When Protective Features Fail: Sharps Injures from Activating Protective Devices and Device Malfunctions

BACKGROUND:  Using sharps with engineered sharps injury protections (SESIPs) is an effective method to prevent sharps injuries (SIs) among healthcare workers. However, SESIPs are not perfect. SIs can happen while activating the injury protection mechanism or if the device malfunctions.  Using data from the Massachusetts Sharps Injury Surveillance System at the Massachusetts Department of Public Health (MDPH), this study sought to examine the circumstances surrounding injuries occurring during activation of injury protection mechanisms or following device malfunctions.  

METHODS:  The analysis was restricted to SIs occurring with SESIPs. SIs were divided into three categories based on how they occurred: 1) while activating the mechanism, 2) device malfunction, and 3) all other causes. We compared the percentage of SIs by occupation and device for each of the three categories. For hypodermic needle/syringes, we compared the proportion of SIs from specific injury protection mechanisms between the three categories. 

RESULTS:  13,852 SIs occurring with SESIPs were reported to MDPH from 2002 to 2013. Of those, 2,353 (17.0%) occurred while activating the injury protection mechanism, 496 (3.6%) involved a device malfunction, and 11,003 (79.3%) were from to other causes. For injuries while activating the mechanism, hypodermic needles/syringes accounted for 60.4% of SIs, but only 41.7% of device malfunctions and 48.3% of SIs due to other causes. For injuries with hypodermic needle/syringes occurring while activating the mechanism, sliding sheath (47.1%) and hinged arm (36.5%) mechanisms represented a higher percentage of SIs compared to injuries due to other causes involving those same mechanisms (sliding sheath = 38.4%, hinged arm = 25.7%). Retractable mechanisms accounted for a lower percentage of injuries occurring while activating the mechanism with hypodermic needles/syringes (10.9%) compared to the other causes category (25.3%). For injuries while activating the mechanism and from device malfunctions, nurses represented about 70% compared to 58.2% in the other causes category, perhaps because they more often use the device types associated with activation or malfunction injuries. 

CONCLUSIONS:  SIs with SESIPs occurring after use should be very rare. SIs while activating the mechanism may indicate that the mechanism is difficult and not intuitive to activate or more training in using it is necessary. For hypodermic needles/syringes, the focus should be on those mechanisms that account for a disproportionately high number of SIs (i.e., sliding sheaths and hinged arms). SIs due to device malfunctions may indicate that there is a defect in the product; these require more attention and should be reported to the FDA.