NIOSH alert: High-risk needlesticks a priority
January 1, 2000 3 minutes read
NIOSH alert: High-risk needlesticks a priority
Focus on needles used in veins and arteries
The National Institute for Occupational Safety and Health, a Washington, DC-based research branch of the Centers for Disease Control and Prevention, has issued an alert that emphasizes using needle safety devices to prevent needlesticks, particularly those at highest risk of transmitting bloodborne infection to health care workers.1
"Identify priorities based on assessments of how needlestick injuries are occurring, patterns of device use in the institution, and local and national data on injury and disease transmission trends," the NIOSH alert states. "Give the highest priority to needle devices with safety features that will have the greatest impact on preventing occupational infection (e.g., hollow-bore needles used in veins and arteries)."
As safer devices are introduced, worker training is essential to ensure proper use, NIOSH emphasizes. A number of job-related factors influence the adoption of safety behaviors by health care workers, who often place patient needs before their personal safety. "They are less likely to perform a safety measure they perceive to interfere with patient care or to require added steps," NIOSH reminds. "Therefore, employers must address both the hazards that contribute to needlestick injuries and the institutional barriers and attitudes that affect safe work practices." By the same token, workers must be encouraged to report needlesticks, both to ensure appropriate postexposure follow-up and to compile a record for assessing needlestick hazards in the work environment, the agency notes. Other highlights of the NIOSH alert are summarized as follows:
Desirable needle device characteristics: Desir able characteristics of needle safety devices include:
• The safety feature is integral to the device.
• The device works passively (i.e., it requires no activation by the user). If user activation is necessary, the safety feature can be engaged with a single-handed technique and allows the worker’s hands to remain behind the exposed sharp.
• The user can easily tell whether the safety feature is activated.
• The safety feature cannot be deactivated and remains protective through disposal. The device performs reliably and is easy to use and practical.
Device examples: Examples of safety devices include:
• Needleless connectors for IV delivery systems (e.g., blunt cannula for use with prepierced ports and valved connectors that accept tapered ends of IV tubing).
• Protected needle IV connectors (e.g., the IV connector needle is permanently recessed in a rigid plastic housing that fits over IV ports).
• Needles that retract into a syringe or vacuum tube holder.
• Hinged or sliding shields attached to phlebotomy needles, winged-steel needles, and blood gas needles.
• Protective encasements to receive an IV stylet as it is withdrawn from the catheter.
• Sliding needle shields attached to disposable syringes and vacuum tube holders.
• Self-blunting phlebotomy and winged-steel needles (a blunt cannula seated inside the phlebotomy needle is advanced beyond the needle tip before the needle is withdrawn from the vein).
• Retractable finger/heel-stick lancets.
Evaluation strategies: When selecting a safer device, identify its intended scope of use in the health care facility and any special technique or design factors that will influence its safety and acceptability. Conduct a product evaluation, making sure that the participants represent the scope of eventual product users. The following steps will contribute to a successful product evaluation:
• Establish clear criteria and measures to evaluate the device with regard to both health care worker safety and patient care.
• Conduct on-site follow-up to obtain feedback, identify problems, and provide guidance.
• Monitor the use of a new device after implementation to determine the need for additional training. Solicit feedback on health care worker experience with the device, and identify possible adverse effects of the device on patient care. Ongoing review of current devices and options will be necessary. As with any evolving technology, the process will be dynamic, and with experience, improved devices with safety features will emerge.
Reference
1. National Institute for Occupational Safety and Health. "NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings. DHHS NIOSH Publication No. 2000-108." Washington, DC: November 1999.
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