Case Study

28 Hospital Before and After study

Sharps containers are associated with sharps injuries, and more than 90% of these injuries are related to container design

Terry Grimmond

The Challenge

Ascension Health comprises 67 acute care hospitals and is the largest Catholic and nonprofit health system in US. The group adopted sharps safety devices early and found these devices had markedly reduced sharps injuries, but that the annual decrease in sharps injuries had slowed. To assist in their sharps injury reduction strategies, container associated sharps injuries were identified as a subset to address. It is a reality that sharps containers are associated with sharps injuries, and more than 90% of these injuries are related to container design. This study was intended to address the hypothesis that sharps containers with enhanced engineering can reduce sharps injuries.  

Our Approach


The Device was adopted by study group hospitals between 2006 and 2007. No other hospital-wide sharps injury intervention was introduced during the 2-year study period. In-service training on the use of the device was implemented on the day the device was installed and repeated over the following week to capture other staff. Employee descriptions of their sharps injuries were obtained retrospectively from each hospital’s Ascension Health-standardised detailed sharps injury log for 12 months prior to, and for 12 months after adoption of the Sharpsmart sharps container system. Staff who suffered sharps injuries were not aware of the study at the time of their injury report. Data for the month in which conversion to the Daniels Sharpsmart took place were excluded in order to remove risk of placing sharps injuries in an incorrect study period. 


In a before/after intervention study from 2006 to 2008, we examined the impact of conversion to the Sharpsmart sharps container with its enhanced engineering, on sharps injuries categories in 14 Ascension Health hospitals. The Sharpsmart's safety features included large horizontal aperture, sensitive counterbalanced door, large atrium, and passive overfill prevention. This study group results were also compared with a control cohort of 14 contemporaneous size-matched, Ascension Health hospitals. Together, the 28 hospitals were selected to examine the impact of conversion from disposable sharps containment systems to the Daniels Sharpsmart reusable container. 14 hospitals converted to the Daniels reusable system, and 14 hospitals remained as a control cohort group who did not convert and retained their current disposable sharps containers. 


Total Sharps injury and total container-associated sharps injury figures were obtained for 2006 and 2007 from Ascension Health' standardised corporate summaries of sharps injury categories from the 14 control group hospitals. Detailed sharps injury logs were not examined in control group hospitals. Full Time Equivalent Staff data was obtained for all hospitals for each study period and used as the sharps injury denominator. Sharps injury categories per 1000 full time equivalent staff were used to compare sharps injury rates before and after. In study group hospitals, average daily census data was obtained for the year prior to adoption of the Device to enable comparison of sharps injuries per 100 occupied beds with national databases. The study was reviewed and approved by the Ascension Health System Office. Approval by ethical review boards was waived as no patients or patient specimens were involved and no staff names were revealed.

The Solution

Sharps injuries in study group hospitals were categorised as follows: 

• During-procedure, 

• After-procedure-but-before-disposal (for example, device activation, reprocessing, transporting to container, recapping); 

• Container associated (CASI), where the following modification of Massachusetts’ classification system was utilised 

The Outcome

In the 14 hospitals who converted to Daniels Sharpsmarts:

• After-Procedure Sharps Injuries fell 30%

• Disposal Related Sharps Injuries fell 57%

• Container Associated Sharps Injuries fell 81%


In the control group using disposable sharps containers:

• No significant reductions occurred in container associated injuries

• Total Sharps Injuries increased


“Enhanced aperture design can significantly reduce container-associated Sharps Injuries. Other factors contributing to reduced injuries may include hand deposit, safe closure, hand restriction, and pre-assembly.”


The Results

Reduction in after-procedure sharps injuries
Reduction in disposal related sharps injuries
Reduction in container associated sharps injuries