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The Guideline for Sharps Safety was approved by the AORN Guidelines Advisory Board and became effective as of January 1, 2025. Information about the systematic review supporting this guideline, including the PROSPERO registration number, systematic review questions, description of the search strategy and evidence review, PRISMA 2020 flow diagram, evidence rating model, and evidence summary table is available at https://www.aorn.org/evidencetables/.

Purpose

This document provides guidance to the perioperative team for identifying potential sharps hazards and developing and implementing best practices to prevent sharps injuries and reduce possible occupational exposure to blood, body fluids, or other potentially infectious materials (OPIM) for perioperative patients and personnel.

Health care workers worldwide are at risk for percutaneous injury, exposure to bloodborne pathogens, and occupational transmission of disease.1  A 1-year global pooled prevalence of needlestick injuries among health care workers was calculated to be 44.5%.1  In a review of studies from 35 countries, clinical nurses were found to have an overall needlestick injury prevalence of 40.97%, with the highest prevalence in developing countries and those with a low-middle socioeconomic development index.2  Researchers calculated an annual global prevalence of 59.9% for non-reporting of needlestick injuries among health care workers.3 

A study of workers in the United States who were treated in an emergency department for sharps injuries revealed that health care industry workers reported 16 times the rate of sharps injuries compared to workers in all other industries.4  An estimated 209,200 percutaneous injuries occur among hospital health care workers in the United States annually,4  which is down from previous estimates.5  However, experts agree that the actual number of sharps injuries in the United States is likely much greater because of underreporting.4 

There is a risk of occupational transmission of bloodborne pathogens after percutaneous injury. The most common bloodborne pathogens that put health care workers at risk include hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).6,7  It is estimated that the risk of transmission of HBV is between 6% and 30% after exposure for nonimmune individuals.7  Individuals who have received the full HBV vaccination series and develop an immune response are considered to have protection from HBV infection.7  The estimated risk of transmission of HIV after percutaneous injury from a contaminated sharp is around 0.3%.7  Coinfection of HCV is possible among individuals living with HIV,8  posing an increased risk to health care workers.9  Infection with HCV is often asymptomatic in the acute phase, can lead to serious disease, and can be fatal.6,8  The risk of occupational exposure to emerging pathogens continues to be a concern.9 

The perioperative setting is a high-risk environment for exposure to bloodborne pathogens from percutaneous injuries because of the presence of large quantities of blood, body fluids, and OPIM; prolonged exposure to open surgical sites; frequent handling of sharp instruments; and the requirement for coordination between team members while passing sharp surgical instruments.10  In a 2023 report of needlestick and sharp object injuries, 42.8% of the injuries were reported to have occurred in the perioperative area.11  All members of the surgical team are at risk for sharps injuries including surgical technologists, nurses, surgeons, assistants, and students.10-18  Most of the injuries sustained by surgeons and surgical residents occur during use, although the sharps injuries to nurses and surgical technologists occur during passing, disassembling, and disposal.10  Authors of a systematic review of 16 studies identified a pooled prevalence from the included cross-sectional studies of 41.5% for sharps and needlestick injuries in the operating room (OR), and they calculated that 22% of the sharps injuries occurred during handing or receiving an instrument.19 

The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens standard, 29 CFR 1910.1030, became effective March 6, 1992.20  The purpose of the Bloodborne Pathogens standard is to limit health care worker exposure to blood, body fluids, and OPIM in the workplace through the implementation of engineering and work practice controls. The OSHA standard requires employers to offer the HBV vaccination series at no charge to their employees who may have occupational exposure.20 

The Needlestick Safety and Prevention Act, signed into law on November 6, 2000, directed OSHA to revise the Bloodborne Pathogens standard.21  The revisions included the addition of engineering control definitions and requirements for technology changes that eliminate or reduce blood, body fluid, and OPIM exposure in exposure control plans; input from frontline, non-managerial employees in the identification, evaluation, and selection of safety-engineered devices and work practice controls; annual documentation of the evaluation in the exposure control plan; team member input into the exposure control plan; and maintenance of a sharps injury log.20  There are 29 states with OSHA-approved state plans, which are required to be at least as effective as OSHA’s federal programs.22 

The hierarchy of controls adopted by the Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH) provides structure for prioritizing interventions to reduce bloodborne pathogen exposure.23  An organizational commitment to safety and a culture of support woven throughout a comprehensive sharps safety program are important for successful application of the hierarchy of controls.9  The hierarchy starts with elimination or substitution of the hazard if possible, followed by the use of engineering controls, administrative controls, and personal protective equipment (PPE). The OSHA Bloodborne Pathogens standard requires the use of PPE where there is a risk for occupational exposure to blood, body fluids, or OPIM after engineering and work practice controls are implemented.20 

Sharps safety is a priority in the perioperative environment and can include consideration for standard precautions, health care worker immunization protocols, postexposure treatment, and management of health care workers infected with a bloodborne pathogen. These topics are discussed in more detail in the AORN Guideline for Transmission-Based Precautions24  and are outside the scope of this document.

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