How safety became the norm, not needlesticks
How safety became the norm, not needlesticks
Why not make 'airbags' for needles?
Janine Jagger was working on integrating airbags in cars when her colleagues at the University of Virginia told her about another safety problem: Health care workers stuck with needles were at risk of contracting HIV/AIDS, as well as other bloodborne diseases.
To her, the answer was obvious. Create the equivalent of an airbag for a needle.
"I'm an injury epidemiologist. Altering the design of hazardous products is one of the most straightforward ways of solving an injury problem," says Jagger, PhD, MPH, who is now director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville.
Twenty years later, Jagger can proudly point to a culture change in health care. A federal law requires safety-engineered sharps, and safer devices have widespread acceptance. From 1993 to 2001, percutaneous injuries to nurses declined by 51%; needlesticks from IV lines were eliminated with the adoption of needleless IV systems.1 In 2002, Jagger won a McArthur Foundation award for her work as a pioneer in sharps safety.
"You know there are health care workers out there whose lives have been saved. You don't know who they are, but you know there are many," she says.
Yet there is much work left to be done, both in the United States and abroad. Jagger's EPINet (Exposure Prevention Information Network) surveillance shows a rate of 24 needlesticks per 100 beds in the 48 facilities reporting in 2003. More than half of the needlesticks occurred with non-safety devices — despite a federal law and a U.S. Occupational Safety and Health Administration (OSHA) standard requiring the use of safety-engineered sharps wherever feasible.
The operating room remains an area of non-compliance, with 18% of all sharps injuries caused by suture needles, according to exposure data aggregated by the Centers for Disease Control and Prevention (CDC).
Jagger continues to work on these issues, as well as promoting adoption of safer devices in other countries. She remains an optimist about the prospects for tackling the more difficult remaining obstacles to sharps safety.
Despite some resistance, Jagger feels confident about making a big difference in the OR.
Recapping as a 'safety' measure
When Jagger turned her attention to needle safety in 1985, needlesticks largely were viewed as a work practice problem. Nurses and other health care workers just needed to be more careful.
In her first article on the subject, in the New England Journal of Medicine, Jagger documented how and why needlesticks were occurring, placing the blame on product design.2 For example, she noted that although the CDC recommended against recapping, nurses often chose to recap to reduce other hazards from an exposed needle before it could be disposed of. She urged health care facilities and manufacturers to work toward designs that allowed workers' hands to stay behind the needle while activating a cover.
"It is difficult to explain the relative complacency that prevailed about needlestick injuries before the AIDS epidemic, given the serious consequences of hepatitis B virus and other infectious agents transmitted in this manner," she wrote.
Change came slowly. Needleless IV systems were the first and most widespread change in technology, but acceptance of other devices was spotty; many hospitals were reluctant to purchase the new devices because of higher costs.
Jagger's approach was to gather data on needlesticks and demonstrate the benefits of safer devices. She developed EPINet to collect information on percutaneous injuries from hospitals by type of device, occupation, cause of injury, and other factors. In the journal of the International Health Care Worker Safety Center, Advances in Exposure Prevention, she highlighted problems in specific areas, such as blood drawing or home health, and she told the stories of health care workers whose lives were altered by a needlestick.
In April 1998, the San Francisco Chronicle published a three-part series that contended not enough was being done to protect health care workers from deadly diseases spread through needlesticks. The articles brought public attention to the problem and triggered political response.
In November 1998, California became the first state to require the use of safer sharps devices, the involvement of frontline health care workers in their selection, and the tracking of needlesticks. It became model legislation that influenced subsequent laws in 19 other states.
Making advances in exposure prevention
By 2000, momentum had built for a national response. Congress passed the Needlestick Safety and Prevention Act, which was signed by President Bill Clinton Nov. 6, 2000. It directed OSHA to revise its Bloodborne Pathogen Standard to require the use of safety-engineered sharps devices and to obtain frontline worker input in their selection. Recapping of needles is expressly prohibited.
"Our achievement in the United States has been a landmark achievement," says Jagger. But she adds, "I don't feel I really have time to celebrate our accomplishment because there's so much left to do in other parts of the world."
Jagger has used some of her McArthur award, which provides $500,000 over a five-year period, to promote health care worker safety and safe disposal of medical waste in Africa. Advances in the United States directly benefit other countries, which often adopt our regulations, she says. With our huge market, safety products also become less expensive and more affordable for other countries, she notes.
"There is very significant impact in other areas of the world," she says of the federal law. "This is one of the most meaningful public health measures that I think has ever been undertaken."
(Editor's note: The International Health Care Worker Safety Center would like to add hospitals to its EPINet research database. If your hospital has been using EPINet but is not part of a research network and you would be interested in joining, please contact Ginger Parker at [email protected].)
References
1. Jagger J and Perry J. Preventing Occupational Exposures to Bloodborne Pathogens, Janine Jagger and Jane Perry, eds. International Health Care Worker Safety Center, University of Virginia, Charlottesville, 2004.
2. Jagger J, Hunt EH, Brand-Elnaggar J, and Pearson RD. Rates of needle-stick injury caused by various devices in a university hospital. NEJM 1988; 319:284-288.
3. Holding R and Carlsen W. Epidemic ravages caregivers; Thousands die from diseases contracted through needle sticks. San Francisco Chronicle April 13, 1998, p. 1. http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/1998/04/13/MN64658.DTL&type=special.
Janine Jagger was working on integrating airbags in cars when her colleagues at the University of Virginia told her about another safety problem: Health care workers stuck with needles were at risk of contracting HIV/AIDS, as well as other bloodborne diseases.Subscribe Now for Access
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