Infection Control Today - 12/2003: OR Topics

Combating Sharps-Safety Myths

By John Roark

The Occupational Safety and Health Administration (OSHA) estimates that 8 million workers in the healthcare industry and related occupations are at risk of occupational exposure to bloodborne pathogens. Any worker handling sharp devices or equipment is at risk of injury.1

Considering that sharps safety is an integral part of the lives of all healthcare practitioners, it is surprising how many misconceptions surround this ubiquitous issue. Following are some of the most common fallacies, and the realities behind the myths.

MYTH: Compliance is optional.

TRUTH: The misconception is, you only need to do this if you want to, says Katherine West, BSN, MSEd, CIC, an infection control consultant with Infection Control Emerging Concepts. Some places still think its an option! Its federal law the first one from U.S. congress of 2000, and the new OSHA Bloodborne Pathogen regulation in January 2002.

MYTH: Sharps safety is OSHAs primary focus on inspections.

TRUTH: According to West, of the top seven OSHA citations for 2002, four were related to sharp safety. They were:

1. Failure to reflect changes in technology in the exposure control plan. Each office or facility has to have an exposure control plan, and part of that is what needle-safe devices theyve brought in, evaluated, selected, which ones theyre still looking for, she says.

2. Failure to use engineering controls. (Engineering controls are needle- safe devices.) 3. Failure to train employees appropriately. With needle-safe devices, thats supposed to be hands-on training, West adds.

4. Failure to keep a sharps injury log. There are places that have not even integrated needle-safe devices many, many hospitals. Theyre trying to weed out back stock, or theyre making the decision theyre not going to do it because of cost. A couple of those facilities are now in court, she says.

MYTH: When it comes to sharps safety, OSHA is solely employee-protection oriented.

TRUTH: The origin of OSHA comes from worker safety. It started out with the industrial safety and health that union workers were petitioning for, says West. Created in 1970, OSHA has a mandate to insure worker health and safety. It has been solely employee-protection oriented. Whats different, with sharps safety, is that there is one waiver that is pro-patient. The provision says that if you have a choice of only one device, because, say, the marketplace is limited, and the patients complain about discomfort, or the device is not well-designed and impedes the procedure, you can defer from the use of that product until you find a better one. So there is some consideration for the patient as well.

MYTH: All sharps that pose a risk of percutaneous injury must be replaced with a safety device.

TRUTH: OSHA requires that safety devices replace only those sharps that have the potential to expose a worker to an injury from contaminated sharp devices (i.e., potentially contaminated with bloodborne pathogens). Devices that will not be contaminated with bloodborne pathogens and thus do not pose a risk of injury from a contaminated sharp are not required by OSHA to be replaced with safety devices. One example would be a syringe with a needle used in pharmacy for sterile admixture procedures.2

MYTH: Because its a safety device you dont have to worry about needlesticks.

TRUTH: It is only in rare instances that use of a safety device doesnt require hands-on experience, says David Crimmins, RN, infection control practitioner at Beth Israel Medical Center in New York. We end up with situations where people get a needle stick because theyre unfamiliar with the use of a safety device, and very often they dont activate it. A lot of this isnt rocket science its pretty simple stuff. Actually, the biggest problem we see is just a matter of dexterity. The more familiar you are with a device, the more likely its going to work for you. And they dont all work the same. They may look similar or the same, but they have very different methods of activation.

MYTH: Im better off using equipment Im more comfortable with.

TRUTH: Until we get to products that automatically engage themselves, were going to have the problem of people not activating them, says Crimmins. I know nurses that refuse to use safety products. Its out of habit Ive always done it this way, this is what Im comfortable with. And if youre in a quiet phlebotomy area, the patient is cooperative, there are some of the safety devices that are not all that easy to use. Youre probably safer than trying to introduce a more cumbersome safety product.

In the big picture, it is better to do everything you can to keep yourself safe, Crimmins continues. That means that even if it is a safety product, you still want a controlled environment, no distractions, all the equipment you need at hand. But you also need some kind of training, some kind of experience with the product. No matter how good you are, or how cooperative the patients are, there is going to be that accident. Your chances of seroconversion are extremely low, but if youre the one that it happens to, then its no help at all.

MYTH: Vacutainers are reusable.

TRUTH: Vacu-tainers must not only be needle-safe, but single-use only. According to the OSHA Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, A reusable sharps container system for disposable sharps will be acceptable if it does not expose employees to the risk of percutaneous injury. No system involving the manual opening, emptying, or cleaning of the containers will be allowed. The only acceptable system is a fully automated container cleaning system that eliminates employee exposure to sharps.

MYTH: By definition, sharps does not include glass.

TRUTH: Many people fail to recognize that the definition of sharps includes glass, says West. Glass blood tubes, glass capillary tubes, glass slides have to go. And when a product is switched from glass to non-glass, many times the lab values will be off, so you have to re-calibrate.

MYTH: The lab will always fill your order with OSHA-compliant supplies.

TRUTH: Some of the labs are trying to clear out back-stock, and theyre putting their customers in non-compliance, cautions West. Check on your labs to make sure theyre sending you compliance product. If you say, I didnt know this is what the lab sent me, that isnt going to fly. The onus of responsibility is on the facility.

MYTH: There arent enough OSHA inspectors its unlikely our facility will be inspected.

TRUTH: People think, They couldnt possibly come to my workplace, theyre too limited. Theyre not going to get around to our small facility. Not true, says West. OSHA has been well-funded, and most of their inspections are being random selected in all disciplines. Only 20 percent of complaints last year were employee-generated. I think a lot of people dont realize they do random computer selection, and that they look at OSHA 300 Accident and Injury logs, and that sometimes triggers the workplace that they will focus on.

MYTH: Federal law is it. State laws have no impact.

TRUTH: Staff need to be familiar with their states sharps injury laws to see if they differ, or if there is anything additional beyond what the Feds have asked, says West. Id say about half of the states have their own laws; many are pending in other states. State laws may add things like presumption laws if you have a sharps injury and you get a disease, it is presumed it was related to that injury, that it was occupationally- acquired. Check your state laws you never know what youre going to find.

MYTH: Incidence of needle stick injuries in limited to patient care areas.

TRUTH: Conceivably, sharps injuries can occur in virtually any area of a healthcare facility. Ironically, the area where most of our incidences of improper needle disposal occurs is in the public restrooms, says Janet Brown, manager of facilities at Beth Israel Medical Center in New York.

Thats where very often a patient, very innocently, will be self-medicating and not know better, and just throw a needle into the garbage can. Many of our needles have been found in our outpatient care areas in a public restroom. So thats where weve put up signage to help our patients understand about safety inside of a hospital. Thats why its really important to educate patients on proper needle disposal.

The problem with the needles in the trash, adds Crimmins, is a lot of it is just totally anonymous. If youre working on a patient, we can find out the their hepatitis status, we can get a history. You get one in the trash and the skys the limit. You have no information, and fear takes over.

MYTH: Disposable is cheaper.

TRUTH: When it comes to waste management, this is not necessarily the case, says Brown. When youre comparing systems, its important to look at the full life cycle analysis in order to get the true cost of the program. I would much rather go for the reusable based on the environmental impact less garbage plus, its just safer. We had much less incidence of over-filled containers; because youre not paying by the container, you dont have that incentive to fill it up all the way. Youre paying for a service someone comes in and changes them all before they reach capacity.

MYTH: If the medical facility has a purchasing contract with a certain vendor, that vendors product will ultimately be selected.

TRUTH: Not true. The purchasing contracts do not hold, says West. The product is selected based on input and trial evaluation from the employees. They are not at the mercy of their purchasing contract. But the purchasing people will try to say otherwise, and so will administration, because these products cost more. You may be going from a product that costs 79 cents to one thats $1.50. A lot of administration is looking at it short term and not over the long haul. They should be looking at how many sharps injuries there were per year, and what it cost to follow up with those individuals. You can buy a lot of sharps devices with that money.

MYTH: You can use up whatever remaining stock you have, and then buy the new OSHA-compliant stock.

TRUTH: Not true, cautions West. Ive talked with one OSHA regional bloodborne pathogens coordinator, and she said three months was too long to clear out back stock, one month was reasonable. I would say somewhere between one to two months is really all you have to clear out back stock. Purchasing has to make sure that the vendors arent clearing out their back stock by sending it to the purchaser, thus making the purchaser non-compliant.

MYTH: Healthcare workers are being adequately trained in the use of sharps safety devices.

TRUTH: Not so, says West. A paramedic in one of my classes said, The hospitals arent teaching us. They stock our boxes, but they arent teaching us how to use these devices. Our patients dont look at us with a lot of confidence when were driving down the road trying to read the instructions. People not only have to be well-educated, but have the hands-on training so they become proficient in using something that is new. If you dont know how to use it, what good is it doing to do?

Training has to be hands-on, West underscores. You cant just watch a demonstration or a video. Hands-on means practicing with the actual device. Hospitals are shortcutting every way they can, and most likely theyre going to show a video. But thats not going to cut it.

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