Skip to main content
    • Aa
    • Aa

Issues in Understanding the Impact of the Needlestick Safety and Prevention Act on Hospital Sharps Injuries

  • Elayne Kornblatt Phillips (a1) (a2), Mark Conaway (a3), Ginger Parker (a4), Jane Perry (a4) and Janine Jagger (a1)...

Measuring the effect of the Needlestick Safety and Prevention Act (NSPA) is challenging. No agreement exists on a common denominator for calculating injury rates. Does it make a difference? How are the law and safety-engineered devices related? What is the effect on injuries and costs? This study examines those issues in assessing the impact of the legislation on hospital worker percutaneous injuries.


Using a historic prospective design, we analyzed injury data from 85 hospitals. Injury rates were calculated per 100 full-time equivalents, 100 staffed beds, and 100 admissions each year from 1995 to 2005. We compared changes for each denominator. We measured the proportion of the injury rate attributed to safety-engineered devices. Finally, we estimated a national change in injuries and associated costs.


For all denominators, a precipitous drop in injury rates of greater than one-third (P<.001) occurred in 2001, immediately following the legislation. The decrease was sustained through 2005. Concomitant with the decrease in rates, the proportion of injuries from safety-engineered devices nearly tripled (P <.001) across all denominators. We estimated annual reductions of more than 100,000 sharps injuries at a cost savings of $69-$415 million.


While the data cannot demonstrate cause and effect, the evidence suggests a reduction in hospital worker injury rates related to the NSPA, regardless of denominator. It also suggests an association between the increase in safety-engineered devices and the reduction in overall injury rates. The decreases observed translate into significant reductions in injuries and associated costs.

Corresponding author
University of Virginia, School of Nursing, PO Box 800782, Charlottesville, VA 22908-0782 (
Hide All
1. Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens: final rule, 29 CFR §1910.1030, 56 Federal Register 2235, 64004-64182 (1991).
2.Doebbeling BN, Vaughn TE, McCoy KD, et al. Percutaneous injury, blood exposure, and adherence to standard precautions: are hospital-based health care providers still at risk? Clin Infect Dis 2003;37:10061013.
3.Panlilio AL, Orelien JG, Srivastava PU, Jagger J, Cohn RD, Cardo DM. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infect Control Hosp Epidemiol 2004;25:556562.
4.Jagger J, Perry J, Gomaa A, Phillips EK. The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: the critical role of safety-engineered devices. J Infect Public Health 2008;1:6271.
5. Needlestick Safety and Prevention Act, 114 CFR §106-430, 1901 (2000).
6. Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needle-sticks and other sharps injuries; final rule, 29 CFR §1910.1030, 66 Federal Register 12, 5318-5325 (2001).
7.Phillips EK, Conaway MR, Jagger JC. Percutaneous injuries before and after the Needlestick Safety and Prevention Act. NEngl I Med 2012;366:670671.
8.Billiet LS, Parker CR, Tanley PC, Wallas CW. Needlestick injury rate reduction during phlebotomy: a comparative study of two safety devices. Lab Med 1991;22:120123.
9.Younger B, Hunt EH, Robinson C, McLemore C. Impact of a shielded safety syringe on needlestick injuries among healthcare workers. Infect Control Hosp Epidemiol 1992;13:349353.
10.L'Ecuyer PB, Schwab EO, Iademarco E, Barr N, Aton EA, Fraser VJ. Randomized prospective study of the impact of three needleless intravenous systems on needlestick injury rates. Infect Control Hosp Epidemiol 1996;17:803808.
11.Centers for Disease Control and Prevention. Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures— New York City, March 1993-June 1994. MMWR Morb Mort Wkly Rep 1997;46:2529.
12.Zakrzewska JM, Greenwood I, Jackson J. Introducing safety syringes into a UK dental school: a controlled study. Brit Dent 2001;190:8892.
13.Parker G, Perry J, Jagger J. EPINet report: 1999 percutaneous injury rates. Adv Exposure Prev 2002;6:78.
14.Sohn S, Eagan J, Sepkowitz KA, Zuccotti G. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infect Control Hosp Epidemiol 2004;25:536542.
15.American Hospital Association (AHA). AHA hospital statistics, 1995-2005. Chicago: AHA.
16. US Census Bureau. Reference resources for understanding Census Bureau geography: census regions and divisions of the United States, Accessed December 27, 2011.
17. US Department of Agriculture, Economic Research Service. 2003 rural-urban continuum codes. Accessed December 27, 2011.
18.Hogan A. Gaps and successes of safety device market conversion. Mater Manag Health Care 2005;14:3334.
19. US Department of Labor Bureau of Labor Statistics. Injuries, illnesses, and fatalities. http://www.bls.gOv/iif/#data. Accessed July 13, 2012.
20.Perry J, Jagger J. OSHA enforcement activity on BPS: an update. Accessed April 13, 2012.
21. Standard precautions in hospitals. In: Betsy Lehman Center for Patient Safety and Medical Error Reduction, JSI Research and Training Institute. Prevention and control of healthcare-associated infections in Massachusetts. Pt 1. Final recommendations of the expert panel. Boston: Massachusetts Department of Public Health; 2008:42-49. = 12917. Accessed April 15, 2013.
22. Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program, Accessed April 17, 2013.
23. US General Accounting Office. Occupational safety: selected cost and benefit implications of needlestick prevention devices for hospitals, GAO-01-60R (2000).
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 3
Total number of PDF views: 62 *
Loading metrics...

Abstract views

Total abstract views: 431 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st October 2017. This data will be updated every 24 hours.