Sharps Safety in Oncology Nursing: A Critical Perspective

Handling sharps safely is paramount in oncology nursing due to the unique risks posed by chemotherapeutic agents and the frequent use of needles and other sharp instruments. Oncology nurses must navigate these hazards while providing compassionate care to vulnerable patients.

 The Unique Challenges in Oncology Nursing

Oncology nurses face a higher risk of sharps injuries due to the frequent administration of chemotherapeutic agents and other injectable treatments. These substances are hazardous and require meticulous handling to prevent accidental exposure, which can have serious health implications. Despite advancements in safety-engineered devices, the risk remains significant.

 The Global Context of Sharps Injuries

Sharps injuries are a global concern, transcending from high-income countries to low- and middle-income countries (LMICs) where resources are limited, and the endemic rates of blood-borne pathogens are higher. The World Health Organization (WHO) reports that from 2019 to 2022, there were 2.8 million new cases of HIV, hepatitis B, and hepatitis C, highlighting the critical need for stringent infection control measures in all healthcare settings.  These statistics underscore the importance of continued efforts in infection control and prevention, particularly in healthcare settings where the risk of exposure to bloodborne pathogens through sharps injuries is significant.

 Sharps Safety in the Oncology Setting

In oncology, the risk of sharps injuries is compounded by the use of needles and other sharp instruments in chemotherapy administration. Nurses are at the frontline, often performing tasks that increase their risk of exposure. For instance, intramuscular and subcutaneous injections, which are common in oncology, are a primary source of needle stick injuries (NSIs).

 The Role of Safety-Engineered Devices

Despite the availability of safety-engineered devices, injuries still occur. According to the International Safety Center’s EPINet data, 33.3% of sharps injuries involved a safety device, and in 12.8% of these cases, the safety mechanism was properly activated. This underscores the need for ongoing training and vigilance in using these devices correctly.

 Regulatory and Safety Measures

The Needlestick Safety and Prevention Act, enacted in 2000, as well as OSHA’s Revised Bloodborne Standard mandates the use of safety-engineered sharp devices and requires healthcare facilities to maintain a sharps injury log and update their exposure control plans annually. This legislation provides a framework for preventing sharps injuries but requires robust implementation and adherence.

Training and Awareness

Continuous education and training in the proper use of safety devices and adherence to safety protocols are essential. Oncology nurses must stay informed about the latest safety technologies and practices to minimize their risk of injury. This includes understanding the correct disposal of sharps to protect not only themselves but also other healthcare workers and patients.

 Innovative Approach to Infusion

Innovations in administering oncologic solutions that aim to minimize sharps injuries are promising and diverse. Hear are some key developments:

  1. Needle-Free Injection Systems

Needle-free injection systems (NFIS) are designed to deliver medication through the skin without using needles. These devices use high-pressure to propel a fine stream of medication through the skin. Innovations in this technology could significantly reduce sharps injuries in oncology settings where frequent injections are necessary. Examples include jet injectors and microneedle patches.

  1. Closed System Transfer Devices (CSTDs)

CSTDs are engineered to prevent the escape of hazardous drugs into the environment during the drug preparation and administration processes. These systems can greatly reduce the risk of needlestick injuries and exposure to hazardous drugs. CSTDs have shown effectiveness in oncology, where handling of cytotoxic drugs is common.

  1. Smart Syringes

Smart syringes with passive safety features are a significant advancement in preventing needlestick injuries. These devices automatically engage safety mechanisms without requiring additional actions from the user, making them highly reliable in high-pressure environments. Passive safety features include auto-disable functionality after a single use, retractable needles that retract automatically upon completion of the injection, and integrated needle shields that deploy automatically to cover the needle. These innovations are particularly beneficial in settings where large volumes of injections are administered, as they minimize the risk of human error and ensure consistent protection for healthcare workers.

By reducing the need for manual activation of safety mechanisms, passive safety devices enhance compliance and safety, ensuring that protective measures are always in place. This approach contrasts with active safety devices, which rely on the user to manually engage the safety features, potentially leading to lapses in protection due to oversight or improper use. Therefore, the adoption of smart syringes with passive safety features is crucial for improving sharps safety in healthcare settings.

  1. Wearable Drug Delivery Devices

Wearable devices that deliver drugs transdermally or subcutaneously over extended periods can reduce the need for repeated injections. These devices can be particularly useful for chemotherapy administration, improving patient compliance and safety. Examples include insulin pumps adapted for chemotherapy drugs.

  1. Dissolvable Microneedles

Dissolvable microneedle patches for drug delivery are an emerging technology. These patches can administer drugs directly through the skin in a minimally invasive manner. They are designed to dissolve after the drug is delivered, eliminating the need for sharps disposal and reducing the risk of needlestick injuries.

  1. Automated Drug Delivery Systems

Automated systems, such as robotic drug compounding and administration units, can minimize human involvement in the preparation and delivery of oncologic drugs. These systems can ensure precision in dosage and reduce the risk of exposure and injury from handling sharps.

  1. Advanced Infusion Pumps

Modern infusion pumps with enhanced safety features can help in the precise administration of oncologic solutions while minimizing the need for frequent needle use. Innovations include smart pumps with dose error reduction systems (DERS) and closed-loop systems that automatically adjust the infusion rate.


Sharps safety is a critical component of oncology nursing, requiring a combination of advanced safety devices, rigorous training, and adherence to safety protocols. By prioritizing these measures, oncology nurses can protect themselves and their patients from the dangers of sharps injuries and hazardous drug exposure.

Ron Stoker, MS, Executive Director of the International Sharps Injury Prevention Society (ISIPS), has extensive experience in advocating for and implementing sharps safety measures across various healthcare settings.