Brian Mach, chief operating officer, Sandel Medical, commented, "Ninety-nine percent is an incredible statistic, and if that tells us anything it’s that we have a long way to go to improve the working conditions of the periOperative team. I believe those rates can be improved by continually evaluating safety products and procedures, and sharing a comprehensive attitude and belief that by teamwork and education the ‘99 percent’ figure will be decreased."

Nurses too feel the sting of needlestick injury. A recent study linked longer working hours to a higher rate of needlestick injuries.2 While the reasons for sharps injuries are many – over half (57 percent) of the surgical residents surveyed said they felt rushed1 – the core issue is that needlesticks continue to happen to healthcare workers at a rate of 600,000 to 800,000 per year.3

There have been many champions for sharps safety over the decades. Ron Stoker, executive director for the International Sharps Injury Prevention Society (ISIPS), tipped his hat to nurse activist pioneers such as Karen Daley, Lisa Black, Lynda Arnold, Janine Jagger, and others who actively campaigned for a needlestick safety law. "I think we owe a great debt of gratitude to them," said Stoker. "They really made a difference in promoting sharps safety."

Indeed, their efforts paid off. In November 2000, President Bill Clinton signed the Needlestick Safety and Prevention Act into law, and the following January, the Occupational Safety & Health Administration (OSHA) revised its Bloodborne Pathogen and Needlestick Prevention Standard4 mandating that:

•Employers must implement the safer medical devices that are appropriate, commercially available, and effective and document consideration and implementation of safer medical devices annually.

•Employers must get input for these devices from those responsible for direct patient care. This input must be documented.

•Employers must train employees to use new devices and/or procedures and document training in the Exposure Control Plan.

•Employers must maintain a log of injuries from contaminated sharps."

Several years later there was a modification to the standard that prohibited the reuse of blood collection holders, noted Stoker. "The new standards now specifically state that you need to use safety products, it specifically says you cannot recap a needle, and it says you really have to evaluate safety products," said Stoker. "There are a number of issues that it covers that changed the claim dramatically from where it was."

He emphasized, "OSHA requires that clinicians evaluate safety products, requires that we involve front line workers, the people who are actually using the product. A lot of institutions are not doing it and they’re being fined."

A key component of an effective sharps safety program is the documentation – and that includes keeping track of how many needlestick injuries are happening, advised Stoker. "If we keep track of things it’s easier to find out if we’re improving or not."

"OSHA requires facilities to continually look into ways to improve working conditions. They want facilities to continually look at ‘safe engineering controls’," concluded Mach.

"As every institution evaluates their safety devices there are a lot of things that I think are really important for them to look at," explained Stoker. "Number one, I would make sure the clinician’s hands are far behind the needle, and that activating the safety device doesn’t require the clinician to put his/her hand down by the needle. It’s got to be simple and easy to use.

"You’ve got to make sure the device can be used by both right- and left-handed employees," continued Stoker. "You have to know that the safety feature’s been activated, for example, with an audible click. Finally, and most importantly, the product has to be effective and safe in patient care."

"The key issue is, every institution, every department, needs to evaluate and determine what meets their needs? OSHA doesn’t give you a list of approved products, they say it’s your responsibility to evaluate," said Stoker.

Premier Inc. recently distributed a "Prevent Needlestick Injuries" educational brochure (available at www.premier inc.com/needlestick), in which it suggested that devices include features that:

• Permit the practitioner’s hands to remain behind the needle at all times

• Integrate the safety feature into the device so the features are not just an accessory

• Are simple and easy to use

• Can be used effectively by both left and right handed employees

• Determine easily whether the safety feature has been activated

• Cannot be defeated once permanently engaged

• Are safe and effective in patient care.

Stoker recommended that devices that don’t require a change in technique to use will go far to help promote adoption by clinicians. For example, he described how the design of safety scalpels has evolved over the years to suit surgeon demands. "Some of the earliest safety scalpels, I’ve heard them described as box knives," said Stoker. "In recent years however, new products have come out, including weighted safety scalpels. They feel the same in their hand as the scalpels they’ve been used to using for the past five or ten years."

Mach described the development of Sandel Medical’s Weighted Safety Scalpel, "About five years ago as we were starting the company we solicited ideas from nurses. A nurse in Georgia said, ‘the reason surgeons don’t want to use safety Scalpels in the OR is because they are not weighted’. And thus started everything… we developed the only totally disposable Weighted safety Scalpel with removable Time Out sleeve."

Mach added,"I believe the key to improving sharps safety lies with teamwork and a willingness to be open-minded with all team members. All team members have to embrace the word ‘change’, and improve their working environment for all those individuals who work in a periOperative environment."

"Visible Senior management commitment for improving worker safety is the key to changing the culture of safety in an organization... This includes supporting effort to get safer devices in the hands of all workers," said Gina Pugliese, vice president, Safety Institute, Premier Inc.

References:

1. "Needlestick Injuries among Surgeons in Training," Martin A. Makary, M.D., M.P.H., Ali Al-Attar, M.D., Ph.D., Christine G. Holzmueller, B.A., J. Bryan Sexton, Ph.D., Dora Syin, B.S., Marta M. Gilson, Ph.D., Mark S. Sulkowski, M.D., and Peter J. Pronovost, M.D., Ph.D., Volume 356:2693-2699, June 28, 2007, Number 26, http://content.nejm.org/cgi/content/short/356/26/2693

2. "Work schedule, needle use, and needlestick injuries among registered nurses", Trinkoff AM, Le R, Geiger-Brown J, Lipscomb J. Infect Control Hosp Epidemiol. 2007 Feb;28(2):156-64.

3. NIOSH Alert: preventing needlestick injuries in health care settings. Washington, DC: National Institute for Occupational Safety and Health, 1999. (Publication no. 2000-108.)