Why are needlesticks and other sharps injuries occurring in home healthcare?

Background and Objectives. In a previous study, we documented risks of needlesticks and other sharps injuries (SI) among home healthcare (HHC) nurses and aides. These SI occurred despite more than a decade of federal legislation aimed at prevention. The objectives of this study were to assess how sharps get into the HHC environment and to identify new preventive interventions.

Methods. Sharps procurement, use, and disposal were assessed via 25 in-depth interviews with a wide range of sharps safety stakeholders including HHC agency clinicians and managers, diabetes educators, devices manufacturers, insurers, sharps disposal representatives, and pharmacists. Interview transcripts, as well as documents related to sharps policies and practices, were coded using NVivo software to identify sharps-related themes. The themes were integrated in a map showing how sharps enter and leave a home and the location of key decision-makers in the HHC system.

Results. Sharps enter the HHC environment via multiple pathways that may be outside the healthcare system and are not coordinated by the HHC worker or any other decision-maker. Sharps with injury prevention features are more expensive and sometimes harder to use than conventional sharps. Unlike in hospitals, sharps are frequently re-used by HHC patients and left around the home, increasing risks to HHC workers. Free-of-charge sharps disposal containers, sharps collection sites for consumers, and safety training for HHC workers and patients can be successful interventions.

Conclusions. Sharps use in HHC needs coordination. Interventions are needed to prevent injuries. Qualitative methods are effective in investigating how and why SI occur.