Exposures to bloodborne pathogens through injuries with used sharps ('needlesticks') are a leading occupational health risk for nurses and other health care workers. Despite declines in sharps injuries through the 1990s attributable in large part to the development and adoption of specially designed devices that reduce exposure to bare sharps, injuries continue to occur. This study examined survey data from almost 40,000 nurses delivering care in hospitals, home health agencies and nursing homes in 4 major states (California, Florida, New Jersey and Pennsylvania) that were collected in 2006-2007. The aim was to determine current patterns in terms of sharps injuries, procedures exposing nurses to risk, and use of safety-engineered devices, and explore associations how characteristics of hospitals such as their size, staffing levels, and working environments influence risk. Across the 4 states, approximately 7% of the direct care nurses reported experiencing one or more sharps injuries with a used needle in the prior year, and 3% reported one or more injuries with a sharp device other than a needle. Hospital nurses' injury rates were lowest in Florida and comparable across the other three states. From 80 to 90% of the hospital nurse respondents reported that safety engineered equipment were in routine use in their institutions and higher reported use of safety devices at the hospital level was generally associated with lowered injury risk. Nurses working in operating rooms had three times higher risk of injuries. Nurses with less than 5 years of experience appeared to be at particular risk of injuries, as were nurses from Asian and Filipino backgrounds. General support was found for the notion that working conditions (for instance, support from managers and safety climate) were associated with sharps injury risk, although the associations were small. Nursing home nurses were found to have rates of injuries comparable to nurses in hospitals despite much lower rates of performing risky procedures, a pattern that is potentially explainable by the much lower reports of routine use of safety-engineered sharp devices in nursing homes. Home health nurses appeared to be at much lower risk of sharps injuries; however, their use of needles in daily practice appeared to be very low. Some evidence was found that relative inexperience and working conditions (for instance, supportive working environments) might explain at least some variation in sharps injuries in nursing homes and home health settings as well as in hospitals. Overall, this large-scale survey of direct care nurses provided confirmation of findings regarding sharps injury incidence and risk factors from earlier studies, highlighted a number of groups of nurses at high risk for sharps injuries deserving of deeper study and documented historical trends while providing a new data point for tracking this occupational health issue.
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