What Happened?

A first-year graduate student researcher was inserting a hypodermic needle into a catheter connected to an infusion pump loaded with primary human cells for injection into mice. The student held the catheter with forceps while manipulating the needle with the other hand. The student's hand slipped during the procedure, resulting in a needlestick injury and potential exposure to a bloodborne pathogen (BBP).

What went right: The student immediately expressed the wound, washed the area with soap and water for 15 min, and sought medical evaluation. They also reported the incident to their principal investigator (PI) and safety office.

What Was The Cause?

• Immediate cause: The student's hand slipped while manually manipulating a loaded hypodermic needle, resulting in a percutaneous needlestick injury and potential BBP exposure from human-cell-loaded sharps.
• Underlying causes: 
  • Inadequate work practice controls: The procedure required single-hand needle manipulation without a mechanical securing device, creating an unstable grip on a contaminated sharp.
  • Absence of engineering controls: No needle safety device, guide, or stabilizing fixture was in place to reduce free-hand contact with the needle tip during catheter insertion.
  • High-precision task with inherent instability: Simultaneous use of forceps (non-dominant hand) and free needle manipulation (dominant hand) increased the risk of loss of control during a fine-motor procedure.
  • PPE limitations: Standard gloves reduce dexterity and do not protect against needlestick penetration, yet no cut-resistant or puncture-resistant glove alternative was used.
• Root causes:
  • Lack of a written safe operating procedure (SOP): No standardized step-by-step procedure appears to have been in place specifically advising needle-to-catheter manipulation while the pump was loaded with human cells
  • Insufficient hazard assessment prior to procedure: A pre-task BBP risk assessment would have identified the one-handed sharps manipulation as a high-risk step requiring an engineering control or procedural safeguard
  • Training gaps: Graduate student researchers, particularly those with limited bench experience, are recognized as a high-risk group for sharps injuries due to underdeveloped manual technique.
  • No sharps safety device evaluation: OSHA's BBP standard (29 CFR 1910.1030) requires employers to evaluate and implement safety-engineered sharps where feasible; this incident suggests that the requirement may not have been applied to this procedure.

How Can Incidents Like This Be Prevented?

• Use safety-engineered needles: In this case, blunt-tip alternatives are compatible with the pump and catheter system; the CDC estimates that 62–88% of sharps injuries are preventable with safer devices alone.
• Introduce a needle-stabilizing fixture, guide, or armrest to eliminate or stabilize free-hand manipulation during catheter connection.
• Load the pump after the needle-catheter connection is secured, so the needle is never under live pressure during the highest-risk manipulation step
• Use a needleless system for any steps in the procedure where direct needle contact is not strictly required

Resources

• CDC Emergency Sharps Information
• Canadian Centre for Occupational Health Facts on Needlestick and Sharps Injuries