APIC joins chorus against unsafe needle devices

Concerted effort’ required to protect HCWs

Needlestick prevention efforts must be focused on replacing unsafe needle device designs with new safer technology, according to guidelines released by the Washington, DC-based Association for Professionals in Infection Control and Epidemiology (APIC).1

APIC joins such organizations as the Service Employees International Union in Washington, DC, and the Charlottesville, VA-based Health care Worker Safety Center at the University of Virginia in urging hospitals to use safer needle device technology.

In addition, several federal agencies have accelerated efforts to seek ways of minimizing needlestick injuries among the nation’s health care workers in response to a congressional directive. (See Hospital Employee Health, March 1999, pp. 25-28.) For example, the Food and Drug Administration recently delivered a list of suggested sharps injury prevention device characteristics to the U.S. Occupational Safety and Health Administration. (See related story, p. 52.)

Past prevention efforts have focused on changing behaviors such as recapping needles and on improving sharps container designs but have been effective in reducing only those injuries associated with recapping or disposal. However, as many of 85% of sharps injuries could be eliminated by using safer devices for non-skin-puncturing procedures, APIC says.

Although data show injury reductions when safer devices are used, many hospitals cite higher cost as the reason for not using them. However, the recommendations point out that "the cost of postexposure testing, counseling, and treatment also must be considered when determining cost-effectiveness. . . . The use of safer medical devices may appear to increase costs, but institutions must consider the ethical, legal, and regulatory compliance implications of sharps injuries when calculating the overall financial impact."

APIC suggests that institutions with limited funds assess injury rates associated with certain high-risk devices as a means of deciding which safer devices to purchase.

For example, many institutions have purchased needleless intravenous systems to reduce IV therapy-related sharps injuries, "but those injuries are unlikely to transmit bloodborne pathogens to health care workers because there usually is no blood involved," says Robert J. Sharbaugh, PhD, CIC, chairman of the APIC Guidelines Commit tee. "Instead, the vast majority of exposures and subsequent infections involve phlebotomy."

The guidelines advise hospitals to form multidisciplinary teams to select new products, including representatives from employee health, infection control, administration, materials management, risk management, finance, and end users. Team members should know the institution’s sharps injury epidemiology, perform a literature review, analyze product efficacy, and determine product cost-effectiveness. Staff education and clinical trials are essential for each product selected.

Replacing unsafe devices requires "a concerted effort by individual institutions, researchers, manufacturers, government agencies, and professional organizations," the guidelines state.

Specifically, APIC recommends "collaborative efforts" focusing on:

    • encouraging Food and Drug Administration safety alerts to facilitate removal of unsafe conventional devices;

    • institutional development of device-related sharps injury surveillance and risk reduction strategies;

    • urging manufacturers to standardize device design allowing for universal usage;

    • more epidemiologic studies of the effect of safety devices on risk reduction;

    • accelerating the transfer of new technology into workplaces through research funding, consortia study, professional publication of clinical evaluations, and presentations at meetings;

    • forming coalitions or joint task forces of industry, government, and health care.

    • establishing a central clearinghouse to develop device-specific criteria and eliminate unsafe products;

    • creating a national repository for device information, evaluation, and compatibility;

    • developing cost-effective strategies for implementing safer technologies.


1. APIC 1997 and 1998 Guidelines Committees. APIC position paper: Prevention of device-mediated bloodborne infections to health care workers. Am J Infect Control 1998; 26:578-80.