Ditch the Pinch: Bilateral Exposure Injuries During Subcutaneous Injection

Monday, 18 November 2013: 3:15 PM

Lisa M Black, PhD, RN, CNE
Orvis School of Nursing, University of Nevada, Reno, Reno, NV

Learning Objective 1: The participant will describe the mechanism of bilateral exposure injuries.

Learning Objective 2: The participant will identify risk factors for bilateral exposure injuries in clinical practice.


Subcutaneous injection of medication into an elevated (“pinched”) skin fold poses a risk of ‘bilateral exposure’ injury whereby the needle pierces the opposite side of a skin fold and subsequently enters the tissue of the healthcare worker. The needle must then be withdrawn from both the patient and the HCW; simultaneously exposing each to the blood of the other.  The purpose of this research is to describe factors contributing to bilateral bloodborne pathogen (BBP) exposure injuries among healthcare providers in acute care settings.


Narrative injury data from 2,402 percutaneous injuries that occurred during the administration of subcutaneous injections between the years 2000 and 2009 were examined to identify factors that contribute to bilateral exposure injuries. Descriptive and multivariate logistic regression analyses were performed.


Eighty-five bilateral exposure injuries were identified between 2000 and 2009, representing 3.5% (n/N = 85/2,402) of all percutaneous injuries occurring during subcutaneous injection. Nurses and nursing students administered 73% (n/N 1,751/2,398) of all subcutaneous injections that resulted in a percutaneous injury, and 4.6% (n/N = 81/1,751) of injuries to nurses resulted in a bilateral exposure. Sixty-five percent of the variance in bilateral exposure injury occurrence is explained through examination of: (1) manual elevation of subcutaneous tissue prior to injection; (2) thin/emaciated patient; (3) injection of insulin, heparin, enoxaparin; (6) whether a safety device was used; and (7) whether the healthcare worker was wearing gloves at the time of the injury (X2(7) = 424.2; p < 0.01). 


While ubiquitously used, manual skinfold elevation potentially places both the health care worker and the patient at risk for exposure to bloodborne disease. The risk of bilateral bloodborne pathogen exposure injuries could be minimized through the use of appropriately-sized needles that permit injection into the subcutaneous tissue without the need for a manually elevated skin fold.