Ensure That Primary Prevention Is Part Of Your Needlestick Safety Program
By Marilyn Hanchett, RN
Developing and maintaining an effective needlestick prevention program is one of the most important organizational safety measures for minimizing, and ideally eliminating, the threat of occupational exposures for clinicians and other at-risk employees. But designing this type of program is not a simple process and most healthcare facilities continue to struggle with needlestick safety.
Traditionally, needlestick safety programs have focused on the use of secondary prevention measures. In secondary prevention the needle or other sharp object is made safer through blunting, shielding or retracting. Primary prevention seeks to remove the needle or sharp object completely or, when that is not feasible, to reduce the frequency of its use.
Today, both approaches are important in a comprehensive safety program. Unfortunately, many organizations are not aware of primary prevention. Yet program managers, along with infection control professionals and safety staff, are challenged to assure that both primary and secondary prevention measures are included in the organization's plan.
How can healthcare organizations make sure employees are aware of and use both primary and secondary measures? The National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI) offers the following advice and resources.
SHARE THE NAPPSI CLINICIAN ADVISORY
NAPPSI has issued a Clinician Advisory to alert and inform healthcare professionals of the need for primary prevention. The Clinician Advisory, which is posted on the NAPPSI Web site (www.nappsi.org), is an excellent tool for both communication and education. For example, the Veterans Health Administration and the National Institute for Occupational Safety and Health (NIOSH) have recently added links to the NAPPSI Clinician Advisory to their Web sites in order to help keep employees and site visitors fully informed.
- Action items: 1. Copy and distribute the Clinician Advisory as part of an inservice or your annual training update. 2. Determine if a link to the NAPPSI Clinician Advisory is feasible on your facility or organization's Web site.
EXAMINE HOW SUTURES ARE USED
While sutures remain essential in many surgical procedures, evolving technology has now virtually eliminated the need to use them in securing central venous catheters. The new Centers for Disease Control and Prevention (CDC) Guidelines for the Prevention of Intravascular Catheter-Related Infections states, "Sutureless securement devices can be advantageous over suture in preventing catheter-related bloodstream infections."1 In fact, Venetec International, manufacturer of the StatLock brand of securement devices, has now petitioned the Food and Drug Administration (FDA) to ban suture securement of central venous catheters completely.
- Action item: Analyze if/how sutures are used for IV catheters in your facility and look for opportunities to use primary prevention alternatives.
REVIEW YOUR SAFETY DEVICE LIST AND BBP DEVICE TRAINING
The revised Bloodborne Pathogens Standard from the Occupational Safety and Health Administration (OSHA) requires that the facility's exposure control plan and related employee training be updated annually. To facilitate these processes, a complete safety device list differentiating primary and secondary products is now available at the NAPPSI web site. Employees can use this detailed list to clearly identify if products they are using are primary or secondary prevention devices.
- Action items: 1. Conduct a primary prevention product inventory assessment. Use the list to analyze if the safety devices currently used in your facility include both primary and secondary prevention products. 2. Use this list as part of your training to give employees concrete examples of the differences in primary and secondary safety products. 3. Use the list as a reference when you update your exposure control plan and approved organizational safety device list.
VISIT THE NAPPSI WEB SITE
The NAPPSI web site has other helpful information. For example, unique primary prevention products are featured regularly. You can quickly locate pertinent regulatory and legislative news. The NAPPSI site also has needlestick information and links to many needlestick/sharps safety Web sites.
- Action item: Check the NAPPSI site regularly for the latest news and include what you learn in your safety meetings, in revisions to your exposure control plan, and in updated educational offerings.
BECOME A NAPPSI MEMBER
The growing interest in primary prevention is reflected in NAPPSI's increasing number of corporate, organization, and individual memberships. Corporate members now include product safety proponents such as BD, Bard Access Systems, HDC Corp., Alaris Medical, Venetec International and Abbott Laboratories. Corporate affiliations continue to expand. Many professional organizations, such as the National Association of Residents and Interns, the Infusion Nurses Society, the Association of Occupational Professionals in Healthcare, the American Association of Critical Care Nurses and the National Association of Vascular Access Networks have affiliated with NAPPSI and share primary prevention information with their members. However, primary prevention can only benefit those who are aware of its importance and use the appropriate products.
- Action item: Join NAPPSI and encourage your colleagues to become members. Remember, NAPPSI membership remains free to clinicians and healthcare organizations at this time.
While there is no perfect solution to the dangerous problem of needlestick and sharps-related injuries in healthcare, it is encouraging to see the technological innovations and next generation of safety products within the scope of primary prevention. Infection control professionals, safety officers and program managers can dramatically increase the success rates of their facility's programs by assuring that primary prevention strategies are evaluated within the context of that organization's needs and providing appropriate primary and secondary safety products to employees.
Marilyn Hanchett, RN, is director of nursing at IgG America Inc. in Linthicum, Md. and is a national speaker for NAPPSI. She can be reached at firstname.lastname@example.org.