New needlestick law means take steps now
(Editor’s note: This is the second of a two-part series on needlesticks and the emergency department. This month, we cover prevention of needlestick injuries and reporting requirements.)
As an ED manager, you have more incentive than ever to prevent and track needlestick injuries.
"Eliminating needlesticks can save hospitals thousands of dollars for treatment and make employees much safer and happier, as well," says Barbara Pierce, RN, MN, director of emergency services for Huntsville (AL) Hospital System.
A 1999 compliance directive from the Washington, DC-based Occupational Safety and Health Administration includes a requirement for you to involve employees in the selection and evaluation of safer needle devices. (See safer needle devices vendor listing, in this issue.)
Months later, the Needlestick Safety and Prevention Act was passed. The new federal law requires you to track needlestick injuries with a sharps injury log recording the following information:
• the type and brand of device involved in the incident;
• the department or work area where the exposure incident occurred;
• an explanation of how the incident occurred;
• the information must be recorded and maintained in a way that protects the confidentiality of the injured employee. (See sharps injury log.)
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You have to make needlestick prevention a priority, urges Pierce. "It is our safety initiative for this year," she reports. "We monitored areas with the highest rates and intervene, conducted a housewide survey, and formed task forces." (See sample sharps action plan.)
Sharps Action Plan
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Source: This chart has been excerpted from The California Guide to Preventing Sharps Injuries and is reprinted with permission of the California Healthcare Association. The cost is $35 for the manual or $55 for a manual with a Microsoft Word disk, plus $5 per item for shipping. To order the manual, contact: California Healthcare Association, Publishing Sales Center, 1101 North Market Blvd., No. 9, Sacramento, CA 95834. Telephone: (800) 494-2001 or (916) 552-7522. Fax: (916) 928-1643. E-mail: [email protected]. To obtain copies of the order form, go to the Web: www.calhealth.org. Click on "resources" and then "publications."
Source: This chart has been excerpted from The California Guide to Preventing Sharps Injuries and is reprinted with permission of the California Healthcare Association. The cost is $35 for the manual or $55 for a manual with a Microsoft Word disk, plus $5 per item for shipping. To order the manual, contact: California Healthcare Association, Publishing Sales Center, 1101 North Market Blvd., No. 9, Sacramento, CA 95834. Telephone: (800) 494-2001 or (916) 552-7522. Fax: (916) 928-1643. E-mail: [email protected]. To obtain copies of the order form, go to the Web: www.calhealth.org. Click on "resources" and then "publications."
Here are ways to comply with prevention and reporting requirements:
• Have an internal reporting mechanism.
This reporting mechanism should provide for confidentiality, swiftness in reporting, the ability to alert all appropriate personnel (infection control, risk management, employee health), and a way to follow up, says Darlene Matsuoka, RN, BSN, CEN, CCRN, ED clinical nurse educator at Harborview Medical Center in Seattle.
"The physical needs of the injured employee take precedence," she stresses. "There should be a system set up for employees to be screened and treated in an expeditious manner."
At Harborview’s ED, an incident report is filled out in triplicate and submitted to the nurse manager. "She ensures proper treatment was done and routes it to the appropriate departments for follow-up," says Matsuoka. If the injury occurred during the day, the employee reports to employee health. If it occurs after hours, the employee goes to the ED.
In either location, the puncture is treated, the employee’s blood drawn, and prophylaxis is started as necessary, Matsuoka explains. "Prophylaxis is started only within a small time window and if the source patient was high-risk," she says. "The source patient is also tested as able."
The incident report then goes into a computer database, so trends can be monitored and individual data pulled up as needed, says Matsuoka.
A central person needs to review all the data on sticks to identify trends, says Pierce. "You need to find repeat injuries due to equipment design flaws and behavior patterns," she says.
• Do a walk-through of the ED.
As you examine storage areas in your ED, ask the following questions, says Pierce:
— Is equipment convenient for the staff to get? For example, are needle boxes at the right height and in the right places?
— Is there an adequate supply for the patient volume?
— Are there any obstacles to access?
Identify and eliminate any barriers to staff use, Pierce says. "Ask staff where they feel equipment should be," she suggests.
• Ask staff to test equipment.
Have staff try out equipment and provide input, Pierce advises. "We have replaced gloves that the staff did not like and that didn’t hold up to the wear and tear of the ED environment," she says. "We also recently changed out all of the needle boxes related to a poor design which led to injuries of the staff."
Equipment is changing rapidly, so ensure that you are using the best possible devices to protect the staff, says Pierce. "A common complaint about wearing goggles is blurred or distorted vision. So to avoid splash exposure, we are looking at ordering prescription goggles for staff," she reports.
• Make sure staff comply with universal precautions.
Wearing universal precautions must be a performance expectation, urges Pierce. "Don’t allow the staff any room for choice," she says.
Enforcement is a challenge, Pierce acknowledges. "First, you have to clearly define the expectations and what to wear for what procedure. For example, this may include gloves, gown, or mask," she says.
If staff don’t comply, follow the hospital disciplinary policy as needed, including verbal and written warnings, Pierce advises. "The public expects that staff will wear gloves and use proper gear," she says. "Many have complained when staff fail to dress out appropriately. Respond to these complaints."
Reward "good behavior" when possible, Pierce recommends. "Remind staff to dress out when they are not, hand them gloves or goggles as needed, and give positive feedback," she says. "Staff respond better to positive action, but when nothing else works, then discipline is the answer."
Pierce recommends using leadership to role-model appropriate behavior. "We tried a campaign with catchy pictures of ED doctors and key people wearing gloves," she says. "It had some success and brought some attention to the problem."
• Educate staff.
Any staff involved in patient care needs to be trained and re-trained annually in needlestick injury prevention, says Pierce. She recommends that the following topics be covered:
— epidemiology, including needlestick statistics, the costs to the hospital for exposures, and the risks (hepatitis C, HIV, etc.);
— how to protect yourself;
— proper disposal of sharps;
— the gear to wear and when to wear it;
— what to do if you are stuck.
Staff should be counseled after needlestick injuries, recommends Pierce. "This is for education and not discipline. They need to understand what happened and how to change their behaviors — for example, recapping — so that it won’t happen again," she says. "They can be sent for repeat training as needed."
Staff behavior can be changed only if they understand the impact if they fail to change, Pierce says. "Awareness is key," she adds. "You cannot totally eliminate needlesticks, but they can be minimized with behavior changes, equipment changes, and education."
Sources
For more information about preventing and reporting needlestick injuries, contact:
• Darlene Matsuoka, RN, BSN, CEN, CCRN, Harborview Medical Center, Emergency Department, Mail Stop 359875, 325 Ninth Ave., Seattle, WA 98104. Telephone: (206) 731-2646. Fax: (206) 731-8671. E-mail: [email protected].
• Barbara Pierce, RN, MN, Emergency Services, Huntsville Hospital System, 101 Sivley Road, Huntsville, AL 35801. Telephone: (256) 517-8202. Fax: (256) 517-2982. E-mail: [email protected].
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