HCWs still stuck with nonsafety sharps

'I don't like it' not a reason for exemptions

Almost 10 years after the Needlestick Safety and Prevention Act created a legal mandate for safer sharps, health care workers still are being stuck with convention devices.

In some cases, health care facilities may have documented an exemption in the exposure control plan, noting the need for the preferred device. But exemptions need to be reviewed annually — and as new technologies evolve, many of the remaining conventional devices should be replaced with safer alternatives, needle safety experts say.

Needlestick surveillance from Massachusetts illustrates the problem: More than one quarter (29%) of injuries involving hypodermic needles and syringes in 2007 occurred with devices that lacked safety features, even though those safety devices are readily available. Overall, more than half (57%) of all sharps injuries for which safety information was available involved conventional devices.

"There are still needlestick injuries that occur every single day. There are [U.S. Occupational Safety and Health Administration] citations every week of institutions that are not in compliance," says Ron Stoker, MS, executive director of the International Sharps Injury Prevention Society, which maintains a list of available safety devices on its web site, www.isips.org.

"Some [employers] are very lax about being in compliance," he reports. "One of the most frequent violations is that the exposure control plan is not kept updated with at least an annual review of what sharps safety products are available."

In fact, failure to maintain an exposure control plan and failure to update the plan are the most common citations under the Bloodborne Patho- gens Standard. "We would want to make sure that they're looking to see if any new development has happened with regard to technology," says Dionne Williams, MPH, a senior industrial hygienist with OSHA specializing in the prevention of bloodborne pathogen exposures. "You need to have someone look at devices each year," she adds.

OR is a problem area

It can be difficult to keep abreast of new technology. But too often, health care facilities simply aren't purchasing readily available devices, needle safety experts say.

The operating room remains a problematic area. The Massachusetts surveillance data, for example, found that one-third of sharps injuries (34%) occurred in operating rooms; 23% of all injuries involved suture needles, although blunt sutures are available and considered appropriate for fascia closure.

Conventional needle devices end up in the OR, as well. This is particularly a problem with pre-packaged kits, which include needles and syringes, says Angela Laramie, MPH, epidemiologist with the Sharps Injury Surveillance Project in the Massachusetts Department of Public Health in Boston. "We have heard from many hospitals that the standard kit comes with devices lacking sharps injury prevention features. In order to make a change to the products included in the kits, hospitals need to place a special order for a custom kit, which often results in an increased cost."

As far as OSHA is concerned, however, cost should not be a guiding factor in the protection of health care workers, notes Stoker. And when they fail to provide adequate safety devices, employers open themselves to potential citations and fines from OSHA, as well as the expenses associated with testing and treating bloodborne pathogen exposures, he says.

Meanwhile, the design of sharps safety devices has greatly improved, providing even stronger reason to take a new look at devices. June M. Fisher, MD, director of the TDICT (Training for Development of Innovative Control Technologies) Project in San Francisco, advises hospitals to conduct a task analysis to evaluate the activities that require sharps devices, then to evaluate the available safety devices that will meet the hospital's needs. (Evaluation forms are available at www.tdict.org/evaluation2.html.)

Yet Fisher and others would like to see more research evaluating the different types of safety designs. "We don't have appropriate performance standards for the safer devices," she says.

Laramie concurs. "While there has been research comparing the use of devices with and without sharps injury prevention features, demonstrating the efficacy of devices with safety features in reducing sharps injuries, there has been little, if any, research comparing the different types of sharps injury prevention features," she says. "The various devices with sharps injury prevention features need to be evaluated as well to determine which are most effective."

Some health care facilities seek consistency when it comes to sharps safety exemptions. In other words, disliking a safety device isn't reason enough to grant an exemption.

"If a provider in our facility needs to use a nonsafety needle they need to [file] an exception form stating what procedure it is specifically that they need this needle for," says Bruce Cunha, RN, MS, COHN-S, manager of employee health and safety at the Marshfield (WI) Clinic. "We don't grant general exemptions."

Providers also must detail what other safety measures they will take if they're going to use a nonsafety needle, he says. Cunha notes that Marshfield Clinic has about 40 clinical centers. "If one [provider] says I need an exception for a specific procedure, but other providers doing the same procedure don't need an exception, I can't grant that," he says.

Cunha and his colleagues also inspect sharps containers to see if safety devices have been activated. Repeated failure to activate safety features could point to the need for retraining — or for the re-evaluation of safety devices, he says.

Even 10 years after the development of stronger needlestick prevention requirements, many devices still aren't available in a safety version, Cunha says. "There are ways of putting a safety device on a lot of products that don't have them now," he says.

Consumer demand may play a role in the development of new products. But ultimately, new regulatory measures may be needed to press manu- facturers to produce new designs or to stop manufacturing some conventional needles, he says.