Healthcare Workers Use Engineering Controls to Eliminate BloodbornePathogens Hazard

July 1, 2001

Healthcare Workers Use Engineering Controls to Eliminate BloodbornePathogens Hazard

Healthcare Workers Use Engineering Controls to Eliminate BloodbornePathogens Hazard

By Pat Tydell, RN, MSN, MPH

The Needlestick Safety and Prevention Act, which took effect on Nov. 2, 2000after being passed unanimously by Congress, directed specific revisions of theOccupational Safety and Health Administration's (OSHA) Bloodborne PathogensStandard. The agency was required to make these changes within six months. Inorder for the revised standards to be adopted quickly, the Legislature exemptedOSHA from certain rule-making requirements.

The changes to the bloodborne pathogens standard, which intend to reduceneedlestick injuries among healthcare workers and others who handle medicalsharps, went into effect on April 18, 2001. OSHA is planning a 90-day outreachand education effort before enforcing the new rules.

Sharps are defined by the standard as any object that can penetrate the skinincluding, but not limited to: needles, scalpels, broken glass, broken capillarytubes, and exposed ends of dental wires. The revisions state the need foremployers to select safer needle devices as they become available, and toinvolve employees in identifying and choosing the devices. Many facilities haveconducted equipment fairs where vendors display their product for the staff thatwill use it. A task group, composed of frontline staff, should be assembled andrequested to recommend several products for pilot testing in the facility. Oncethe pilot testing is complete and staff members have had the opportunity toprovide their feedback, the facility can make purchasing decisions. Periodicreview of products used by the staff is also done to ensure that they continueto be involved in the process of selection and evaluation.

Technology vs. Human Interface

People, being only human, are prone to errors in practice due to a variety ofreasons. We can lose concentration working in an environment that is loaded withdistractions like phones ringing, bells sounding, and people talking. We arefrequently interrupted in our efforts to complete our tasks, and we are prone tothe effects fatigue has on our coordination and mental sharpness. We have amillion things on our minds, some demanding attention simultaneously. So whileno machine or device can match our intellectual reasoning and problem-solvingability, many machines can outperform us on simple, repetitive tasks. When thosetasks are engineered to control or eliminate our weaknesses, we perform themmore effectively, efficiently or safely.

The revisions to the bloodborne pathogens standard ask that the healthcareindustry use engineering controls to provide a safer workplace. Engineeringcontrols isolate or remove the bloodborne pathogen hazard from the workplace.These controls are sharps disposal containers, self-sheathing needles, safermedical devices such as sharps with engineered sharps injury protections, andneedleless systems. Needleless systems are devices that do not use needles forthe collection of bodily fluids or withdrawal of body fluids after initialvenous or arterial access is established. Needleless systems are available forthe administration of medications and fluids and for any other procedureinvolving the potential for exposure to bloodborne pathogens due to percutaneousinjuries from contaminated sharps. Sharps with engineered sharps injuryprotections are non-needle sharps or needle devices used for withdrawing bodyfluids, accessing a vein or artery, or administering medications or otherfluids, with a built-in safety feature or mechanism that effectively reduces therisk of an exposure to a bloodborne pathogen. Currently on the market aredevices that sheath or retract a needle or sharp before and after use. If theneedle or sharp is automatically retracted from the injection/incision site, thechance of injury is significantly reduced. This engineering designed featuretakes the human error element out of the equation. Engineering controls that cando this are more likely to protect the person using the device.

Why do we resist devices designed to protect us? We tend to reject what wedon't understand. Therefore, it is essential that the people using the devicesfrequently be the ones brought into the decision making process early and often.They need to be able to pilot the equipment being considered for use and providefeedback. They need to be heard and their ideas and suggestions used if thedevice is to have any chance of being adopted by the staff. Secondly, the devicehas to be user friendly. Staff members have to feel comfortable using it and ithas to perform reliably in actual clinical situations. It must require minimaltraining to use. Although staff members want inservices on new equipment anddevices, it has to be concise and done in a relatively short amount of time.During this selection, evaluation, and education process, a prime opportunityexists to introduce the changes to your bloodborne pathogens plan. Focus on thechanges to the exposure control plan that requires that the plan reflect changesin technology that eliminate or reduce exposure. Additionally, inform them thatthe plan requires the facility to document annually consideration andimplementation of appropriate commercially available and effective safer medicaldevices designed to eliminate or minimize exposure to injuries from contaminatedsharps. Lastly, make sure they know that the plan specifically requires directpatient caregivers to have input into the identification, evaluation, andselection of effective engineering and workplace controls and that the input hasto be documented by the organization.

The last issue with using engineering controls is the cost of the device.Many healthcare practitioners have a difficult time convincing their purchasingco-workers of the necessity of safe sharp products. It's a job made moredifficult if the staff is resisting the changes to a safer product. Once youhave the staff on board, convincing the financial personnel is easier. Acost/benefit analysis of the cost of supplying safe sharp products vs. the costof exposure to bloodborne pathogens can help.When the cost of exposureidentification, care, follow-up, reporting and other OSHA requirements arelisted, it becomes more apparent why purchasing somewhat more expensive productsare actually less expensive than treating long term bloodborne diseases inhealthcare workers.

What's out there?

The accompanying product showcase (starting on page 33) outlines the varietyof products available to protect healthcare workers (HCW). The standards do notspecify what product to use, but do require that some system be used. The choiceof products must also be reviewed annually for emerging technology and inputfrom direct caregivers used when selecting and evaluating products.

OSHA gives the healthcare industry 90 days to implement the changes to thebloodborne pathogens standard. The changes require interdisciplinary planningand action. The focus of these changes must be reinforced to the persons beingaffected by the change. The healthcare worker will experience fewer sharpsinjuries, and therefore, will be at less of a risk to become infected with abloodborne pathogen via needlestick. This is the true benefit of the newtechnologies in safer sharp products.

Pat Tydell, RN, MSN, MPH, is risk manager at North Chicago VeteransAdministration Medical Center (VAMC) in North Chicago, Ill.

SHARPS SAFETY PRODUCTS

ABBOTT LABORATORIES
200 Abbott Park Road
Abbott Park, IL 60064
1-800-ABBOTT3
Fax: (847) 937-7515
www.abbott.comProducts: Blood collection devices, needleless IV connectors,needleless IV systems, needleless syringes, shielded needle syringes

ALARIS MEDICAL SYSTEMS, INC.
10221 Wateridge Circle
San Diego, CA 92121
1-800-4824822
Fax: (858) 458-7760
www.alarismed.comProducts: Needleless IV line connectors, needleless IV systems

BAXA CORPORATION
13760 E. Arapahoe
Englewood, CO 80112-3903
1-800-567-2292
Fax: (303) 690-4804
www.baxa.comProducts: Syringe tip caps, oral syringes

BECTON DICKINSON
1 Becton Drive
Franklin Lakes, NH 04417
888-237-2762
www.bd.comProducts: Blood collection devices, blunt tip cannulae, disposalunits/containers, needleless IV line connectors, needleless IV systems, shieldedIV/catheters, safety lancets, needle crushers/cutters, needle dispenser boxes,needle holders, needle trays, scalpel holders, disposable scalpels, safetyscalpels, needleless syringes, regional anesthesia trays with safety engineereddevices, specimen tubes, blood sampling system

BEMIS MANUFACTURING COMPANY
300 Mill Street
Sheboygan Falls, WI 53085
1-800-558-7651
Fax: (920) 467-8573
www.bemismfg.comProducts: Disposal units/containers

BIOJECT INC.
7620 S.W. Bridgeport Rd.
Portland, OR 97224
(503) 639-7221 x. 436
Fax: (503) 624-9002
www.bioject.comProducts: Needlefree IM and SC injectors for clinical use and personaluse

BIOMEDICAL DISPOSAL, INC.
3690 Holcomb Bridge Road
Norcross, GA
(888) 393-9595
Fax: (770) 300-9306
www.biodisposal.comProducts: Electric needle destruction unit and web-based compliancesoftware

BIO-PLEXUS, INC.
129 Reservoir Road
Vernon, CT 06066
1-800-223-0010
Fax: (860) 870-6345
www.bio-plexus.comProducts: Blood collection devices, needle holders

B. BRAUN MEDICAL, INC.
824 12th Ave.
Bethlehem, PA 18034
1-800-227-8862
Fax: (610) 266-6122
www.bbraunusa.comProducts: Blunt tip cannulae, needleless IV line connectors, recessedneedle IV line connectors, needleless IV systems, shielded IV/catheters, filterstraws, procedural kits (CVCs, PCIs, Epidurals, PICCS) with needle block foamsharps holders

CELL ROBOTICS
2715 Broadbent Parkway, NE Suites A-E
Albuquerque, NM 87107
(505) 343-1131 x.100
Fax: (505) 344-8112
www.cellrobotics.comProducts: Laser assisted blood sampling device

DEROYAL
200 DeBusk Lane
Powell, TN 37849-1046
www.deroyal.comProducts: Blade removers, blood collection devices, disposalunits/containers, needle holders, needle recapping devices, needle trays,scalpel holders, disposable scalpels, safety scalpels, transfer trays,instrument pads, suture assist devices, needle counters, safety instrumentstrainers

ETHICON ENDO-SURGERY VASCULAR ACCESS
4545 Creek Road
Cincinnati, OH 45242
(513) 337-8898
Fax: (513) 337-2898
www.vascularaccess.comProducts: Shielded IV/catheters

FUTURA MEDICAL CORPORATION
3820 Academy Parkway North NE
Albuquerque, NM 87109
1-800-631-0076
Fax: (505) 342-9735
www.futuramedical.comProducts: Blood collection devices, disposal units/containers,needleless IV line connectors, safety lancets, needle holders, disposablescalpels, needleless syringes, needle incinerators

GETTIG PHARMACEUTICAL INSTRUMENTCO.
1 Streamside Place West
Spring Mills, PA 16875
(814) 422-8892
Fax: (814) 422-8011
www.gettig.comProducts: Safety needle, sliding sheath

GRIFF INDUSTRIES, INC.
20717 Prairie St.
Chatsworth, CA 91311
(818) 709-4743
Fax: (818) 709-4768
Products: Blade removers, needle dispenser boxes, needle recappingdevices, needle trays, scalpel holders, blade loader/unloaders

INVIRO MEDICAL DEVICES, INC.
1188 Thurlow Street
Vancouver, BC V63 1X3
(604) 688-6115
Fax: (604) 685-6694
Products: Recessed needle syringes

KENDALL
15 Hampshire St.
Mansfield, MA 02048
1-800-962-9888
www.kendallhq.comProducts: Blood collection devices, disposal units/containers, safetylancets, needle dispenser boxes, needle holders, needleless syringes, sharpsdisposal containers

MAXXIM MEDICAL
4750 118th Ave. North
Clearwater, FL 33762
1-800-356-8849
www.maxximmedical.comProducts: Disposal units/containers

MEDISYSTEMS CORPORATION
701 Pike Street Floor 16
Seattle, WA 98101
1-800-369-MEDI
Fax: (888) 373-HEMO
www.medisystems.comProducts: Blunt tip cannulae, needleless IV systems, shielded needlesyringes

MEDPRO, INC.
817 Winchester Rd #200
Lexington, KY 40505
(859) 225-5375
Fax: (859) 225-5347
www.needlyzer.comProducts: Needle recapping devices, Needlyzer model NDZ-needledestruction device, Safemate-dental safety needle.

MICROTEK MEDICAL, INC.
512 Lehmberg Road
Columbus, MS 39702
1-800-824-3027
Fax: 1-800-642-0255
www.microtekmed.comProducts: Disposal units/containers, needle dispenser boxes, isolysersolidification products for sharps

NEW MEDICAL TECHNOLGY, INC.
23 National Drive
Franklin, MA 02038
19-800-522-1512
Fax: (508) 520-4556
www.newmedicaltechnology.comProducts: Safety syringes

NORTH AMERICAN MEDICAL PRODUCTS, INC.
3 Walker Way
Albany, NY 12205
1-800-488-6267
Fax: (518) 218-0405
www.nampinc.comProducts: Blood collection devices, safety lancets, recessed needlesyringes, shielded needle syringes, safety multi-draw blood collection needle,safety butterfly needles

OMNI/AJAX
49 Seven Point Trail
Gouldsboro, PA 18424
(570) 848-4186
Fax: (570) 848-4187
www.omni-ajax.comProducts: Blood collection devices, safety scalpels, cementsolidification stabilization powders/agents

OWEN MUMFORD
1755-A West Oak Commons Court
Marietta, GA 30062
(770) 977-2226
Fax: (770) 977-2866
www.owenmumford.comProducts: Safety lancets

SAFETY 1ST MEDICAL
1740 E. Garry Ave #108
Santa Ana, CA 92705
1-800-977-2331
Fax: (48) 476-5559
www.safety1stmedical.comProducts: Shielded needle syringes

SAFETY SYRINGES
1925 Palomar Oaks Way Suite 204
Carlsbad, CA 92008
(706) 918-9908
Fax: (706) 918-0565
www.safetysyringes.comProducts: Shielded needle syringes

SIMS PORTEX INC.
10 Bowman Dr.
Keene, NH 03437
1-800-258-5361
Fax: (603) 352-3703
www.portexusa.comProducts: Blood collection devices, disposal units/containers, needledispenser boxes, needle recapping devices, syringe tip caps, shielded needlesyringes, disposable vacuum tube, shielded holder, mini-sharps containers

TERUMO MEDICAL CORPORATION
2101 Cottontail Lane
Somerset, NH 08873
1-800-888-3786
Fax: 1-800-411-5870
www.terumomedical.comProducts: Shielded needles

WALSH INTEGRATED ENVIRONMENTAL SYSTEMS, INC.
2555 Dollard Ave. Building 5, Suite 202
Montreal, Quebec H8N 3A9
1-800-925-7460
Fax: (514) 364-1559
www.walshenvironmental.comProducts: Sharps handling and disposal

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