the most rapidly growing sectors of the workforce in Massachusetts and elsewhere in the US. Licensed hospitals in Massachusetts are required to report sharps injuries to workers, including those sustained by hospital-affiliated HHC workers, to the state health department. While these data underestimate the magnitude of the problem due to underreporting, they can identify patterns of reported sharps injuries specific to HHC. Of the 63 reported cases of sharps injuries to Massachusetts HHC workers in 2001-2004, the majority (56, 89%) were sustained by nurses. The top three devices involved were hypodermic needle (23, 37%), lancet (19, 30%) and butterfly needle (10, 16%). Almost two-thirds of the devices (37, 59%) did not have engineered safety features; these included the majority of lancets (14, 74%) and hypodermic needles (15, 65%). Only 16% (10) of sharps injuries were sustained during use of the device, while 70% (44) occurred after use of the device, either before or during its disposal. As expected, patterns of sharps injuries in HHC differed from those sustained in hospitals. These findings, while based on a small number of surveillance cases, underscore the importance of procurement policies that promote use of medical devices with safety features in patient's homes, as well as policies and practices for their safe disposal.