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by Jeannie Akridge

"We’re pretty far out from the Needlestick Safety and Prevention Act and OSHA’s revision of their standard, but I think that we still have not crossed the finish line on getting safety to replace traditional devices in all applications, in all situations," observed Gina Pugliese, vice president, Safety Institute, Premier Inc., Charlotte, NC. "There’s been a lot of progress, but we’re just not there yet. And I think that the farther we get away from it, we just have so many other competing priorities in the area of safety – both worker and patient safety – that it’s one of many safety priorities that hospitals are still working on."

The American Nurses Association (ANA) recently announced the findings of the 2008 Study of Nurses’ Views on Workplace Safety and Needlestick Injuries, an independent nationwide survey of more than 700 nurses, developed and co-sponsored by ANA and Inviro Medical Devices. According to the latest research, nearly two-thirds (64%) of U.S. nurses say needlestick injuries and blood borne infections remain major concerns, and 55% believe their workplace safety climate negatively impacts their own personal safety. Furthermore, despite the requirements of NSPA, 75% of the needlestick injuries reported involved a standard (non-safety) syringe. Among those nurses reporting needlestick injuries, 74% have been stuck by a contaminated needle while working. The study can be downloaded at www.nursingworld.org.

Gareth Clarke, CEO, Inviro Medical Devices, Lawrenceville, GA, commented, "I think the objective ought to be ‘zero needlesticks’ – a ‘zero-tolerance’ mentality applied to this area. We don’t want to get it down to 30 percent of what it was, we want to eliminate it. If you don’t take the zero mentality then you’re going to be in the same place in three or four years."

The Premier healthcare alliance is collaborating with the Centers for Disease Control and Prevention (CDC) on an initiative to eliminate occupational injuries from needlesticks and other sharp objects. As part of this initiative, a comprehensive workbook on sharps injury prevention, wall signs, and an educational CD-ROM are being made available to healthcare administrators and staff. The CDC’s 2008 Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program and other sharps safety tools are available from the Premier Safety Institute at www.premierinc.com/safety.

Craig Fernandes, director of marketing, DeRoyal Industries, Powell, TN, remarked that "a tremendous amount of progress has been made in needles that are used for injection," with major manufacturers discontinuing the production of standard needles in favor of safety devices. In addition, needleless IV access devices are becoming the norm: "It’s very hard to find IVs anymore where you have to stick a needle in to inject a drug."

But such compliance rates don’t hold true when it comes to the use of safety scalpels in the OR, said Fernandes. "Hospitals are changing over, it’s just happening a lot more slowly in the OR with safety scalpels." While adoption of disposable safety scalpels is becoming more common for applications such as catheter insertions, minor surgeries and some ER procedures, the use of reusable safety scalpels in the OR to replace traditional metal slab-handled scalpels is much more rare. Physicians simply may not be willing to use the safety scalpels offered them, and many hospitals are "more afraid of losing the physician’s business than they are of getting fined," suggested Fernandes.

Workplace safety climate When needlestick injuries occur Excerpted from 2008 Study of Nurses Views on Workplace Safety and Needlestick Injuries - an independent study sponsored by American Nurses Association (ANA) and Inviro Medical Devices

"Usually people don’t like to change – that’s human nature. And I think that’s even more true with physicians who have routines of how they practice their medicine and their tools of the trade," said Fernandes. A surgeon may be more willing to embrace a safety device that doesn’t require a change in technique, he noted. For example, "physicians would like a product that allows them to choose what blade they put on their scalpel, because they’re finicky about the sharpness of the blades. They have certain brands of blades that they like and have used for years." Physicians are also looking for safety scalpels that are similar in size, shape and ergonomic fit as their current slab handle scalpels. "They want something that’s not going to change the way the product feels in their hand," said Fernandes. "Ease of changing blades with a one-handed technique is also important." Finally, "they want a product that does not impede their ability to utilize the full length of the blade. They want to make sure that they can use the entire depth of cut of a blade, not impeded by a safety mechanism that would block it." At the same time, hospitals will appreciate a durable, long-lasting product that’s easy to process using their current sterilization methods, he added.

According to Fernandes, DeRoyal’s Canica-Safety Reusable Retractable/Ejectable Scalpel Handle is the only reusable safety scalpel handle on the market that allows the user to choose any blade, a feature that surgeons will appreciate and may also protect buyers from being locked into more expensive and proprietary safety blades. The Canica-Safety scalpel handle provides touchless blade removal, the same ergonomic feel of slab handle scalpels, and comes apart for easy cleaning.

Fernandes noted that there still remain areas of the hospital "where they have not yet developed safety products to replace the current sharps." To help fill the need for a safety device to replace standard guidewire introducer needles, DeRoyal recently introduced the SP Pro Safety Needle, which not only covers the tip of the needle, but also unfurls a plastic sheath that covers the entire shaft of the needle and any blood on the shaft.

As part of OSHA’s Bloodborne Pathogens standard (66:5317-5325), employers are required to review sharps technology on an annual basis, including "newly available medical devices". "They need to trial it at the non-managerial level," emphasized Fernandes. "They need to get it down to the workers that actually insert the needle, and they need to write it up in their exposure control plan why they chose to use it or why they chose not to use it."

Pugliese clarified, "OSHA law says you have to include front line workers in the selection process, and that can be done in a variety of ways. They can actually be part of the evaluation, you can get representatives of front line workers to sit on larger committees. As long as you get a representative sampling and include front line workers – that’s what’s important." She added, "There are a lot of different user preferences so sometimes it’s hard to select a single device. The challenge, is does every single department get to pick their own safety device? It has to be a balance, and some hospitals find that challenging, because you want to be sure you have worker representation."

Sadly, the ANA study found that 66% of nurses do not have the opportunity to influence the selection of sharps safety devices in their workplace, up from 58% in 2007.

To help meet the goal of eliminating sharps injuries, Pugliese advises "a combination of strategies which include the devices, activation of the devices, safer work practices, and reporting injuries to help guide your selection process." She added, "I think that hospitals that have a culture of safety in general – both patient and worker safety – are much more apt to be very active in their pursuit of ways to keep workers safe. And they’re always looking for ways to improve, for example whether it’s sharps safety or back injury prevention, or chemical exposures, they’re always looking for ways to reduce risks for workers."

Agreed Clarke, "I think a big part of this is assessing the overall safety climate – what is top management’s attitude towards making sharps safety a priority for the organization? A sharps safety program or a sharps safety committee will function well if the environment is right. If people are simply conducting an annual review of sharps products just so they can check the box so to speak, it’s really not a commitment or a top priority for management; and thus you’re not going to make a lot of progress. What we’ve found as we talk to hospitals is it’s really a top-down issue in terms of setting the tone and the attitude. And perhaps the key is truly involving your front line workers who are actually using the syringes as part of the selection process."

Clarke recommended that facilities consider the three different technologies available in safety syringes – retrofitted, manually retractable and automatic retractable. With Inviro’s line of manually retractable InviroSNAP! with InviroSTRIPE safety syringes, when the user pulls back the plunger after giving an injection the needle is pulled back inside the syringe barrel. Then by snapping off the plunger with the needle encapsulated inside, it becomes its own mini sharps container, he explained.

"Look at the different technologies available as opposed to the same technology from two or three suppliers," he said. "I think offering safety syringe technology based on the application will help drive down the needlestick numbers."