Needle devices just part of larger injury picture

Examine multiple causes, conference speaker says

While safer needle devices remain the focus of efforts to prevent percutaneous injuries that could transmit HIV and other bloodborne pathogens, a speaker at the recent Frontline Healthcare Workers Safety Conference in Washington, DC, emphasizes the need to investigate multiple causes of needlestick incidents.

Scott Deitchman, MD, supervisory medical officer in the HIV activity branch of the National Institute for Occupational Safety and Health (NIOSH), an arm of the U.S. Centers for Disease Control and Prevention, says safer devices are only a part of preventing accidents.

"I don’t want to minimize the importance of safer devices, but they fit into a larger environment," he says. He lists three concepts that lead to a broader approach:

1. "Accidents are not caused by a single event; they’re caused by a chain of circumstances," he maintains.

For example, "Jane Doe," an HCW at San Francisco General Hospital, became infected with HIV from an intravenous needle she had withdrawn from a patient in the patient’s room. She was on the 11th hour of a 12-hour night shift, in a room so small that moving around was difficult, and the sharps disposal box was located in the bathroom instead of near the patient’s bed, he points out.

"The focus should not be just on the needle and [thinking] if the hospital had been using a safety needle, it wouldn’t have happened," Deitchman says. "It wasn’t just the needle. The sharps disposal box wasn’t where it should have been, she was probably more tired than usual, and the small room made it awkward to move around."

2. Injury incidents aren’t caused by rare events. "They show you the potential dangers of your normal everyday procedures. Nothing that happened that night was itself out of the ordinary, except that night all of the events linked up to produce an unusual outcome," he says.

3. Because incidents have multiple causes, no single solution is guaranteed to prevent all of them, although some interventions, such as safer needle devices and disposal boxes, definitely reduce the odds.

Deitchman says this approach "encourages people to look at causes, at the entire incident, not just the type of needle involved, but at the job being done and the circumstances that might have set up that person for an accident." Only then can effective changes be made to prevent needlestick injuries, he says.