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By Brad Poulos
The Primary Prevention Safety Award is sponsored by theNational Alliance for the Primary Prevention of Sharps Injuries (NAPPSI) andICT. The award recognizes a healthcare facility that has demonstrated efforts toprevent sharps injuries and champion primary prevention techniques andtechnologies.
Health First is a Florida-based, private, not-for-profithealthcare provider comprised of three medical centers: Holmes Regional MedicalCenter in Melbourne (550 beds); Cape Canaveral Hospital in Cocoa Beach (150beds); Palm Bay Community Hospital in Palm Bay (60 beds). Health First is partof VHA, a nationwide cooperative of community-owned healthcare organizations.
Health Firsts mission is to improve the health ofindividuals within our communities through disease prevention, health education,and the delivery of quality healthcare services. Their philosophy of caringfor patients, not for profit was demonstrated in fiscal year 2003 byproviding more than $81million in charity care to patients who were unable topay for their care.
Health First embraced sharps safety products more than 10years ago, even before the 2001 changes to the Occupational Safety and HealthAdministration (OSHA) Bloodborne Pathogens Standards (BBP). The infectioncontrol department led efforts to introduce safety syringes and a needleless IVsystem shortly after their introduction to the marketplace. Health Firstsmembers of administration and risk management have been strong supporters ofsafety initiatives and prevention strategies. Until recently, commercialavailability of safer medical devices was limited, and the devices did notalways meet clinical requirements.
The Health First Exposure Prevention Program was developed in2001 with an initial safety product survey and needs assessment. The survey is a comprehensive list of all categories of sharpsdevices in use throughout the organization. Each category is assessed forcurrent safety product use, and commercial availability of safety products. TheMedical Product Standards Committee is responsible for review, evaluation andimplementation of new products where appropriate. The ultimate goal of theprogram and the committee is to systematically convert all sharps to a safetydevice.
Implementation of a new safety device can be the mostchallenging aspect of an exposure-prevention program. At Health First, theMedical Product Standards Committee uses a multi-disciplinary approach tofacilitate change. Members of the committee are assigned roles for introductionof each new device. Patient care services plays a key role in productevaluations and contract and supply chain; administration provides the costanalysis, product alternatives and coordinates the new product entry; and humanresource development organizes the training of end users. Infection control, employee health, and safety and securitymonitor compliance and efficacy through exposure reports and employee feedback.
Recent successes at Health First include a state-of-the-artneedle-less IV system, safety IV catheters and a safety bone marrow biopsyneedle. Today, virtually all percutaneous puncture (IV placement, injections,biopsies, blood draws, etc.) is done with a sharps safety device.
Of course, education plays a huge role in work practices andcompliance when changing to a safety product. Educational tools at Health Firstinclude Prevention (an infection control newsletter) Safety On The Go (anenvironment-of-care newsletter); the Associates Press (monthly employee newsletter), anIntranet education site; and an online learning program covering the OSHA BBPstandards and sharps safety. Annual skill fairs focus on providing informationabout sharps-safety products.
The primary prevention technologies implemented by HealthFirst are:
Using primary prevention technologies whenever possible is aconstant goal at Health First. For example, the IV team recognized the value ofusing catheter-securement devices as a way to not only reduce sharps injuriesfrom suture needles and IV needles due to unscheduled restarts, but also toenhance patient safety, improve healthcare worker productivity, and reducecosts. Intravenous therapy at Health First begins with insertion using a safety IV catheter, the BD Insyte Autoguard (a secondary prevention technology) and the ICUMedical ClaveÂ® needle-free connector (a primary prevention technology). TheVenetec StatLockÂ® IV (a primary prevention technology) is used to secure thecatheter, thus maximizing healthcare worker safety. Health First recognizes the fact that it is less expensive toprevent sharps injuries than to treat them.
The secondary prevention technologies implemented by HealthFirst are:
The NAPPSI Clinician Advisory calls upon clinicians to employboth primary and secondary prevention measures to maximize sharps injuryprotection in the healthcare workplace. Clearly, Health First has taken thespirit of the advisory to heart. By implementing and reinforcing primaryprevention strategies, long before they became mandatory under federal law,countless sharps injuries have doubtless been prevented and thousands of sharpshave been kept out of this exemplary healthcare workplace. Congratulations tothe Health First system for their wise and widespread implementation of sharpsinjury prevention. Clearly, they have earned the 2004 Primary Prevention SharpsSafety Award.
Brad Poulos is director of the National Alliance for thePrimary Prevention of Sharps Injuries (NAPPSI).
HealthEast Care System in St. Paul, Minn. was selected as thefirst runner- up in the 2004 Primary Prevention Safety Award. HealthEast CareSystem is a network of integrated care services, including four hospitals, whichserve the cities of Minneapolis and St. Paul, Minn. and the surroundingcommunities. In 1999, a system-wide, multi-disciplinary needle-safety committeewas formed to assist in creating a culture of sharps safety. The committee developed a mission, vision and goal for thisimportant work. The mission was to effectively reduce occupationally acquiredsharps injuries through elimination of sharps where possible, and use safetydevices and safer work practices and education as part of a comprehensive,systematic process for improvement. The vision was to develop a culture where prevention of sharpsinjuries is a work habit and an organizational commitment, and the goal was tohave zero sharps injuries.
The team developed a campaign logo and theme titled, TheGoal is Zero: Zero-In on Accidental Needlesticks! Campaign for Worker Safetythrough Sharps Injury Prevention, as well as a communication plan thatincludes posters, stickers, and an ongoing newsletter called Nix the Sticks!
According to Boyd Wilson, system director of infectioncontrol, eliminating sharps injuries is a very difficult goal for a number ofreasons.
Needle safety is challenging to address because it requirespeople to be comfortable with change in behavior and oftentimes clinicalpractice, he explains. We have tried very hard to include our staffin the decision-making process regarding needle safety, so they could buy intothe benefits before we implemented the program.
The HealthEast Needle Safe Committee, co-chaired by KathyMiller, St. Johns Hospital infection control specialist, and Debbie Hulbert,system director of employee occupational health, has been instrumental in thisprocess.
By 2003, HealthEast experienced a decrease in injury rates inall of the hospitals where the majority of sharps injuries occur and thesharps injury rate was cut nearly in half across the system. In 2004, they havefocused on reducing sharps injuries in surgery and have seen some improvementalready in the first quarter.
It has taken awhile to see the success in reducing ourinjuries, Wilson continues. Its a project that requires continualevaluation and openness to change in order to create a shift to create a cultureof safety. We applaud the Needle Safe Committee for their work and our staff andphysicians for their trust and support of this program.
Rather than using a traditional performance improvement modelfor this work, the team used an eight-stage change model, described by John P. Kotter in his 1996 book Leading Change, to support theculture transformation. The eight stages are:
They also implemented communication and educationmodifications to include a new needle-safety module as a part of thecomputerized mandatory education, and updated the sharps safety informationprovided during general orientation and site/department orientation.
Success has been due to the combined approach of implementingsafety devices, providing ongoing educational support, and assessing workpractices. The group seizes every opportunity to continue to keep a highawareness level regarding preventing sharps injuries. An important part of theculture transformation is that non-safety needles and sharps are beingeliminated where clinically feasible. Wherever a safer alternative has beenidentified, the group used an exemption form process for those departmentsrequesting a non-safety device. Therefore, the purchasing department serves as a stopgap toprevent departments from ordering non-safety products without review andapproval of the needle safe committee.
Their culture is continually transforming, and good habits arebeing nurtured sometimes in unexpected ways. At a recent emergencydepartment infection control in-service, a physician presented a bottle of wineto a nurse who had pointed out to him recently that he did not clean up hissharps after a procedure. He agreed it was his responsibility and said he owedher a bottle of wine and would change his practice. They are celebrating theirsuccesses when they come and continue to work toward the goal of zero bytransforming the work culture to one where sharps injury prevention and workersafety are becoming a habit. This work was presented as a performanceimprovement initiative during recent JCAHO surveys and was presented at the 2003APIC-Minnesota Fall Conference.
Brad Poulos is director of NAPPSI.
A pioneer of safety-inspired advancements, Baxter is yourconnection to safety. With the introduction of the Interlink System, Baxterbecame the first medical device manufacturer to offer split septum access ports,greatly reducing the need for traditional steel needles and the potential foraccidental needle-stick injuries. Baxter's latest needleless technology, theClearlink System, offers cannula-free, Luer-activated access. Clearlink alsopromotes safety through its unique, clear housing. This provides visualizationof the fluid path, allowing clinicians to see the results of flushing.
(800) 4 BAXTER or www.baxter.com
The passive IntrocanÂ® Safety IV Catheter is designed to minimize accidentalneedlesticks without requiring user activation. A stainless steel clip is usedto shield the needle tip. The passive design eliminates risk of inadvertentactivation while offering a short learning curve with minimal inservicetraining. Compliance is virtually assured since the safety mechanism cannot bebypassed. A syringe can be pre-attached to the Introcan Safety IV Catheter tofacilitate aspiration and injection during insertion.
(800) 854-6851 or www.bbraunusa.com
Bio Systems is the expert in providing full service sharpsmanagement solutions to hospitals throughout the United States. Through theutilization of our unique re-usable sharps containers and handling process, BioSystems has been successful in providing safe, environmentally friendly and costeffective sharps management programs to hundreds of major hospitals since 1984.
(888) 776-2288 or www.biosystemsusa.com
Cell Robotics, Inc.
Cell Robotics, Inc. provides the only sharps-free instrumentfor capillary blood sampling. The new LasetteÂ® P200 laser lancing device isredesigned specifically for clinical screening and point-of-care blood analysisfeaturing higher blood flow, one-handed operation, and simplified controls.Laser lancing requires no physical penetration of the skin and eliminates theuse of medical sharps.
(800) 846-0590 or www.cellrobotics.com
Hospira is a global specialty pharmaceutical and medicationdelivery company dedicated to Advancing Wellness by developing, manufacturingand marketing products that help improve the safety and efficacy of patientcare. Created from the core global hospital products business of AbbottLaboratories, Hospira is a new company with 70 years of service to the hospitalindustry. The companys portfolio includes the industrys broadestline of acute-care injectables and integrated solutions for medicationmanagement and infusion therapy.
(877) 9HOSPIRA or www.hospira.com
Tyco Kendall has demonstrated its commitment to providingtop-quality sharps containers, needles and syringes and blood collectionproducts to the healthcare industry, developing and manufacturing the broadestrange of products available with the clinician in mind and strict qualitycontrol measures in place. The best products for the job, the safest products onthe market.
(508) 261-8000 or www.tycohealthcare.com
StatLock safety securement devices replace the outmodedcatheter fixation techniques of tape and suture to provide dramatically improvedpatient safety, healthcare worker protection and cost-benefits. StatLock isfastbecoming the new standard for securement of all medical tubes and catheters.In fact, the CDC has recently acknowledged that StatLock is superior to suturein reducing catheter-related blood stream infection. Similarly, OSHA and theU.S. Congress have recognized StatLock as a needlestick safety device under thelaw. And, with over 10,000 patients studied, StatLock is indisputably superiorto tape for securement of peripheral IV catheters. StatLock the new Standard of Care for vascular accessdevice securement.
(800) 833-3895 or www.statlock.com