Sharps Safety: On the Edge and to the Point

April 1, 2002

hinsidecen.gif (3062 bytes)

Sharps Safety: On the Edge and to the Point

By Dave Wise, CSPDT, and Penny Sabrosky, BS, CSPDT

Many
healthcare workers (HCWs) may not be aware that the central service (CS)
processing area can be a hazardous place to work. Consider this: As a CS
manager, you are summoned to the decontamination area where the technician
informs you that a bloody saw blade was returned on a tray from the operating
room (OR). On another visit you notice a suture needle left from surgery in the
emergency room (ER). There are a number of different sharps that end up in the
central sterile department that should have been disposed of at the point of
use. What should be done to protect staff from a potentially dangerous situation
like this? Does your department have safeguards in place to protect workers from
injury?

More that 1 million sharps injuries occur annually. HCWs encounter hazardous
situations daily, so how they prepare for and respond to these situations is
critical. CS departments must develop polices and procedures that protect
employees who work with sharps. Following are a few suggestions to assist in
protecting staff in your department:

1. Establish a safety task force comprises key players from infection
control, nursing, risk management, materials management and frontline workers to
identify the causes of injury and develop procedures regarding the proper
disposal of sharps. Input from a diverse group is important when evaluating
rates and causes of injury, and in calculating the potential exposure to
bloodborne pathogens. The team approach is also useful when appraising and/or
implementing new equipment. Creating a department safety team of three people is
a good start. One individual on the team should be assigned to oversee sharps
injury prevention.

2. A well-written training plan is essential to avoid injuries. New employees
should receive extensive instruction regarding needle stick and sharps
education. The plan should include precautions to be taken when handling sharp
items, what personal protective equipment (PPE) should be worn when in contact
with contaminated items, disposal procedures, and who to notify in the event of
an injury. An exposure plan must be part of the training, and infection control,
risk management and CS should write it together.

3. Conduct an awareness campaign. Information about diseases and protective
procedures should be disseminated in newsletters, meeting minutes and posters.
Some risks are minimal, while others may be life-threatening, as in the case of
hepatitis B and C, and HIV. Make sure your staff is well educated. Access to Web
sites that deal with sharps safety and bloodborne pathogens play a vital role in
educating staff on the dangers of improperly handling sharps. Sites that are
helpful include:

4. Establish an instrument tracking system, a key element of a good
sharps-safety program. One of the best ways to combat sharps injuries is to
monitor the type and amount of sharps that return to the decontamination area
over a two-week period. Sharps commonly enter decontam from surgery, the ER, OB,
and radiology services.

Instrument tracking and sharps awareness took on added importance for one
hospital after a central service employee sustained a needlestick injury to her
index finger from a soiled emergency room laceration tray. This tray was grossly
unprepared and contained three types of sharps that were not removed where the
patient was treated: a No. 3 knife blade, a hollow bore needle still attached to
the disposable syringe and a suture needle left on the needleholder. This CS
employee did all the right things. She immediately removed her double gloves
then washed her hands, and reported directly to the emergency department to
identify a patient for blood testing. Unfortunately the blood and body fluid
were classified as an "unknown source" because instrument tracking was
not up to par. It greatly comforts an employee who has been injured or poked to
know that the source patient will be tested for HIV and HBV, and results will be
provided in a confidential manner.

The Federal Needlestick Prevention Act of November 2000 does not protect the
CS employees from sharps exposure. While government-mandated use of
extraordinary safety devices will prevent and reduce needlestick injuries in
nursing and other patient care areas, what will protect the CS employee from saw
blades, drill bits, suture needles and other dangerous sharps that enter the
decontamination work area? Many times these sharps go undetected until it is too
late and it is impossible to trace the patient source.

In the past it was customary for CS technicians to remove sharps and dispose
of them properly. Spectrum Health Blodgett Campus in Grand Rapids, Mich.,
developed a new policy, "Disposal of Contaminated Sharps in the
Decontamination Area," which provides guidelines to protect the CS worker.
This policy places the burden of sharps removal on the department responsible
for sending it. The CS supervisor or manager contacts the department responsible
for improper sharps disposal, and they are ultimately responsible to send
personnel to the CS decontamination area to dispose of the object.

While many remain unaware of the hazards associated with working in the CS
department, there seems to be a growing attentiveness to sharps and preventive
techniques [within healthcare]. CS workers are feeling more protected these
days, and responsible sharps users are increasingly aware of sharps removal in
the field. P

Penny Sabrosky, BS, CSPDT, is the manager of central processing at Spectrum
Health Blodgett campus in Grand Rapids Mich., and is president of the Michigan
Society for Healthcare Central Service Professionals.

David Wise, CSPDT, is lead technician at Saint Mary's Mercy Medical Center in
Grand Rapids, Mich., and is Region 5 board director for the American Society of
Healthcare Central Service Professionals (ASHCSP).