Breaking the Cycle of Silence: Why Sharps Injuries Go Unreported and What Can Be Done

Despite advancements in safety protocols and the availability of engineered safety devices, sharps injuries remain a persistent threat in health care settings, particularly in perioperative environments. One of the biggest barriers to reducing these injuries is not just the tools or techniques being used, but the culture that surrounds reporting. Many health care workers, especially nurses new to the operating room, hesitate to report injuries due to feelings of shame or fear of being blamed.

In this Infection Control Today^® (ICT^®) interview with Amanda Heitman, BSN, RN, CNOR, perioperative educational consultant for Periop Anew, and supervisor of education of surgical services at WakeMed in Cary, North Carolina, she explains how to create that transformation."When you give that [sharps safety] education to them, and they understand it and repeat it," Heitman said. "When we do that, we allow them to play with them right in front of them, so we can watch them do it, make sure they're doing it correctly...making sure that's happening, then that just builds their confidence. Then it just becomes part of their normal routine that this is the device I need to use."

This culture of silence is often reinforced by a perceived lack of support or inconsistent messaging. A staff member may learn safe practices in formal training but find those standards undermined by preceptors or colleagues in clinical settings who rely on outdated methods. This inconsistency can lead to preventable injuries and discourage early-career professionals from speaking up. Still, when staff are empowered—when they recognize their right to safety and are encouraged to advocate for it—they can become champions for change. In some cases, an injury has even served as a turning point, inspiring nurses to speak out and lead safety education efforts among their peers.

Engineered safety devices are part of the solution, but not all are created equal. Passive safety devices—those that activate automatically, like retractable syringes and single-handed scalpel blade removers—offer superior protection compared to active devices that require manual activation. Unfortunately, these tools are often overlooked, misunderstood, or even removed by surgeons who see them as impediments to their workflow. But with proper education and practice, these devices can become second nature to clinical staff, integrated seamlessly into routine care.

The key to changing the culture lies in education, confidence-building, and consistency. When staff are trained properly, given opportunities to handle and become familiar with the devices, and supported in reporting injuries without fear of blame, safety becomes a norm—not an afterthought. Culture change takes time, but with each empowered voice and each reported incident, the system grows safer for all. Infection preventionists, educators, and clinical leaders must work together to build and sustain this culture of protection.