Develop a safety program in your ED

Remind administrators that OSHA requires facilities to re-evaluate exposure control plan on a yearly basis

ED nurses need to be proactive in implementing safety programs to avoid needlesticks, says Beth Anne Algie, RN, a former ED nurse who contracted hepatitis B as a result of a needlestick. "Nurses battle for our patients every day, but we're often too busy to battle for ourselves," she stresses. "We have a responsibility to ourselves and our profession to know the technology that is available and make sure it gets in our hands."

Here are some ways to prevent needlesticks in your ED:

Provide inservicing for safety products. "Whenever you bring any new product in a facility, there is a learning curve," says Kathy L. Farley, RN, MSN, CNA, manager of worldwide clinical education for Johnson & Johnson Medical Inc., based in Arlington, TX. "You need to be sure clinicians are able to use the product comfortably."

Promote awareness in advance that a new safety product is coming. "That way, people can make plans to attend an inservice or watch an educational video," says Farley.

Make special arrangements for nurses who work night shifts. "It's not a good idea for a nurse who has worked all night long to attend an inservice at 7:00 in the morning, because they will be half asleep," says Farley. "Most facilities can't spare people to leave their unit to go to a class, so be flexible enough to allow people to come in an hour before their shift starts, so they can learn while they're fresh."

Eliminate old products. It's safest to standardize products used in the ED as much as possible, Farley recommends. "Removal of non-safety devices is important. If you don't pull the old product out of your department, people may mix techniques," says Farley. "Also, if nurses use one product exclusively, they will get used to that product much more quickly."

Research safety devices. "Find out what safety devices your ED is currently using," recommends Farley. "You might have to go beyond your local community and find out what the national standard of practice is." Obtaining a customer list from safety device vendors is a good way to learn what other facilities are using, she says.

Make sure to get on the appropriate committee, armed with products in hand. "People might be sitting on the committee who don't even know what an IV catheter is," says Farley. "Take products with you and demonstrate how you use them, and explain how a health care worker can be injured without that device."

Arm yourself with statistics. If administrators balk at purchasing safety devices for the ED, point out the costs of needlesticks. "Every time a nurse is stuck, it costs thousands [of dollars] in counseling, lab work, medications, even if they don't get sick," says Algie. "You can use those statistics to show them this is a much more cost-effective alternative."

Informing administrators of OSHA requirements may also be helpful. "OSHA says that every facility needs to regularly re-evaluate their exposure control plan, which includes looking at all new technology at least every year, but I haven't found a hospital yet that is enforcing that rule," says Algie.

Documentation can help. "Write a note to your administrator or manager, either handwritten or typed, that says you are aware that there is technology to eliminate needlestick injuries, and you are working on the front lines and want this available," says Algie. "Point out that OSHA rules state that you should at least be able to evaluate it."

Get outside support. If you don't have support for a safety program in the ED, you might need to go to other departments, says Farley. "Find out what safety devices the hospital is currently using and find out who championed those devices and brought them in," she advises. "Also, find out which committees receive reports on needlestick injuries."

ED managers might wholeheartedly support a safety program but lack the time to do anything about it, Farley says. "Once you get your supervisors' buy-in, they need to see what committees in your facility are doing, because they might have something in the works already."


1. Ippolito G, Puro V, Petrosillo N, et al. Prevention, Management & Chemoprophylaxis of Occupational Exposure to HIV. Charlottesville, VA. International Health Care Worker Safety Center, University of Virginia; 1997:12.