It takes a blitz to promote needle safety
NIOSH shows change in attitude, behavior
Changing habits is a lot more difficult than switching to safety devices. Almost five years after passage of a federal law requiring the use of safer sharps, hospitals still are struggling to reduce needlesticks and sharps injuries.
It’s time for an all-out blitz. Presenting your message for four to six weeks in many different formats — posters, presentations, newsletters, incentives, safety fairs — can boost awareness and reduce injuries, according to research by the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati.
Pre- and post-blitz surveys showed changes in knowledge and attitudes. At one hospital, the proportion of respondents who knew about the relative risk of contracting hepatitis C from a blood or body fluid exposure rose by 46%. At another hospital, the number of respondents saying, “I worry about the risk of blood/body fluid exposure to members of my surgical team” rose significantly.
Even the use of blunt suture needles rose at one hospital that focused on OR sharps safety.
“We can say that, as a result of the blitz, if you have sufficient support for sharps safety from management, doing a blitz will likely result in an improvement in behavior in the workplace,” says Ray Sinclair, PhD, NIOSH health communications researcher and coordinator of the project.
A blitz can be an effective way to get the message across in the OR, where surgeons and employees otherwise may be resistant to change, notes Alice Weiss, RN, performance improvement coordinator for surgical and anesthesia services at Palmetto Health Richland in Columbia, SC.
“It directly increases awareness of the risk and awareness of what is happening in their hospital,” she says. “It provides them with a list of behaviors and practices they can institute.”
Creating a blitz is fundamentally different from standard sharps safety training, says Sinclair. NIOSH is drafting guidance on how to conduct a blitz, but here are some initial pointers:
• Plan a sustained campaign. A blitz differs from other sharps safety training in its intensity. This isn’t just a one-hour seminar, or a set of snazzy posters placed around the hospital. The blitz is tailored to each hospital, but it always involves many different ways of getting out the message, Sinclair says. “It comes from communication theory that you do multiple messages using multiple means of communication. Too often, people put up a series of posters and think that’s enough.” Keep the message going for at least several weeks, and then repeat a version of the blitz about once a year, he advises. “You have to have a sustained program if you’re going to get sustained results.”
• Focus on your problem areas. NIOSH conducted a blitz at four acute care hospitals, one cardiac specialty hospital, and a nursing home in the Columbia, SC. Each blitz was tailored to the needs of the hospital. For example, Baptist Hospital wanted to improve compliance with eye protection in the OR, so a portion of the blitz focused on that issue. The hospital brought in new eyewear and had a contest with rewards for the surgical team that had the highest compliance with eyewear rules during a blitz week. Sinclair advises using the hospital’s exposure data to determine which areas of the hospital to target with a blitz. Facilitywide blitzes can be beneficial, but a focused blitz can attack one problem area. For instance, you may discover the OR only has 5% of the hospital’s employees but 25% of the exposures. Reducing exposures there can have a big impact. “It’s difficult to focus on everybody in an awareness campaign that’s going to be really effective,” he says.
• Involve opinion leaders. Success depends on leadership, Weiss notes. “You’ve got to have an influential physician or physicians and representatives from all the involved groups — surgical techs, circulating nurses, anesthesiologists, environmental services, even sterile processing.” You’ll need a physician champion and commitment from top leadership to change longstanding behavior, she says. If you decide to bring in new devices, you’ll need financial resources and someone who can influence change. In the blitzes, NIOSH brought in experts to talk about sharps safety, particularly in the OR. But outside speakers aren’t necessarily the most convincing. “It’s better to have local people who are opinion leaders in their own community,” Sinclair says.
• Provide feedback. In addition to surveys, NIOSH used behavior observation before and after the blitz to gauge progress. “It’s very, very telling,” Sinclair explains. “It will give you a wealth of insight about where the main problems are and how you improved.” Weiss regularly posts information about exposures in the OR and provides information by job classification — anesthesia, scrub techs, nurses, residents. But she notes, with greater awareness about sharps safety, you actually may have an increase in exposures as your reporting improves. How-ever, after the initial increase in exposures as a result of improved reporting, the facility likely will see a decrease in exposures. Weiss also encourages employees to complete an occurrence report when they have a near miss. “We believe we’ve gotten an improved reporting system, and the employees know they have the support of management and that they want these things to be reported.”
• Follow up after the blitz. A blitz alone won’t transform needle safety in your hospital. It’s just a beginning, but it can provide momentum for change, Weiss notes. “It jumpstarted a continuing focus on sharps safety in the OR.” For example, she found three safety scalpels that have a similar feel to the conventional version and would be acceptable to surgeons. They planned to select one of the three to adopt in the OR. Weiss also continues to share information on blood and body fluid exposures. She has focused sharps safety training on new residents and constantly looks for new safety engineered devices. That long-term commitment is essential, she says. “If you want to make behavioral changes, there has to be something that follows up on the blitz. That has to be prepared before the blitz ever starts.”
Changing habits is a lot more difficult than switching to safety devices. Almost five years after passage of a federal law requiring the use of safer sharps, hospitals still are struggling to reduce needlesticks and sharps injuries.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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