Background
Contaminated sharps, such as needles, lancets, scalpels, broken glass, specimen tubes, and other instruments, can transmit bloodborne pathogens such as HIV, hepatitis B (HBV), and hepatitis C viruses (HCV).

Methods
Observation of facilities and injections and questionnaire-guided interviews were conducted in 2005 among health care workers (HCWs) in 2 public hospitals in Santo Domingo and 136 public immunization clinics (IC) in the Dominican Republic. Injection practices and sharps injuries (SIs) in health care facilities in the Dominican Republic were assessed in cross-sectional surveys to identify areas in which preventive efforts might be directed to make injection practices safer.

Results
Of the 304 hospital HCWs and 136 ICs HCWs interviewed, 98 (22.3%) reported =1 SIs during the previous 12 months. ICs had a lower incidence (13 per 100 per person-years [p-y]) of SIs than hospitals (65 per 100 p-y) (P < .0001). Unsafe needle recapping was observed in 98% of all injections observed at hospitals but in only 12% of injections at ICs (P < .0001). Sharps were observed improperly disposed in regular waste containers in 24 (92%) of 26 areas at which injections are prepared at the hospitals but in only 11 (8%) of 136 ICs (P < .0001). Training in injection safety was received by 4% of HCWs in hospitals but by 77% in ICs (P < .001). Of 425 HCWs, 247 (58%) were fully immunized against hepatitis B. There was a higher risk of SIs among staff dentists (adjusted relative risks [aRR], 5.9; 95% confidence interval [CI]: 2.8-12.6), resident physicians (aRR, 3.5; 95% CI: 1.8-6.9), and those who gave =11 therapeutic injections per day (aRR, 1.6; 95% CI: 1.1-2.4).

Conclusion
Injection practices at ICs were safer than those found at public hospitals. Preventive strategies to lower SIs in public hospitals should include regular training of hospital staff to minimize needle recapping and improper disposal, among other interventions to reduce the dangers of needles.

Contaminated sharps, such as needles, lancets, scalpels, broken glass, specimen tubes, and other instruments, can transmit bloodborne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Transmission of bloodborne pathogens to patients, health care workers (HCWs), and community members can occur from nonsterile injections, accidental needlesticks, and improper “recycling” of needles and syringes.1, 2, 3 It has been estimated that 66,000 HBV, 16,000 HCV, and 1000 HIV infections attributable to contaminated sharps injuries among HCWs may occur annually worldwide.4 Several epidemiologic studies have described the risks and circumstances of needlestick and other sharps injuries (SI) among health care personnel but mostly in developed countries.5, 6 Few such studies are from the Americas, and none are from the Caribbean.

The Expanded Program for Immunization (EPI) in the Dominican Republic has developed guidelines for safe injections that include proper injection technique (eg, no recapping of used needles before disposal in safety boxes), use of sharps boxes or other puncture-proof containers, and proper final disposal of sharps waste, similar to those recommended by the World Health Organization.7 However, anecdotal reports suggest universal precautions on injection practices may not be followed regularly in the Dominican Republic. A high prevalence of HBV infection has been reported there, with 4.1% chronic carriers among adult blood donors.8 The prevalence of HCV infection was reported to be 2.6% in males and 2.2% in females.9 HIV/AIDS is also a problem, with a seroprevalence in 2002 of 1.0% of the population.10 With this prevalence of bloodborne pathogens, the potential exists for their transmission to HCWs workers as a result of unsafe injection practices. Given the paucity of data on needlestick injuries and the absence of a surveillance system to monitor needlesticks and sharps injuries in the Dominican Republic, we surveyed HCWs and injection safety practices in facilities in which injections occur to understand better the epidemiology of SI and to identify areas in which preventive efforts can be targeted.