Ensure That Primary Prevention Is Part Of Your Needlestick Safety Program

Ensure That Primary Prevention Is Part Of Your Needlestick Safety Program

By Marilyn Hanchett, RN

Developingand maintaining an effective needlestick prevention program is one of the mostimportant organizational safety measures for minimizing, and ideallyeliminating, the threat of occupational exposures for clinicians and otherat-risk employees. But designing this type of program is not a simple processand most healthcare facilities continue to struggle with needlestick safety.

Traditionally, needlestick safety programs have focused on the use ofsecondary prevention measures. In secondary prevention the needle or other sharpobject is made safer through blunting, shielding or retracting. Primaryprevention seeks to remove the needle or sharp object completely or, when thatis 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. Yetprogram managers, along with infection control professionals and safety staff,are challenged to assure that both primary and secondary prevention measures areincluded in the organization's plan.

How can healthcare organizations make sure employees are aware of and useboth primary and secondary measures? The National Alliance for the PrimaryPrevention of Sharps Injuries (NAPPSI) offers the following advice andresources.


NAPPSI has issued a Clinician Advisory to alert and inform healthcareprofessionals of the need for primary prevention. The Clinician Advisory, whichis posted on the NAPPSI Web site (www.nappsi.org),is an excellent tool for both communication and education. For example, theVeterans Health Administration and the National Institute for OccupationalSafety and Health (NIOSH) have recently added links to the NAPPSI ClinicianAdvisory to their Web sites in order to help keep employees and site visitorsfully 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.


While sutures remain essential in many surgical procedures, evolvingtechnology has now virtually eliminated the need to use them in securing centralvenous catheters. The new Centers for Disease Control and Prevention (CDC)Guidelines for the Prevention of Intravascular Catheter-Related Infectionsstates, "Sutureless securement devices can be advantageous over suture inpreventing 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 suturesecurement 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.


The revised Bloodborne Pathogens Standard from the Occupational Safety andHealth Administration (OSHA) requires that the facility's exposure control planand related employee training be updated annually. To facilitate theseprocesses, a complete safety device list differentiating primary and secondaryproducts is now available at the NAPPSI web site. Employees can use thisdetailed list to clearly identify if products they are using are primary orsecondary 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.


The NAPPSI web site has other helpful information. For example, uniqueprimary prevention products are featured regularly. You can quickly locatepertinent regulatory and legislative news. The NAPPSI site also has needlestickinformation 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.


The growing interest in primary prevention is reflected in NAPPSI'sincreasing number of corporate, organization, and individual memberships.Corporate members now include product safety proponents such as BD, Bard AccessSystems, HDC Corp., Alaris Medical, Venetec International and AbbottLaboratories. Corporate affiliations continue to expand. Many professionalorganizations, such as the National Association of Residents and Interns, theInfusion Nurses Society, the Association of Occupational Professionals inHealthcare, the American Association of Critical Care Nurses and the NationalAssociation of Vascular Access Networks have affiliated with NAPPSI and shareprimary prevention information with their members. However, primary preventioncan only benefit those who are aware of its importance and use the appropriateproducts.

  • 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 needlestickand sharps-related injuries in healthcare, it is encouraging to see thetechnological innovations and next generation of safety products within thescope of primary prevention. Infection control professionals, safety officersand program managers can dramatically increase the success rates of theirfacility's programs by assuring that primary prevention strategies are evaluatedwithin the context of that organization's needs and providing appropriateprimary and secondary safety products to employees.

To utilize these resources, visit www.nappsi.orgor email info@nappsi.org. You can alsocontact the NAPPSI office at (858) 350-8623.

Marilyn Hanchett, RN, is director of nursing at IgG America Inc. inLinthicum, Md. and is a national speaker for NAPPSI. She can be reached at mhanchett@iggamerica.com.