Controlling needlesticks can lower injuries, costs
By Michael Garvin
Safety Engineer
University of Iowa Hospitals and Clinics
Iowa City, IA
(Editor’s note: This is the first of a two-part series.)
Accidental needlesticks cause illness, pain, and mental anguish for health care workers and are a continuous source of liability for hospitals. The proper use of newly developed devices can help hospitals sharply reduce the problems resulting from needlesticks.
The number of accidental needlesticks continues to increase despite safety regulations that call for increased education and training. The federal Centers for Disease Control and Prevention in Atlanta has estimated that every year more than 200 health professionals die of a work-acquired disease, mostly of hepatitis.1 Many of those infections are acquired through accidental needlesticks.
As many as 12,000 clinicians already have become infected with hepatitis B as the result of an accidental needlestick or other occupational hazards. Studies have documented the transmission of at least 20 different pathogens by accidental exposure.2-19 Fortunately, new safety devices have proved successful in protecting clinicians from this deadly risk and thereby lessening hospital liability.
Risk managers are beginning to focus a new effort on reducing the number of sharps-related injuries in the hospital. Programs that decrease the probability of sharps injuries benefit the facility in a number of ways. First, such programs reduce the amount of funds necessary for the treatment of these injuries. As managed care affects more and more hospitals, any reduction in expenses is an advantage. Secondly, a reduction in the frequency of sharps-related incidents decreases the possibility of a catastrophic event occurring, such as a nurse acquiring HIV or hepatitis from a sharps injury. Thirdly, a reduction in the number of sharps-related injuries makes it unlikely that the facility will receive an Occupational Safety and Health Administration (OSHA) citation if an inspection occurs.
Education alone not enough
Finding effective solutions to the problem has been a frustrating challenge for hospitals. Health care professionals are shifting their attention to safety devices, no longer believing that education and training is the only approach to eliminating the needlestick problem. Studies have indicated that design, education, and safety device interventions can reduce the occurrence of needlesticks, lessening hospital liability.20 The change in focus is supported by research from Janine Jagger, PhD, MPH, director of the Health Care Worker Safety Project at the University of Virginia Medical Center in Charlottesville, and who is nationally known for her work on accidental needlesticks.
"Health care workers are victims of hazardous devices that they are required to handle under difficult circumstances," Jagger has reported.21 Since the "difficult circumstances" that health care workers face cannot be removed, potentially hazardous devices should be eliminated and replaced by safer alternatives.
Substantial savings possible
The cost of treating a sharps injury can be substantial. Studies have indicated that treatment costs can range from $300 to well over $2,000, depending on the possibility of HIV involvement. An employee who is injured by a needle that is suspected of contamination with HIV-infected blood faces a tremendous number of personal health restrictions, including an impact on sexual activity.
A study conducted at the University of Iowa indicated that the cost of treating sharps-related injuries was, on the average, $750 per incident. A safety program that combined education with the careful selection of safety devices reduced the number of annual injuries from 426 to 176 between 1990 and 1995. The estimated savings from the avoidance of those treatment costs was $187,500 annually.
Yet the biggest benefit was the 66% risk reduction of experiencing a catastrophic event. Such events have cost facilities hundreds of thousands of dollars in treatment costs and lawsuit settlements, plus the cost of dramatically increased workers’ compensation premiums. Those unfortunate facilities also have received a considerable amount of negative publicity.
This legal liability and regulatory obligation makes a compelling argument for hospitals to continually strive to reduce needlesticks. The 1991 OSHA Bloodborne Pathogen Standard provided the first regulatory incentive for hospitals to reduce accidental needlestick injuries. Although this ruling has contributed to some reduction and increased awareness of the problem, it has not eliminated the accidental needlesticks. The OSHA standard requires hospitals to monitor incidents, such as accidental needlesticks, that may contribute to occupationally acquired disease.22 If hospitals do not provide evidence that such incidents are being monitored and addressed, the institutions may be fined by OSHA surveyors. Despite the pressures of regulation, there is little evidence that needlesticks are decreasing. Accidental needlestick incidents continue to contribute to occupationally acquired disease. These diseases involve such illnesses as AIDS, hepatitis, Rocky Mountain spotted fever, and even Ebola virus.23
Managed care has focused the health care debate on cost and value. The system for the evaluating medical safety devices is no exception. Hospitals are reassessing their accidental- needlestick data to determine not which sharp produces the most injuries but which sharp has the highest risk. This difference in assessment approach can give hospitals a manageable plan for reducing accidental needlesticks.
For years, hospitals have been frustrated in their attempts to cost-justify the purchase of safety devices. Hospitals often tried to justify the purchase of safety devices that replace syringes, a leading device involved in injuries. Yet, implementing a safety syringe program can cost a hospital as much as $100,000. Hospitals are now identifying "high-risk" sharp devices (such as blood draw sets) as a more cost-effective product to convert to a safety device. In most cases, the implementation costs can be closer to $10,000 for a medium-sized hospital. The safety device dollar seems to get a better value in the high-risk device.
Hospitals’ assessment of needlestick data has sometimes been misleading. Many have considered frequency of needlestick injuries to be the best indicator of high-risk procedures. Current research points to a new understanding. Hospitals are now considering each sharp’s injury potential. According to Jagger, "Needles used for different purposes appear to carry different risks. The risk profiles of different professional groups are in part linked to the frequency with which they perform blood drawing procedures."24
Data assessment for calculating "highest-risk" sharps devices can be accomplished by dividing the number of injuries associated with a certain device by the number of that item used within a certain period of time. This approach often results in syringes, which commonly are involved in the largest number of accidental needlesticks, generating one of the lowest risk coefficients. Hospitals are now focusing on "high risk" sharps injuries because the amount of money necessary to affect the problem is lower and therefore the value is higher. The data evaluation technique is called "volume-corrected" assessment.
Many researchers agree that one of the highest-risk "volume-corrected" sharps devices is the blood draw set. Some sets employ a reusable holder. In order to disconnect the needle from the holder, the device usually has to be recapped so that the clinician can get a proper grip at the base of the needle. This procedure can increase exposure of staff to the contaminated needle. Hospitals evaluating safety devices for blood-drawing procedures need to ensure that the safety device can operate without the clinician placing a hand in front of the needle point, which OSHA regulation prohibits.
Where do your dollars count most?
It makes sense for hospitals to direct their safety dollars to areas where those dollars can have the most positive effect. Most blood draws are performed with phlebotomy needles. Safety phlebotomy products may be the best value for hospital funds because they can protect workers who are at maximum risk of infection by bloodborne pathogens. Unlike many new technologies that risk managers are accustomed to seeing, these devices are reasonably priced. When well-designed and implemented in the highest-risk areas, protective needles can safeguard workers’ health while saving the hospital money.
Jagger reports in an article on blood draw risk that, "According to a study by the Centers for Disease Control on the exposure circumstances of workers with occupationally acquired HIV infection, those who were exposed to needlesticks had all been stuck by hollow bore, blood-filled needles. Phlebotomy was the procedure most frequently associated with HIV exposure."24 Blood collection sets are now identified as one of the highest-risk categories. One accidental needlestick from a blood collection needle could mean more costs and liability than several exposures from a needle used to inject medication in a solution bag. Therefore, well-designed phlebotomy safety devices can protect workers who are at greatest risk. They can also help control hospital liability costs.
When compared to the cost of accidental needlesticks, the cost of phlebotomy safety needles is very reasonable. The cost of one needlestick has been estimated to be approximately $750 to $2,000, which includes cost of treatment, laboratory tests, HIV counseling, and follow-up, as well as the cost of medication. These costs are for evaluation only, and do not include long-term treatment expenses. If one hospital employee contracts HIV, the direct and indirect medical, morbidity, and mortality costs could be more than $500,000. For a medium-sized hospital, phlebotomy safety devices can be implemented for an annual increase of approximately $10,000 to $12,000 over current costs or expenditures. Rarely can a manager direct funds in such a calculated manner to solve a dangerous problem for so little of the institution’s financial resources.
Managed care has forced hospitals to look at the total cost of systems. For years, hospitals only considered the purchase price of a blood draw system. They failed to see the hidden needlestick treatment cost of using that system. Hospitals are now buying safety blood draw systems because of their lower total cost.
(Editor’s note: In the second part of this report in the December 1996 issue of Healthcare Risk Management, look for advice on how to choose a safety system for reducing sharps injuries, along with brand-name reviews of several systems.)
References
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22. Occupational Safety and Health Administration (OSHA). Bloodborne Pathogen Standard; 1991.
23. Jagger J, et al. 6-8, 14, 16.
24. Jagger J. Risky procedures, risky devices, risky job. Advances in Exposure Prevention, Report on Blood Drawing. November/December 1994; 1:4.
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