Safe’ needles still can lead to needlesticks

Hospital reevaluates, lowers injury rates

Can a needle safety device be unsafe? It can, when it isn’t activated properly or when the device proves too cumbersome. That was the lesson learned by one hospital, which saw a 74% reduction in device-related needlesticks after switching brands.

Although record-keeping regulations require hospitals to collect information on the device on needlestick logs, there is still little information about how devices perform in everyday use. Even if such information existed, how one device performs in a certain unit or hospital may differ greatly from the experience in another unit or hospital, needle safety experts caution.

But Norman (OK) Regional Hospital discovered that the safety features can make a big difference in injury rates. The hospital’s experience shows the value of analyzing needlesticks and reevaluating device choices.

"We noticed that we were still having a significant number of injuries [after implementing a safety device]. We just didn’t feel comfortable with it," says Gwen Harrington, RN, the hospital’s infection control specialist. "Needlesticks were not going down as we thought they should."

Harrington and her colleagues in employee health created an improvement team, along with nursing staff, staff from off-site services, supply/materials management staff, and the pharmacy. The chair of the hospital’s infection committee provided physician leadership.

That review of injuries is critical to the process of selecting devices, says Marion Gillen, RN, MPH, PhD, assistant professor at the University of California, San Francisco, School of Nursing, who is analyzing the impact of the California needle safety law. California was the first state to mandate needle safety devices, with a law that became fully effective in January 2000.

In site visits to 79 hospitals to evaluate compliance, Gillen found many cases of employees who were stuck by safety devices. "They thought they were activated, and they weren’t. Or they were improperly activated," she says. "Sometimes, part of the device didn’t move smoothly enough; their hand would slip; and they would be stuck.

"Because of that, we are going to do a small pilot study starting soon with health care workers just about product design," she says.

At Norman Regional, Harrington and her colleagues discovered that some employees were getting stuck while they slid down the cover on the Monoject Safety Syringe, manufactured by Kendall Healthcare Products Inc. In some cases, the staff thought the device was protected, but the cover hadn’t locked into place.

The improvement team began evaluating other products, and conducted a trial in areas where injuries had occurred, such as the intensive care unit, oncology, and the urgent care center. The team chose the SafetyGlide needle produced by Becton Dickinson of Franklin Lakes, NJ.

Activation is single-handed, and it is easier to tell if the cover is locked into place, Harrington says.

From March to December 2001, the hospital had six needlesticks related to activation of the safety device. In the same period of 2000, 23 such injuries occurred.

"There are a lot of great products out there, but there are little data saying how effective they really are," Harrington notes. That’s why it’s important to be alert for "red flags" in your injury data, she points out.

In California, hospitals are required to ask employees what they thought could have prevented the needlestick and to record the answer on the log. But the full significance of that question is often overlooked, Gillen says.

The easy answer may be improper activation. In the rush to care for a critically ill patient, the health care worker didn’t activate the device, or mistakenly thought it was activated.

"If somebody said they were rushing but they were working with a safety device that was difficult to activate or they thought was activated and wasn’t, then the rushing is secondary," Gillen says. "If the device had worked, they wouldn’t have been stuck." In some cases, improper activation may reflect inadequate training on the use of devices, she notes.

Employee health professionals may want to follow up several days or a week after the injury to learn more about the circumstances, Gillen suggests. In the aftermath of the needlestick itself, the employee is more concerned about evaluating the need for post-exposure prophylaxis or other follow-up.

The U.S. Occupational Safety and Health Administration requires employers to update their exposure control plans every year, with a review of new technologies. In fact, selection of safety devices is a never-ending process, Gillen says. "It isn’t over once you pick a device," she says. "You need to constantly evaluate your needlestick data and look at new trends and the kinds of injuries that are occurring related to needle devices."