A needlestick injury is defined by the Center for Disease Control (CDC) as a percutaneous injury due to accidental handling of a sharp. The CDC estimates that approximately 400,000 needlestick incidences occur each year in United States healthcare facilities, and reports from other developed countries, such as the United Kingdom and Spain, share similar frequencies. Further, the World Health Organization (WHO) estimates two million international healthcare workers are exposed annually to infectious disease as a consequence of a needlestick event, resulting in 37.6% and 39% of hepatitis B and hepatitis C cases, respectively. In the United States, federal and state legislation have greatly reduced incidence rates since the late 1980s, providing education, better protocols and effective post-exposure management. Additionally, the introduction of national surveillance databases led to stronger epidemiological support for the causation of needlestick injury and consequently, a stronger national awareness. In an effort to better protect healthcare workers, corporations such as DuPont and BD have further reduced needlestick incidences in the United States by designing products ranging from safety-engineered syringes to adhesive strips surrounded in strong synthetic materials such as Kevlar® and Lycra®. These devices are instrumental in minimizing the needlestick problem in both the clinic and in the operating room. As part of the current United States legislation, healthcare organizations are mandated to implement and utilize these safety-engineered syringes and needles. Despite the rise in protective equipment, national database surveillance and federal/state legislature, the incidence rate remains high as hundreds of thousands of injuries persist each year. We sought to find other solutions for better protecting healthcare workers through the implementation of golden orb weaver spider silk in personal protective equipment. This silk, gathered from the Nephila clavipes, is one of the strongest and toughest biomaterials in known existence. Its characteristically high energy absorption makes it an ideal material for reinforcing gloves and other protective equipment for healthcare workers. We believe that products made from this silk would serve as strong barriers against needlestick injury and bloodborne pathogen exposure. We are in the process of designing and fabricating such a glove and completed preliminary strength testing to ensure the superiority of our material. Tensile testing conducted at Tufts' Department of Biomedical Engineering suggests that our silk possesses the same mechanical profile as N. clavipes silk found in published literature. We plan on utilizing Fourier-transform infrared (DSC-FTIR) microspectroscopy to study the protein structure and possibly conducting enzyme degradation assays to assess the property changes under unique conditions. This information combined with our patented extraction and reinforcing methodology will provide the groundwork for partnering with industry leaders to make this product a reality and help eliminate the incidence of needlestick injury.

Needlestick injuries (NSIs) are a recognized risk for occupationally-related transmission of bloodborne pathogens (BBP). The occurrence of NSIs and BBP exposures among firefighters (FFs) and emergency medical services (EMS) personnel has been documented. The purposes of this study were: 1) to define the problem of NSI among FFs and EMS personnel in a suburban fire department (FD) and identify practices and factors that influence sharps use and safety; 2) design and implement and intervention to promote safer sharps device usage; and 3) to measure the effectiveness of the intervention among FFs and EMS personnel. A multi-phase, mixed methods approach was used that included a diagnosis phase that utilized a mixed methods exploratory design, an intervention period, and a quantitative evaluation phase that used a before and after evaluation design. In the diagnosis phase, data regarding sharps device practices were obtained through a count of discarded sharps devices. Qualitative data regarding sharps practices and factors which influenced those practice were obtained via focus groups. The PRECEDE/PROCEED model (PPM) was used as the theoretical framework for assessment, planning, implementation, and evaluation of an intervention to increase the occurrence of safer sharps device behaviors and decrease the frequency of riskier sharps device behaviors. The evaluation phase included a post-intervention sharps count and a post-intervention survey to assess changes in sharps practices and the impact of the intervention. During the baseline sharps count, 2743 sharps devices were counted and classified according to pre-established categories of safer or risky behaviors for NSI. Altered safety devices on IV stylets were the highest count for unsafe behaviors (n=105), followed by recapped traditional needles (n= 53). A statistically significant increase in risky behaviors was observed in discarded sharps from engines, as opposed to ambulances, among all sharps devices combined (p=0.000) and IV stylets (p=0.000). When comparing advanced life support (ALS) medications to all other medications, a statistically significant increase in unsafe behaviors occurred among all sharps devices combined (p=0.000) and prefilled syringes (p=0.000). Input from eight focus groups of firefighters allowed for identification of multiple themes which guided the development of an intervention. The intervention included distribution of a hands-on training kit and booklet, expansion of an existing required BBP training, and posters to increase awareness regarding NSI prevention. In the evaluation phase, a total of 2178 sharps devices were counted and classified in a post-intervention sharps count. Altered safety devices on IV stylets were the highest count of unsafe behaviors (n=50). Recapped traditional needles were the second highest count of unsafe behaviors (n=27), but experienced an 18.7% drop in frequency when compared to baseline. When comparing riskier behaviors to the pre-intervention baseline sharps count, statistically significant decreases in risky behaviors were observed in all sharps devices combined ( 2=25.71, p=0.000), IV stylets (2=16.87, p=0.000), and traditional needles (=5.07, p=0.024). A post-intervention survey, consisting of 15 Likert scale questions, was returned by 165 out of 383 active field personnel (41.3%). Results indicated high frequencies of strongly agree and somewhat agree responses regarding risk perception; the importance of using safer needle devices; the impact of the intervention on safer needle practices and sharps safety awareness. Critical predisposing, reinforcing, enabling, and environmental factors which influenced sharps device practices were identified. This study identified factors and practices which influenced unsafe sharps device behaviors. Due to the statistically significant decreases in risky behavior in the post-intervention sharps count and the positive responses in the post-intervention survey, it can be concluded that the intervention did positively impact sharps device behavior and reduced the risk of NSI. The implications of the study are numerous and include a need to explore these practices and factors at other fire departments and EMS agencies, address gaps in regulations; promote research targeting FFs and EMS personnel in regard to NSI, and promote a nationwide effort to prevent NSI among emergency responders.

Intravascular devices with engineered sharps injury protection (ESIP) are designed to reduce sharps injuries, but have not been investigated for blood splatter potential. In this laboratory-based experiment, which did not use human subjects, 100 intravenous catheters of the same type with a retraction mechanism, were tested for blood splatter. Once blood was obtained from a simulated brachial vein containing mock venous blood, the devices were placed in a testing chamber and scientific filters labeled A, B & C were used to capture blood splatter after activation. The blood splatter was examined visually and microscopically, and the filters were weighed pre- and post-activation on an analytical scale. The research questions in this study were: 1) do retractable intravenous devices produce blood splatter, and 2) does blood splatter frequency differ between visual methods vs. microscopy? The differences in filter mass, visual inspection, and microscopic analysis for presence of blood on filters were the units of analysis. Descriptive statistics, paired t-tests to determine pre and post activation filter weights and kappa statistics to assess degree of agreement between methods were used to analyze the data. For filters B and C, the proportions with blood detected by the naked eye were 12 and 13% respectively. However, for filter A, both visual and microscopic methods detected blood splatter on 70% and 71% of the time respectively. In addition, a statistically significant difference was observed in the mean mass of filter A between pre- and post-activation confirmed by the naked eye (t= - 0.0013, p= 0.01400) and confirmed microscopically (t= - 0.00014, p=0.0092). Substantial agreement between methods was observed for filter A (kappa=0.78; 95% CI: 0.64-0.92), filter B (kappa= 0.73; 95% CI: 0.51-0.95) and filter C (kappa= 0.75; 95% CI: 0.55-0.96). However, in 7 instances (7%), blood was detected by microscopy but not by the naked eye on filters A (5 %), B (1%), and C (1%), respectively. Also, in 6 instances (6%), blood was detected by the naked eye but now by microscopy on filter B (3%), and filter C (3%). Consequently, there is potential for a total of 13 % blood splatter. The findings indicate potential for bloodborne pathogen exposure with use of a specific retractable intravascular catheter. The finding that blood splatter was detected by microscopy in 7% of the instances has important occupational health implications. Healthcare workers (HCWs) may not be able to detect this blood splatter when it occurs and may not report a splash to mucous membranes or non-intact skin. This study therefore reinforces the need for HCWs to wear personal protective equipment, such as masks, face shields, goggles, when using intravascular catheters with retractable mechanisms. It is recommended that the research protocol used in this study be replicated by other investigators and tested on all brands of retractable intravascular devices.