Twelve Years After Legislation, Sharps Safety Still a Concern in All Healthcare Settings

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On Nov. 6, 2012, U.S. clinicians and sharps-device manufacturers celebrated the 12th anniversary of the Needlestick Safety and Prevention Act. Since the legislation was signed into law, the number of needlestick injuries decreased by one-third; however, the numbers of healthcare personnel at risk of injury can be staggering. Some numbers to consider:
- Approximately 150 million doses of flu vaccine will be administered across the U.S during the influenza season (one injection will be given to almost 1 in every 2 U.S. citizens).
- OSHA says 5.6 million workers in the U.S. healthcare industry are at risk of occupational exposure to bloodborne pathogens via needlestick injuries
- The CDC says that 385,000 needlestick injuries and other sharps-related injuries are sustained annually by hospital-based healthcare personnel.

Currently, the European Union (EU)’s Health and Safety Executive is reviewing the need for needlestick regulations, with a May 2013 deadline. Mary Foley, PhD, chairperson for Safe in Common, a non-profit organization established to promote needlestick safety within the United States, has been speaking with the UK press on her recommendations for how the EU can learn from and build upon the mistakes of the U.S., including ignoring healthcare personal who work in clinics and physicians' offices who are still at high risk for sharps-related injuries. ICT sat down with Mary Foley to discuss these issues.

Q: As you travel around the country working with Safe in Common, what are you hearing from clinicians in terms of ongoing sharps safety-related issues? 
A: As I travel with Safe in Common (SIC), I am struck by two important findings. 1) Healthcare workers are anxious to talk about needlestick and sharp injuries, and are grateful that Safe in Common is working to raise this as an important issue in healthcare again, and 2) that workers are reporting injuries they continue to sustain. From student nurses to environmental workers to direct-care practitioners, not all equipment is safe, and even safety-engineered devices are leading to injuries.

Q: What are the lingering challenges in inpatient facilities? Outpatient facilities? 
A: I would have to acknowledge that acute-care facilities have in large part adopted safety engineered devices.  Many are the "first generation" devices that were released immediately after the passage of the 2000 Needlestick Safety and Prevention Act.  Many of those devices meet the intent of the law, but are not integral to the product, and require the healthcare worker to activate the protection. That are not passive or automatically safe. Many require two hands, or steps that my be difficult to perform in the heat of the delivery of care. However, in acute care, surgical settings continue to be areas of high risk, and that is the result of both the many "sharp" devices such as sutures scalpels, and towel clips. So, if the devices are not easily modified, the practices must be. That requires a change in behaviors, and that is not easily achieved. Outpatient/clinic/home care settings are relatively unstudied. Little is known either about the best devices, specific risk issues, or remedies to those concerns. Like surgery, non-acute care is in need of a concentrated focus to reduce risk and improve safety.
 
Q: Twelve years have passed since the needlestick legislation – what has been accomplished and remains undone?
A: A lot has been accomplished but ongoing enforcement has been lacking, attention to non-acute settings has been absent, and newer and better devices are not making their way to practice settings. The focus on patient safety, while very important, has diverted the attention to worker safety. Instead, both safety agendas should be integrated, and priority given to work in both arenas. 

Q: Based on your experiences, and upon the Consensus Statement and Call to Action issued earlier this year, what should be the agenda moving forward?
A: The consensus statement helps focus the conversation on the "unfinished agenda" and should be a roadmap to what needs to be accomplished so the U.S. can really say it addressed the issue of sharp injury prevention in a comprehensive manner. I have always been impressed by Dr. Janine Jagger's work, and she not only introduced the notion of safer devices starting in the 1980s, but she continues to remind us of work that needs to be completed.

Q: What lessons from the U.S. should the UK consider, now that they are taking under advisement what our country has experienced? What has your experience been in the UK?
A: This is an opportunity for the UK to learn from the good work of 2000. Focus on non-hospital care, surgery, and special populations cannot be understated, and be sure that is built in to the current work. Also, be sure to require adequate enforcement efforts, or the non-acute settings will again slip through the cracks.

Q: What are your concerns about influenza season and safety-engineered devices?
A: My concern about the flu campaign is that many pharmaceutical companies make the drug, and then distribute it without any safety device built in. These products go to physician offices, grocery stores, and health departments across the country. Flu clinics include parking lots and airports, and without safety features, these devices put large numbers of skilled, and non-skilled staff at risk for injury. Not only is the care provider at risk, but so are the communities in which those devices will be disposed. That is wrong!  Protecting the public should not be traded off for risks to the care provider, or the community.

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