Take away the needle — and the needlestick
Devices replace syringes, lancets, sutures
What is the best possible safety device? One with no needle at all. New developments have led to a rapid increase in the use of needleless technology. Hospitals can now administer vaccines or medication with needleless injectors. Nasal and intradermal alternatives are emerging. Adhesives are replacing sutures, and there’s even a laser that eliminates the need for a lancet.
"Eliminate the needle, and you eliminate the risk [of needlesticks] entirely," says Brad Poulos, executive director of the National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI), an alliance of device manufacturers based in Carlsbad, CA.
"Those are very important ways to reduce the use of needles," agrees Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville.
NAPPSI has petitioned the National Institute of Occupational Safety and Health to issue an advisory stating that health care facilities should use both primary and secondary prevention to reduce needlesticks. Whenever possible, the advisory would recommend using primary prevention, a term borrowed from epidemiology where it describes the protective impact of vaccines, says Steve Bierman, MD, NAPPSI founder and president of Venetec International. The San Diego-based company produces a device that secures central venous catheters without sutures.
"If you bring a needle into the institution, whether there’s a safety mechanism or not, you run a risk," Bierman says. "The safety mechanism may fail; the nurse may fail to use it. In the haste of the moment, a needlestick may occur."
NAPPSI will request advisories from other agencies and organizations, such as the Food and Drug Administration, he says. "To date, the greater part of the attention that’s been dedicated to needlestick safety has gone to retractable and sheathing secondary devices," he says. "We want to call attention in the workplace to all the devices that NAPPSI members make, which are [primary] safety devices."
Slowly, needle replacement is gaining favor in hospitals as new products emerge. For example, manufacturers are refining the designs of needleless injectors to allow for more widespread use with a variety of medications. Some medicines are injected into the muscle and others under the skin, which means the injectors must be able to accommodate the different transmission. "What I’m seeing is a fair number of drug development companies partnering with drug injection companies," Poulos says.
At Marshfield (WI) Clinic, employees have had widely differing views on the needleless injectors. Bruce Cunha, RN, MS, manager of employee health and safety, administered flu vaccines to employees two years ago with the Biojector, from Bioject Medical Technologies in Portland, OR. In a survey, 53% said they liked it. The other 47% didn’t.
"It’s absolutely fine. But it gives a different kind of injection," he says. "It has a different reaction from the public. Some people love it; some people hate it."
The force of the injection can cause slight bruising, Cunha notes. But it’s also fast and causes little pain, he says. The clinic purchases the injectors as one option for employees to use. They also have retractable and safety-cap syringes.
"How do you convince people that even though it’s different — it’s not the same as giving an injection, and it has different properties — that it’s actually a better device?" he says. "In Wisconsin, [the injector] is not even considered a sharp, so you don’t even have to throw it in a sharps container."
It would seem impossible to develop a needleless method for blood collection. But even in this area, noninvasive devices are coming to the forefront. Probes under development use reflectance spectroscopy to conduct a complete blood count or to measure blood glucose level.
It will take time for some of these devices to gain favor in cost-conscious hospitals, Poulos acknowledges. "Cost is going to be the issue, as with any new technology until there’s a large adaptation of it," he says. "We’re still early in the evolution of these things."
Needleless alternatives also usually involve a greater change in technique, which means health care workers must alter long-held habits. Bierman acknowledges that "when you’re changing habits, it’s a higher hill to climb." But he adds, "I think more and more the marketplace is recognizing that the benefit is worth the change."
(Editor’s note: More information on primary prevention of needlesticks is available from the National Alliance for the Primary Prevention of Sharps Injuries. Web site: www.nappsi.org.)
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