Switching from active to passive needle safety device dramatically reduced needlesticks in an 11-facility healthcare system, creating cost avoidance in reporting, treating, and follow-up that justified the additional expenditure for the devices, reported Ashleigh J. Goris, RN, BSN, MPH, CIC, manager of infection prevention and control at Missouri Baptist Medical Center in St. Louis.
The hospital is part of the BJC HealthCare system, where active safety engineered devices were widely used for subcutaneous delivery of medications. The active devices, which require the user to slide a shield over the needle after use, accounted for roughly 35% of the total number of needlesticks in the health system, Goris said in Nashville at the 2015 conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
“These were devices that require an active motion by the nurse or provider of the medication — an active motion typically toward the needle point,” she said.
Given the needlestick problem, the decision was made to go to a completely passive device for subcutaneous medications.
“Passive safety engineered devices do not require any active motion or changing of hand position of healthcare providers who administer medication,” Goris says. “[The] devices automatically and instantly retract the needle from the patient into the barrel of the syringe once the medication is delivered. By design, the device is safer during use, after use, and prior to disposal because the needle is never exposed outside of the patient.”
The passive device was implemented at the BJC system’s largest academic facility, with rather striking results. “We did a nine-month trial at our largest facility and in four of our medical surgical units there, and also one of our ICUs, our needlestick injury rate went down to zero,” she said.
Based on those results, the decision was made to implement the passive devices systemwide.
“The existing active safety devices were removed from all of our facilities and replaced with the same size passive retractable needles, specifically a .5 ml, a 1 ml and most recently a 3 ml,” Goris says.
The cost impact was immediate, as swapping out the devices led to a net expenditure increase of $21,000. However, that cost was more than offset as the systemwide needlestick rate fell 31% in one year.
“Cost saving or cost avoidance due to needlestick injuries was evaluated at our facilities,” she says. “These consisted of occupational health department hours for both nursing and administrative staff when needlestick injuries were reported. That included the time to report and also respond to healthcare providers. It included the laboratory tests and the analysis needed for both source patients and employees for up to 12 months depending on the nature of exposure. It also included exposed employee hours for reporting and testing. It included HIV post-exposure medications, typically a 28-day regimen.”
During the 24-month pre-implementation period, 404 needlesticks with active devices were reported, with a rate of 0.58 injuries per 100,000 productive employee hours. During the 12-month implementation period, 160 needlesticks were reported for a rate of 0.46 injuries per 100,000 productive hours. Goris calculated an overall cost savings/avoidance of $11,000.
Of course, there is no cost value to assign for the absence of anxiety and dread that can accompany a needlestick exposure to a patient infected with a bloodborne pathogen, let alone a subsequent seroconversion. It might be priceless.