Historical Review: Developing a Sharps Injury Prevention Team and the Use of Cognitive Aids to Promote Sharp Safety Awareness

Roy H. Constantine  PA-C, MPH, PhD, FCCM, DFAAPA

Former CSPS Representative and Chair


Article originally printed in Sutureline: Sep/Oct 2014 pp. 17-18

As a member of the CSPS the AASPA is actively participating in a 2014 “Sharps Safety Campaign.” To be successful CSPS members will work collaboratively to promote educational tools and resources that can be used by each member of the surgical team. This 4th submission, provides a historical review, how to develop a sharps injury prevention team and the use of cognitive aids to promote sharp safety awareness.

Sharp exposures carry the risk of infection with Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV), the virus that causes AIDS. Each of these viruses poses a different risk if a health care worker is exposed (CDC).



Sharps Safety in the Operating Room Environment

The CDC estimates approximately 385,000 sharps injuries annually in the hospital environment. This amounts to greater than 1,000 injuries per day. This data does not encompass the other settings where these injuries also occur. A direct concern is the increased risk for blood borne virus transmission and the associated quality and cost ramifications. (CDC)

The effort of multiple stakeholders can be seen in annual events that focus on minimizing harm across the continuum of care amongst healthcare personnel. Dr. Mary Foley PhD, RN – Chairperson of “Safe in Common” (SIC) and Director of the Center for Nursing Research and Innovation at the University of California San Francisco (UCSF) School of Nursing along with other distinguished colleagues has provided online conferences to help “strengthen the Federal Needle stick Safety and Prevention Act, raise awareness of needle stick safety, and utilize safer engineering controls to protect healthcare personnel from unnecessary needle stick injuries. The importance in raising awareness in needle stick safety is imperative (Foley).

The AORN has and continues to provide guidance for the interdisciplinary team to implement risk reduction strategies and apply them towards surgical and invasive procedures. As Mary J. Ogg MSN, RN, CNOR (a sharps expert with the Association of perioperative Registered Nurses) notes all need to see the data to be convinced that adapted practices can decrease the incidence of sharps injuries and needle sticks (Fields). AORN resources have helped many to overcome barriers to compliance with sharps safety protocols (AORN).

There is in-depth research in the area of sharps safety. In one study, a review of RCTs and meta-analysis of RCTs found several interventions to overcome sharps barriers. The intent was to look at the use of safety scalpels and their relationship to reduction in the risk of injury. This review supported risk reductions with double gloving and the use of blunt suture needles. There was additional evidence that passing a tray in a neutral zone was of benefit, but there was insufficient evidence to support the regulated use of safety scalpels at this time (DeGirolamo).


To learn more about “Exposure Prevention Information” a good resource is the “International Healthcare Worker Safety Center.”  The Exposure Prevention Network (EpiNet) was developed by Janine Jagger M.P.H., Ph.D. and colleagues in 1991. Detailed information can be obtained on targeting high-risk devices in the institutional setting. In addition, data can be obtained that “identifies injuries that may be prevented with safer medical devices, information on successful prevention measures, efficacy of new devices designed to prevent injury, targeted high-risk devices, procedures for interventions and injury frequencies.” (University of Virginia Health System)

The International Sharps Injury Prevention Society (ISIPS) is “comprised of medical device and pharmaceutical manufacturers, health organizations, healthcare professionals, medical waste disposal experts, hospitals, insurance industry, managed care organizations, alternate site providers, correction officials, law enforcement personnel and others that have joined forces to provide education, information and product knowledge that will help reduce the number of sharps injuries that occur yearly.”  The Society promotes multiple activities, which include seminars, associations, chapters, presentations, articles and on-line education (ISIPS).

Sustainable HOSPITALS is part of The Lowell Center for Sustainable Production and is located at the University of Massachusetts. Their long-term goal “is to redefine environmentalism and occupational health and safety while also demonstrating how these concepts are compatible with new systems of production and consumption that are healthy for workers, environmentally sound, economically viable, and socially oriented.”  The site allows the user four ways to find alternative products. Products can be searched by category, by manufacturer, by the particular hazard and by the product itself (Sustainable HOSPITALS).

The National Institute for Occupational Safety and Health (NIOSH) collects shared experiences on how safer medical device practices were implemented. Interventions, barriers, lessons learned are discussed

A strong healthcare intervention is the “Development of a Sharps Injury Prevention Team.”  The CDC site – Blood borne Infectious Diseases: HIV/AIDS, HEPATITIS B, HEPATIS C provides seven hospital power points that revolve around criteria for member selection, description of a team, designating a team coordinator, task force coordination and mechanisms for product review (NIOSH).

The CDC also has an excellent “Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program.”  The information in the workbook is for application in your healthcare settings. The content provides a strong overview, organizational steps, operational processes, helpful references which include “toolkits” (CDC workbook)

AORN has several publications on this topic. Two excellent submissions that I reviewed include: 1) Sharps Injury Prevention in the Perioperative Setting (An AORN Guidance Statement) and 2) AORN Sharps Safety Tool Kit – Selection of Sharps Injury Prevention Devices (with adaptation from the CDC workbook).

Cognitive Aids Provide Sharp Safety Awareness

Cognitive aids act as prompts which can affect team function (Marshall, 2013). A review of the literature reinforces how cognitive aids can improve routine and emergent performance. The format for information can be as simple as a paper reminder (Stanford, 2014).

Professional posters can attract staff and provide essential reminders concerning sharps safety. Specific risks can be reinforced with staff members illustrating proper and improper safety approaches. Incorporating graphs, charts and data further supports outcomes and enhances staff knowledge regarding positive / negative trends (CDC, 2014)

Selected posters should be displayed in several locations to maximize awareness. Five types of selected posters can be printed from the CDC links: General Awareness, Data display, Correct Technique, Fast Facts and informational Display.

I reviewed the “General Awareness Posters” and they are excellent. A team members picture can be inserted within the poster. The “Data Display Poster” allows institutional data to be posted, but a unique feature of these posters includes the testimonial quotes from members that have experienced or witnessed a sharps injury. The “Correct Technique Poster” demonstrates several safe work processes that should be reminded and incorporated in daily practice. The “Fast Fact Posters” provide brief informative statements. In the era of Electronic Medical Record (EMR) these types of messages can easily be floated on computer screen savers. Finally, the “Informational Display Board” provides more sophisticated graphics in order to customize a poster display (CDC, 2014).

The Lucian Leape Institute at the National Patient Safety Foundation (NPSF) was established in 2007. NPSFs mission is to improve safety of care provided to patients. An excellent publication that I recommend reading is entitled, “ Through the Eyes of the Workforce” – Creating Joy, Meaning, and Safer Health Care (2013).”  Vulnerable workplaces occur because of an omission in design and inattention.

Recommendations for Developing Effective Organizations include:

Strategy 1: Develop and embody shared

core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.

Strategy 2: Adopt the explicit aim to eliminate harm to the workforce and to patients.

Strategy 3: Commit to creating a high-reliability organization (HRO) and demonstrate

the discipline to achieve highly reliable performance. This will require creating a learning and improvement system and adopting evidence-based management skills for reliability.

Strategy 4: Create a learning and improvement system.

Strategy 5: Establish data capture, database, and performance metrics for accountability and improvement.

Strategy 6: Recognize and celebrate the work and accomplishments of the workforce, regularly and with high visibility.

Strategy 7: Support industry-wide research to design and conduct studies that will explore issues and conditions in health care that are harming our workforce and our patients.

Improving and redesigning systems strengthen interdisciplinary processes and prevention. Accident causation can be a direct result of system failure and human error. Cognitive aids can help to overcome personal, structural, cultural and social barriers. Select and evaluate interventions that meet the needs of your patients and the multidisciplinary team.

It is extremely important to enhance “Sharp Injury” awareness. All members of the Council on Surgical and Perioperative Safety (CSPS) are united in this campaign. Excellent resources can be obtained from each of the professional sites (American Association of Nurse Anesthetists (AANA), American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), American Society of PeriAnesthesia Nurses (ASPAN), Association of perioperative Registered Nurses (AORN), Association of Surgical Technologists (AST) and the American Association of Surgical Physician Assistants (AASPA). We are passionately united in providing you with education to overcome dangers associated with needle sticks and sharps injury.

Patient safety is the responsibility of everyone. Physician Assistants are important “patient safety” stakeholders. It is imperative that  “You Participate” in your Patient Safety and Quality Care Programs.



  1. AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting. Association of perioperative Registered Nurses; Anonymous. (2005)Association of Operating Room Nurses. AORN Journal
  2. CDC (2014). Poster Templates – Centers for Disease Control and Prevention. Retrieved on May 13, 2014 from http://www.cdc.gov/niosh/stopsticks/postertemplates.html
  3. CDC Workbook - http://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf
  4. DeGirolamo, K. et. al. (2013). Use of Safety Scalpels and other Safety Practices to Reduce Sharps Injury in the Operating Room: What is the Evidence. Canadian Journal of Surgery, 56(4), 263-9
  5. EPINET – Retrieved from http://www.healthsystem.virginia.edu/pub/epinet 
  6. Fields, R. (2011) 6 Ways to Decrease Sharps Injuries and Needle Sticks in the OR. Becker’s ASC Review.
  7. Foley, M. (2013) Safe in Common’s Online Conference– The Unfinished Agenda: Addressing the Challenges- to Explore Unmet Needlestick and Sharps Protection Needs”  U.S. Newswire
  8. ISIPS – Retrieved from http://www.isips.lrg/page/purpose
  9. Marshall, S. (2013). The Use of Cognitive Aids During Emergencies in Anesthesia: A Review of the Literature. Anesthesia and Analgesia. Nov; 117(5): 1162-71.
  10. Preventing Needle sticks and Other Sharps Injuries…Everything You Need to Know (Part I. Background) – www.cdc.gov/sharpsafety/PPT/2PreventingNeedlesticksPartI.ppt.
  11. Stanford School of Medicine – Cognitive Aids in Medicine, Retrieved on  June 22, 1014 from http://cogaids.stanford.edu
  12. Sustainable HOSPITALS - http://www.sustainablehospitals.org/cgi-bin/DB_Index.cgi
  13. Through the Eyes of the Workforce- Creating Joy, Meaning, and Safer Health Care, Lucian Leap Institute – Report of the Roundtable on Joy and Meaning in Work and Workforce Safety, (2013), National Patient Safety Foundation