title: Understanding sharps injuries in home healthcare: The Safe Home Care qualitative methods study to identify pathways for injury prevention.
abstract: BACKGROUND
  Home healthcare is one of the fastest growing sectors in the United States. Percutaneous injuries from sharp medical devices (sharps) are a source of bloodborne pathogen infections among home healthcare workers and community members. Sharps use and disposal practices in the home are highly variable and there is no comprehensive analysis of the system of sharps procurement, use and disposal in home healthcare. This gap is a barrier to effective public health interventions. The objectives of this study were to i) identify the full range of pathways by which sharps enter and exit the home, stakeholders involved, and barriers for using sharps with injury prevention features; and ii) assess the leverage points for preventive interventions.
  
  
  METHODS
  This study employed qualitative research methods to develop two systems maps of the use of sharps and prevention of sharps injuries in home healthcare. Twenty-six in-depth interview sessions were conducted including home healthcare agency clinicians, public health practitioners, sharps device manufacturers, injury prevention advocates, pharmacists and others. Interview transcripts were audio-recorded and analyzed thematically using NVIVO qualitative research analysis software. Analysis of supporting archival material also was conducted. All findings guided development of the two maps.
  
  
  RESULTS
  Sharps enter the home via multiple complex pathways involving home healthcare providers and home users. The providers reported using sharps with injury prevention features. However, home users' sharps seldom had injury prevention features and sharps were commonly re-used for convenience and cost-savings. Improperly discarded sharps present hazards to caregivers, waste handlers, and community members. The most effective intervention potential exists at the beginning of the sharps systems maps where interventions can eliminate or minimize sharps injuries, in particular with needleless treatment methods and sharps with injury prevention features. Manufacturers and insurance providers can improve safety with more affordable and accessible sharps with injury prevention features for home users. Sharps disposal campaigns, free-of-charge disposal containers, and convenient disposal options remain essential.
  
  
  CONCLUSIONS
  Sharps injuries are preventable through public health actions that promote needleless treatment methods, sharps with injury prevention features, and safe disposal practices. Communication about hazards regarding sharps is needed for all home healthcare stakeholders.
authors.affiliation: Department of Work Environment, College of Health Sciences, University of Massachusetts Lowell, Lowell, (MA), USA. Pia_Markkanen@uml.edu.
authors.forename: Pia
authors.initials: P
authors.lastname: Markkanen
authors.affiliation: Department of Work Environment, College of Health Sciences, University of Massachusetts Lowell, Lowell, (MA), USA. Catherine_Galligan@uml.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Galligan
authors.affiliation: Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, (MA), USA. Angela.Laramie@state.ma.us.
authors.forename: Angela
authors.initials: A
authors.lastname: Laramie
authors.affiliation: Training for Development of Innovative Control Technology Project, San Francisco, (CA), USA. tdictproj@aol.com.
authors.forename: June
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Department of Work Environment, College of Health Sciences, University of Massachusetts Lowell, Lowell, (MA), USA. Susan_Sama@uml.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Sama
authors.affiliation: Department of Work Environment, College of Health Sciences, University of Massachusetts Lowell, Lowell, (MA), USA. Margaret_Quinn@uml.edu.
authors.forename: Margaret
authors.initials: M
authors.lastname: Quinn
mesh_terms: D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D017744:Medical Waste Disposal / Q000379:methods; D016602:Needlestick Injuries / Q000517:prevention & control*; D019064:Product Packaging; D036301:Qualitative Research; D014481:United States
chemical_list: D017744:Medical Waste Disposal