Infection Control Today - 12/2003: OR Topics

December 1, 2003

Combating Sharps-Safety Myths

By John Roark

The Occupational Safety and Health Administration (OSHA) estimates that 8million workers in the healthcare industry and related occupations are at riskof occupational exposure to bloodborne pathogens. Any worker handling sharpdevices or equipment is at risk of injury.1

Considering that sharps safety is an integral part of the lives of allhealthcare practitioners, it is surprising how many misconceptions surround thisubiquitous issue. Following are some of the most common fallacies, and therealities behind the myths.

MYTH: Compliance is optional.

TRUTH: The misconception is, you only need to do this if you want to,says Katherine West, BSN, MSEd, CIC, an infection control consultant withInfection Control Emerging Concepts. Some places still think its anoption! Its federal law the first one from U.S. congress of 2000, and thenew OSHA Bloodborne Pathogen regulation in January 2002.

MYTH: Sharps safety is OSHAs primary focus on inspections.

TRUTH: According to West, of the top seven OSHA citations for 2002, four wererelated to sharp safety. They were:

1. Failure to reflect changes in technology in the exposure control plan. Eachoffice or facility has to have an exposure control plan, and part of that iswhat needle-safe devices theyve brought in, evaluated, selected, which onestheyre still looking for, she says.

2. Failure to use engineering controls. (Engineering controls are needle-safe devices.) 3. Failure to train employees appropriately. With needle-safedevices, thats supposed to be hands-on training, West adds.

4. Failure to keep a sharps injury log. There are places that have noteven integrated needle-safe devices many, many hospitals. Theyre tryingto weed out back stock, or theyre making the decision theyre not going todo it because of cost. A couple of those facilities are now in court, shesays.

MYTH: When it comes to sharps safety, OSHA is solely employee-protectionoriented.

TRUTH: The origin of OSHA comes from worker safety. It started out withthe industrial safety and health that union workers were petitioning for,says West. Created in 1970, OSHA has a mandate to insure worker health andsafety. It has been solely employee-protection oriented. Whats different,with sharps safety, is that there is one waiver that is pro-patient. Theprovision says that if you have a choice of only one device, because, say, themarketplace is limited, and the patients complain about discomfort, or thedevice is not well-designed and impedes the procedure, you can defer from theuse of that product until you find a better one. So there is some considerationfor the patient as well.

MYTH: All sharps that pose a risk of percutaneous injury must bereplaced with a safety device.

TRUTH: OSHA requires that safety devices replace only those sharps that havethe potential to expose a worker to an injury from contaminated sharp devices(i.e., potentially contaminated with bloodborne pathogens). Devices that willnot be contaminated with bloodborne pathogens and thus do not pose a risk ofinjury from a contaminated sharp are not required by OSHA to be replaced with safety devices. Oneexample would be a syringe with a needle used in pharmacy for sterile admixture procedures.2

MYTH: Because its a safety device you dont have to worry aboutneedlesticks.

TRUTH: It is only in rare instances that use of a safety device doesntrequire hands-on experience, says David Crimmins, RN, infection controlpractitioner at Beth Israel Medical Center in New York. We end up withsituations where people get a needle stick because theyre unfamiliar with theuse of a safety device, and very often they dont activate it. A lot of thisisnt rocket science its pretty simple stuff. Actually, the biggest problem we see is just a matter of dexterity. The morefamiliar you are with a device, the more likely its going to work for you.And they dont all work the same. They may look similar or the same, but theyhave very different methods of activation.

MYTH: Im better off using equipment Im more comfortable with.

TRUTH: Until we get to products that automatically engage themselves, weregoing to have the problem of people not activating them, says Crimmins. Iknow nurses that refuse to use safety products. Its out of habit Ive always done it this way, this is what Imcomfortable with. And if youre in a quiet phlebotomy area, the patient iscooperative, there are some of the safety devices that are not all that easy to use. Youre probably safer than trying to introduce a morecumbersome safety product.

In the big picture, it is better to do everything you can to keep yourselfsafe, Crimmins continues. That means that even if it is a safety product,you still want a controlled environment, no distractions, all the equipment youneed at hand. But you also need some kind of training, some kind of experiencewith the product. No matter how good you are, or how cooperative the patientsare, there is going to be that accident. Your chances of seroconversion are extremely low, but if youre the onethat it happens to, then its no help at all.

MYTH: Vacutainers are reusable.

TRUTH: Vacu-tainers must not only be needle-safe, but single-use only. According to the OSHA Enforcement Procedures for the Occupational Exposureto Bloodborne Pathogens, A reusable sharps container system for disposablesharps will be acceptable if it does not expose employees to the risk ofpercutaneous injury. No system involving the manual opening, emptying, orcleaning of the containers will be allowed. The only acceptable system is afully automated container cleaning system that eliminates employee exposure tosharps.

MYTH: By definition, sharps does not include glass.

TRUTH: Many people fail to recognize that the definition of sharpsincludes glass, says West. Glass blood tubes, glass capillary tubes, glassslides have to go. And when a product is switched from glass to non-glass, manytimes the lab values will be off, so you have to re-calibrate.

MYTH: The lab will always fill your order with OSHA-compliant supplies.

TRUTH: Some of the labs are trying to clear out back-stock, and theyreputting their customers in non-compliance, cautions West. Check on your labs to make sure theyre sending you compliance product. If you say, I didnt know this is what the lab sent me, that isntgoing to fly. The onus of responsibility is on the facility.

MYTH: There arent enough OSHA inspectors its unlikely our facilitywill be inspected.

TRUTH: People think, They couldnt possibly come to my workplace,theyre too limited. Theyre not going to get around to our small facility. Not true, says West. OSHA has been well-funded, and most of theirinspections are being random selected in all disciplines. Only 20 percent ofcomplaints last year were employee-generated. I think a lot of people dontrealize they do random computer selection, and that they look at OSHA 300Accident and Injury logs, and that sometimes triggers the workplace that theywill focus on.

MYTH: Federal law is it. State laws have no impact.

TRUTH: Staff need to be familiar with their states sharps injury lawsto see if they differ, or if there is anything additional beyond what the Fedshave asked, says West. Id say about half of the states have their ownlaws; many are pending in other states. State laws may add things likepresumption laws if you have a sharps injury and you get a disease, it ispresumed it was related to that injury, that it was occupationally- acquired. Check your state laws you never know what youre going to find.

MYTH: Incidence of needle stick injuries in limited to patient care areas.

TRUTH: Conceivably, sharps injuries can occur in virtually any area of ahealthcare facility. Ironically, the area where most of our incidences ofimproper needle disposal occurs is in the public restrooms, says Janet Brown,manager of facilities at Beth Israel Medical Center in New York.

Thats where very often a patient, very innocently, will beself-medicating and not know better, and just throw a needle into the garbagecan. Many of our needles have been found in our outpatient care areas in apublic restroom. So thats where weve put up signage to help our patientsunderstand about safety inside of a hospital. Thats why its reallyimportant to educate patients on proper needle disposal.

The problem with the needles in the trash, adds Crimmins, is a lotof it is just totally anonymous. If youre working on a patient, we can findout the their hepatitis status, we can get a history. You get one in the trashand the skys the limit. You have no information, and fear takes over.

MYTH: Disposable is cheaper.

TRUTH: When it comes to waste management, this is not necessarily the case,says Brown. When youre comparing systems, its important to look at thefull life cycle analysis in order to get the true cost of the program. I wouldmuch rather go for the reusable based on the environmental impact lessgarbage plus, its just safer. We had much less incidence of over-filledcontainers; because youre not paying by the container, you dont have thatincentive to fill it up all the way. Youre paying for a service someone comes in and changes them allbefore they reach capacity.

MYTH: If the medical facility has a purchasing contract with a certainvendor, that vendors product will ultimately be selected.

TRUTH: Not true. The purchasing contracts do not hold, says West. Theproduct is selected based on input and trial evaluation from the employees. Theyare not at the mercy of their purchasing contract. But the purchasing people will try to say otherwise, and so willadministration, because these products cost more. You may be going from aproduct that costs 79 cents to one thats $1.50. A lot of administration islooking at it short term and not over the long haul. They should be looking athow many sharps injuries there were per year, and what it cost to follow up withthose individuals. You can buy a lot of sharps devices with that money.

MYTH: You can use up whatever remaining stock you have, and then buy the newOSHA-compliant stock.

TRUTH: Not true, cautions West. Ive talked with one OSHA regionalbloodborne pathogens coordinator, and she said three months was too long toclear out back stock, one month was reasonable. I would say somewhere betweenone to two months is really all you have to clear out back stock. Purchasing hasto make sure that the vendors arent clearing out their back stock bysending it to the purchaser, thus making the purchaser non-compliant.

MYTH: Healthcare workers are being adequately trained in the use of sharpssafety devices.

TRUTH: Not so, says West. A paramedic in one of my classes said, Thehospitals arent teaching us. They stock our boxes, but they arent teachingus how to use these devices. Our patients dont look at us with a lot ofconfidence when were driving down the road trying to read the instructions.People not only have to be well-educated, but have the hands-on training so theybecome proficient in using something that is new. If you dont know how to useit, what good is it doing to do?

Training has to be hands-on, West underscores. You cant just watch ademonstration or a video. Hands-on means practicing with the actual device.Hospitals are shortcutting every way they can, and most likely theyre goingto show a video. But thats not going to cut it.