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By Kelly M. Pyrek
Capitalizing on the momentum created by a 2010 conference, a new consensus statement released this spring focuses on the future of the prevention of needlesticks and other sharps-related injuries and creates a road map for achieving improved occupational health and safety among healthcare workers.
The document, "Moving the Sharps Safety Agenda Forward in the United States: Consensus Statement and Call to Action," was drafted by members of the steering committee for the conference, “Tenth Anniversary of the Needlestick Safety and Prevention Act: Mapping Progress, Charting a Future Path,” held in 2010 and sponsored by the International Healthcare Worker Safety Center (IHWSC) at the University of Virginia. The recommendations contained in the consensus statement are based on the presentations, panels and informal discussions that took place at the conference. The speakers and participants represented a broad range of stakeholders relevant to the issue of sharps safety, including clinicians, researchers, and healthcare administrators, as well as representatives from government agencies such as NIOSH, CDC and OSHA, as well as professional associations and the medical device industry.
The consensus statement acknowledges that although the U.S. has led the efforts to address risks to healthcare workers from occupational exposures to bloodborne pathogens -- including regulatory and legislative measures such as OSHA's Bloodborne Pathogen Standard and the Needlestick Safety and Prevention Act (NSPA) and improved device design by introducing safety-engineered technology -- preventable sharps injuries and blood exposures continue to occur in U.S. healthcare settings. As the consensus statement notes, "In an increasingly complex and changing healthcare environment, we need a renewed commitment to achieve further progress."
Janine Jagger, MPH, PhD, director of the IHWSC and research professor of medicine at the University of Virginia, hopes the consensus statement can be used by infection preventionists to advance their facility's sharps safety agenda. "Each relevant party should look at the document and see what remains to be applied at the front lines of healthcare and bring these issues to the decision-makers in their institution," Jagger says. "For instance, safety policies in the operating room should be near the top of everyone's list. The consensus statement can be a point of departure for identifying safety policies and devices that remain to be implemented there. At the institutional level the evaluation process for selecting new products should be given a fresh look to assure that more effective products have not been overlooked and that an appropriate level of worker input has been maintained. They should review whether devices that are used together are compatible with each other. It's an opportunity for a top-down assessment of safety devices and policies and for renewing the discussion of safety with frontline healthcare workers to insure their input when device decisions are made.”
The Current State of Sharps-Related Injuries
Data from two large, multihospital sharps injury surveillance networks provide a picture of where sharps-injury rates stand today -- the EPINet Sharps Injury Surveillance research group (EPINet-SIS) coordinated by the IHWSC and the Massachusetts Sharps Injury Surveillance System (MSISS), maintained by the Massachusetts Department of Public Health (MDPH). In 2007, a total of 29 hospitals (one each from Nebraska, Pennsylvania and Virginia, the rest from South Carolina) contributed data, with an aggregate of 951 sharps injuries (SIs) reported and an average injury rate of 28 SIs per 100 occupied beds. In Massachusetts, all hospitals are required to report sharps injury data to the MDPH; this was mandated by a state law in 2001, and collection of data began in 2002. For 2008, 99 hospitals contributed data, with a total of 3,126 SIs reported and an average SI rate of 17.2 per 100 licensed beds. For both EPINet-SIS and MSISS, rates varied according to teaching status and hospital size, with substantially higher rates typically seen for teaching hospitals and hospitals over 300 beds (with the two being closely correlated (i.e., teaching hospitals tend to be large hospitals).
According to the consensus statement, nurses sustained the largest share of injuries in both EPINet and MSISS data—34 percent and 38 percent, respectively. Sharps injuries occur most often in the surgical setting (EPINet: 36 percent; MSISS: 32 percent) and patient rooms (EPINet: 23 percent; MSISS: 22 percent). A large proportion of injuries are sustained by workers other than the original user of the device. In EPINet-SIS data from 2007, 30 percent of sharps injuries were sustained by such workers, including clinicians, housekeepers, laundry and waste management personnel, and even administrative staff.
As the document notes, "Clearly, we still have much room for improvement. The data show that while the U.S. has been successful in significantly reducing sharps injury risk to healthcare workers in most hospital settings, challenges remain, particularly in surgical and non-hospital settings. Healthcare is increasingly being provided outside of hospitals, such as practitioners’ offices and clinics, patient homes, rehabilitation centers, and long-term care facilities. This shift is expected to continue well into the future; yet these are the very settings in which enforcement of the BPS has been weakest and implementation of safety-engineered devices, according to market data, has been lowest. We believe that our healthcare workers represent a critical national resource, and that we should do everything we can to protect them from harm while they care for others. We also believe that healthcare worker safety is a crucial component of patient safety, and of the overall safety and quality of the healthcare environment."
Jagger emphasizes that although there is more progress to be made, we must not lose sight of the accomplishments made by the healthcare industry working together to address sharps injuries.
"Despite the fact that with this consensus statement we're focusing on what still remains to be done, I think we should recognize that we have come a long way, and integration of safety devices is one aspect of it in the overall reduction in risk of bloodborne pathogens to healthcare workers," Jagger says. "In the past 20 years there have been tremendous progress made, and all of the parties involved deserve some encouragement and congratulations for their participation in bringing about tremendous change. For example, It's remarkable how the entire medical device industry has stepped up to the plate because we were asking them not just for a new device, but for a whole new generation of devices. And the retooling of industry has been massive."