Setting the ultimate safety benchmark
Hospital goal is no more needlesticks
At the Robert Wood Johnson University Hospital in New Brunswick, NJ, the needlestick benchmark is simple and never-changing: Zero.
Doris L Dicristina, RN, BSN, MS, COHN-S/CM, director of Employee Health and Wellness Services, was proud that her hospital ranked among the top "sharps safe" hospitals in a study by the Association of Occupational Health Professionals in Healthcare (AOHP). (See related story, p. 15.) But she's still not satisfied.
Rather than compare needlestick rates with other hospitals, she looks at her own injury trends. "Zero needlesticks is my goal," says Dicristina. "It doesn't matter to me how many employees I have because if you're the employee who gets stuck, it's catastrophic."
She is well aware of the emotional, physical and financial toll of a single conversion. One occurred in 2009, from a needlestick that happened in 2008, just months before Dicristina began working at the hospital.
The clinical care technician who contracted hepatitis C from the needlestick takes anti-viral medications, needs frequent follow-up with an infectious disease physician, and has had both acute symptoms and chronic illness. His care has cost the hospital more than $80,000.
"That person is young and he will be under our care for the rest of his life due to that conversion," she says. "Over a lifetime he may ultimately need a liver transplant."
Dicristina is dedicated to keeping that from happening to anyone else.
Seeking a better device
The sharps injury log is an important tool for guiding needlestick prevention. In 2011, Dicristina saw a concerning trend — 43% of the needlesticks occurred among clinical care techs who were using butterfly-style devices to draw blood on the patient floors.
"The safety feature was activated by sliding the protective cover over the needle by moving their hand towards the needle. We were concerned about that," she says. "We drilled down to find out about the risks associated with the device."
She also discovered that the tubing had a recoil effect, which sometimes caused the needle to flip back and hit the tech's hand before the safety feature was activated.
Dicristina wanted to look for a better device but she wanted the clinical care techs to make the decision. (That is in keeping with the Bloodborne Pathogen Standard of the U.S. Occupational Safety and Health Administration, which requires annual review of new technology and input from frontline workers.)
At a vendor fair, the techs tried out different devices. They selected a retractable butterfly device. By pressing a button, the employee activates the safety feature, retracting the needle while it's still in the patient's vein. "If it's done correctly, there's no risk," says Dicristina.
There was one other practical concern. The new devices were more expensive. Dicristina partnered with a director in materials management who is also a nurse. She was able to negotiate a lower price from the vendor, and she conducted a cost-benefit analysis to justify the additional expense.
It's important to collaborate with nursing, infection prevention, purchasing and others, Dicristina says. "I made the safety case, they made the business case," she says.
With the change, there were fewer than five needlesticks from the butterfly devices in 2012 and 2013.
Safety requires vigilance
Robert Wood Johnson University Hospital is now going through the same process to reduce needlesticks from insulin syringes. The current device also uses a sliding shield. Nurses tried out alternatives at a vendor fair, and they selected a retractable device to use in a trial.
"I'll be interested to see if they feel comfortable with it," says Dicristina. "The end user needs to feel comfortable with it. If the end user doesn't like it, end of story."
Meanwhile, she has revised training to improve practice and raise awareness about sharps safety. She also provides quarterly updates to the infection prevention committee and she keeps hospital leadership informed of her progress. "We're constantly looking at the data," she says.
Each success feels good, but then Dicristina regroups and looks ahead. "I still have a lot of work to do, but clearly I'm heading in the right direction, because nationally I'm in the top 5 [for sharps safety] with similar [teaching] hospitals," she says. Yet she still feels far from her goal. "I'm not there because I'm not at zero. And then I'm not there until I stay at zero.
"It takes constant vigilance and focus and organizational collaboration to get where you want to be, which is [to ensure] the overall safety of our employees," she says.