Prevention from Sharp Injuries in the Hospital Sector: An Italian National Observatory on the Implementation of the Council Directive 2010/32/EU before and during the COVID-19 Pandemic

Abstract

Sharp injuries, determining the risk of bloodborne infections and psychological distress in healthcare workers, may be prevented by a set of strategies, legally enforced in Europe through the Directive 2010/32/EU. To assess its level of implementation in Italy, a national survey was conducted in 2017 and again in 2021, evaluating the progress and possible drawbacks of the COVID-19 pandemic. Altogether, 285 safety managers and 330 nurses from a representative sample of 97 and 117 public hospitals were interviewed using a standardized questionnaire. Knowledge of the Directive requirements decreased significantly, with <60% of participants answering correctly in 2021, and nurses’ attendance in specific courses dropped to 25% in 2021 compared to 54% in 2017. Over 75% of hospitals introduced multiple safety-engineered devices (SED), though total replacement occurred in <50% of cases; routine SED availability increased for blood collection (89%) and venous access devices (83%). Incorrect behaviors in handling sharps decreased significantly over time. Nurses’ HBV vaccination coverage was high (89% in both surveys); in the last year, 97% were vaccinated against COVID, and 47% against influenza. Average annual injuries per hospital did not increase significantly (32 in 2021 vs. 26 in 2017). In 2017, nurses’ perceived safety barriers were working in emergency situations (49%) and lack of resources (40%); in 2021, understaffing (73%), physical fatigue (62%), and handling difficulties while wearing full protective equipment (59%). Safety measures were implemented in Italian hospitals, and although the average injuries per hospital did not show a decrease, these measures could have helped protect healthcare workers during the pandemic, mitigating its potential impact on the increase in situations at risk of injury.

Did safety-engineered device implementation contribute to reducing the risk of needlestick and sharps injuries? Retrospective investigation of 20 years of observation in a Specialist Tertiary Referral Hospital

“…This confirms the importance of training and organizational factors in implementing effective infection prevention programs, which, combined with the availability of safe equipment, improve workplace safety and hygiene. The significance of training is supported by the findings of de Curli et al [26], who assessed the impact of implementing Directive 2010/32/EU in 97 and 117 Italian hospitals in 2017 and 2021, respectively. In the cited study conducted in 2021, a decrease in the number of training sessions attended by healthcare personnel was observed compared to 2017.…”

“…This decline was accompanied by a decrease in knowledge levels regarding the prevention of bloodborne infections, as well as a sustained injury rate at a similar level, despite the implementation of multiple safety-engineered devices. Specifically, this involved 89% of SEDs for blood collection and 83% for venous access [26]. Training is also necessary when using safe equipment.…”

Change in Medical Sharps Injury Characteristics During the COVID-19 Pandemic

“…Various precautions are taken to prevent these accidents. [2,4] During the COVID-19 pandemic, there have been serious restrictions on routine patient admission and routine procedures. During the pandemic, many additional precautions were taken regarding approach to patients and various new procedures began to be implemented.…”

“…It has been stated that needle tips are the most common cause of medical sharps injuries. [1][2][3][4] Major changes have been made in many practices during the pandemic process, and many strict procedures have begun to be implemented regarding contact with patients. These applications; It has also caused differences in some processes such as the use, collection and disposal of materials.…”

“…Even in the reporting of such accidents, there are some deficiencies and there may be a risk of some health and legal problems. [1][2][3][4] During the Coronavirus Disease-2019 (COVID-19) pandemic, routine patient admissions have been restricted and nonurgent operations have been postponed all over the world. In addition, serious safety precautions have been taken and strict procedures have been implemented in approaching patients in health centers.…”