Exposure to bloodborne pathogens is one of the most serious occupational hazards for healthcare workers. According to the World Health Organization’s report, “Preventing Needlestick Injuries Among Healthcare Workers, authors Susan Q. Wilburn, BSN, MPH, and Gerry Eijkemans, MD, note, “The healthcare workforce, 35 million people worldwide, represents 12 percent of the working population. The occupational health of this significant group has long been neglected both organizationally and by governments. The misconception exists that the healthcare industry is ‘clean‘ and without hazard, when in fact the chemical and bloodborne exposures encountered can be career- and life-ending.”
ICT turned to experts in the industry to see what tips they can offer infection preventionists to boost sharps safety in their facilities.
Jan Harris, MPH, BSDH, director of environmental health and safety at Sharps Compliance, Inc., emphasizes that even though it has been seven years since the Needlestick Safety and Prevention Act was passed and the Occupational Safety and Health Administration (OSHA) updated its Bloodborne Pathogens Standard, compliance lapses are all too common.
“Sharps safety, just like many aspects of employee safety and health, still often comes down to following regulations instead of understanding the goals, objectives and reasons behind those regulations,” Harris says. “Supplying a variety of safety devices to be chosen based on the situation and educating the healthcare provider on selection encourages buy-in because the selection is solution-based, not just rules-based. Including employees in the selection of safety devices is required by the Bloodborne Pathogens Standard. This does not have to only mean a defined selection committee who performs an annual evaluation of sharps injuries. It should include methods for continued field evaluation. Gathering data throughout the year on difficulty of use, near misses, and work practices that do not work often mean more than actual sharps injury data collection at the end of the year.”
Harris advises that healthcare providers learn to engage in critical thinking skills that take compliance to a level beyond that of mere rule-following without understanding the imperatives of sharps injury avoidance.
“Situation-based education provides learners the ability to apply what they learn to real-life circumstances they encounter every day,” Harris explains. “Just like patients are encouraged to ask questions of their healthcare providers and become active participants in their own healthcare, the healthcare provider must be encouraged to think critically and ask why particular procedures or methods are done a certain way instead of simply doing things the way they’ve always been done. Learning should not be only about memorizing rules it should be about questioning those rules when they do not make sense. If education alone was all that was needed to prevent unsafe work practices, there would be very few accidents; since many of us have had bloodborne pathogens and sharps injury prevention training now for more than 20 years. The infection preventionist must find ways to engage the clinician to think ahead of the task they are about to perform; to believe that their safety is as important as the patient’s.”
“It is very simple,” says Dr. Michael Sinnott, MBBS, FACEM, FRACP, of Qlicksmart. “For medical staff to take personal safety seriously, two things must happen: safety practices must be made compulsory through relevant regulations, and compliance with these recommended practices and guidelines must be audited. Education is nice but not effective, as medical staff members have too many great excuses, such as, ‘But the patient comes first...’ Education on its own makes little or no difference – it is like ‘preaching to the converted.’ You must have strict, succinct regulations and guidelines and these must be audited.”
Infection preventionists can best educate healthcare workers about the importance of preventing sharps injuries and exposure to bloodborne pathogens through ongoing education and training programs.
“Facilities must initiate an ongoing education program regarding chronic diseases such as hepatitis and HIV caused by needlestick injuries,” advises Dan Daley, director of sales
For Safety 1st Medical Inc. “Presently, a similar message is repeated daily on TV concerning smoking, obesity, drugs, etc. When was the last time you walked into a hospital or facility and viewed an effective sharps safety message?”
“During in-services, people can relate about their experiences with common sharps-injury occurrences,” says Gary Chilcott of Sure-Way.
Marie Barsamian, marketing manager for Cardinal Health’s Safe-T PLUS Diagnostic and Procedure Trays, reminds infection preventionists that the Cenetrs for Disease Control and Prevention (CDC), the Occupational Safety and Health Organization (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) offer a great deal of information and resources on their Websites that can be used to educate on sharps safety and prevention of bloodborne pathogens.
Employing engineered safety devices – both active and passive – along with training on how to use them can reduce the number of sharps-related injuries.
“Employees must be shown the advantages of using safety devices that will reduce sharps injuries,” Daley says. “Infection control staff should be accumulating data that support a reduction in injuries using these devices. Most importantly, these healthcare professionals should be working with manufacturers to make their products more user-friendly and safer.”
Inviro Medical’s senior vice president of sales, Mark Stoppenbach, notes, “To boost sharps safety practices in the acute-care environment, awareness of the available sharps safety products on the market is first and foremost. Education on sharps safety products may be obtained via Web sites, peer-reviewed articles, surveys and advertisements, etc. Involving acute-care clinicians in the facility’s mandatory annual review of sharps safety products will educate them thereby increasing their desire to promote the use of sharps safety in their environment.”
Barsamian says, “Giving clinicians an option to always use sharps safety devices where they could incur a sharps injury is the best way to boost safety practices for clinicians and patients. A terrific way to demonstrate this practice is through the new Safe-T™ PLUS Trays available from Cardinal Health. These new trays contain every device a clinician needs during the selected procedure to be completely compliant with sharps safety regulations and recommendations put forth by the CDC, OSHA and NIOSH.
Ana Stankovic, MD, Phd, MSPH, vice president of medical and scientific affairs and clinical operations for BD Diagnostics - Preanalytical Systems, advises, “Obviously, having devices available that provide healthcare workers with the highest possible level of protection against sharps-related exposure to bloodborne pathogens is important, so the need to improve and refine these safety-engineered devices is an ongoing one. BD is committed to remaining at the forefront of this safety evolution by offering safety-engineered needles designed to prevent exposure to bloodborne pathogens during phlebotomy and injection procedures. One product of note is the BD Vacutainer® Push Button Blood Collection Set, designed to reduce two very important issues associated with blood collection procedures: exposure time and ease-of-use. This blood collection set activates while the needle is still in the vein, resulting in zero exposure time if used properly. The safety-engineered mechanism is activated with the simple push of a button, making healthcare worker compliance more frequent and reliable.”
Stankovic points to a study by the University of Nebraska that shows 74.3 percent of users activated the safety feature on traditional blood collection methods, while 97.6 percent of users activated the safety feature of BD Vacutainer® Push Button Blood Collection Set.1 Moreover, data published in the Journal of Clinical Chemistry states that, over a five-year period, one large institution realized an 83 percent reduction in needlestick injuries, with an impressive 100 percent reduction (zero needlestick injuries) during the final 12 months of the study.2 “These data show that an intuitive device can result in higher activation rates, which in turn helps prevent opportunities for injury and pathogen exposure,” Stankovic says. “Working with device manufacturers to establish the best possible educational tools is critical to helping infection preventionists get the message out to healthcare workers about how to protect themselves. At BD, we offer full in-service training, educational materials, and preanalytical education programs designed to inform healthcare workers about the importance of employing best practices, particularly in phlebotomy, to prevent sharps injury as much as possible.”
Sometimes the best strategy is prevention in the first place. “Infection control practitioners can best educate healthcare workers about the importance of preventing sharps injuries and exposure to bloodborne pathogens by determining the cause of the sharps injury and securing the best products to prevent them,” Stoppenbach emphasizes. “According to the 2008 Study of Nurses’ Views on Workplace Safety and Needlestick Injuries, sponsored by Inviro Medical Devices and the American Nurses Association, 64 percent of U.S. nurses report being accidentally stuck by a needle while working, identical to findings in the 2006 Study of Needlestick Injuries and Safety Devices. The majority of nurses (59 percent) believe their most recent NSI could have been prevented by improved safety syringe design.”
Knowing how to properly handle and dispose of sharps is essential, reminds Offad Vallejo, marketing leader BD Medical - Medical Surgical Systems, a unit of BD. Vallejo points to the CDC/NIOSH publication, “Selecting, Evaluating, and Using Sharps Disposal Containers,” which indicates that the factors most often related to sharps injuries include inadequate design or inappropriate placement of the sharps disposal container, overfilling of sharps disposal containers, and inappropriate sharps disposal practices by the user.”
Vallejo continues, “To enhance safety practices in a hospital environment, the hospital should implement a procedure that minimizes or eliminates eliminates overfilling of the sharps container. On many occasions, needlestick injuries occur when sharps containers overfill. We work with healthcare facilities to assist them in developing practical solutions to remove sharps collectors prior to overfilling. In addition, BD sharps collectors have translucency features which help the healthcare worker easily identify fill levels in sharps collectors.”
Michael Ferrara, senior director of hypodermic products at BD Medical, notes, “The two critical components in boosting sharps safety practice are creating a safety-minded culture and choosing safety technology to support that culture. BD invests in clinical programming and sharps safety technology as we recognize that customers may not achieve their safety goals without both. For clinical support to build a safety-minded culture, BD provides nursing education with in-servicing and education tools on our sharps safety products. When it comes to the products themselves, BD’s portfolio of products including BD SafetyGlide™ with safety Activation Assist™ are designed to provide seamless and easy-to-use solutions without compromising clinical technique or efficiency.
Ferrara adds, “Infection preventionists can best educate HCWs by making visible the facility’s priority of preventing sharps injuries and exposure to bloodborne pathogens. Building a safety-minded culture takes persistence and commitment. BD stands committed along side our customers to build awareness through in-servicing and other education tools. Such clinical support is standard for BD and is why many facilities choose BD for sharps safety products.”
Vallejo offers some easy-to-implement recommendations:
— Sharp object injury surveillance programs can investigate current disposal processes and procedures and point out any gaps to existing guidelines
— Data inputs at the point of generation can be used to help identify disposal related needs and circumstances and point out gaps in safety practices.
— Safety audits of existing sharps collectors can determine proper placement and disposal practices
— Audit observations and follow-up recommendations can be an invaluable tool to train new employees and should be strongly considered as part of a new employee on-boarding program.
“Infectious preventionists manage many issues in a hospital,” Vallejo says. “Sharps safety is one issue that can be part of the culture of the hospital when all employees feel ownership in preventing injuries. Sharp safety training should be constantly reminded and the infectious preventionist should advocate this training with all healthcare workers at all levels in the organization.”
1. Rupp M, et al. Effect of a Safety-Engineered Phlebotomy Device on Activation Compliance and Sharps Injury. University of Nebraska. Poster summary.
2. Hotaling M. Efficacy of a Retractable Safety Winged Steel Needle (Butterfly Needle) to Significantly Reduce Needlestick Injuries in Healthcare Workers: A 21-Month Experience. Poster summary of a 2008 Journal of Clinical Chemistry article.