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).