Needle devices require frequent re-evaluation
January 1, 2000 4 minutes read
Needle devices require frequent re-evaluation
Process starts again after just six months
As hospitals move to safer needle devices, they enter a period of intense evaluation. Is it the safest? Is it easy to use? How will it impact patient care?
But those questions don’t end with product selection. As new and better products reach the market, employee health practitioners must launch a re-evaluation.
In its new bloodborne pathogens directive, the U.S. Occupational Health and Safety Administra tion is requiring annual reviews of the exposure control plan. But some hospitals will look at new devices at even more frequent intervals.
"Because there are so many new devices coming out now, we thought for the next year we would do [the evaluation process] every six months," says Cynthia Fine, RN, MSN, CIC, infection control and employee health program consultant at Catholic Healthcare West in San Francisco. "As things start to slow down on products, we would go to once a year."
That re-evaluation is important, because some of the newest products may represent real advancements in safer technology, she notes. "Within the next year, I think we’ll start to see many more devices that are passive devices and easier to use," she says.
The evaluation needs to occur in all areas that will use the product, advises June Fisher, MD, director of the Training for Development of Inno vative Control Technology (TDICT) project, which is based at the Trauma Foundation of San Francisco General Hospital.
"There’s no one device. The needs are different in different areas," Fisher says. "An emergency room in San Francisco has more in common with an emergency room in Baltimore than [with] its own pediatric service. I strongly advocate that each unit determine what its needs are in a very systematic way."
Set criteria, simulated and real testing
Units should use a systematic process with clear guidelines in the evaluation process, Fisher says. Many hospitals base their process on one developed by TDICT, which is available at the organization’s Web site (www.tdict.org). OSHA’s newly updated bloodborne pathogens directive also includes evaluation forms developed by TDICT.
Using basic criteria, a device committee can first rule out products that don’t seem to provide adequate safety or quality patient care. TDICT publishes criteria-based evaluation sheets with items on the technique and time required to use the devices, training, reprocessing, reliability, and other issues. (For more information on the TDICT evaluation process, see Hospital Employee Health, April 1999, p. 40, and safety evaluation forms inserted in the issue.)
"Scenarios" allow health care workers to test products in a setting that closely resembles the actual working environment, with similar lighting, noise, crowding, and patient states. Finally, health care workers conduct pilot tests and respond to detailed evaluation forms.
Meanwhile, someone at the hospital should continually monitor the release of new products that may be superior to those currently in use. While OSHA doesn’t specify safe products, the bloodborne pathogens directive makes it clear that hospitals should stay current with safe device technology.
At Catholic Healthcare West, health care workers receive a re-evaluation form, asking them whether the new device made them feel safer and how it affected patient care. (See sample re-evaluation form, inserted in this issue.)
"Re-evaluation forms will be sent out to all hospitals and all front-line practitioners," says Fine. "It lists all the devices we approved and has check boxes: It makes me feel safer, it doesn’t make me feel safer.’ We’ll be reconvening our team and looking at our input again. It may be that we’ll be replacing our devices."
The safe device evaluation teams have a task that is daunting, at best. "Our goal is to try to find the best device, but in some ways I don’t think that is practical," says Phil Numoto, CIH, director of environmental health and safety at San Francisco General Hospital. "There may not be a single best device."
To accommodate union concerns, Numoto’s evaluation team has equal representation from management and labor. He worried that the committee would become bogged down with conflict between those groups. Instead, the differences of opinion occur among those who use the devices.
Still, Numoto wants to hear those strong feelings about the use of new devices. "This committee was founded on the premise that user input is very, very important."
Staff may initially feel uncomfortable with new devices because, even with training, the new technique may seem awkward, notes Fine.
"There’s a learning curve and it’s going to take time. I’m still hearing complaints about things," she says. "As we get better devices, more of the passive devices, that will make it easier for them. They’ll feel safer and they won’t be frustrated. That’s my hope. Within the next year, I think we’ll start to see many more devices that are passive devices and easier to use."
The ultimate goal, of course, is to prevent needlestick injuries. Good record-keeping will allow employee health practitioners to determine the effectiveness of the new technology.
While it’s too early for data comparisons, the devices seem to be working so far, says Fine.
"No one has called me and said we have needlesticks caused by the devices, and I’ve had e-mail saying we seem to be reducing them, so we seem to be on the right track," she says.
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