Securing Medical Catheters
By Kathy Dix
Aug. 2, 2004, the Occupational Safety & Health Administration (OSHA) posted a revision to its fact sheet on securing medical catheters, which had initially been published online in early 2004. The revision focuses on the possibility of unsafe conditions created by the use of tape or sutures to secure catheters.
The document obliges all employers of workers with occupational exposure to blood or other potentially infectious materials to annually review (and implement) appropriate, available and effective safer medical devices designed to eliminate or minimize that exposure.
Engineering controls that reduce the potential for needlesticks by eliminating the need to suture medical catheters in place are one option for healthcare employers to consider, the fact sheet explains. As part of their annual review of methods to reduce needlesticks, employers must review options for securing medical catheters and consider appropriate engineering and work practice controls.
The review must include the input of non-managerial employees who are responsible for direct patient care those who are potentially exposed to injuries from contaminated sharps in the identification, evaluation and selection of effective engineering and work practice controls, the fact sheet continues.
Katie Schatzlein, RN, MS, a consultant in vascular access based in Austin, Texas, points out that abiding by these guidelines might be somewhat confusing. Is documentation of catheter securement required? Its a paper tiger; you tell people to include the input of nonmanagerial employees. If OSHA walks in and asks for your log showing the input of the non-managerial employees and your review of the latest technologies ... where is it? she asks.
OSHAs Bloodborne Pathogens Standard, 1910.1030, reads, in part, Document annually consideration and implementation of appropriate commercially avail and effective safer medical devices designed to eliminate or minimize occupational exposure. Employers must also document the solicitation of non-managerial employees input in a written Exposure Control Plan.
The only way youre going to get compliance this is from my own personal experience is to have OSHA be something that is a real threat, Schatzlein points out. If you work in a hospital, when its time for JCAHO, they all start toeing the line. But OSHA doesnt do periodic visits; thats why its easier for people to get by with not complying.
Schatzlein consults at one facility that is a rehabilitation hospital; this facility has no safety needles at all. They dont even know theyve done something wrong, she says. OSHA is not Big Brother enough yet. If they go into the major cities and penalize a couple of hospitals in every major city, then people will start getting scared. Right now, its a That happened in New York; we dont need to worry about it kind of attitude.
Acute-care hospitals where Schatzlein consults have been more compliant, she adds. They dragged their feet, but eventually they did it. The rehab center had an open supply room. They went to the trouble to create a closed supply room, and theyve labeled all the bins, and its all organized, but theyve thrown in their regular run-of-the-mill non-safety devices that theyve made bins for!
A New York hospital was fi ned for sharps violations because medical students or residents turned them in, Schatzlein recalls. When OSHA visited, they found that although the hospital did stock many safety devices, they still had the old non-safety devices. It doesnt matter how many; its the fact that you do it at all. I think I counted 150 22-gauge angiocaths, and Im thinking, I wonder if anybody here has the remotest idea how this is almost contraband, she says.
The violations are not limited to small geographic pockets; they can happen anywhere, she adds. So how seriously do people take OSHA? It varies. But I believe that JCAHO is now looking for OSHA compliance. If JCAHO walks in and wants to see your IV cart, they know what the safety devices look like. If theyre not finding any, thats as serious as OSHA walking in. Theyre backing each other up. That will help, because JCAHO does come routinely.
Schatzlein observes that to make the OSHA regulations work in practice, JCAHO may need to become more involved. OSHA does not make many actual visits, she says, but when they do, its pretty horrendous when they fi nd a violation. They respond to reports, so somebody at a facility can send an anonymous report, and theyll follow up on it, but they dont just go and visit your hospital. I dont know why, whether theres not money in the department to do that, or thats not the way they want to approach it, but they dont do what JCAHO does.
As for catheter securement specifically, its still a little bit of a leap to get people to see that it needs to be taken seriously, Schatzlein says. Thats going to happen where people working at the ground level show doctors, You dont have to suture that; you can just use this little pad here. Pretty soon, they say, I need some more pads. Its the people working day to day, sharing this information at the grass roots level, and thats where the connection is going to be made.
Physicians, she points out, learned to suture nearly everything in medical school. Its a skill they mastered. And then you show them that the suture site is one of the major causes of catheter-related bloodstream infections. What about the fact that needlestick injuries occur and they are totally avoidable if you dont use a suture? Once they get used to it, once they see how fast it is to put a catheter securement device on, after a while, that time they save becomes more important to them. What becomes the most important thing to them is how fast they can get that patient out and get the next one in.
Tradition is really heard to break, and if you look at what people have to do to get out of the habit that no longer has a purpose, then you have to give them something to replace the other thing, and have them use it for a while until it becomes a habit. Then they cant go back to the old habit, because they realize it was time-consuming, dangerous, and theyve lost interest in it.
For more information, visit www.osha.gov/SLTC/bloodbornepathogens/index.html.