Healthcare Workers Use Engineering Controls to Eliminate BloodbornePathogens Hazard

Healthcare Workers Use Engineering Controls to Eliminate Bloodborne Pathogens Hazard

By Pat Tydell, RN, MSN, MPH

The Needlestick Safety and Prevention Act, which took effect on Nov. 2, 2000 after being passed unanimously by Congress, directed specific revisions of the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard. The agency was required to make these changes within six months. In order for the revised standards to be adopted quickly, the Legislature exempted OSHA from certain rule-making requirements.

The changes to the bloodborne pathogens standard, which intend to reduce needlestick injuries among healthcare workers and others who handle medical sharps, went into effect on April 18, 2001. OSHA is planning a 90-day outreach and education effort before enforcing the new rules.

Sharps are defined by the standard as any object that can penetrate the skin including, but not limited to: needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires. The revisions state the need for employers to select safer needle devices as they become available, and to involve employees in identifying and choosing the devices. Many facilities have conducted equipment fairs where vendors display their product for the staff that will use it. A task group, composed of frontline staff, should be assembled and requested to recommend several products for pilot testing in the facility. Once the pilot testing is complete and staff members have had the opportunity to provide their feedback, the facility can make purchasing decisions. Periodic review of products used by the staff is also done to ensure that they continue to be involved in the process of selection and evaluation.

Technology vs. Human Interface

People, being only human, are prone to errors in practice due to a variety of reasons. We can lose concentration working in an environment that is loaded with distractions like phones ringing, bells sounding, and people talking. We are frequently interrupted in our efforts to complete our tasks, and we are prone to the effects fatigue has on our coordination and mental sharpness. We have a million things on our minds, some demanding attention simultaneously. So while no machine or device can match our intellectual reasoning and problem-solving ability, many machines can outperform us on simple, repetitive tasks. When those tasks are engineered to control or eliminate our weaknesses, we perform them more effectively, efficiently or safely.

The revisions to the bloodborne pathogens standard ask that the healthcare industry use engineering controls to provide a safer workplace. Engineering controls isolate or remove the bloodborne pathogen hazard from the workplace. These controls are sharps disposal containers, self-sheathing needles, safer medical devices such as sharps with engineered sharps injury protections, and needleless systems. Needleless systems are devices that do not use needles for the collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established. Needleless systems are available for the administration of medications and fluids and for any other procedure involving the potential for exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps. Sharps with engineered sharps injury protections are non-needle sharps or needle devices used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure to a bloodborne pathogen. Currently on the market are devices that sheath or retract a needle or sharp before and after use. If the needle or sharp is automatically retracted from the injection/incision site, the chance of injury is significantly reduced. This engineering designed feature takes the human error element out of the equation. Engineering controls that can do this are more likely to protect the person using the device.

Why do we resist devices designed to protect us? We tend to reject what we don't understand. Therefore, it is essential that the people using the devices frequently be the ones brought into the decision making process early and often. They need to be able to pilot the equipment being considered for use and provide feedback. They need to be heard and their ideas and suggestions used if the device is to have any chance of being adopted by the staff. Secondly, the device has to be user friendly. Staff members have to feel comfortable using it and it has to perform reliably in actual clinical situations. It must require minimal training to use. Although staff members want inservices on new equipment and devices, it has to be concise and done in a relatively short amount of time. During this selection, evaluation, and education process, a prime opportunity exists to introduce the changes to your bloodborne pathogens plan. Focus on the changes to the exposure control plan that requires that the plan reflect changes in technology that eliminate or reduce exposure. Additionally, inform them that the plan requires the facility to document annually consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize exposure to injuries from contaminated sharps. Lastly, make sure they know that the plan specifically requires direct patient caregivers to have input into the identification, evaluation, and selection of effective engineering and workplace controls and that the input has to be documented by the organization.

The last issue with using engineering controls is the cost of the device. Many healthcare practitioners have a difficult time convincing their purchasing co-workers of the necessity of safe sharp products. It's a job made more difficult if the staff is resisting the changes to a safer product. Once you have the staff on board, convincing the financial personnel is easier. A cost/benefit analysis of the cost of supplying safe sharp products vs. the cost of exposure to bloodborne pathogens can help.When the cost of exposure identification, care, follow-up, reporting and other OSHA requirements are listed, it becomes more apparent why purchasing somewhat more expensive products are actually less expensive than treating long term bloodborne diseases in healthcare workers.

What's out there?

The accompanying product showcase (starting on page 33) outlines the variety of products available to protect healthcare workers (HCW). The standards do not specify what product to use, but do require that some system be used. The choice of products must also be reviewed annually for emerging technology and input from direct caregivers used when selecting and evaluating products.

OSHA gives the healthcare industry 90 days to implement the changes to the bloodborne pathogens standard. The changes require interdisciplinary planning and action. The focus of these changes must be reinforced to the persons being affected by the change. The healthcare worker will experience fewer sharps injuries, and therefore, will be at less of a risk to become infected with a bloodborne pathogen via needlestick. This is the true benefit of the new technologies in safer sharp products.

Pat Tydell, RN, MSN, MPH, is risk manager at North Chicago Veterans Administration Medical Center (VAMC) in North Chicago, Ill.


SHARPS SAFETY PRODUCTS

ABBOTT LABORATORIES
200 Abbott Park Road
Abbott Park, IL 60064
1-800-ABBOTT3
Fax: (847) 937-7515
www.abbott.com
Products: Blood collection devices, needleless IV connectors, needleless IV systems, needleless syringes, shielded needle syringes

ALARIS MEDICAL SYSTEMS, INC.
10221 Wateridge Circle
San Diego, CA 92121
1-800-4824822
Fax: (858) 458-7760
www.alarismed.com
Products: Needleless IV line connectors, needleless IV systems

BAXA CORPORATION
13760 E. Arapahoe
Englewood, CO 80112-3903
1-800-567-2292
Fax: (303) 690-4804
www.baxa.com
Products: Syringe tip caps, oral syringes

BECTON DICKINSON
1 Becton Drive
Franklin Lakes, NH 04417
888-237-2762
www.bd.com
Products: Blood collection devices, blunt tip cannulae, disposal units/containers, needleless IV line connectors, needleless IV systems, shielded IV/catheters, safety lancets, needle crushers/cutters, needle dispenser boxes, needle holders, needle trays, scalpel holders, disposable scalpels, safety scalpels, needleless syringes, regional anesthesia trays with safety engineered devices, specimen tubes, blood sampling system

BEMIS MANUFACTURING COMPANY
300 Mill Street
Sheboygan Falls, WI 53085
1-800-558-7651
Fax: (920) 467-8573
www.bemismfg.com
Products: Disposal units/containers

BIOJECT INC.
7620 S.W. Bridgeport Rd.
Portland, OR 97224
(503) 639-7221 x. 436
Fax: (503) 624-9002
www.bioject.com
Products: Needlefree IM and SC injectors for clinical use and personal use

BIOMEDICAL DISPOSAL, INC.
3690 Holcomb Bridge Road
Norcross, GA
(888) 393-9595
Fax: (770) 300-9306
www.biodisposal.com
Products: Electric needle destruction unit and web-based compliance software

BIO-PLEXUS, INC.
129 Reservoir Road
Vernon, CT 06066
1-800-223-0010
Fax: (860) 870-6345
www.bio-plexus.com
Products: Blood collection devices, needle holders

B. BRAUN MEDICAL, INC.
824 12th Ave.
Bethlehem, PA 18034
1-800-227-8862
Fax: (610) 266-6122
www.bbraunusa.com
Products: Blunt tip cannulae, needleless IV line connectors, recessed needle IV line connectors, needleless IV systems, shielded IV/catheters, filter straws, procedural kits (CVCs, PCIs, Epidurals, PICCS) with needle block foam sharps holders

CELL ROBOTICS
2715 Broadbent Parkway, NE Suites A-E
Albuquerque, NM 87107
(505) 343-1131 x.100
Fax: (505) 344-8112
www.cellrobotics.com
Products: Laser assisted blood sampling device

DEROYAL
200 DeBusk Lane
Powell, TN 37849-1046
www.deroyal.com
Products: Blade removers, blood collection devices, disposal units/containers, needle holders, needle recapping devices, needle trays, scalpel holders, disposable scalpels, safety scalpels, transfer trays, instrument pads, suture assist devices, needle counters, safety instrument strainers

ETHICON ENDO-SURGERY VASCULAR ACCESS
4545 Creek Road
Cincinnati, OH 45242
(513) 337-8898
Fax: (513) 337-2898
www.vascularaccess.com
Products: Shielded IV/catheters

FUTURA MEDICAL CORPORATION
3820 Academy Parkway North NE
Albuquerque, NM 87109
1-800-631-0076
Fax: (505) 342-9735
www.futuramedical.com
Products: Blood collection devices, disposal units/containers, needleless IV line connectors, safety lancets, needle holders, disposable scalpels, needleless syringes, needle incinerators

GETTIG PHARMACEUTICAL INSTRUMENTCO.
1 Streamside Place West
Spring Mills, PA 16875
(814) 422-8892
Fax: (814) 422-8011
www.gettig.com
Products: Safety needle, sliding sheath

GRIFF INDUSTRIES, INC.
20717 Prairie St.
Chatsworth, CA 91311
(818) 709-4743
Fax: (818) 709-4768
Products: Blade removers, needle dispenser boxes, needle recapping devices, needle trays, scalpel holders, blade loader/unloaders

INVIRO MEDICAL DEVICES, INC.
1188 Thurlow Street
Vancouver, BC V63 1X3
(604) 688-6115
Fax: (604) 685-6694
Products: Recessed needle syringes

KENDALL
15 Hampshire St.
Mansfield, MA 02048
1-800-962-9888
www.kendallhq.com
Products: Blood collection devices, disposal units/containers, safety lancets, needle dispenser boxes, needle holders, needleless syringes, sharps disposal containers

MAXXIM MEDICAL
4750 118th Ave. North
Clearwater, FL 33762
1-800-356-8849
www.maxximmedical.com
Products: Disposal units/containers

MEDISYSTEMS CORPORATION
701 Pike Street Floor 16
Seattle, WA 98101
1-800-369-MEDI
Fax: (888) 373-HEMO
www.medisystems.com
Products: Blunt tip cannulae, needleless IV systems, shielded needle syringes

MEDPRO, INC.
817 Winchester Rd #200
Lexington, KY 40505
(859) 225-5375
Fax: (859) 225-5347
www.needlyzer.com
Products: Needle recapping devices, Needlyzer model NDZ-needle destruction device, Safemate-dental safety needle.

MICROTEK MEDICAL, INC.
512 Lehmberg Road
Columbus, MS 39702
1-800-824-3027
Fax: 1-800-642-0255
www.microtekmed.com
Products: Disposal units/containers, needle dispenser boxes, isolyser solidification products for sharps

NEW MEDICAL TECHNOLGY, INC.
23 National Drive
Franklin, MA 02038
19-800-522-1512
Fax: (508) 520-4556
www.newmedicaltechnology.com
Products: Safety syringes

NORTH AMERICAN MEDICAL PRODUCTS, INC.
3 Walker Way
Albany, NY 12205
1-800-488-6267
Fax: (518) 218-0405
www.nampinc.com
Products: Blood collection devices, safety lancets, recessed needle syringes, shielded needle syringes, safety multi-draw blood collection needle, safety butterfly needles

OMNI/AJAX
49 Seven Point Trail
Gouldsboro, PA 18424
(570) 848-4186
Fax: (570) 848-4187
www.omni-ajax.com
Products: Blood collection devices, safety scalpels, cement solidification stabilization powders/agents

OWEN MUMFORD
1755-A West Oak Commons Court
Marietta, GA 30062
(770) 977-2226
Fax: (770) 977-2866
www.owenmumford.com
Products: Safety lancets

SAFETY 1ST MEDICAL
1740 E. Garry Ave #108
Santa Ana, CA 92705
1-800-977-2331
Fax: (48) 476-5559
www.safety1stmedical.com
Products: Shielded needle syringes

SAFETY SYRINGES
1925 Palomar Oaks Way Suite 204
Carlsbad, CA 92008
(706) 918-9908
Fax: (706) 918-0565
www.safetysyringes.com
Products: Shielded needle syringes

SIMS PORTEX INC.
10 Bowman Dr.
Keene, NH 03437
1-800-258-5361
Fax: (603) 352-3703
www.portexusa.com
Products: Blood collection devices, disposal units/containers, needle dispenser boxes, needle recapping devices, syringe tip caps, shielded needle syringes, disposable vacuum tube, shielded holder, mini-sharps containers

TERUMO MEDICAL CORPORATION
2101 Cottontail Lane
Somerset, NH 08873
1-800-888-3786
Fax: 1-800-411-5870
www.terumomedical.com
Products: Shielded needles

WALSH INTEGRATED ENVIRONMENTAL SYSTEMS, INC.
2555 Dollard Ave. Building 5, Suite 202
Montreal, Quebec H8N 3A9
1-800-925-7460
Fax: (514) 364-1559
www.walshenvironmental.com
Products: Sharps handling and disposal

This listing is provided by Infection Control Today® as a service to our readers. We regret we cannot be responsible for any errors or omissions that might occur.



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