Massachusetts Department Of Public Health Research Articles

Screening for Hepatitis C as a Prevention Enhancement (SHAPE) for HIV: An Integration Pilot Initiative in a Massachusetts County Correctional Facility

The Massachusetts Department of Public Health (MDPH) and the Barnstable County Sheriff's Department (BCSD) in Massachusetts initiated a pilot program in July 2009 offering education and hepatitis C virus (HCV) antibody testing to inmates and detainees, concurrent with routine HIV testing. The initiative was implemented to assess the feasibility of integrating HCV screening into an HIV screening program in a correctional setting and the efficacy of linking HCV antibody-positive inmates to clinical care upon release. Through the Screening for Hepatitis C as a Prevention Enhancement initiative, HCV and HIV testing were offered to inmates and detainees shortly after admission, and by request at any time during incarceration. In preparation for release, referrals were made to community-based medical providers for HCV follow-up care. Data from BCSD were compared with routine surveillance data received by MDPH. Confirmatory HCV test results received by April 15, 2012, were considered indicators of appropriate post-release clinical care. From July 2009 through December 2011, 22% (n=596) and 25% (n=667) of 2,716 inmates/detainees accepted HCV and HIV testing, respectively. Of those tested for HCV antibody, 20.5% (n=122) were positive. Of those tested for HIV antibody, 0.8% (n=5) were positive. Of the inmates who tested HCV positive at BCSD and had been released, 37.8% were identified as receiving post-release medical care. We determined that integration of HCV education and screening into correctional facilities is feasible and reveals high rates of HCV infection. Although this model presupposes programmatic infrastructure, elements of the service design and integration could inform a range of correctional programs. Effective linkage to care, while substantial, was not routine based on our analysis, and may require additional resources given its cost and complexity.

Automated Influenza-like Illness Reporting—An Efficient Adjunct to Traditional Sentinel Surveillance

We compared an electronic health record-based influenza-like illness (ILI) surveillance system with manual sentinel surveillance and virologic data to evaluate the utility of the automated system for routine ILI surveillance. We obtained weekly aggregate ILI reports from the Electronic medical record Support for Public Health (ESP) disease-detection and reporting system, which used an automated algorithm to identify ILI visits among a patient population of about 700,000 in Eastern Massachusetts. The percentage of total visits for ILI ("percent ILI") in ESP, percent ILI in the Massachusetts Department of Public Health's sentinel surveillance system, and percentage of laboratory specimens submitted to participating Massachusetts laboratories that tested positive for influenza were compared for the period October 2007-September 2011. We calculated Spearman's correlation coefficients and compared ESP and sentinel surveillance systems qualitatively, in terms of simplicity, flexibility, data quality, acceptability, timeliness, and usefulness. ESP and sentinel surveillance percent ILI always peaked within one week of each other. There was 80% correlation between the two and 71%-73% correlation with laboratory data. Sentinel surveillance percent ILI was higher than ESP percent ILI during influenza seasons. The amplitude of variation in ESP percent ILI was greatest for 5- to 49-year-olds and typically peaked for the 5- to 24-year-old age group before the others. The ESP system produces percent ILI data of similar quality to sentinel surveillance and offers the advantages of shifting disease reporting burden from clinicians to information systems, allowing tracking of disease by age group, facilitating efficient surveillance for very large populations, and producing consistent and timely reports.

4th generation HIV screening in Massachusetts: A partnership between laboratory and program

BackgroundThe Massachusetts Department of Public Health's (MDPH) Office of HIV/AIDS (OHA) and Hinton State Laboratory Institute (HSLI) have offered HIV screening since 1985. Point-of-care screening and serum collection for laboratory-based testing is conducted at clinic and non-clinic-based sites across Massachusetts as part of an integrated communicable disease screening intervention. Objectives and project designMDPH aimed to transition to a 4th generation HIV screening-based algorithm for testing all serum specimens collected at OHA-funded programs and submitted to the HSLI to detect acute HIV infections, detect and differentiate HIV-1 and HIV-2 infections, eliminate indeterminate results, reduce cost and turnaround time, and link newly diagnosed HIV+ individuals to care. The HSLI and OHA created a joint project management team to plan and lead the transition. ResultsThe laboratory transitioned successfully to a 4th generation screening assay as part of a revised diagnostic algorithm. In the 12 months since implementation, a total of 7984 serum specimens were tested with 258 (3.2%) positive for HIV-1 and one positive for HIV-2. Eight were reported as acute HIV-1 infections. These individuals were linked to medical care and partner services in a timely manner. Turnaround time was reduced and the laboratory realized an overall cost savings of approximately 15%. ConclusionsThe identification of eight acute HIV infections in the first year underscores the importance of using the most sensitive screening tests available. A multi-disciplinary program and laboratory team was critical to the success of the transition, and the lessons learned may be useful for other jurisdictions.

A critical analysis of the “Wind Turbine Health Impact Study: Report of Independent Expert Panel”

The “Wind Turbine Health Impact Study: Report of Independent Expert Panel” study, herein the “Massachusetts study,” says: “The Massachusetts Department of Environmental Protection (MassDEP) in collaboration with the Massachusetts Department of Public Health (MDPH) convened a panel of independent experts to identify any documented or potential health impacts of risks that may be associated with exposure to wind turbines, and, specifically, to facilitate discussion of wind turbines and public health based on scientific findings.” It continues to say: “The scope of the Panel’s effort was focused on health impacts of wind turbines per se.” The Massachusetts study treats health affects broadly in accordance with WHO and includes direct health effects, annoyance, and sleep disruption. In many ways, the Massachusetts study is a critique of the literature relating to wind farm acoustic emissions and health effects. This paper is a critique of the critics. In particular, this critique examines some of the physical acoustic findings and some of the social survey findings. The Massachusetts study employed very strict standards to what they deemed to be quality, acceptable studies, and it is only fair that they be judged by their own criteria. It is the judgment of this reviewer that they failed.

Healthy workplaces? A survey of Massachusetts employers.

This study examines worksite health promotion (WHP) and occupational health and safety (OHS) activities by Massachusetts employers, and the extent to which workplaces with programming in one domain were more likely to have the other as well. In 2008, the Massachusetts Department of Public Health surveyed a stratified sample of Massachusetts worksites. A mailed questionnaire to be completed by workplace representatives. Massachusetts worksites returning the questionnaire. Questionnaire items about worksite characteristics, WHP, and some OHS practices. We scored levels of WHP and OHS activity; examined the relationship between activities in the two domains by employer characteristics; and assessed self-reported coordination between them. The 890 responding worksites had higher scores for OHS (mean = 48% of practices, SD = 24%) than WHP (mean = 20%, SD = 12%). The difference between these scores varied by a factor of two across industry sectors and was smallest for workforces of 100+ employees (p = .001). Employers with no unionized workers reported fewer activities in both domains (p < .0001). Only 28% of respondents reported always/often coordinating OHS and WHP efforts; these organizations had more activities overall in both domains. Larger and unionized workplaces in Massachusetts were more likely to offer both WHP and OHS programming. Self-reported coordination was somewhat associated with more activity in both domains, although levels of WHP activity varied widely.

Has the tobacco industry evaded the FDA's ban on ‘Light’ cigarette descriptors?

BackgroundUnder the Family Smoking Prevention and Tobacco Control Act (FSPTCA), the Food and Drug Administration (FDA) banned the use of “Lights” descriptors or similar terms on tobacco products that convey...

Population Use, Sales, and Design: A Multidimensional Assessment of “Light” Cigarettes in the United States, 2009

We compared multiple measures of surveillance of "light" cigarette use, including population use, sales, and design features. Measures were obtained before the 2010 descriptors ban to establish a baseline for future evaluation of the effect of the ban. We examined light cigarette use, sales, and design using 3 data sets from 2009. We assessed population use using National Survey on Drug Use and Health data. Sales data were drawn from AC Nielsen. We gathered design features, including nicotine concentration, filter ventilation, and weight, from tobacco industry disclosures mandated by the Massachusetts Department of Public Health. In 2009, 52.7% of smokers self-reported light cigarette use, which accounted for 56.0% of cigarettes sold in the United States. Self-reported light smokers were more likely to be female, White, older, and nondaily smokers. Of design features analyzed, only average filter ventilation differed significantly between light and "full-flavored" cigarettes. Assessment of the impact of the descriptors ban and any future policies surrounding light cigarettes should use multiple surveillance strategies, including measures of population use, sales, and cigarette design.

Implementing a State-based Stroke Quality Improvement Collaborative

The Stroke Collaborative Reaching for Excellence is a voluntary stroke quality improvement (QI) collaborative led by a partnership between the Massachusetts Department of Public Health and the American Heart Association/American Stroke Association. Since 2005, the collaborative has assisted Massachusetts Primary Stroke Service hospitals in improving the quality of acute stroke care based on national clinical guidelines. We provide a general overview for states seeking to establish a public-private partnership to promote hospital stroke QI. Based on the Institute for Healthcare Improvement's Collaborative model, the program enrolled hospitals, trained staff in data collection, and provided expertise on clinical QI. To assess the success of the model at engaging hospitals, rates of change in participation and case entry were calculated with descriptive statistics. From 2005 to 2010, 58 of 70 (83%) Primary Stroke Service hospitals participated in the collaborative, accounting for over 85% of the statewide annual stroke discharges. On average, 74% of hospital representatives attended learning sessions, 55% participated in data quality conference calls, and 54% attended regional meetings. Over 39,000 cases were entered into the registry from 2007 to 2010, with a 15% increase from 2007 (mean, 171 ± 136; n = 9425) to 2010 (mean, 197 ± 143; n = 10,809). Consistent participation and case entry confirm that a voluntary state-based hospital QI collaborative is feasible and sustainable. This occurred in the absence of continued hospital funding. Further research is needed to identify the relationship between program participation and improved patient care and the generalizability of the model.

Editorial introductions

Editorial introductions

Predictors of Increased Intravenous Tissue Plasminogen Activator Use Among Hospitals Participating in the Massachusetts Primary Stroke Service Program

We sought to determine if intravenous tissue plasminogen activator (IV tPA) use for acute ischemic stroke increased in Massachusetts in association with the Primary Stroke Service program, a statewide stroke center designation and quality improvement initiative. We analyzed prospectively acquired data from the Massachusetts Department of Public Health between October 2004 and June 2008, including 10 045 consecutive emergency department-based acute ischemic stroke encounters arriving ≤ 3 hours after stroke onset at 69 participating Massachusetts PSS hospitals. The overall rate of IV tPA use was 854 of 3866 (22.1%) of patients arriving ≤ 2 hours of symptom onset. IV tPA use increased steadily from 2005 (the first full year of the program) to 2008 (18.4%, 21.9%, 22.6%, 25.5%; P=0.001). Patients treated with IV tPA were more likely to be younger (72.3 ± 14.1 versus 74.7 ± 14.0 years, P<0.005) and to have presented after emergency medical services rerouting in July 2005 (96% versus 94%, P=0.009). Patients who arrived at hospitals with a performance achievement award from the Get With The Guidelines-Stroke program were more likely to receive IV tPA after versus before award recognition (28.1% versus 22.3%, P<0.001). In this nearly complete capture of statewide data, rates of IV tPA improved significantly in Massachusetts from 2005 to 2008 in association with a state Primary Stroke Service designation program. Further studies are needed to confirm that treatment disparities exist for older acute ischemic stroke patients and that the rates of thrombolysis have increased above and beyond secular trends.

Editorial Commentary: Accounting for Pertussis

The resurgence of measles and pertussis in the United States [1, 2] is a reminder of the importance of maximum immunization coverage, even in a developed country with relatively high rates of childhood immunization. The exact parameters of herd immunity may not be established for some vaccine-preventable diseases, but maximal effective use of available vaccines providespopulation-level immunity toprevent or reduce transmission. Evidencebased strategies published by the Advisory Committee on Immunization Practices (ACIP) for improved control of pertussis promote effective use [3, 4]. Observation of vaccine effectiveness in routine clinical use provides insight that may not be available from clinical efficacy trials and may be used to inform recommendations. The article by Witt et al [5] in this issue of Clinical Infectious Diseases presents a retrospective study of acellular pertussis vaccine effectiveness made possible by the unique circumstances of a community-wide outbreak of Bordetella pertussis infection affecting a large population under the care of an integrated healthcare system.This allowedestimation of vaccine effectiveness by age group. The relative duration of protection achieved with diphtheria toxoid–tetanus toxoid–acellular pertussis (DTaP) vaccines (introduced in theUnited States in the 1990s) remains a question [6], one made more relevant by the possibilities arising from the availability of pertussis antigen containing vaccines (tetanus toxoid– reduced diphtheria toxoid–acellular pertussis vaccine for adolescents and adults [Tdap]) that allow for booster dosing of individuals >7 years of age. The authors were able to demonstrate less than expected effectiveness of DTaP in 8to 12year-olds, while also demonstrating substantial overall effectiveness of pertussis vaccines. On the basis of their observations, they suggest evaluation of earlier and more frequent doses of pertussis containing vaccine (Tdap) in outbreak settings, and even on a routine basis. More studies of strategic use of Tdap as a booster dose vaccine would be worthwhile, especially after the broad experience with the vaccine and its safety profile. The ACIP already recommends Tdap use in undervaccinated children as young as 7 years of age [3]. A question might be raised as to the use of polymerase chain reaction (PCR) as the exclusive diagnostic test for pertussis in the Witt et al study, especially as the minimal cough duration in the practice guidance was only 1 week. PCR is a widely used, sensitive test that is faster and easier to perform than culture and can identify evidence of B. pertussis infection in situations where culture results are negative. However, high sensitivity and low specificity, with pseudo-outbreaks described due to false positives and environmental contamination with B. pertussis genome [7, 8], suggest that PCR only be used with care and for patients with cough duration of≥2 weeks and a clinical picture consistent with pertussis. However, the observations by Witt et al [5] occurred in the presence of a widespread, welldocumented stateand community-wide outbreak of pertussis (high prevalence of diseaseimprovingpositivepredictivevalue), and testing was done in a central laboratory, using a closed system test platform, and simultaneous testing for Bordetella parapertussis. Furthermore, rates of testing were high across the spectrum of ages, but rates of positive PCR results are very different by age, so false-positive test results do not seem to be a factor contributing to the results unless there was a systematic bias in selection for testing by age. Pertussis remains a threat to infants, in whom protection awaits the initial doses of the DTaP vaccine series. Public health recommendations for the use of Tdap vaccines have been a work in progress since licensure in the United States, and approaches have been designed to protect older children, adolescents, and adults, in large part to protect infants they may expose to pertussis (as symptomatic and asymptomatic cases to the extent that overall reduction in incidence may reduce asymptomatic carriage). Initially, Tdap Received 27 February 2011; accepted 1 March 2012; electronically published 15 March 2012. Correspondence: Altred De Maria Jr, Bureau of Infectious Disease, Massachusetts Department of Public Health, William A. Hinton State Laboratory Institute, 305 South St, Jamaica Plain, MA 02130 (Alfred.DeMaria@state.ma.us). Clinical Infectious Diseases 2012;54(12):1736–8 © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@ oup.com. DOI: 10.1093/cid/cis313

Clinical Findings and Diagnosis in Human Granulocytic Anaplasmosis: A Case Series From Massachusetts

ObjectiveTo describe clinical findings and the use of a tick-associated pathogen panel in a series of patients with human granulocytic anaplasmosis (HGA) at a suburban Boston hospital. Patients and MethodsMedical records were reviewed for inpatients and outpatients at Newton-Wellesley Hospital with a positive polymerase chain reaction (PCR) result for Anaplasma phagocytophilum during the study period March 1 through November 30, 2009. A PCR panel was used to test for tick-borne pathogens. Postal zip code data from the patients' areas of residence were used to estimate the area of disease transmission. ResultsThirty-three cases were confirmed during the 2009 transmission season, and 14 of these patients (42%) required hospitalization. Thrombocytopenia and/or leukopenia were observed at the time of presentation in 25 of 30 patients (86%) in whom both white blood cell and platelet counts were determined, and 28 of 33 patients (85%) reported fever. Rash occurred in only 2 of the 33 patients (6%), and 25 (76%) reported one or more respiratory or gastrointestinal symptom. Cases were geographically distributed diffusely throughout the hospital catchment area, with one possible focus of infection identified in Weston, MA. Due to a lack of clinical data reporting to the Massachusetts Department of Public Health, only 20 of 32 HGA cases (63%) fulfilled the case confirmation criteria. ConclusionDiagnosis of HGA requires a high suspicion for infection even in endemic areas. Use of a tick-associated pathogen panel that includes PCR assays for several organisms could improve detection of underrecognized tick-borne diseases in endemic areas. Lack of epidemiological follow-up to confirm corroborating clinical findings prevents accurate case reporting and assessment of the true HGA burden.

Abstract NS 9: An Educational Intervention to Enhance Acute Stroke Symptom Recognition Skills Among Nursing Home Nursing Assistants

Background: Treatment of stroke requires a coordinated effort by clinicians educated to identify and transfer presumed acute stroke patients to hospital Emergency Departments (EDs) for expedited evaluation. With the aging of the population and the increasing demand for nursing home (NH) services, the community of clinicians educated to identify acute symptoms of stroke needs to be inclusive of Nursing Assistants (CNAs) in NH settings, who provide 70 to 80% of direct-care hours to NH residents. Approximately 25% of NH residents are referred to EDs for emergency care each year. Poorly executed transitions between EDs and NHs have the potential to delay assessment and intervention in a context in which “time is brain.” Purpose: The goal of this educational intervention was to integrate evidence-based messages for acute stroke symptom recognition into NH CNA practice and to assess knowledge change by comparing stroke-related knowledge at baseline to knowledge acquired immediately post-intervention. Methods: An educational module on acute stroke symptom recognition based on the Massachusetts Department of Public Health’s “Stroke Heroes Act FAST Education Guide” was delivered live by an advanced practice nurse to a convenience sample of 39 CNAs from 4 of an urban NH’s skilled nursing units. Pre- and post-test surveys, based on the “Hip Hop Stroke” survey questions, were administered to participants and results were analyzed using descriptive statistics. Results: Mean age of participants was 43.2 years (SD = 8.1), 82.1% were female, and 74.4% were Black. Mean years of clinical experience were 12.6 (SD = 8.2). Most (94.7%) described stroke as involving the brain on the pre-test, but only 22.2% of CNAs could select all 4 signs of stroke from the eight options offered on the pre-test. Post-intervention, 100% indicated that a stroke involves the brain and 33.3% correctly selected all 4 signs of stroke. In addition, 78.6% accurately described the meaning of all 4 “FAST” letters on the post-test. Conclusions: This educational intervention improved NH CNA knowledge of stroke symptoms. While this intervention could be replicated in other NH settings, the effect of early stroke symptom recognition on the quality of the emergency care provided to NH residents, and the impact of that emergency care on stroke-related morbidity and mortality among NH residents, warrant further study. It is notable that most participants were Black, as it is well documented that racial-ethnic minorities are less likely to be aware of acute stroke symptoms and the need for urgent treatment. Further research is needed to determine the optimal design of educational interventions in at-risk populations.

Quality Measurement and Improvement in the Cardiac Catheterization Laboratory

Case Presentation: A 46-year-old man with a past medical history significant for morbid obesity (body mass index of 66), hypertension, tobacco use, and dyslipidemia presented to an outside hospital with a non–ST-segment elevation myocardial infarction and was transferred for coronary angiography. Femoral arterial access was obtained for an uncomplicated percutaneous intervention (PCI) with the use of unfractionated heparin and a glycoprotein IIB/IIIA inhibitor. After successful PCI of the right coronary artery with drug-eluting stent implantation, the femoral arteriotomy was closed without complication. Two hours after the completion of the procedure, the patient experienced ventricular fibrillation and respiratory arrest requiring prolonged resuscitation with a subsequent hematocrit level noted to be 12.5%. The patient was resuscitated with fluid and blood products. Emergent angiography showed no active iliofemoral contrast extravasation and a widely patent coronary stent. An abdominal CT scan without contrast confirmed the diagnosis of a retroperitoneal hemorrhage. Unfortunately, the patient experienced recurrent ventricular fibrillation, and he died despite additional resuscitative efforts. Cardiac catheterization is one of the most common invasive procedures performed in the United States.1 Although the benefits of cardiac catheterization remain great, the large number of procedures performed coupled with infrequent but potentially significant complications make the cardiac catheterization laboratory an important environment in which to constantly strive to improve quality. Although optimal patient outcomes remain paramount, state and national regulatory requirements, public reporting, and payers' interests in both outcomes and cost raise the importance of quality measurement and improvement in the cardiac catheterization laboratory.2 Minimal requirements for quality monitoring in the cardiac catheterization laboratory vary with individual state regulatory practices. As an example, in Massachusetts, data elements are collected and reported as mandated by the Massachusetts Department of Public Health, The Joint Commission, Centers for Medicare & Medicaid Services, and mandated participation in the American College …

Bridging the Practices of Yoga Therapy and Behavioral Health Service Delivery for Adolescents

Historically, substance use and mental health disorder interventions for adolescents were derived from adult models, such as Cognitive Behavioral Therapy and 12-step programs, which are rooted in traditional talk therapy. Young people may struggle to benefit from treatments using these models because they may not be developmentally appropriate. A need exists for developmentally attuned interventions that can engage children and adolescents. This article briefly reviews the process of bridging yoga therapy and behavioral health service delivery for adolescents served by the Massachusetts Department of Public Health (DPH).

Estimation of the prevalence of undiagnosed and diagnosed HIV in an urban emergency department.

ObjectiveTo estimate the prevalence of undiagnosed HIV, the prevalence of diagnosed HIV, and proportion of HIV that is undiagnosed in populations with similar demographics as the Universal Screening for HIV in the Emergency Room (USHER) Trial and the Brigham and Women's Hospital (BWH) Emergency Department (ED) in Boston, MA. We also sought to estimate these quantities within demographic and risk behavior subgroups.MethodWe used data from the USHER Trial, which was a randomized clinical trial of HIV screening conducted in the BWH ED. Since eligible participants were HIV-free at time of enrollment, we were able to calculate the prevalence of undiagnosed HIV. We used data from the Massachusetts Department of Public Health (MA/DPH) to estimate the prevalence of diagnosed HIV since the MA/DPH records the number of persons within MA who are HIV-positive. We calculated the proportion of HIV that is undiagnosed using these estimates of the prevalence of undiagnosed and diagnosed HIV. Estimates were stratified by age, sex, race/ethnicity, history of testing, and risk behaviors.ResultsThe overall expected prevalence of diagnosed HIV in a population similar to those presenting to the BWH ED was 0.71% (95% CI: 0.63%, 0.78%). The prevalence of undiagnosed HIV was estimated at 0.22% (95% CI: 0.10%, 0.42%) and resultant overall prevalence was 0.93%. The proportion of HIV-infection that is undiagnosed in this ED-based setting was estimated to be 23.7% (95% CI: 11.6%, 34.9%) of total HIV-infections.ConclusionsDespite different methodology, our estimate of the proportion of HIV that is undiagnosed in an ED-setting was similar to previous estimates based on national surveillance data. Universal routine testing programs in EDs should use these data to help plan their yield of HIV detection.

Setting the Standards for Collecting Ethnicity Data in the Commonwealth of Massachusetts

The 1997 revision to Federal Office of Management and Budget (OMB) Directive No. 15 Race and Ethnic Standards for Federal Statistics and Administrative Reporting provides standard classifications for reporting broad race categories and Hispanic/non-Hispanic ethnicity. However, the current system may be masking disparities in health behaviors and outcomes across ethnic groups. Since 2000, the Massachusetts Department of Public Health has been developing an alternative approach to collecting race, ethnicity, and language preference data to better serve the local population. Our data collection tool adheres to OMB standards but captures detailed ethnicity data independent of broad race categories. We believe that training personnel is an essential component of data collection, and we are planning to develop online training materials. Although we encourage states to learn from our experience, data need to be comparable within and across states as well as over time to monitor health disparities.

Editorial introductions

Editorial introductions

Pandemic H1N1 Influenza Infection in Adult Transplant Recipients

Pandemic H1N1 Influenza Infection in Adult Transplant Recipients

Sharps Injuries among Employees of Acute Care Hospitals in Massachusetts, 2002–2007

Sharps with engineered sharps injury protections (SESIPs) have been found to reduce risk of sharps injuries (SIs). We examined trends in SI rates among employees of acute care hospitals in Massachusetts, including the impact of SESIPs on SI trends during 2002-2007. Prospective surveillance. Seventy-six acute care hospitals licensed by the Massachusetts Department of Public Health. Employees of acute care hospitals who reported SIs to their employers. Data on SIs in acute care hospitals collected by the Massachusetts Sharps Injury Surveillance System were used to examine trends in SI rates over time by occupation, hospital size, and device. Negative binomial regression was used to assess trends. During 2002-2007, 16,158 SIs among employees of 76 acute care hospitals were reported to the surveillance system. The annual SI rate decreased by 22%, with an annual decline of 4.7% (P < .001). Rates declined significantly among nurses (-7.2% per year; P < .001) but not among physicians (-0.9% per year; P = .553). SI rates associated with winged steel needles and hypodermic needles and syringes also declined significantly as the proportion of injuries involving devices with sharps injury prevention features increased during the same time period. SI rates involving devices for which SESIPs are widely available and appear to be increasingly used have declined. The continued use of devices lacking SI protections for which SESIPs are available needs to be addressed. The extent to which injuries involving SESIPs are due to flaws in design or lack of experience and training must be examined.