While infection preventionists are focusing their sharps safety efforts close to home, it's worthwhile to remind ourselves that from a global perspective, the U.S. must continually strive for improvement.
"We have been able to make some direct comparisons to other nations and we are really the cutting-edge country in terms of sharps safety," Jagegr says. "We've introduced more technology faster and we have made its use mandatory, so we have been ahead of all other countries in that regard. However, we have propagated our surveillance methods such that we can do direct comparisons among countries and what we have found every time, that compared to a country relatively equivalent to ours in terms of economic status, we have significantly higher injury rates per healthcare worker and per bed. This has always been a shock to us and to people in other countries because they expect us to have the lowest rates. So there is definitely something about our healthcare system that requires closer analysis. In the U.S. we have made huge efforts to compress healthcare into shorter periods of time; the average length of hospital stay is lowest in the U.S. compared to any other country. That means that we have invasive procedures that are performed within a shorter timeframe, so healthcare workers are handling more sharps devices under time-pressured circumstances and that translates to a higher risk of injury. Healthcare workers in the U.S. are at higher risk of injury than healthcare personnel in other countries because they have to perform more needle-based and invasive procedures. Because of this higher risk inherent in our healthcare system, I think we owe it to our healthcare workers to provide them with the technology that will afford them the best protection."
Expert Shares Thoughts on Consensus Statement
Elise Handelman, MEd., COHN-S, an occupational and environmental health consultant, is co-chair of the steering committee for the conference, “10th Anniversary of the Needlestick Safety and Prevention Act: Mapping Progress, Charting a Future Path” in November 2010 where the Consensus Statement and Call to Action were drafted. She shares her thoughts on the significance of this document:
“The Consensus Statement and Call to Action is the result of reflective, analytical and insightful thought by some the most notable researchers on this topic in the world. The conference where these recommendations were developed occurred in an atmosphere of creativity and openness that I have rarely seen.
She adds, "The recommendations are well grounded in research, they are feasible and compelling. For those who are committed to further prevent sharps injuries, this Consensus Statement and Call to Action provides a roadmap to get that done.
"My best hope is that practitioners, regulators, academicians, employers, professional organizations and manufacturers will use the solid ground of these recommendations to support them in their stand against bloodborne pathogen diseases and the tragedies that result from unintentional needlestick injuries."
The Sharps Safety Marathon: A Run Against Apathy
By Mary Foley, PhD, RN
This year marks a decade since U.S. healthcare facilities were required by federal law to comply with strengthened provisions in the Bloodborne Pathogens Standard to protect healthcare workers at risk of needlestick and sharps injuries.
I was honored to be part of the early struggle to secure the passage of these laws, and their enforcement by OSHA. During my career as a nurse, I was one of the many healthcare workers to combat the emerging HIV-AIDS epidemic during my work at Saint Francis Memorial Hospital in San Francisco in the 1980s. I later stepped up to secure the passage in California of the first state-based laws in the U.S. mandating the use safety medical devices.
During the 1990s, I joined other nursing and healthcare advocates to campaign for the adoption of the Federal Needlestick Safety and Prevention Act. This was a marathon-length effort by healthcare safety advocates. It was also a race against apathy.
After being elected president of the American Nurses Association (ANA), I was proud to stand alongside my colleagues in the Oval Office of the White House when President Bill Clinton enacted the Act into law in 2000. At the time, it seemed to us that we had finally crossed the finish line.
We were wrong. The race continues, and the end isn’t near.
There is no question that needlestick injuries have declined during the last 10 years within some areas. However in many other key areas, the risk of harm has not been significantly reduced.
For example, recently published data for reported needlestick injuries in Massachusetts healthcare facilities during 2010 found that slightly more than half of all incidents still involved devices that did not have a safety feature. Meanwhile, in some high-risk categories such as needles and syringes, the overall number of recorded needlestick injuries has remained largely stable since 2002, with safety engineered devices now causing a record 75 percent of all injuries.
I believe that particularly in recent years, the topic of sharps safety has once again begun to evoke apathy. Many within our industry feel as though it has slid down the list of healthcare list of priorities.
Many healthcare organizations including the University of Virginia's International Healthcare Worker Safety Center, the American Nurses Association and Safe in Common are now aligning together to fight apathy. We believe it’s time to generate new momentum behind the promotion and strengthening of Federal laws, raising awareness of needlestick safety and utilizing safer engineering controls.
As a result of these early efforts, the need to prevent needlestick injuries is now beginning to re-enter the national conversation. But now, as it was before, it’s still a race against apathy.
More programs and campaigns are needed to keep professionals up-to-date about needlestick and sharp injuries and to stimulate knowledge about new and better devices that have been created but not properly introduced into healthcare facilities.
Promoting a safer environment for staff and patients, and sharing safety messages and information about innovative products that align those two priorities will go far to helping eradicate apathy and optimizing protection to those at risk of harm.
One of the most important things healthcare personnel can do as they work each day is to help others learn how to care for themselves. By carrying that baton through the marathon, they will be better prepared to care for others.
Fighting apathy also needs to begin in the workplace. The healthcare environment needs to engage frontline personnel to hear their concerns and ideas surrounding innovation that will reduce the risk of needlestick injury and improve their safety.
The Consensus Statement and Call to Action generated by the International Healthcare Worker Safety Center and the ANA in March 2012 was an excellent step towards identifying the key risk areas for healthcare personnel exposure to bloodborne pathogens.
Outlined within the consensus statement are five pivotal areas that healthcare personnel today and tomorrow must rally around:
• Improving sharps safety in surgical settings
• Understanding and reducing exposure risks in non-hospital settings (which include physicians’ offices, clinics, home healthcare, and an array of other settings)
• Involving frontline workers in the selection of safety devices
• Addressing gaps in available safety devices, and encourage innovative designs and technology
• Enhancing worker education and training.
To support those pillars, healthcare personnel need to align with the myriad of professional organizations advocating on their behalf for better needlestick standards. That’s where organizations like Safe in Common can help.
We recognize that personal safety isn't front of mind for healthcare students and personnel. They are instead focused on taking good care of their patients. Too often, they put their own safety in second place.
There is an increased institutional focus on preventing injuries due to patient lifting and positioning. Due consideration also needs to be given to violence in the workplace. But these worthy initiatives should not come at the cost of ignoring exposures to bloodborne pathogens.
Needlestick and sharp injury exposures require a combination of activities by professional, purchasers, employers, and manufacturers. When that coalition works together on education, better equipment, and safer work practices, and sharing knowledge about devices that are available with better designs to provide a passive protection whenever possible (meaning the worker does not have to consciously activate safety features but the safety is built in) then there will be improvements and less apathy.
I encourage all healthcare personnel and safety advocates to take the Needlestick Safety Pledge.
Mary Foley, PhD, RN, is chairperson of Safe in Common, a non-profit organization established to enhance and save the lives of U.S. healthcare personnel at risk of harm from needlestick injuries. For more information visit www.safeincommon.org .