Needlesticks and sharps injuries once were a hot topic in risk management, but in recent years they may have fallen off the priority list at some healthcare facilities. The risk remains and should be addressed with a comprehensive strategy.
The issue was another unfortunate result of COVID-19, says Marie K. Moss, MPH, RN, BSN, CIC, CPHQ, FAPIC, a member of the Association for Professionals in Infection Control and Epidemiology's Communications Committee. Like many other concerns, needlesticks and sharps injuries fell by the wayside as healthcare providers struggled with the demands of the pandemic.
“We have to educate healthcare workers on infection prevention principles that they knew before COVID. Everything sort of went out the window in terms of what people knew because their heads were filled with worry and concern and issues with regular work practice issues,” Moss says. “Now, we have to go back to what we were doing. One of those things is getting healthcare workers educated on sharps injury prevention.”
Needlesticks are underreported, partly because healthcare workers are concerned that they will be blamed for a mistake or because they do not think the exposure is significant enough to report.
“If I get scratched with a needle and I touch the patient’s skin, and then I touch my pierced skin, I may decide that that’s not really a big deal and I’m not going to report it,” Moss says. “The healthcare worker can make decisions about what they think should be reported and what’s not a big deal.”
Those workers may start to worry later about possible exposure, but post-exposure prophylaxis should be provided within two hours, Moss says. By the time they are awake at night worried about hepatitis or HIV, the optimal window for treatment has passed.
To address the problem, Moss advises risk managers to study occurrence reports, looking for clues as to how, where, and when sharps injuries occur. There may be commonalities that can suggest ways to improve sharps safety. For example, a facility may experience sharps injuries from overfilled disposal containers, which Moss says is a common problem.
Sharps containers have a fill line at two-thirds, but they commonly are filled past that point because the box appears to have plenty more room, Moss explains. Even when facilities invest in safer sharps technology, people may not use it correctly.
“I might give you an intravenous catheter or a butterfly needle where you can press a button and the needle or guidewires are trapped. But if you don’t activate that because you don’t understand how to use it, you put it in the sharps container with a needle exposed,” Moss says. “Then I come along and throw away my needle, which may be covered, but I get stuck with that needle that wasn’t.”
Similarly, workers may properly use a device that retracts the needle before disposal but then think that makes the item safe to throw away in a regular trash bin, Moss notes. It does not.
“We need to train people every year to make sure that everybody is aware of how to use all the sharps devices and to make them knowledgeable about not recapping, and how to passively cap a sharp, if necessary,” Moss says. “There has been a loss in this knowledge and the importance of protecting themselves and others from sharps. We have to address this gap.”
SOURCE
- Marie K. Moss, MPH, RN, BSN, CIC, CPHQ, FAPIC, director, Department of Infection Prevention and Control, Mount Sinai Beth Israel, New York City. Phone: (212) 420-2000.
Needlesticks and sharps injuries once were a hot topic in risk management, but in recent years they may have fallen off the priority list at some healthcare facilities. The risk remains and should be addressed with a comprehensive strategy.
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