The Sharps Safety Agenda: Acknowledging Past Progress, Working Toward the Future

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The Recommendations

Let's take a look at the recommendations contained in the consensus statement:

1. Improving Sharps Safety in Surgical Settings
A study published in 2010 showed that despite the revised Bloodborne Pathogens Standard and advances in sharps safety technology, sharps injuries in surgical settings from 2001 to 2006 increased by 6.5 percent, while injuries in all other hospital settings decreased by 31.6 percent. The study also indicated that the majority of injuries in the surgical setting are caused by suture needles and scalpel blades, with a significant proportion sustained during instrument passing and after use. The consensus statement says that blunt suture needles, which can prevent injuries during suturing of internal tissue and fascia—injuries which account for about one-third of suture needle injuries overall—are currently vastly underutilized by U.S. surgeons, despite recommendations from the American College of Surgeons (ACS), the Association of periOperative Registered Nurses (AORN), and other professional associations.

"We are focusing on what is still left to do, and much of it is very feasible to accomplish," Jagger says. "It's not that these things are difficult to do but they are things that have been overlooked, especially in the operating room. There are so many well-conceived strategies that have yet to be fully implemented. That's one area in which I would like to see real institutional pressure brought to bear because that's the toughest part of the institution in which to get change. So infection preventionists need to engage the decision-makers in the OR. The device decisions made by the surgeons affect everyone else in the operating room; you have more injuries from suture needles to operating room staff than to surgeons but it's the surgeons' choice of device that is made. Surgeons need to take into consideration their responsibility to staff. I think that is the most difficult consideration of all --  the consideration for the patient is primary, but there is also consideration for the surgical technique and what is convenient for the surgeon to use, and the consideration of the surgeon of the safety of OR staff. Institutional leadership in taking those perspectives into consideration is needed."


Jagger suggests that a solid cost argument can help infection preventionists get the attention of their facility's administrators so that safer instruments such as blunt suture needles are implemented in the surgical suite, especially when sharp suture needles cause such a high proportion of injuries in the OR. "Some ammunition that has not been used is that blunt suture needles are the one safety device where you have net cost savings in prevention of injuries because the cost of the blunt needles is so close to the cost of the sharp needles -- all of the prevention becomes tangible savings with every needlestick averted.," Jagger explains. "People always bring up the cost of safety devices as an issue to overcome, and this is one device category where they have the cost issue on their side. So going to the OR manager and administration and showing the cost argument is an unused type of leverage which should be a big opportunity for infection preventionists. This is the one device where you have real net savings, so hammer that message home."

The recommendations from the consensus statement are:
- Institutions adopt a site-specific sharps safety policy for the OR. Such a policy should mandate the availability, training, and use of specific sharps safety devices and implementation of risk mitigation strategies outlined by the ACS and AORN. When available and reasonable, users should be able to choose between several comparable and effective safety devices or personal protective equipment (scalpels, gloves, goggles, etc.) to suit their individual work practices, body sizes, and comfort. Sharps safety should not be an individual choice, since many injuries are sustained by workers other than the original users (and choosers) of devices.
- Surgeons, OR nurses and other surgical personnel work cooperatively to develop sharps safety standards and practices that are consistently implemented and followed in all surgical environments.
- Professional groups and manufacturers join forces to encourage the use of blunt suture needles for appropriate applications.
- OSHA place greater emphasis on Bloodborne Pathogen Standard compliance in surgical settings by evaluating overall adoption of safety devices to eliminate or minimize exposure risks. For example, compliance officers should determine if a facility encourages the use of blunt suture needles when clinically appropriate.

2. Understanding and Reducing Exposure Risks in Non-Hospital Settings
The consensus statement reports that personnel in non-hospital settings account for about 65 percent of the U.S. healthcare workforce. While safety-engineered devices are in widespread use in most hospitals, data show that their use in non-hospital settings (including home healthcare, long-term care, doctors' offices and ambulatory surgery centers) has been much less consistent. The consensus statement explains further that "Valid and reliable sharps injury data from non-hospital settings is limited; a critical need exists for data that specifically target these different environments, each of which has a unique risk profile. Studies by two research groups, one examining exposure risks to home healthcare workers and the other risks to paramedics, have begun to fill in the overall picture, but more such setting-specific studies are needed."

The recommendations from the consensus statement are:
- Health and Human Services agencies such as CDC/NIOSH and other government and non-governmental agencies and professional organizations support epidemiological research that evaluates risks to workers in a wide range of non-hospital settings.
- OSHA promote regional emphasis programs that focus on enforcement of the Bloodborne Pathogen Standard in non-hospital settings; further, that other relevant groups, such as accrediting and licensing bodies and healthcare and workers’ compensation insurers enhance compliance incentives for non-hospital employers.
- Professional organizations and medical product distributors for non-hospital care settings collaborate to make sharps safety a priority and ensure that appropriate devices and educational and training materials are available which are targeted for workers in these settings.

3. Involving Frontline Healthcare Workers in the Selection of Safety Devices
Anecdotal evidence suggests that frontline healthcare workers are not consistently involved in the selection of safety devices. However, the Bloodborne Pathogen Standard requires that workers— those who will actually be using the devices—be included in annual device evaluations. Also, hospitals may be inclined to base decisions about safety devices on cost, but cost alone cannot be the main criteria for selection. An OSHA Letter of Interpretation, issued in 2002, states that “selecting a safer device based solely on the lowest cost is not appropriate. Selection must be based on employee feedback and device effectiveness.”  The consensus statement says that "Employers should make input from workers a priority in selection criteria, and need to weigh the relative efficacy of different safety devices for particular applications. Which devices do workers prefer and why? Have improvements been made in device technology? At a time when the pressure to reduce healthcare costs is intense, it is important to keep these user-oriented questions at the forefront of device selection."

The recommendations from the consensus statement are:
- Organizations representing healthcare workers educate members about the legal obligation of employers to include frontline workers in the selection of safety devices. Members need to be encouraged to participate in this process.
- Hospital and healthcare employers consistently involve frontline healthcare workers in the selection and evaluation of safety devices, as is their obligation under the Bloodborne Pathogens Standard. Employers also need to enlist frontline workers in regular and systematic assessment of the devices currently in use in their institution, to ensure such devices are appropriate and, according to OSHA, “eliminate or minimize employee exposure” to the “lowest feasible extent.”
- NIOSH or another government agency consider funding research to assess whether and to what extent the requirement to include healthcare workers in the device selection process is being met in facilities across the country, and the ways in which this is being done. This research could provide the basis for developing a model program for frontline worker participation in device selection and evaluation.

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