The truth about sharps injuries? They still happen.
By now, who doesn’t know about the hazards of sharps injuries in the healthcare setting? After all, the Needlestick Safety and Prevention Act has been in effect almost 19 years.
Yet healthcare workers continue to sustain sharps injuries (though exactly how many such injuries occur every year is a difficult statistic to pin down). Why? Perceived higher costs of protective devices, time pressures, habit, or simply the attitude, “This won’t happen to me.”
Repertoire asked two product experts about healthcare workers and sharps-safety devices:
- Jonathan Roberts, national sales manager, Terumo Medical Corp.
- Cheryl Wozniak, product director, vascular access, B. Braun Medical.
Repertoire: The Needlestick Safety and Prevention Act went into effect in April 2001. How would you characterize 1) awareness of sharps safety and 2) adherence to safety procedures, including use of engineering controls, on the part of healthcare providers?
Jonathan Roberts: Some misunderstandings still exist because of the perceived grey areas in OSHA law language. The language regarding the employer’s responsibility to “evaluate and use” effective, safer technologies [OSHA1999b] is often interpreted by medical practices that as long as a healthcare provider evaluates safety devices, they are in compliance with the law. Many believe that if they don’t prefer using safety devices, they aren’t mandated by law to use them. This is an expressed perception I have heard in the field many times.
It has been our observation that complex medical groups and health systems understand sharps safety law, but that among smaller or more rural medical practices, sharps safety remains misunderstood or, in some cases, not taken as seriously. I would surmise it is due to a greater degree of emphasis on risk-management/liability, more dedicated resources for enforcing compliance and workplace safety, greater financial implications for non-compliance, as well as a more competitive environment between larger health systems.
The adherence to safety procedures and protocols is directly related to the versatility and ease of use of the safety device. Additionally, training resources are important to give the healthcare professional the best chance of successfully using safety-engineered medical devices.
Cheryl Wozniak: Awareness of safety sharps today is very prevalent in both the hospital and outpatient markets. Safety engineered devices are the expected standard of care for peripheral IV safety catheters and needleless connectors. There is also growing awareness in the healthcare market that adherence to safety requirements is ensured by using products with engineering controls that automatically engage without reliance on the clinician to activate the safety mechanism so it cannot be bypassed or inadvertently activated by the clinician. This type of safety-engineered device mechanism is known as passive safety.
Repertoire: How has the discussion about sharps safety evolved since the Needlestick Safety and Prevention Act went into effect in 2001?
Roberts: There was a spike in interest and awareness 5-6 years ago, after OSHA imposed heavy fines in various regions. Additionally, the consolidated marketplace has driven the need for a higher degree of compliance to internal standards, not just to federal regulations. This increased the need for larger groups to be more aware of OSHA law and to design protocols around it. Healthcare providers have put a higher degree of importance on compliance.
Wozniak: Certainly healthcare workers have grown more aware of the risks associated with needlesticks. The focus of the discussion today is moving healthcare providers towards devices that passively activate and automatically engage, without reliance on human intervention to activate the devices. With respect to peripheral IV catheters, we are seeing a strong and growing movement to reduce exposure to blood during the IV procedure. This has led to rapid growth in the use of blood control safety IV catheters.
Repertoire: What are the greatest impediments to compliance with sharps-safety regulations among healthcare providers?
Roberts: Weak federal enforcement of the law, unclear language in OSHA law leaving room for interpretation, increase in cost from conventional to safety, lack of options for how to activate a device, difficulty with device activation, time/efficiency pressures, and pain of change.
Wozniak: One of the greatest impediments to compliance is time pressure placed upon healthcare workers today. Clinicians are tasked with multiple responsibilities, and their time limitations can lead to failure to engage a device’s safety mechanism.
Repertoire: How can distributor sales reps help their provider customers address these impediments?
Roberts: Communicate not only the law, but educate your customers on the risks and implications associated with non-compliance. Cite any known local instances of OSHA fines. Help medical groups understand important considerations, such as the average cost of a needlestick (medications for injured staff, potential financial impact of litigation, staff attrition, etc.) and how those factors impact their system.
Wozniak: Distributors can best assist by helping to inform their customers of the sharps safety engineering controls available to clinicians to provide the best safety platforms that ensure compliance.
Sharps safety: Some re-energizing needed
Mary Ogg
Perioperative team members are acutely aware of sharps injuries, as the OR has the highest percentage of injuries in healthcare facilities, says Mary Ogg, MSN, RN, CNOR, senior perioperative specialist, Association of periOperative Registered Nurses (AORN). But their awareness of and adherence to sharps safety appears to be lagging.
After OSHA’s release of the Bloodborne Pathogens Standard [in 1991] followed by the Needlestick Safety and Prevention Act, “safety-engineered devices were developed, work practice controls were instituted, and personal protective equipment (PPE) – especially gloves – were worn anytime there was a potential for exposure to blood or other potentially infectious material,” says Ogg.
“With these measures in place there was a precipitous drop in sharps injuries. … and hope that sharps injuries would continue to decline and one day be virtually eliminated. However, the epidemiological data from the last several years demonstrates that the number of sharps injuries remains the same with very little to no improvement.”
That’s true for several reasons, says Ogg.
“Safety devices cost more than a conventional device, but money can be saved with decreased injuries and the costs associated with treatment and follow-up,” she says. What’s more, “the perioperative team is faced with the time pressures of doing more and more procedures in less time and turning over rooms quicker.
“But the resistance to change is the most difficult to overcome,” she says. “For example, safety scalpels may have been tried when they first came on the market. They did not feel like a traditional scalpel handle and blade. The disposables were lightweight and the blades were often of inferior quality. Now, even though the safety scalpels have greatly improved, it is difficult to reintroduce them as an option.”
Yet the OR team can draw upon many evidence-based interventions to reduce sharps injuries, says Ogg.
“Double gloving rates have increased over the past several years,” she says. “Recent evidence suggests that using a perforation indicator system (i.e., a pair of colored surgical gloves worn under a standard pair of surgical gloves) when double gloving increases the detection of perforations.”
The neutral-zone or hands-free technique is very effective in reducing sharps injuries by ensuring that the surgeon and scrub person do not touch the same sharp instrument at the same time, she adds. “This technique is accomplished by establishing a designated neutral zone on the sterile field and placing sharp items within the zone for transfer of the item between scrubbed personnel. The resistance to this technique is that it takes a few seconds longer than passing a sharp instrument hand-to-hand.”
Today, healthcare professionals such as Ogg are seeking ways to re-energize the efforts to eliminate sharps injuries. And she believes distributors can help.
“During the annual OSHA-required evaluation of appropriate, commercially available and effective safer medical devices, they can provide their customers with the latest and improved devices for consideration and product evaluation,” she says.