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  • Infection Control & Hospital Epidemiology, Volume 34, Issue 9
  • September 2013, pp. 935-939

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)
  • DOI:
  • Published online: 01 January 2015

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 (
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2.BN Doebbeling , TE Vaughn , KD McCoy , 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.

4.J Jagger , J Perry , A Gomaa , EK Phillips . 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.

7.EK Phillips , MR Conaway , JC Jagger . Percutaneous injuries before and after the Needlestick Safety and Prevention Act. NEngl I Med 2012;366:670671.

8.LS Billiet , CR Parker , PC Tanley , CW Wallas . Needlestick injury rate reduction during phlebotomy: a comparative study of two safety devices. Lab Med 1991;22:120123.

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12.JM Zakrzewska , I Greenwood , J Jackson . Introducing safety syringes into a UK dental school: a controlled study. Brit Dent 2001;190:8892.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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