Are you getting the most out of safer needles?
Training, good disposal help reduce injuries
Switching to safer needle devices can reduce needlestick injuries by 75% or more. But what causes the remaining injuries? Can they be prevented?
Even safety devices aren’t foolproof. But your training programs and safety policies can help you get the most out of your investment in safer devices, needle safety experts say.
"If there’s a needle on a device, there are going to be some needlesticks," says Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville. "The question is, how much is a device going to reduce needlesticks? An 85% or 90% reduction is fantastic. We shouldn’t consider those [remaining] events evidence that the device doesn’t work."
Needles with safety devices accounted for only 6.3% of all needlestick injuries from 1993 to 1997, according to EPINet, a data-sharing network with information from 84 hospitals. About one-quarter of the injuries from safer devices occurred during use, and 11% during or after disposal.1
Safety products have proven effective
As safety designs improve, the risk of injury will decline further, says Jagger. Still, the products on the market have proven to be quite effective, she says.
"I haven’t seen a safety device that didn’t to some degree reduce injury," she says. "Some of them have a higher fraction of injury prevention than others. If you pick out a device that’s on the market that’s within your cost parameters and that your staff feels comfortable with, you can expect that you will experience injury reduction."
Recent state laws, such as those in California and New Jersey, are placing pressure on hospitals to switch swiftly to alternative devices. But if the choice is made too rashly, hospitals may end up buying costly devices that aren’t readily accepted by staff or that actually increase patient discomfort, cautions Robyn Gershon, DrPH, associate scientist in the department of environmental health sciences at the Johns Hopkins School of Public Health in Baltimore.
"It’s still a very, very new market," she says. "As you might suspect, it’s not an easy technology to undo. It’s complicated to get a device that will be sharp and get into the patient’s vein or muscle and tissue and not be a danger to the health care worker."
Here are some steps that hospital employee health professionals can take to make the most of safer sharps technology:
• Choose devices based on how they perform in a clinical setting.
You need to know how the device performs in the workplace, not just in a simulation, advises Jagger. "A product evaluation that is based solely on experts providing their opinion or experts or health care workers sitting around a table and discussing the device and doing simulations of the device are absolutely inadequate and should not be relied upon to provide accurate information," she says.
Evaluations also should include various clinical settings, Jagger recommends. "The same device can be given a high evaluation in one clinical setting [but] a very poor evaluation in another setting."
Evaluate everything from setting to hand size
A wide range of factors can influence the acceptance of new needle devices, notes Gina Pugliese, RN, MS, director of the Premier Safety Institute, a health care alliance based in Chicago. For example, an evaluation might take into account the experience level of the staff, how adaptable they are to change, how compatible the device is to others already in use, and even the size of the users’ hands. Patients also differ greatly; a device that works well in one unit might not be feasible for pediatric care or elderly patients.
"The consensus among sharps injury prevention experts is that there isn’t a single device that you can use across categories that everyone in the institution will like," says Pugliese, who is senior associate editor of the Journal of Infection Control and Hospital Epidemiology.
• Conduct thorough training programs in the context of an overall safe workplace.
It can be very time-consuming to pull staff away for extensive training. But without adequate training, you may be wasting your money on the new devices.
"They’re only safer if you’re using them properly," says Gershon. "There are very few devices that are truly completely passive. There is usually something you have to do to make it happen."
Jagger recalls a hospital in the EPINet database that had injury rates from a safety device that were about the same as a conventional device. "Every single one of those injuries was during needle access to an IV port, [yet] it was a needleless IV system," she says. "They should have been using a needless syringe. If they had appropriately used the IV system, they would not have had a single injury."
There isn’t a cookbook approach to this’
Each hospital will need to decide how to implement the new devices, notes Pugliese. If training occurs unit by unit, how will you handle employees who transfer from one unit to another? What about a patient with a needleless IV system who is transferred to a unit with staff who don’t know how to use the device?
There is no simple answer to those questions, she says. "There isn’t a cookbook approach to this," she says. "What works for one facility is not going to work for another."
• Provide well-designed disposal containers.
A comprehensive sharps injury prevention program includes a review of the location and selection of disposal containers, says Gershon.
In a study at a 450-bed community hospital in Washington, DC, Gershon and other researchers found that a new sharps disposal system contributed to a significant decline in needlestick injuries.2 The new containers had a more convenient design and location and were changed regularly by a sharps disposal firm.
From 1990 to 1998, sharps injuries related to intravenous lines declined by 93%, and hollow-bore needlesticks decreased by 75%. Better disposal systems may have contributed to the decline in injuries among ancillary workers (such as maintenance and housekeeping staff) and the reduction in recapping injuries.
"We feel very strongly that safety devices should be part of an overall safety strategy," says Gershon.
• Monitor the success of your safety program and provide feedback to employees.
Where are needlestick injuries occurring and why? To answer that question, you need to track sharps injury data.
Providing feedback to employees and supervisors can help make them feel accountable to safety in their departments, says Gershon. Compliance with safe practices and the use of safety devices can become a part of employee and manager job performance evaluation, she says.
There are other ways to get the safety message out as well, including newsletters, safety committees with employee involvement, and training programs.
"There’s a tremendous psychological component," says Gershon. "Employees have to perceive that it’s a safe work environment, and then they act safer."
[Editor’s note: More detailed information about implementing safer devices can be found in Sharps Injury Prevention Program: A Step-by-step Guide, a publication of the American Hospital Association (catalog no. 196311, $25 members, $75 nonmembers). For more information, contact AHA, One North Franklin, Chicago, IL 60606. Telephone: (800) AHA-2626.]
References
1. Jagger J, Bentley M. Safe disposal of safety devices. Advances in Exposure Prevention 1999; 4:16-17.
2. Gershon RRM, Pearse L, Grimes M, et al. The impact of multifocused interventions on sharps injury rates at an acute-care hospital. Infect Control Hosp Epidemiol 1999; 20: 806-811.
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