Phlebotomy Safety Devices: Are They Worth It?
Abstract & Commentary
Synopsis: Now that safety devices for phlebotomy have been shown to be effective, it will be hard not to use them. While the trend seems to be toward increasing use of safety devices, this also carries a risk. A recent report shows that technical difficulties with the devices still remain.
Source: Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among health care workers during phlebotomy procedures. MMWR Morb Mortal Wkly Rep 1997;46:21-25.
The centers for disease control and preven-tion (CDC) conducted a study of safety devices for phlebotomy in Minneapolis-St. Paul, New York City, and San Francisco from 1993 to 1995. Six hospitals were involved in this study of three different devices, including the Safety-Lok (Becton-Dickinson), the Punctur-Guard (Bio-Plexus, Inc.), and Venipuncture Needle-Pro (Smith Industries). More than 7 million phlebotomies were studied during the three-year period. The Safety-Lok system included a resheathable winged steel needle, the Punctur-Guard had a bluntable vacuum-tube blood collection needle, and Venipuncture Needle-Pro consisted of a vacuum-tube blood collection needle with a hinged recapping sheath. Safe needle systems were placed on the floors and in the laboratories with education programs.
Per 100,000 phlebotomies with conventional needles, 3.4-4.0 percutaneous injuries were reported. Among the three different devices, the Safety-Lok system reduced percutaneous injuries by 23% (from 4.0 to 3.1/100,000). The Punctur-Guard reduced injuries by 76%, and the Needle-Pro system reduced them by 66%. There were, however, technical difficulties associated with the devices, especially the Punctur-Guard system. Of the 41 percutaneous injuries associated with safety devices, 25 involved an injury before activation of the safety feature. Six percent occurred during the activation of the safety feature (all with Safety-Lok). Only 60% of the Safety-Lok and Punctur-Guard systems were activated, judging from the examination of the devices in disposal containers. The Needle-Pro system was virtually always activated. A final survey of health care workers indicated that 44% preferred the safety device over the conventional equipment. Thirty-three percent were unsure.
COMMENT BY ALAN D. TICE, MD, FACP
The risk of infections from needlesticks is of increasing concern because of the prevalence of HIV, hepatitis B, CMV, and Hepatitis C. Percutaneous exposures may also pose significant risks with other pathogens that we are not able to detect. Health care workers are at particular risk for percutaneous injuries, yet their risk of exposure to blood and blood products is unavoidable.
There has been considerable interest in developing new and practical systems for avoiding percutaneous injuriesfor which the three above products may prove helpful. Judging from the results of the CDC study, there is still considerable need for improvement. The Safety-Lok system did not appear to be as effective in reducing injuries, but it was easy to use. The Punctur-Guard system seemed quite effective in reducing injuries, but it was difficult to use. The Needle-Pro was effective in reducing injuries, plus it had the benefit of a high use rate and a low incidence of technical problems.
There is growing concern by OSHA about the safety of health care workers. Now that safety devices for phlebotomy have been clearly shown to be effective, it will be hard not to use them. While the trend seems to be toward increasing use of safety devices, this also carries a risk. Technical difficulties with the devices remain. Regulations may soon follow. There is also the added factor of cost, which may be in the tens, if not hundreds, of thousands of dollars for many medical centers. Whether the additional cost can be justified or not remains a question. The money may be better spent on hiring more phlebotomists and providing more training for them, rather than buying safe needle systems. Finally, a recent report suggests that the use of needleless devices is associated with an increased risk of bloodstream infections in pediatric hematology/oncology patients receiving home infusion therapy (Kellerman S, et al. J Pediatr 1996;129:711-717).
In the same issue of MMWR, there was an evaluation of blunt suture needles and their ability to reduce percutaneous injuries during gynecologic surgery.1 This all seems well and good from a health care worker standpoint, but I am not sure I would want to be a patient on whom blunt needles are used. I still remember the days when needles were sharpened rather than dulled for use.
Reference
1. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 1997;46:25-29.
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