Infection Control Today - 05/2002: Open Forum

Why Do We Need to Know About Primary Prevention?

By Marilyn Hanchett, RN, PhD, CPHQ

Triggered by the HIV/AIDs crises and supported by federal mandates, the safety movement in healthcare has fostered the rapid development of safety technology. Those who have practiced since the introduction of the first Occupational Safety and Health Administration (OSHA) initiative have seen and most likely used safety products designed to make the use of needles or others sharps safer than they had been prior to the 1990s. These new safety products have had an undeniable impact on helping protect healthcare workers against exposure incidents.

However, while professional and administrative attention has been focused on the use of these new devices, another generation of safety technology is emerging. Unlike the first generation of safety products, the new technology is seeking to eliminate the use of needles and/or sharps. And in cases where current technology cannot yet eliminate needles and sharps, it seeks to reduce the frequency with which they must be used. Specifically, the next generation of safety technology intends to increase safety by removing the potential hazard rather than making contact with the hazard less dangerous.

In fact, the new technology is evolving so quickly that it is now possible to differentiate among the categories of safety products. According to the National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI), devices that use a needle or other sharp component with some sort of protective mechanism to prevent any injury can be described as secondary prevention. That is, the safely technology is secondary to the continued use of the needle or sharp component. Conversely, devices that completely eliminate the use of needles or reduce the frequency with which they must be used are known as primary prevention. The primary focus of this technology is the elimination, or in cases where they cannot yet be eliminated the reduced use, of the actual needle or sharp component.

For example, a safety syringe uses a secondary prevention mechanism to prevent the needle from injuring the clinician once the injection is completed. However, a needleless injector is an example of primary prevention, since no needle is used within the device. Both products inject medication, but the exposure risk to the clinician differs significantly between the two systems.

The impact of primary prevention is already surfacing is many areas of healthcare. Suture needles, a common cause of needlestick injuries in surgery, can now be replaced by surgical adhesives or sealants that require no needles, at least for superficial closures. Management of diabetes mellitus shows similar new and emerging options. For example, blood glucose monitoring, which for decades was based on urine testing or painful finger sticks, can now be done without the use of needles. Current research in the United States is aggressively pursuing needle-free options for insulin administration for diabetic patients.

Infusion therapy, one of the most frequently required invasive treatments in acute care, is an important area for primary prevention. IV-securing devices, developed within the past 10 years, are now used to not only prevent catheter dislodgement, but to reduce the frequency of IV restarts within a facility. It is significant that most hospitals do not measure how often IV catheters must be reinserted; however, recent studies conducted within large health centers have shown that an IV securement device can reduce the frequency of IV restarts by more than half. By reducing the need to reinsert IV catheters, the number of potential needlestick exposures to the clinician is dramatically decreased. For this reason, IV securement devices are classified as a form of primary prevention.

At this time, both primary and secondary prevention devices are available. Both types of devices should be included in order to have an optimum safety program in your healthcare facility. Selection of products from among the many primary and secondary prevention choices must be based on the types of care provided and the exposure risk potential associated with that care.

There is no exact formula for a sharps prevention program. Every healthcare provider must develop a program based on its special characteristics, but all providers can draw from basic principles in designing a sharps safety program. These include

  • A needle and sharps injury prevention program requires the combined use of both primary and secondary prevention products.
  • Product evaluation and selection must be revised regularly in response to the dynamic and progressive nature of safety technology.
  • Clinician education about and participation in the sharps safety program are fundamental in creating the safest possible workplace.

The continuing evolution of safety products challenges us to design better programs and to examine our fundamental attitudes toward injury prevention. Everyone working in healthcare today has organized their beliefs, behaviors and opinions on the fact that alternatives to needles and sharps have been, until very recently, unavoidable. When the use of needles is widespread and alternatives nonexistent or unknown, it is difficult to imagine any needle-free treatments. However, the emergence of primary prevention technology urges us to do exactly that -- to imagine, understand and pursue a workplace safer than it has ever been before. While this may sound futuristic, current examples of primary prevention technology remind us that previously unheard of breakthroughs in safety products are indeed a reality.

NAPPSI has been formed to help device manufacturers, clinicians, healthcare organizations and providers obtain state of the art information about primary prevention strategies and establish dialogue about evolving technology. While NAPPSI is organized to foster primary prevention, the organization acknowledges that the use of primary and secondary prevention products are essential to prevent sharps-related injuries. Since many clinicians remain unaware of new and developing primary prevention devices, NAPPSI offers many educational tools at www.nappsi.org.

There are many stakeholders in the healthcare safety movement, but personal safety rests largely with the individual. Users of sharps must be the foremost advocates of their own safety, based on a full understanding of options in preventing unnecessary and deadly injuries. The new and emerging products presented by primary prevention offer an important addition to the range the safety choices, but clinicians must know about them and call for their use, as appropriate, for the safety movement to achieve its most critical and enduring impact. Primary prevention supports us in our struggle to reach this yet unrealized goal and that is why we all need know about it.

Marilyn Hanchett RN, PhD, CPHQ, is a published author and a national speaker for NAPPSI. She can be reached at mhanchett@ktis.net.

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