A Sharp Learning Curve: New Nurses and Needlesticks
January 1, 2023 3 minutes read
By Gary Evans
There is some concern incoming nurse graduates whose training was compromised by the COVID-19 pandemic may be vulnerable to needlesticks in clinical settings.
“With COVID, we saw nursing students not allowed in hospitals, and so the training became essentially virtual,” said Nancy Yuill, PhD, RN, a nurse education consultant and former president of Chamberlain University Nursing School in Pearland, TX. “We have a whole group of new nurses coming out of the education systems who are not well trained in the use of sharps.”
Yuill spoke on a podcast presented by the Association of Occupational Health Professionals in Healthcare (AOHP).1 A related finding was presented as a poster at the 2022 AOHP conference. The retrospective evaluation of sharps injuries sustained by registered nurses from January 2020 through June 2020 included a root cause analysis. In that period, 47 nurses suffered needlesticks. Of those injured, “68% were between the ages of 19-25, with 54% reporting a job tenure of one to two years,” the authors reported. “Technique was the primary cause of the sharps injuries among the RNs. Recent RN graduates had the highest rate of sharps injuries in this study. Training and education on sharps injuries and mitigating strategies should be an integral part of orientation for new RN graduates.”2
Hospital administration and occupational health should prioritize training and education of new RNs. “Results suggest that tenure, patient behavior, and technique were potential root causes of sharps injuries among RNs during the timeframe,” the authors concluded.
“We did have a slight increase in nursing students [exposures] from 2020 to 2021. That could very well have come into play,” Amber Mitchell, DrPH, director of the International Safety Center, said during the podcast. “The mucocutaneous exposures are mostly to nurses at the bedside. The majority of those exposures are happening to the eyes. Even with the COVID pandemic going on and more awareness about eye protection and face protection, we saw increased face mask use — but not eye protection and face shields. That was surprising to us.”
Some Safety Features Are Unfamiliar
In a breakdown of the 2021 data, the sharps exposures were roughly divided primarily between physicians and nurses.
“Physician injuries are mostly occurring in operating rooms and surgical environments,” Mitchell said. “Suture injuries are No. 1, mostly in physicians in the operating room and emergency department. The other exposures are mostly to nurses responsible for patients. [Needlesticks with] hypodermic disposable syringes have skyrocketed with mass vaccination programs for COVID and insulin injections related to type 2 diabetes due to increasing obesity. The third [highest injury] goes back to physicians, which is mostly with scalpels that do not have sharps injury prevention features on them.”
The problem with this instrument and other devices is safety features sometimes are too different from the equipment clinicians trained with.
“Going from a heavy stainless-steel scalpel to a plastic disposable scalpel is a very different feel,” Mitchell noted. “They are hesitant. That’s another reason it is important to do simulations and have medical device manufacturers work with us.”
Blunt suture needles are similarly underused, resulting in many of the suture injuries. “There are safety technologies now for skin closures, like adhesives and staples, that substitute out that suture [needles], but if you are constantly training to do skin closure with a sharp suture [needle], the learning curve is very high for a different kind of technology,” Mitchell said.
The failure to replace dangerous sharps with safety devices poses a downstream injury risk to laundry workers, housekeeping, and central sterile supply. “About 25% of injuries are to non-users of the needle,” Mitchell said.
REFERENCES
- Association of Occupational Health Professionals in Healthcare. AOHP Caring for Healthcare Professionals Podcast — Episode 42 — Needlestick and sharps injury prevention. Oct. 2, 2022.
- Stallard C, Heaton K, Montgomery A, et al. A snapshot of sharps injuries to RNs working in a large urban health system. Poster 2022PP002. AOHP Conference, Austin, TX. Sept. 2022.
There is some concern incoming nurse graduates whose training was compromised by the COVID-19 pandemic may be vulnerable to needlesticks in clinical settings.
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