GUEST COLUMN
Protect yourself against bloodborne pathogens
A quick look at preventing needlestick injuries
By Nina Moore Elledge, CRNI
Castro Valley, CA
Bloodborne pathogens are an everyday occupational risk for nurses, particularly those of us practicing in the specialty of intravenous therapy and line placement.
In a study of 63 hospitals conducted by the Health Care Worker Safety Center, sharp object injuries occurred at a rate of 27 per 100 occupied beds per year.1 This amounted to 3,552 total incidents in a three-year period. Of these incidents, almost 69% were caused by hollow-bore needles, the kind you and I use every day.
Of these sharp object injuries, 50% were to nurses (only .1% of these injuries were to IV team members), 13% to physicians, and 5% each to nursing assistants and housekeeping staff. The most frequent injuries were caused by IV catheter stylets, followed by butterfly needles, phlebotomy needles, blood gas syringes, and injection syringes, respectively.1
We must also take into account when reading these statistics that under-reporting has been documented in several studies by 40% to 53% for nursing personnel, and up to 92% for laboratory technicians.2 In addition to the risk of tissue, nerve, and bone trauma, we are also exposed to over 20 pathogens each time we incur a contaminated sharps injury.3
Safer devices are the answer
We can insure workplace safety by proper training of employees in the use of safety devices, handling contaminated sharps, and generally increasing the level of awareness of the dangers we may face in our daily routines.
The five primary activities associated with most needlestick injuries are:
1. Disposing of needles used during patient care procedures.
2. Administering injections.
3. Drawing blood.
4. Recapping needles.
5. Handling trash and dirty linens (a.k.a. "downstream injuries").
Certainly using universal precautions and personal protective equipment have decreased the incidents of occupational exposure to bloodborne pathogens. However, we must remember that most personal protective equipment is penetrated easily by a needle. Safer needle devices have been shown to significantly reduce the incidence of accidental needlesticks and exposure to bloodborne illness.4
More steps to safety
The recent passage of legislation in California (AB 1208, Migden) is also a step in the right direction of protecting healthcare workers appropriately. It mandates a revision of CalOSHA’s bloodborne pathogen standard to include needleless systems and needles with engineered sharps injury protection.
These engineering controls (many of which have been available on the market for several years) must be provided by employers in work areas no later than Aug. 1. Non-compliance with this revised standard is a misdemeanor. Similar legislation is likely to be enacted in other states in the near future.
Another method of protecting ourselves against contaminated needle injury is the one-handed recapping technique. This procedure is addressed in sections (d)(2)(vii)(A) and (B) of the OSHA Bloodborne Pathogen Standard Number 1910.1030.5
While it is not advisable to recap contaminated needles, there are occasions when this technique can protect you if no other alternative to safe disposal of the sharp object is available. Several examples include unobtainable sharps container or needle cork (after an arterial blood gas has been drawn). The procedure involves placing the tip of the needle cover against a solid, immovable object (such as the rim of a bedside table) prior to obtaining your sample or giving an injection. After completing the procedure, you would then use your dominant hand to gently slide the needle into the needle cover. The object’s resistance will allow you to apply gently pressure to secure the needle cover. Then, dispose of the unit in the nearest sharps container as soon as possible. It must be noted that shearing or breaking a contaminated needle is prohibited by OSHA Standards.
A final note on the proper use of our tools of the trade.’ We must be aware that manufacturers’ recommendations for devices which carry the potential for user injury state that we must be trained in the proper use of these devices. This protects them from legal liability. It also reminds us that if we are expected to use a piece of equipment with which we are unfamiliar, we must be instructed on its proper use (it is also a good idea to have this training documented in your employee file).
Doing so will protect us in cases of litigation. Most of us can think of instances in our personal careers where improper or non-existent training affected us directly or indirectly, and may have resulted in an incident report, or worse, and injury to ourselves or our patients. To this end, we all need to practice with a jury in mind. Proper training, proper equipment, and proper documentation protect all of us.
Nina Elledge is an independent nurse consultant in the San Francisco Bay Area of California. She has been clinically active in intravenous therapy for nearly 20 years from the ICU to the home setting. She also is a legal consultant specializing in plaintiff and defense litigation in pediatrics, home care, and vascular access issues.
References
1. OSHA Office of Occupational Health Nursing. Safer Needle Devices: Protecting Health Care Workers 1997; October:4-6.
2. Chiarello, LA. Selection of Safer Needle Devices: A Conceptual Framework for Approaching Product Evaluation. J Infect Control 1995; 23:386-395.
3. OSHA Office of Occupational Health Nursing. Safer Needle Devices: Protecting Health Care Workers 1997; October:4.
4. Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among health care workers during phlebotomy procedures — Minneapolis, St. Paul, New York City, and San Francisco, 1993-1995. MMWR 1997; 46:29-33.
5. OSHA Web site: www.osha.gov.
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