EHP Success Story

Sharps patrol’ cuts disposal-related injuries

Intervention also provides modified-duty jobs

An employee-staffed "sharps patrol" at a San Diego hospital not only eliminated needlesticks related to disposal box violations, but also creates meaningful modified-duty jobs for injured health care workers and raises safety awareness.

In the fourth quarter of 1996, three sharps injury incidents were all found to be related to disposal box problems, says Andine Davenport, RN, COHN-S, occupational health coordinator at 1,800-employee Scripps Mercy Hospital.

"We had been working on reducing sharps injuries throughout the years, and every year you get different challenges," says Davenport, who presented the results of her sharps patrol intervention at the poster session of the recent Association of Occupational Health Professionals in Healthcare (AOHP) conference in Orlando, FL.

When Davenport noted the three disposal box-related injuries, she immediately surveyed the hospital’s approximately 400 sharps containers and found that 14% of them contained what she calls "discrepancies" — either a sharp was protruding from the top or the box was more than three-quarters full.

To raise awareness about the importance of sharps safety, she arranged a staff seminar featuring Lynda Arnold, a Pennsylvania nurse who had contracted HIV through a contaminated needlestick (see Hospital Employee Health, April 1996, pp. 37-42), to speak to employees.

"At the same time, I was coordinating modified-duty workers and was looking for meaningful work that would help the institution," Davenport says.

She came up with the idea of sending out injured workers on modified duty to survey the hospital’s sharps containers for discrepancies, thus establishing the sharps patrol in March 1997. In the first month, discrepancies were reduced from 14% to 5% "with just a little bit of effort," she says.

In 1998, that number was reduced to less than 1%, with disposal box-related sharps injuries dropping from three in 1996 to one in the first quarter of 1997, and then none from that time to the present.

Sharps patrol modified-duty jobs are suitable for workers of all educational levels and job categories from housekeepers to nursing aides and nurses, Davenport says. As long as workers are mobile and do not have walking restrictions, they can do the job. Armed with a simple checklist of each department, directions to note how many containers are observed, and an explanation of the two discrepancies, one worker can check every sharps container in the hospital in one eight-hour day or two four-hour shifts.

If patrol workers find a sharp protruding from a box, they are asked to knock it into the container with a large hemostat, if possible, while noting the discrepancy on the checklist. They also can request that someone change the liner if the box is more than three-quarters full. Immediate correction of discrepancies is essential for preventing injuries.

Another element contributing to the success of the program is the report to department managers. When the sharps patrol worker returns with the completed checklist, Davenport sends out the results via internal e-mail. Not only do managers receive results for their own department, they also see other departments’ results. She also has produced a quarterly report card, rating departments on how well they’re doing with sharps container safety. Each quarterly report includes from eight to 10 unannounced sharps patrol surveys of the departments’ containers.

"We want to do at least eight surveys to have a larger, more meaningful sample size. We didn’t want a department to be penalized for just one bad day," she explains. "Each department gets a letter grade from A to F. We let them know immediately by broadcasting the results in e-mail and sending them out in interdepartmental mail. We have a competition going among managers because they don’t want to have an F on their report card. Everyone sees everyone else’s grade, and all of a sudden they were competing against each other and touting how their grade was from the sharps patrol. No one wants to look bad among their peers."

Safety awareness increases

The sharps patrol also has significantly increased safety awareness, Davenport adds.

"Many managers are now counseling people on safe work practices," she says. "At first they complained a lot because it meant more work for them, but in the long term it was the managers who said no, please continue. That’s a real buy-in."

At least 20 injured workers have been on sharps patrol modified duty, and Davenport has advice for other employee health practitioners who might want to start a similar program:

"Show them that they make a difference, and then they will understand that the work is meaningful. Show them the number of sharps injuries and explain that they can help save somebody’s life," she says. "Another big advantage is that they leave modified duty with an increased awareness, and they go back to their home unit with a new set of eyes. They are more aware of safety concerns, and that will be a benefit for their personal safety and for that of the whole department."