Complete the transition with safety sharps
Don’t let your first step to needle safety be your last
Amid the current trend toward greater safety, it’s clear that more and more providers are implementing the use of safety needle devices. In fact, it could be just a matter of time before such devices become mandatory.
Robert Orenstein, DO, director of HIV/AIDS at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, VA, says most providers are only halfway to where they should be. While many have begun using needleless tubing systems, which is a major step in the right direction, they’ve yet to replace needles and other hollow-bore devices.
"Needleless systems for IV therapy have reduced injuries in nurses close to 90%, which is where most injuries were occurring," says Orenstein. "However, they were lower-risk injuries."
The more dangerous (albeit less frequent) problem lies elsewhere.
"The problems tend to be with the devices that are going directly into the patient to draw blood or insert an IV," he says. "Those are the higher-risk needlestick injuries where there is direct contact with blood, and those are the injuries we have not done a very good job of preventing."
The trend toward safety seems to have thus far fallen short of where it should be, he says.
"If you look nationally at what devices people are using, most have switched to the needleless IV systems, but they have not switched to the devices that will protect people from the high-risk injuries," adds Orenstein. "This certainly gives people a false sense of security."
Lynda Arnold, RN, an activist for needlestick prevention through the National Campaign for Healthcare Worker Safety, says the problem may be that the safety emphasis has been placed on the least dangerous area.
"The biggest mistake people make is trying to identify which devices are causing the most frequent needlestick injuries, and that is the wrong approach," she says. "The devices causing the highest frequency of needlesticks are probably getting the most use and may not pose the biggest danger." (See related story, p. 125.)
Arnold recommends identifying the biggest risk first, which typically are hollow-bore, blood-filled needles.
"Don’t look at frequency first, because while you may be taking care of the most prevalent problem, you’re not taking care of the biggest risk," she says.
Orenstein points out that the move to safety appears to be coming in the form of a two-step process. Phase one was the move to needleless tubing.
"In the first stage, everyone looked at where the greatest number of needlesticks was occurring rather than at the highest risk," he notes. "The original objective was to reduce the frequency of needlesticks, hoping that if you reduced the total number of needlesticks you would reduce the risk of transmission of bloodborne diseases. But there is not much data showing a reduction because it is such an infrequent event to start with. There aren’t that many health care workers who are getting infected by needles at work."
In Orenstein’s opinion, a move to safer hollow-bore, blood-filled devices will have a greater impact on reducing the incidence of transmitted bloodborne diseases.
"Preventing blood exposure would certainly have a larger impact on disease transmissions," he says.
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