Needle Stick Prevention and Sharps Safety
The CDC estimates that hospital-based health care personnel sustain
about 365,000 sharps-related injuries per year; an average of 1,000 per day.
What can be done to prevent needle sticks and other sharps injuries?
By Kelly Fodel
They may not be working on the battlefield, but military and VA health care workers face a threat to their safety every day on the job. According to the Centers for Disease Control, injuries from needles and other sharp devices used in health care and laboratory settings are associated with the occupational transmission of more than 20 blood borne viruses, including HIV, Hepatitis B, and Hepatitis C. The CDC estimates that hospital-based health care personnel sustain about 365,000 sharps-related injuries per year; an average of 1,000 per day.
What can be done to prevent needle sticks and other sharps injuries? According to the experts interviewed by Military Medical Technology, the answer is two-fold. First, hospitals need to continually update their safety equipment. Second, staff must be properly educated and encouraged to use new safety products.
“OSHA requires that we look at the new equipment on a regular basis and evaluate whether that would reduce the risk in our hospital,” said Fluryanne Leach. Leach serves as chief of infection control at Walter Reed Army Medical Center. “We have had for many years a needleless IV system. That used to be the primary source of sharps injuries.”
Sharps collection boxes have evolved over the years. At Walter Reed, for example, the needle syringe boxes are state of the art, which do not allow hands to enter the box. Once the box is full, it will not permit the addition of more needles, thereby preventing overfill. Leach said they rarely see sharps injuries resulting from the disposal of needles anymore.
Walter Reed also uses safety lancets and safety IV catheters. “We have standardized on a new IV catheter that, if used correctly, completely prevents contact with blood and with the sharps,” said Leach. She claimed the use of such products has resulted in a steady decline in needle stick injuries over the past several years. Walter Reed is also considering new safety syringes which retract the needle automatically after use.
Ron Stoker, founder of the International Sharps Injury Prevention Society, said the ideal situation in a health care setting is to eliminate needles altogether. As Stoker put it, “no needle, no risk.” If that is not possible, the ISIPS promotes use of passive safety products, which means the worker does not have to engage the safety device. For example, the device could withdraw the needle on its own, preventing contact with the sharp.
“You don’t actually have to think, ‘oh I have to push here to activate the safety.’ There are not a lot of those [passive systems] out there yet where that is available, but that is what we keep looking for, and that is where technology is trying to move forward,” said Leach.
Leach said the operating room currently poses the most risk, specifically due to suturing. “The problem is that very often they are suturing almost blind, down inside, so it is a very high risk procedure. But there is a blunt suture needle that can be used in some circumstances.” Walter Reed also uses staples rather than sutures when the situation allows.
Lieutenant Kevin Byrd, an OB/GYN resident at the Naval Medical Center San Diego, conducted a research project on the use of blunt suture needles by military and civilian OB/GYNs in San Diego, Orange and Riverside counties. Of the 423 physicians surveyed, only 104 responded. Sixty-six said they had never used a blunt-tipped needle. More than half of those who had never used the needles said it was because they were not available in their hospitals.
Of the reasons behind his research, Byrd said, “OB/GYNS have the highest rate of needle stick injuries, of all the surgical professionals, so we would be the ones most at risk.”
Many medical device companies have been working to introduce new safety products, and the ISIPS monitors and evaluates those products. Below are just a few of the notable innovations.
ISIPS’s Stoker spoke highly of SuturTek, Inc., saying, “These three products will get the attention of the surgeon and the appreciation of the surgical staff.” SuturTek produces three handled suturing devices, which can perform intracorporeal suturing and knot-tying, sternal closure and fascial closure. Rather than using a hand-held needle, the surgeon can perform these tasks with the push of a button or squeeze of the handle.
Another product that can eliminate the use of sutures is the 3M Steri-StripS Surgical Skin Closure. Said Stoker: “This is a most unique product that promotes using tape rather than needles in closing wounds. Whenever I have demonstrated this product or shown a video of the product in a group of clinicians, I always get a bunch of oohs and ahhs.” The Steri-Strip is designed to treat low tension lacerations and surgical incisions.
West Pharmaceuticals is currently highlighting its needleless reconstitution systems. The Vial2Bag needleless system enables safe and convenient reconstitution and transfer of a drug between a vial or syringe and any solution-filled IV bag, while the Mix2Vial needleless system enables simple, fast, vial-to-vial transfer and mixing between two vials for the reconstitution of lyophilized drug products.
ISIPS is a fan of Smiths Medical’s ADVANTIV Safety I.V. Catheter. The catheter combines the preferred safety of an encased needle tip with the high compliance and ease of use of a passive design. “The catheter protects the health care worker from ever having contact with the contaminated needle,” said Stoker. No additional steps are needed to activate the safety feature, and the tip protector is designed to resist bypass.
Education and Behavior Modification
Unfortunately, investing in new safety equipment is only half the battle. The other challenge is convincing the health care worker to use these new products, and use them properly. That is why Walter Reed includes the end users in its evaluations of safety products, in the hope that their input and advice will lead to adoption of products that will be well-received.
The Veterans Health Administration is utilizing an interesting piece of technology to help medical residents get comfortable with sharps safety products. The SimMan is a portable patient simulator, with realistic anatomy. Medical staff can practice using the new safety devices, and determine if current devices are working as desired. The hands-on training is available for staff to use 24 hours a day, 7 days a week. VHA is currently working on involving nursing staff in this training as well.
“Our focus is on starting IV’s, doing central lines, spinal taps, aspirations; anything where there would be a body fluid involved,” said Pam Hirsch, clinical program manager of occupational health.
“Making people comfortable with training, providing training opportunities, and providing training devices; all of that is critical,” said Dr. Michael Hodgson, director of the VHA Occupational Safety and Health Program. “All of that is a big chunk of [our sharps safety program].”
VHA also wants the workers at each facility to choose the devices that they are most comfortable with. “We do not have national standardization. We think local choice of safety equipment makes people willing to use them,” said Hodgson.
“What we are concerned about is that they use a safety device and that their people are trained to use it properly,” said Hirsch.
Moving forward, “What we have seen is that we now need to focus in the operating room and deal with sharps injuries in the OR,” said Hirsch. VHA is putting together focus groups to evaluate issues that are unique to the OR.
NMCSD’s Byrd agrees that education and behavior modification go hand in hand. In the operating room, “We always announce the entry and exit of a needle from the field… alerting to the fact that there is a sharp coming toward someone.” He and his OR staff have been trained to always pass scalpels and other sharps in a basin instead of hand-to-hand.
In his survey of California OB/GYNs, “26 of the respondents had tried blunt tip needles, but no longer used them.” Byrd said. About 35 percent of those people said that they did not like the performance of the needle, which factored into their no longer using the safety product.
But Byrd’s survey revealed that physicians at one hospital had a notably higher usage rate of the blunt tipped needle. “There, they have a very vocal effort to get people to use these needles, whereas the other facilities did not,” Byrd said.
Walter Reed also educates employees about every new product that is introduced at the hospital. Part of the contract when they purchase a product is that a company representative comes on-site to thoroughly educate the staff about its proper usage.
“You always have education and compliance issues,” said Walter Reed’s Leach. “People say, ‘I have never had an injury, why should I worry about it?’ Well, it doesn’t mean it won’t happen in the future. That is why we are working toward those passive devices, where if they are using it, there is no choice. It’s automatic and they are protected.”
“Technology is wonderful, and I am sure we will continue to get more technically safe items,” Leach said. “But the issue will always be people using those items correctly, choosing to use them, and paying attention to what they are doing.” ♦