By Kelly M. Pyrek
Any device that endeavors to protect healthcare workers from needlesticks and other percutaneous injuries is a benefit to the occupational safety and health agenda in healthcare institutions, but a recent study is asking clinicians to consider whether passive safety-engineered devices (SEDs) are most effective at reducing these types of injuries.
Tosini, et al. (2010) sought to evaluate the incidence of needlestick injuries (NSIs) among different models of SEDs (automatic, semiautomatic, and manually activated safety) in healthcare settings by examined all prospectively documented SED-related NSIs reported by healthcare workers. During this multi-center study, conducted from January 2005 through December 2006 in 61 hospitals in France, hospitals were asked retrospectively to report the types, brands and number of SEDs purchased to help the researchers estimate SED-specific rates of NSI.
The researchers report that more than 22 million SEDs were purchased during the study period, and a total of 453 SED-related NSIs were documented; the average frequency of NSIs was 2.05 injuries per 100,000 SEDs purchased. Passive (fully automatic) devices were associated with the lowest NSI incidence rate. Among active devices, those with a semiautomatic safety feature were significantly more effective than those with a manually activated toppling shield, which in turn were significantly more effective than those with a manually activated sliding shield. The researchers conclude that additional studies are needed to determine whether the higher cost of SEDs could be offset by savings related to fewer NSIs and to a reduced need for user training.
Lynn Hadaway, MEd, RN, BC, CRNI, principal of Lynn Hadaway Associates, Inc., an expert in infusion therapy and vascular access, says that one of the key aspects of the study is that redirects emphasis back on healthcare worker safety, something she says has "fallen off the collective radar screen" even though there are more devices in use in healthcare than ever before and the problem of needlestick injuries persists.
"The study is significant because it compares the designs of safety devices so you are comparing safety to safety," Hadaway notes. "In the past we have seen studies that compared conventional, non-safety devices to safety devices. This is the first study that I know of that has looked at comparing different safety designs so the first time we have had a well-designed study with hard data that has addressed this issue. Conventional wisdom has told us that the fewest steps required, and the least amount of handling and manipulation of safety devices required, the better you will be. This data seems to offer a significant volume of evidence to support that and emphasizes that passive designs do reduce the number of injuries."
Hadaway continues, "I think the general consensus is the fewest steps required by the operator to do the procedure are also critical, such as when inserting a catheter. The fewest changes to the traditional technique, the more successful you are going to be. The passive devices do not generally require an additional step you must take to activate the safety mechanism, therefore you use your traditional method for holding the skin and making the venipuncture and advancing the catheter; in other words you don't have to make any changes to your technique when using most of the passive devices. When you have an active device, then it is likely that busy healthcare workers overlook this step; they can get in a hurry and forget that step. When you give them an option to ignore the safety mechanism, it is quite likely that they will. But if it doesn’t require a change in technique and it's a comfortable procedure and there's no active step that has to be done to engage the safety device, everyone is safer."
There are numerous reasons why safety devices do not prevent NSI. As Tosini, et al. (2010) explain, "SED-associated NSIs may occur through mechanical failure of the safety feature, incomplete activation, user noncompliance, or an inherently risky activation procedure. Not all devices used for different types of invasive procedure have undergone the same degree of technical improvement, and SEDs of different generations coexist in the marketplace. Broadly speaking, SEDs are in two categories: active devices that require one- or two-handed activation by the healthcare worker after use and passive devices that are automatically operated throughout the use of the device."
The researchers classified SEDs according to the passive or active nature of the safety activation mechanism. Active devices were then subdivided into those with a protective sliding shield, those with a protective needle shield aligned to the bevel-up position and toppling over the needle, and those with a semiautomatic safety feature (such as an automatic safety feature requiring one-handed activation by pushing a button or a plunger).
Among the active SEDs, those with a manually activated protective sliding shield were significantly less effective than those with a toppling shield, which in turn were significantly less effective than those with a semiautomatic safety feature. Passive devices included in the study, self-retracting lancets (seven different brands), intravenous catheters (two different brands), and insulin pen needles (1 brand), were associated with the lowest NSI incidence rate. Self-retracting lancets accounted for 97 percent of the total number of passive devices purchased and for 40 percent of the number of NSIs by passive devices. SEDs with manually activated safety features were associated with 10.7 times more NSIs than SEDs with semiautomatic or automatic safety features.
