Conventional thinking: Track sharp safety use

Device lists help with inventory review

Despite your best efforts to promote sharps safety, some of your health care workers still use conventional needles and sharp devices that lack an integral safety feature. Perhaps there is no alternative. Or they have rejected the available safety products as inadequate or inappropriate.

But how often are conventional devices used unnecessarily when a comparable safety device is available? And who is using them? You can keep track of the use of conventional sharps by conducting an inventory and keeping a list for review as part of your exposure control plan, sharps safety experts say.

Without such a system, the use of conventional devices may persist long after suitable safety options are available, says Catherine Galligan, MS, clearinghouse manager of the Sustainable Hospitals Program in Lowell, MA.

"If a conventional device is in use — appropriately so for a certain application — just the fact that the device is in the hospital means it could be used for other things," she says. "It's very, very hard to control. It's really surprising how many conventional devices are still out there being used routinely."

There also may be a disconnect between purchasing/materials management and employee health/infection control. When devices appear on a purchasing list, often "no one is really aware of which ones are safety and which ones are conventional," says Galligan.

The Sustainable Hospitals Program offers a simple tool to track conventional devices (see box). The use of conventional devices should require specific approval, Galligan says. "[The products] shouldn't even come through the door without someone signing and recognizing that there are conventional devices coming in," she says.

Conventional devices will confound your efforts to reduce needlesticks. According to an analysis of 2002 percutaneous exposure data in Massachusetts, 62% occurred with conventional devices. Those data encompass 3,413 sharps injuries among 101 hospitals; state law requires hospitals in Massachusetts to report their percutaneous exposures each year.

The problem wasn't just with suture needles, scalpels, or specialty devices. "A majority of the injuries involving hypodermic needles involved standard devices without engineered safety features," says Angela Laramie, MPH, sharps injury surveillance and prevention coordinator with the Massachusetts Department of Public Health in Boston.

Laramie says she expects to see improvements as more recent data are analyzed, but hospitals still need to be vigilant in their conversion to devices with safety features.

Promoting sharps safety may be as simple as asking questions and setting expectations. At the Dana-Farber Cancer Institute in Boston the use of non-safety devices must receive approval from the infection control committee. They are then placed on an exemption list, which is reviewed at least annually. The infection control committee includes representatives from nursing and purchasing, says Susan O'Rourke, RN, CIC, infection control practitioner.

The outpatient facility includes a page in its exposure control plan listing the device exemptions, the department, and the date. For example, a physician who performs Mohs micrographic surgery felt that he didn't get the precision he needed from the facility's safety scalpels. He trialed several scalpels, but still hasn't found one with acceptable performance.

Meanwhile, O'Rourke looks for any conventional devices that may inadvertently have been overlooked. "When we round in the different clinics, I always ask the question, what safety devices are you using? What non-safety devices are you using?" she says.

If a physician brings non-safety devices in to a facility, both the physician and the facility can be cited under multiemployer worksite provisions of the U.S. Occupational Safety and Health Administration (OSHA), notes Amber Hogan, MPH, manager of safety and health policy at BD and a former OSHA industrial hygienist. "Hospitals need to establish and enforce rigorous internal protocol" regarding the use of safety and non-safety devices, she says.

While you are tracking conventional sharps, consider one other option: redesigning the procedure to eliminate the sharp altogether. A method called task analysis, which involves examining each step of a procedure and possible alternatives, can lead to the greatest improvements in safety, says June Fisher, MD, director of the TDICT (Training for the Development of Innovative Control Technologies) project, which provides tools and training to health care facilities for sharps safety devices. She is also associate clinical professor of medicine at the University of California at San Francisco.

"You should think about other ways to do the procedure. Is there a safer way to do it?" says Fisher.

For example, in some cases surgical glues can be used to close incisions rather than sutures, notes Galligan. "You just eliminate the hazard as much as possible," she says.