Safer needle project urges worker participation
TDICT focuses on testing new technology
Frontline health care workers must be involved in purchasing decisions relating to safer needle devices, says a California researcher whose work is known nationwide.
Group purchasing arrangements have caused individual hospitals to lose control over which devices are chosen, and "decisions are being made by those who know nothing about these devices other than their cost," says June Fisher, MD, director of the San Francisco-based Training for Development of Innovative Control Technology (TDICT) project, an occupational health physician, associate clinical professor of medicine at the University of California/San Francisco (UCSF), and lecturer in engineering (product design) at Stanford University in Palo Alto.
Launched in 1990, the TDICT project brings HCWs together with product design engineers and industrial hygienists dedicated to preventing exposure to bloodborne pathogens through better design and evaluation of medical devices and equipment. To further that goal, Fisher has developed the first written criteria for evaluating and selecting more than 20 types of medical devices. (See the four newly updated criteria sheets for safer needle devices, inserted in this issue.)
"Our purpose is to advance the use of safer medical devices, and TDICT is unique in the sense that it brings together product design engineers with health care workers and industrial hygienists. That was revolutionary in itself — to bring people together in a systematic way. In their training, product designers and industrial hygienists never really get to talk with health care workers," Fisher explains.
The criteria sheets were the result of a process involving HCW observation, focus groups, mentoring, and product testing. Some hospitals adapt the criteria sheets for their own use, but whether used as-is or customized, they provide a systematic tool for evaluating the design of safer devices with major emphasis on input from the frontline workers who will be using those devices, she says.
TDICT’s criteria sheets have been incorporated in needlestick-prevention information developed by the American Hospital Association in Chicago and the Washington, DC-based Service Employees International Union. They also are available on the World Wide Web. (See editor’s note at end of article for more information on these materials.)
HCWs enact scenarios for device testing
Scenarios are another TDICT-created evaluation tool for testing new devices. These simulations of real-life use enable HCWs to evaluate devices in settings that reflect the actual circumstances in which the devices tested would be used, without threatening workers’ or patients’ safety. Using criteria sheets, HCWs who would actually provide patient care with the products being tested form a group of "players" in a setting that closely approximates a real environment. Factors considered include room lighting and temperature, noise, crowding, patient state (such as whether the patient is an adult or child, sleeping, violent, or jumpy), and work conditions (such as whether an HCW’s hands will be wet and slippery).
Information gleaned from scenarios enables potential product users to evaluate whether a device is appropriate and effective in the setting tested. For example, some safer devices utilize an audible click that signals users when the safety sheath has been activated. That click might not be heard in a noisy emergency room or other setting.
During a scenario, a "recorder" should be assigned to write down problems discovered, and a "facilitator" will direct the players in recreating use of the device. As data are gathered, groups will be able to assign a score to each device evaluated. (See forms inserted in this issue.)
A new guidance document in development by the National Institute for Occupational Safety and Health probably will include a number of scripted scenarios as examples for hospitals to use in their own device evaluations.
Also in conjunction with frontline HCWs, TDICT created a list of fundamental performance standards to be met by all devices in all phases of use. (See box, p. 41.)
In addition to creating device evaluation tools, TDICT examines needlestick data to obtain epidemiological information for problem identification and promotion of better product design technology. A project currently is under way in the operating rooms of UCSF, where preliminary clinical observations and injury data review suggest that anesthesiology and transplant personnel are most in need of safer devices.
Fisher also is focusing on the needs of home health care workers, which she says are becoming increasingly complex.
"People are doing things that would have been done in intensive care units a few years ago, so complex equipment must be brought to the house where there is not a stable environment in many instances," she says. "The room may be cluttered, there may be animals or children underfoot, and home health care workers might come in and find that their equipment is not compatible with the equipment the patient was given upon discharge from the hospital. All of this is conducive to sharps injuries."
Analyses should include emotional factors’
While cost issues still are a concern in many hospitals’ decisions to purchase safer needle devices, Fisher says cost analyses are inaccurate unless needlestick-related lost time, absenteeism, productivity, and "emotional factors" are included.
"How do you put a cost on emotional factors?" she asks. "People just talk about the conversions, and they say the numbers are low. Cost-benefit analyses eliminate the human factor. A stick that doesn’t convert also has enormous impact on people’s lives and abilities to function. It’s basically a year of hell, and you’re talking about hundreds of thousands of people who are concerned about this issue. It’s scary to think that hospitals refuse to put in safer devices because having people convert is cheaper."
[Editor’s note: For more information about the TDICT project, as well as additional product evaluation forms, log onto the World Wide Web and go to: http://members.aol.com/tdictproj/. To obtain a copy of the American Hospital Association’s information packet on preventing needlestick injuries, call (800) 242-2626. For the Service Employees International Union’s "Guide to Preventing Needlestick Injuries," including a video, call (202) 898-3200.]
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