Journal Review
April 1, 1999 2 minutes read
Journal Review
Dale JC, Pruett SK, Maker MD. Accidental needlesticks in the phlebotomy service of the department of laboratory medicine and pathology at Mayo Clinic Rochester. Mayo Clin Proc 1998; 73:611-615.
Accidental needlestick exposures in a phlebotomy service declined from a high of 1.5/10,000 venipunctures to 0.2/10,000 venipunctures after safety measures and work practice controls were implemented over a period from 1983 to 1996, the authors report. However, not all of the sharps safety designs have been embraced by health care workers, some of whom continue to prefer conventional syringes for drawing blood, they note.
Safety improvements included the implementation of a one-handed recapping block, change to single-use evacuated tube holders, increased number and improved locations of disposal containers for needles, implementation of resheathing needles and retractable capillary puncture devices, discontinuation of the practice of changing needles before inoculation of blood culture bottles, increased emphasis on safety for new and experienced phlebotomists, and improved exposure reporting tools.
"We believe that the decrease in our accidental needlestick exposure rate is correlated with the changes in education, practices, and products that we have implemented," the authors concluded.
The recapping block, which holds the needle cap and tubes and allows the phlebotomist to recap the needle safely with one hand, proved to be a simple, inexpensive device that reduced the need for resheathing needles, they added. Resheathing needles and retractable capillary puncture devices were made available to the phlebotomy service in 1992. The facility stocks a variety of safety devices and allows phlebotomists to select the devices that work best for them.
"Although the cost of supplies might be reduced by limiting the types of devices available for use, we believe that our phlebotomists are specialists in their trade and must have the necessary tools available for optimal performance of their jobs," the authors report. "We also proactively evaluate new safety products as they become available."
Although the clinic has implemented numerous safety devices, staff evaluations of many of the new safety products have identified a variety of problems and have resulted in skepticism regarding many new products, the authors report.
"In comparison with older products, some of the new safety devices are larger, heavier, and more difficult to manipulate," they note. ". . . Many phlebotomists believe that some safety devices that require additional manipulation or entail greater difficulty in use may actually result in an increased number of needlesticks or failed collections; hence, repeated withdrawals impose additional opportunities for exposure. In addition, the extra clicks, flips, and snaps necessary for many new products have raised concerns among our staff about repetitive motion injuries."
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