By Kathy Dix
Aug. 2, 2004, the Occupational Safety & HealthAdministration (OSHA) posted a revision to its fact sheet on securing medicalcatheters, which had initially been published online in early 2004. The revision focuses on the possibility of unsafe conditionscreated by the use of tape or sutures to secure catheters.
The document obliges all employers of workers withoccupational exposure to blood or other potentially infectious materials toannually review (and implement) appropriate, available and effective safermedical devices designed to eliminate or minimize that exposure.
Engineering controls that reduce the potential forneedlesticks by eliminating the need to suture medical catheters in place areone option for healthcare employers to consider, the fact sheet explains. As part of their annual review ofmethods to reduce needlesticks, employers must review options for securingmedical catheters and consider appropriate engineering and work practicecontrols.
The review must include the input of non-managerial employeeswho are responsible for direct patient care those who are potentiallyexposed to injuries from contaminated sharps in the identification, evaluationand selection of effective engineering and work practice controls, the factsheet continues.
Katie Schatzlein, RN, MS, a consultant in vascular accessbased in Austin, Texas, points out that abiding by these guidelines might besomewhat confusing. Is documentation of catheter securement required? Itsa paper tiger; you tell people to include the input of nonmanagerialemployees. If OSHA walks in and asks for your log showing the input of thenon-managerial employees and your review of the latest technologies ... where isit? she asks.
OSHAs Bloodborne Pathogens Standard, 1910.1030, reads, inpart, Document annually consideration and implementation of appropriatecommercially avail and effective safer medical devices designed to eliminate orminimize occupational exposure. Employers must also document the solicitationof non-managerial employees input in a written Exposure Control Plan.
The only way youre going to get compliance this isfrom my own personal experience is to have OSHA be something that is a realthreat, Schatzlein points out. If you work in a hospital, when its timefor JCAHO, they all start toeing the line. But OSHA doesnt do periodicvisits; thats why its easier for people to get by with not complying.
Schatzlein consults at one facility that is a rehabilitationhospital; this facility has no safety needles at all. They dont even knowtheyve done something wrong, she says. OSHA is not Big Brother enoughyet. If they go into the major cities and penalize a couple of hospitals inevery major city, then people will start getting scared. Right now, its a That happened in New York; we dontneed to worry about it kind of attitude.
Acute-care hospitals where Schatzlein consults have been morecompliant, she adds. They dragged their feet, but eventually they did it. Therehab center had an open supply room. They went to the trouble to create aclosed supply room, and theyve labeled all the bins, and its allorganized, but theyve thrown in their regular run-of-the-mill non-safetydevices that theyve made bins for!
A New York hospital was fi ned for sharps violations becausemedical students or residents turned them in, Schatzlein recalls. When OSHAvisited, they found that although the hospital did stock many safety devices,they still had the old non-safety devices. It doesnt matter how many; its the fact that you do it at all. I think I counted 15022-gauge angiocaths, and Im thinking, I wonder if anybody here has theremotest idea how this is almost contraband, she says.
The violations are not limited to small geographic pockets;they can happen anywhere, she adds. So how seriously do people take OSHA? Itvaries. But I believe that JCAHO is now looking for OSHA compliance. If JCAHOwalks in and wants to see your IV cart, they know what the safety devices looklike. If theyre not finding any, thats as serious as OSHA walking in.Theyre backing each other up. That will help, because JCAHO does comeroutinely.
Schatzlein observes that to make the OSHA regulations work inpractice, JCAHO may need to become more involved. OSHA does not make many actualvisits, she says, but when they do, its pretty horrendous when they fi nda violation. They respond to reports, so somebody at a facility can send ananonymous report, and theyll follow up on it, but they dont just go andvisit your hospital. I dont know why, whether theres not money in thedepartment to do that, or thats not the way they want to approach it, butthey dont do what JCAHO does.
As for catheter securement specifically, its still alittle bit of a leap to get people to see that it needs to be taken seriously,Schatzlein says. Thats going to happen where people working at the groundlevel show doctors, You dont have to suture that; you can just use thislittle pad here. Pretty soon, they say, I need some more pads. Itsthe people working day to day, sharing this information at the grass rootslevel, and thats where the connection is going to be made.
Physicians, she points out, learned to suture nearlyeverything in medical school. Its a skill they mastered. And then you showthem that the suture site is one of the major causes of catheter-relatedbloodstream infections. What about the fact that needlestick injuries occur andthey are totally avoidable if you dont use a suture? Once they get used toit, once they see how fast it is to put a catheter securement device on, after awhile, that time they save becomes more important to them. What becomes the mostimportant thing to them is how fast they can get that patient out and get thenext one in.
Tradition is really heard to break, and if you look at whatpeople have to do to get out of the habit that no longer has a purpose, then youhave to give them something to replace the other thing, and have them use it fora while until it becomes a habit. Then they cant go back to the old habit,because they realize it was time-consuming, dangerous, and theyve lostinterest in it.
For more information, visit www.osha.gov/SLTC/bloodbornepathogens/index.html.