New regs require safer needle devices — Is your ED out of compliance?

Use needleless systems — or face fines of up to $70,000

Is your ED doing enough to reduce your risk of getting stuck with a contaminated needle? If your ED doesn’t take steps to comply with regulations aimed at reducing needlestick injuries, your hospital could be fined up to $70,000, warn experts.

Five California hospitals have already been fined for failure to implement state law and change their practices, reports Diana Meyer, RN, MSN, CCNS, CCRN, CEN, clinical nurse specialist for emergency services at Pomona Valley (CA) Hospital Medical Center.

"The financial penalties to organizations have already begun," Meyer notes. "But of course, the greatest risk is to our future when we fail to protect the health of our work force. The cost is extremely high to the individual, the organizations, and our communities."

Although regulations to prevent those injuries have existed for several years, there are still between 600,000 and 800,000 needlesticks per year, according to current estimates. A just-published directive will enforce stringent standards for prevention of needlestick injuries, so surveyors will be taking a close look at your ED.

There is also a flurry of activity on the legislative front: Four states have passed laws to reduce needlestick injuries, and a federal bill is pending. (See related stories on California state law and a federal bill to reduce needlestick injuries, p. 43; and key points of the federal bill, p. 44.)

The compliance directive, just published by the Washington, DC-based Occupational Safety and Health Administration, warns EDs that haven’t already switched to safer systems must do so now. If they don’t, the hospital can be fined up to $7,000 for serious violations, and $70,000 for willful violations.

Your ED must review its plan for injury reduction each year, including use of safer devices, such as needleless systems or needles with self-sheathing. One downside with the needleless systems is that there is a danger of incompatibility of systems when patients are transported by ambulance or transferred to other facilities, experts caution.

However, overall, the change will have a positive impact on your clinical practice, stresses Vicki Cadwell, RN, MS, CEN, CCRN, MICN, ED clinical educator at St. Jude Medical Center in Fullerton, CA, which recently converted to safer needle devices.

"Sharps safety is certainly an issue in the ED, where a controlled chaos is the norm," Cadwell says. "Sharps can often get set down, rather than disposed of immediately and properly. This exposes many people — including physicians, nurses, students, and housekeepers — to risk."

You are at risk for HIV, AIDS, hepatitis B and C viruses, and other bloodborne pathogens, emphasizes Cadwell. "Once there is a change in thinking about sharps safety, involving every part of the ED team, it will be easier to accept a new way of doing things," she predicts.

Here are steps you should take to prevent needlestick injuries and comply with the regulations:

Don’t be afraid of using new devices.

It may be difficult to get accustomed to all the new systems, Meyer notes.

"The process of change does not become any easier despite the importance of protecting ourselves and others," she says. "ED nurses have adopted new technology many times already. But in the beginning, when you feel awkward with a new system, frustration can build up."

For example, the new angiocaths are not difficult to learn how to use, but most do require a change in how nurses have been starting IVs, notes Meyer.

Present a united front

Inservices need to be held prior to changing to any new safety product, says Dianne Kirkpatrick, RN, COHN-S, coordinator of employee health services at St. Jude. "These can be done by the vendor in conjunction with education and employee health," she recommends. "The key to success is a united front to support implementation and usage of these devices."

Support from administration, clinical nurse specialists, and educators is essential to break through the initial resistance, stresses Meyer. "Time and practice, as well continued improvement in the technology, will eventually defeat any naysayers about the new systems," she says.

Know your hospital’s data and plan.

ED managers should share their facility’s data on needlesticks and high-risk areas, advises Meyer.

"You should also be educated about the organization’s needlestick and bloodborne pathogen exposure prevention plan, which includes the importance of reporting all exposures so the organization may evaluate its systems for improvement," Meyer says.

If you are injured, report it.

It is important to report a needlestick injury, stresses Cadwell. "The key to success of exposure control plans is in tracking rates of exposures to determine if devices are indeed decreasing the number of needlesticks," she adds.

If you are stuck with a needle, immediately follow your facility’s needlestick protocol, urges Cadwell.

Be aware of cost issues.

Although the regulations state that safer devices should be used "regardless of cost," the reality is that cost issues are a consideration for all health care institutions, notes Kirkpatrick

An average 300-bed hospital will spend over $71,000 to convert to safer syringes and needles, estimates Kevin Seifert, vice president and general manager of advanced protection technologies at Becton Dickinson & Co., a manufacturer of safer needle devices based in Franklin Lakes, NJ.

There may be increased cost of disposal of the new products, Cadwell notes. "Needle disposal boxes may need to be larger to accommodate the increased size of some of the devices and systems," she says. "Also, many of these devices take up more space, creating storage issues for some facilities."

Many of the new devices are costlier up front, but there is a potential savings down the road, due to decreased risk and medical costs caring for those with an exposure, Cadwell explains. And the costs of the new systems are changing, reports Meyer. "Increasing competition is driving down the costs," she says.

Be aware of transport issues.

During interfacility transport, the transporting nurse should ensure compatibility with his/her equipment, says Cadwell. "That may mean changing out entire tubing sets before taking the patient to ensure that you can use your IV pumps."

There may be problems with fire services/paramedic agencies that arise, notes Cadwell. If a paramedic unit uses one system and the receiving hospital uses another, the system might need to be replaced, she says.

"Potential risk to patients might be infection from opening the system’ or excessive manipulation. You’d also risk losing your access while changing out tubing."

Use a system that functions as an adapter.

At St. Jude, a product is used that has an adapter to fit over IV ports, notes Cadwell. "This eliminates the need to change the entire system and jeopardize patient safety for quick IV access. This reduces the potential for incompatibility of systems." (For information on ordering this system, see InterLink products under list of vendors, p. 45.)

However, for this type of system to work, the equipment should be readily accessible for immediate usage, advises Kirkpatrick.

For more information about needleless systems, contact:

Vicki Cadwell, RN, MS, CEN, CCRN, MICN, Clinical Educator, Emergency Department, St. Jude Medical Center, 101 E. Valencia Mesa, Fullerton, CA 92835. Telephone: (714) 992-3979. Fax: (714) 447-6415. E-mail:

Diana Meyer, RN, MSN, CCNS, CCRN, CEN, Emergency Services, Pomona Valley Hospital Medical Center, 1798 N. Garey Ave., Pomona, CA 91767. Telephone: (909) 865-9577. Fax: (909) 865-9623. E-mail:

Kevin Seifert, Vice President/General Manager, Advanced Protection Technologies, Becton Dickinson & Co., One Becton Drive, Franklin Lakes, NJ 07417. Telephone: (800) 219-7174 or (201) 847-6800. E-mail:

Single copies of the Occupational Safety and Health Administration (OSHA) Compliance Directive, Enforcement Proceedings for Occupational Exposure to Bloodborne Pathogens, dated Nov. 5, 1999, are available at no charge. It can be found on the OSHA Web site. Go to, and click on "directives." Or contact:

OSHA, Publications Office, Room N3101, 200 Constitution Ave. N.W., Washington, DC 20210. Telephone: (202) 693-1888.