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Using Safer Devices, Following Hierarchy of Controls Can Cut Sharps Injuries

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Continued from page 1

In healthcare, the hierarchy is adapted to sharps injury prevention, and, according to WHO, the first of the adapted five guidelines, elimination of hazard, involves eliminating use of a sharp, using needle-less systems, and avoiding unnecessary injections as much as possible; the second, engineering controls, involves using SEDs such as needles that actively or passively retract, sheathe or blunt immediately after use and safety-engineered sharps containers; the third, administrative controls, involves allocating resources to and implementing policies and programs that demonstrate commitment to HCW safety -- such as needlestick prevention committees and education and training on SEDs -- as well as policies and procedures that outline, monitor and enforce universal (standard) precautions; the fourth, work practice controls, refers to good practices in handling sharps such as not recapping needles, placing sharps containers at eye level and at arm’s reach and emptying sharps containers before they are full; and the fifth, PPE, simply reinforces that HCWs need to use mandatory devices that provide barriers and filters between themselves and hazardous situations such as gloves, shields and gowns.55

“For healthcare personnel, No. 1 in the hierarchy of controls is eliminating the sharp whenever possible,” Mitchell says. “No. 2 is use SEDs whenever possible. No. 3 is to use no-hands passing technique, or passing a contaminated sharp not by hand, but by placing it onto a surface in a safe zone like a tray for the other person to pick up. No. 4 is really good communication: ‘This is what I’m going to use, this is when I’m going to use it,’ and so forth. The team needs to be alerted when someone is using a device that could potentially result in an injury. And No. 5 reminds personnel to wear appropriate PPE.”

At the administrative level, facilities should do their part to protect employees from sharps and BBF exposures by developing and implementing strategic initiatives. Healthcare facilities should focus on re-evaluating and updating their occupational safety and injury prevention guidelines, monitoring systems used in tracking HCW compliance, and their exposure reporting and control protocols.56 

Implementing educational and training programs on general precautions, using facility-specific SEDs correctly, safe disposal of devices and other topics is an important consideration in injury prevention plans.57-58 Healthcare facilities should also update and enforce reporting strategies as part of their injury prevention programs.59

Another consideration in developing tailored preventative strategies is quality of the work environment, which can be influenced by staffing levels and other working conditions. Poor organizational climate and high workloads have been associated with 50 percent to two-fold increases in the likelihood of sharps injuries and near-misses to hospital nurses.60 Also, a growing body of research also describes the impact of physical and emotional limitations like fatigue and stress, upon exposure rates.61

Healthcare facilities should use some form of surveillance to monitor facility-specific trends in sharps injuries and BBF exposures.(62) One way is to maintain an exposure log for incidence reporting, listing where and how an injury occurred as well as the type and brand of device used, which should be regularly reviewed to identify trends, possible flaws in design and behavior patterns.63-65 Post-exposure plans should also involve evaluation, counseling, treatment and follow-up of the exposed individual.66 Common reasons for not reporting are believing that the risk of infection from the exposure is low, inadequate understanding of reporting systems and assuming that reporting is difficult.67

“In the future, important considerations include enforcing compliance at the facility and even industry level as well as funding for worker health and safety initiatives,” Mitchell says. “Also, risk management and injury prevention should be expanded into a broader safety system that protects not only the device user but other HCWs like the waste disposal worker collecting sharps disposal containers and the laundry worker finding used needles in the laundry. Holistic, cross-functional approaches like these are going to be important moving forward.”

Elizabeth Srejic is a freelance writer.

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