Occupational Hazards (OH): A recent report, published in Advances in Exposure Prevention, compared needlestick injury rates from 1993 to 2001. The research showed a dramatic drop in needlestick injuries. To what do you attribute that drop?
Janine Jagger: I think the change in needlestick injury rates is due to the proportion of safety devices implemented by healthcare facilities. Most of the changes are required of hospitals and healthcare facilities by law [29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens]. There's no question of whether or not they want to implement safe needle devices. In order to be in compliance with the law, they must do it.
OH: When did the turnaround occur?
Jagger: The transition started in the early 1990s, but it accelerated at the time the law was passed in 2001.
OH: If there was one thing you could say to OSHA, what would it be?
Jagger: The center has worked hand-in-glove with OSHA and has provided documentation to support OSHA's recommendations and requirements. They have been the main, proactive agency on this issue. They've acted with great responsibility, so I guess I'd say "Thank you."
OH: Do you expect the rates of needlestick injuries to continue to drop?
Jagger: It is probably still going down, but there are other factors besides devices that play a role. While the risk of American healthcare workers getting stuck by a device is lower, because of changes in the healthcare system, the length of hospital stays is shorter. Nurses and other healthcare providers see more patients in a shorter period of time and the intensity of care has increased. To some degree, these changes may offset the benefits of safer needle devices.
OH: Have there been problems getting healthcare facilities to switch to safer devices?
Jagger: Anecdotally, we've heard there's been a good-faith effort to comply with the standard, but there have been a lot of imperfections in compliance. For example, there are safety devices, such as self-sheathing syringes, that are being used for inappropriate applications. If a nurse uses a syringe with a safety device to draw blood, then she has to get the blood out of the syringe and into the specimen container. In order to do that, she has to override the self-sheathing safety feature. There are blood-drawing devices available that draw directly into the container, but they are not always used.
OH: Are there areas of noncompliance?
Jagger: In particular, we hear about anesthesiologists who don't want to use safety IV catheters and the administrators at dialysis facilities. Some laboratories doing blood analysis are also problem areas. The problem is not hospitals in general. They are trying to comply because they're inspected on a regular basis. The problem is non-hospital [settings]: clinics, independent doctor's offices. They don't feel the pressure to comply because it's less likely they'll be inspected.
OH: What can be done?
Jagger: Healthcare workers need to be vigilant about insisting they're provided with the safest devices, and they need to report all needlestick injuries. Healthcare workers also should think about filing a complaint with OSHA if their employer is not complying with the standard. That's how these last pockets of resistance will be eliminated.
OH: What has been your proudest professional moment?
Jagger: Seeing the needlestick rates go down and knowing that somewhere there are nurses and doctors who are leading full and healthy lives who otherwise would have been infected.
Snapshot of Dr. Janine Jagger
Janine Jagger, Ph.D., MPH, is an epidemiologist specializing in injury prevention and control. She developed the EPINet surveillance system to provide healthcare facilities with a standardized system for tracking needlestick injuries.
She founded the International Healthcare Worker Safety Center at the University of Virginia to help disseminate the findings from the EPINet network and to accelerate the transition to safety technology.
In 2002, Jagger was named a MacArthur Fellow, also known as "a genius award." It is given to individuals who have shown "extraordinary originality" and dedication in their professional pursuits.
Jagger and a team of colleagues are the inventors of six patented safety needle devices, which were honored with a Distinguished Inventor Award in 1988 by Intellectual Property Owners Inc., and selected for display by the U.S. Patent and Trademark Office for its 1990 Bicentennial Exhibit.