Name: Relias Media
Price range: $

Perception equals reality in sharps safety culture

CDC findings link safety culture, needlesticks

Perception may be as important as reality when it comes to preventing needlestick injuries to health care workers. The more workers perceive that their facility has a "culture of safety," the less likely they are to sustain a needlestick, reports Scott Grytdal, MPH, an epidemiologist at the Centers for Disease Control and Prevention.

Grytdal presented the findings recently in Tampa at the annual conference of the Association for Professionals in Infection Control and Epidemiology. "Personnel perceptions of safety culture were associated with the risk of sustaining a sharps injury," he said. "Perceptions of safety culture should be measured and fostered when designing a sharps injury prevention program."

Health care workers sustain an estimated 385,000 sharps injuries each year in the United States. Sharps injury prevention efforts have been primarily focused on providing safer needle devices and reducing unsafe work practices. However, worker perceptions of institutional safety culture have been associated with adherence to infection control precautions and the risk of sustaining blood and body fluid exposures, he noted.

To see if such a finding extended to sharps injuries, Grytdal and CDC colleagues surveyed 13,700 employees of Detroit Medical Center. Data obtained included occupational demographics, perceptions of safety culture, knowledge of needlestick reporting procedures, and sharps injury history. A portion of the survey measured perceptions of safety culture using a five-point Likert scale, and a total safety culture score was created for each respondent by adding the scores for each question.

Of the 13,700 surveys mailed, 3,043 (22%) were returned. One-third of all respondents were employed in patient care services (nursing). Most (87%) respondents were familiar with hospital protocols for reporting sharps injuries and blood exposures; 109 (3.6%) recalled sustaining a needlestick in the past 12 months. The average safety culture score was 49.4 (with a range 4 to 65, the highest possible score). Overall, 568 (19%) respondents gave positive responses (agreed or strongly agreed) to all questions. After adjusting for occupation, work shift, and knowledge of hospital reporting procedures, respondents with positive perceptions of safety culture (higher total safety culture score) were less likely to have sustained a needlestick in the previous 12 months, he reported.

"Those with higher safety culture score were significantly less likely to have sustained a sharps injury in the previous 12 months," he concluded.

The findings suggest that the perception of a safety culture may have a protective effect.

"Suggested methods of fostering a safety culture could include insuring an organization commitment to safety, involving personnel in activities that promote a safe health care environment, encouraging reporting and removal of sharps injuries hazards, and developing feedback systems to increase safety awareness," he said.

CDC: Safety culture new for health care

According to the CDC sharps safety web site (www.cdc.gov/sharpssafety/) from an organizational perspective, "culture" refers to those aspects of an organization that influence overall attitudes and behavior. A culture of safety is the "shared commitment of management and employees to ensure the safety of the work environment." The concept of institutionalizing a culture of safety is relatively new for the health care industry and much of the focus is on patient safety.

According to the CDC, to create a culture of safety, organizations must address those factors known to influence employees' attitudes and behavior. Organizations also must direct measures to reduce hazards in the environment. Some strategies include:

Involving personnel in the planning and implementation of activities that promote a safe health care environment. Involving personnel from various areas and disciplines while planning and implementing activities improves the culture of safety and is essential to the success of such an initiative. Those personnel who participate on committees or teams created to institutionalize safety serve as conduits of information from and to their various work sites. They also legitimize the importance of the initiative in the eyes of their peers.
Encouraging reporting and removal of sharps injury hazards. Another strategy for institutionalizing a culture of safety is to create a blame-free environment for reporting sharps injuries and injury hazards. Health care personnel who know that management will discuss problems in an open and blame-free manner are more likely to report hazards. Health care organizations can also actively look for sharps injury hazards by performing observational rounds and encouraging staff to report near misses and observed hazards in the work place. Once identified, hazards should be investigated as soon as possible to determine the contributing factors, and actions should be taken to remove or prevent the hazard from occurring in the future.
Developing feedback systems to increase safety awareness. A number of communication strategies can provide timely information and feedback on the status of sharps injury prevention in the organization. One strategy incorporates findings from hazard investigations, ongoing problems with sharps injuries, and prevention improvements into articles in the organization's newsletter, staff memoranda, and/or electronic communication tools. It is important to communicate the value of safety by providing feedback when the problem is first observed and commending improvements. Another strategy is to create brochures and posters that enhance safety awareness. Such materials can reinforce prevention messages and highlight management's commitment to safety.
Promoting individual accountability. Promoting individual accountability for safety communicates a strong message about the organization's commitment to a safe health care environment. In order for accountability to be an effective tool, all levels in the organization must comply. An organization can promote individual accountability for safe practices in general — and sharps injury prevention in particular — in many ways. One way is to incorporate an assessment of safety compliance practices in annual performance evaluations; for managers and supervisors, this might include evaluating methods used to communicate safety concerns to their subordinates. Organizations also might consider having staff sign a pledge to promote a safe health care environment. This could be incorporated into hiring procedures and/or as part of an organizationwide safety campaign.