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By Dave Wise, CSPDT, and Penny Sabrosky, BS, CSPDT
Manyhealthcare workers (HCWs) may not be aware that the central service (CS)processing area can be a hazardous place to work. Consider this: As a CSmanager, you are summoned to the decontamination area where the technicianinforms you that a bloody saw blade was returned on a tray from the operatingroom (OR). On another visit you notice a suture needle left from surgery in theemergency room (ER). There are a number of different sharps that end up in thecentral sterile department that should have been disposed of at the point ofuse. What should be done to protect staff from a potentially dangerous situationlike this? Does your department have safeguards in place to protect workers frominjury?
More that 1 million sharps injuries occur annually. HCWs encounter hazardoussituations daily, so how they prepare for and respond to these situations iscritical. CS departments must develop polices and procedures that protectemployees who work with sharps. Following are a few suggestions to assist inprotecting staff in your department:
1. Establish a safety task force comprises key players from infectioncontrol, nursing, risk management, materials management and frontline workers toidentify the causes of injury and develop procedures regarding the properdisposal of sharps. Input from a diverse group is important when evaluatingrates and causes of injury, and in calculating the potential exposure tobloodborne pathogens. The team approach is also useful when appraising and/orimplementing new equipment. Creating a department safety team of three people isa good start. One individual on the team should be assigned to oversee sharpsinjury prevention.
2. A well-written training plan is essential to avoid injuries. New employeesshould receive extensive instruction regarding needle stick and sharpseducation. The plan should include precautions to be taken when handling sharpitems, what personal protective equipment (PPE) should be worn when in contactwith contaminated items, disposal procedures, and who to notify in the event ofan injury. An exposure plan must be part of the training, and infection control,risk management and CS should write it together.
3. Conduct an awareness campaign. Information about diseases and protectiveprocedures should be disseminated in newsletters, meeting minutes and posters.Some risks are minimal, while others may be life-threatening, as in the case ofhepatitis B and C, and HIV. Make sure your staff is well educated. Access to Websites that deal with sharps safety and bloodborne pathogens play a vital role ineducating staff on the dangers of improperly handling sharps. Sites that arehelpful include:
4. Establish an instrument tracking system, a key element of a goodsharps-safety program. One of the best ways to combat sharps injuries is tomonitor the type and amount of sharps that return to the decontamination areaover a two-week period. Sharps commonly enter decontam from surgery, the ER, OB,and radiology services.
Instrument tracking and sharps awareness took on added importance for onehospital after a central service employee sustained a needlestick injury to herindex finger from a soiled emergency room laceration tray. This tray was grosslyunprepared and contained three types of sharps that were not removed where thepatient was treated: a No. 3 knife blade, a hollow bore needle still attached tothe disposable syringe and a suture needle left on the needleholder. This CSemployee did all the right things. She immediately removed her double glovesthen washed her hands, and reported directly to the emergency department toidentify a patient for blood testing. Unfortunately the blood and body fluidwere classified as an "unknown source" because instrument tracking wasnot up to par. It greatly comforts an employee who has been injured or poked toknow that the source patient will be tested for HIV and HBV, and results will beprovided in a confidential manner.
The Federal Needlestick Prevention Act of November 2000 does not protect theCS employees from sharps exposure. While government-mandated use ofextraordinary safety devices will prevent and reduce needlestick injuries innursing and other patient care areas, what will protect the CS employee from sawblades, drill bits, suture needles and other dangerous sharps that enter thedecontamination work area? Many times these sharps go undetected until it is toolate and it is impossible to trace the patient source.
In the past it was customary for CS technicians to remove sharps and disposeof them properly. Spectrum Health Blodgett Campus in Grand Rapids, Mich.,developed a new policy, "Disposal of Contaminated Sharps in theDecontamination Area," which provides guidelines to protect the CS worker.This policy places the burden of sharps removal on the department responsiblefor sending it. The CS supervisor or manager contacts the department responsiblefor improper sharps disposal, and they are ultimately responsible to sendpersonnel to the CS decontamination area to dispose of the object.
While many remain unaware of the hazards associated with working in the CSdepartment, there seems to be a growing attentiveness to sharps and preventivetechniques [within healthcare]. CS workers are feeling more protected thesedays, and responsible sharps users are increasingly aware of sharps removal inthe field. P
Penny Sabrosky, BS, CSPDT, is the manager of central processing at SpectrumHealth Blodgett campus in Grand Rapids Mich., and is president of the MichiganSociety for Healthcare Central Service Professionals.
David Wise, CSPDT, is lead technician at Saint Mary's Mercy Medical Center inGrand Rapids, Mich., and is Region 5 board director for the American Society ofHealthcare Central Service Professionals (ASHCSP).