Sharps safety starts with safety climate
Managers influence safety practices
If you want employees to comply with sharps safety, then their supervisors have to require it. That is a strong message that emerged from a survey of paramedics related to bloodborne pathogen exposures.
Paramedics whose supervisors made safety a priority and enforced safety regulations had less than half the risk of bloodborne pathogen exposures as those who didn't have safety-oriented supervisors, according to a national survey of 2,664 paramedics sponsored by the National Institute for Occupational Safety and Health (NIOSH).1
"You have to provide [safety devices], but that's not enough," says lead author Jack K. Leiss, PhD, head of the Epidemiology Research Program at the Cedar Grove Institute for Sustainable Communities, a non-profit research organization in Mebane, NC. "Management has to create an environment where the equipment will be used properly and safety practices will be followed."
Unfortunately, many employers continue to lag in their responsibility to provide proper safety equipment. The survey, conducted in 2002 and 2003, more than two years after the passage of the Needlestick Safety and Prevention Act, found that only one-quarter of paramedics were provided with more than three types of sharps safety devices, such as sharps containers or safety-engineered syringes, butterfly needles, IV catheters, or lancets.
About three-quarters of paramedics (77%) said they were always provided safety IV catheters but only 27% said they always had access to winged steel needles. It's not clear how that may have changed in recent years because no further surveys have been conducted. However, in her travels to fire rescue departments, emergency medical services, and hospitals around the country, infection control consultant Katherine West, MSEd, CIC, BSN, finds many instances of lax compliance.
"I'm absolutely shocked and appalled by this," says West, who is a consultant with Infection Control/Emerging Concepts in Manassas, VA. "People are saying, 'These cost more, we're not going to do it.'"
That is faulty logic, says West, because the follow-up and management of needlesticks more than wipes out any "savings."
"My experience on a national scale is that most hospitals are not supplying [emergency medical services] with needle-safe devices, and most of them don't challenge it because they're afraid the hospitals will say 'You're on your own to buy your own,'" West says.
High rates of exposure
Emergency medical personnel remain at high risk of bloodborne pathogen exposure. The survey found that 6.7% of the paramedics had had a blood exposure in the past year. Only health care workers in correctional facilities, surgical techs, and first-year residents had higher rates of exposure, according to a comparison of published surveys.2
"[Putting] their exposures in perspective with other health care workers, it does seem like there are opportunities for improvement," says Winifred L. Boal, MPH, research epidemiologist with the Surveillance Branch of NIOSH's Division of Surveillance, Hazard Evaluations, and Field Studies in Cincinnati.
NIOSH issued a "Workplace Solutions" document last spring, urging employers and paramedics themselves to focus on sharps safety.
Emergency medical services and transports were the second most-cited workplace by the U.S. Occupational Safety and Health Administration (OSHA) under the Bloodborne Pathogens Standard, after skilled nursing facilities. Still, that involved only 54 workplaces, 140 citations, and fines totaling $25,000.
Inadequate training is widespread, says West. While the survey of paramedics indicated significant under-reporting (72% of needlesticks and 29% of exposures to non-intact skin were reported), West says she also finds confusion among paramedics about what constitutes an exposure. Some paramedics report blood on intact skin as an exposure or sticks from sterile needles, she says.
"From my experience, fear is rampant. There has been a lot of fear-mongering training done," she says. Emergency personnel often have an inflated sense of risk of developing HIV or another bloodborne pathogen, she says. "We don't have one documented case of a fire rescue worker acquiring HIV from a contaminated needlestick injury," she says.
OSHA requires annual bloodborne pathogen training with a knowledgeable trainer. That should include hands-on training with the devices, says West, and employees should have input into the selection of safety devices.
Emergency personnel also need to know how to report needlesticks and receive prompt post-exposure follow-up, she says.
References
1. Leiss JK. Management Practices and Risk of Occupational Blood Exposure in U.S. Paramedics: Needlesticks. Am J Ind Med. 2010; 53:866-874.
2. Boal WL, Leiss JK, Ratclive JM, et al. The national study to prevent blood exposure in paramedics: Rates of exposure to blood. Int Arch Occup Environ Health. 2010;83:191–199.
If you want employees to comply with sharps safety, then their supervisors have to require it. That is a strong message that emerged from a survey of paramedics related to bloodborne pathogen exposures.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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