Sharps Safety Device Program Meets with Success
By Virginia Slocum, RN, CIC
From left: Karol Redline, Lab Manager, Barbara Bilconish, Professional Practice, Jeannie Brower, Professional Practice, Linda Bradley, Shore Works Employee Health, and Ginny Slocum, Manager of Infection Control.
Issue: Occupational exposure to hepatitis B and C, viruses, HIV, and other bloodborne pathogens poses a significant risk to HCWs, especially to those with involvement in direct patient care. Implementation of a sharps safety device program will reduce the risk of occupational exposure to bloodborne pathogens.
In 1997 the administration of Shore Health System determined it would provide safer environment for our employees related to needlestick injuries, and efforts would made to reduce their exposure to bloodborne pathogens.
We formed a task force that included representation from nursing, laboratory, professional practice, employee health, pharmacy, materials management, and infection control. This Healthcare Worker Safety Task Force was comprised of management-level employees so that as a plan of action unfolded, decision-making could be accomplished easily.
The first step for the task force was to review information on the risk of exposure by various sharps devices, the actual dollar and emotional cost to the exposed HCW, and the financial impact on our healthcare system. Next we reviewed the historical data for employee exposure for each of the two hospitals prior to the recent affiliation. The hospital data revealed that IV catheters, syringe/needle devices, butterfly needles, and blood-drawing devices caused the highest number and risk of blood exposures to employees in our system.
The employee health department provided the task force with the costs related to a single blood exposure. Two sets of costs were considered; one for the basic exposure without complications, and one for the employee who received a high-risk exposure resulting in multiple testing, prophylaxis, treatment for developing medical conditions, and the potential for life- threatening illness.
The materials management director reviewed the inventory records to establish the number of each of the four categories of devices that were used at each hospital and the cost of these items during the previous year. He then determined the additional cost of replacing each of these devices with a safety device. His analysis revealed that we would need $100,000 in additional funding to implement each of the four safety sharps devices.
A proposal for the implementation of safety sharps devices was prepared utilizing all of the data that was available. The proposal recommended at least one class of safety sharps devices be made available during the 1997-98 budget year and the remaining three implemented during the next fiscal year. In November 1997, the proposal was presented to the senior leadership of Shore Health System and was approved for the required $100,000 in additional funding with a limitation related to contract purchasing. Senior management required that we evaluate products that were available under our contract purchasing. If a contract device was determined by the Healthcare Worker Safety Task Force and the Products Standards Committee to be unsatisfactory, we were required to submit that information to members of senior management in writing so that they would make a decision related to any additional funding. In an environment of tightening budgets, this was a more than generous opportunity to establish a safer environment for our employees.
Education played a major role in implementing the sharps safety program. We provided information to the employees through meeting minutes, hospital newsletters, and posters alerting them to the progress of the sharps safety program. An additional step in education was to share our plans for employee safety with the public through an article in the local newspaper explaining the risks and measures for prevention.
The IV catheter was the first device to be evaluated and purchased in the first six months of the proposed two-year period. Each of the other three devices were evaluated and purchased during an 18 months period. Education played a major role in the successful evaluation and implementation of the safety devices. Company representatives and Professional Practice in-serviced each device throughout the system reaching all shifts of employees including weekends. Rejection of the IV catheter did occur initially on a number of the patient care units but reeducation and one on one training did overcome the concerns of the employees which were primarily work practice issues. All four devices remain in use with the addition of multiple other safety devices to date.
We have a six-member task force with ad hoc representation from staff-level employees who either recommend or will use and evaluate a new or technologically improved safety sharps device. The task force reviews the employee health sharps exposure report to determine the need for new or additional safety sharps devices and recommend education and training. One of the most successful education methods has been to present a products fair, inviting vendors to display their safety products and allowing employees to have hands-on opportunities to try new products. Employees are actively participating in the Sharps Safety Prevention Program and they are voluntarily recommending safety devices. The attitude of members of the products standards committee in approving products for purchase has changed from a primary budget/cost emphasis to that of employee safety. Shore Health System has experienced a gradual decrease in sharps exposure incidents since the implementation of the sharps safety program. The IV catheter rate and the IV butterfly rate have decreased to zero during the first two quarters of 2001. The rate for syringe/needle device exposures has continued to be a concern; therefore, we are evaluating a new syringe that provides automatic needle retraction while still in the patient.
Virginia Slocum is manager of infection control at Shore Health System in Easton, MD.