Can your hospital save money with safer needles?
One hospital did with consolidated purchasing
Switching to safer needle devices doesn’t have to cost a fortune. It may even save money, while it safeguards the health of health care workers.
Certain safety devices do cost more than conventional needles, and hospitals will incur up-front training costs. But a review of hospital purchasing practices may reveal unforeseen opportunities for savings.
Factor in the high cost of needlestick injuries — about $400 for treatment and testing per injury, not counting postexposure prophylaxis — and a safe needle program could be a financial benefit, not a burden.
That is what happened at Lucerne Medical Center in Orlando, FL, a 250-bed hospital that is now part of the Orlando Regional Healthcare System. By consolidating purchasing, the hospital was able to eliminate 12 unnecessary products for a savings of about $3,000 a year. A new syringe used in pharmacy reduced waste of medication trapped in the hub and produced a savings of $19,000 on one drug alone.
Lucerne made its change to safer devices in 1996, before the introduction of tougher mandates for hospitals to implement needlestick prevention. California became the first state with needlestick legislation in 1998. Many states have followed, and the U.S. Occupational Safety and Health Administration issued a directive calling for safer devices in 1999.
"We wanted to go with new devices, but we knew they were more expensive," recalls Mary Ann Boardman, RN, CIC, infection control practitioner at Orlando Regional Healthcare System. "We had to do a lot of homework about what [the products were] costing us and how we could have some savings."
Focus on high-risk devices
The needlestick prevention task force included representatives from nursing, materials management, pharmacy, employee health, and infection control. They focused on IV and phlebotomy devices because those devices presented a greater risk of exposure to bloodborne pathogens.
Focusing your needlestick prevention efforts on potentially high-risk exposures makes sense, not only as a cost-effective measure but to maximize safety, notes Jeanne Culver, RN, COHN-S, clinical manager, employee occupational health services at Emory Healthcare in Atlanta.1
"What you really need to focus on are needles that are going to be in a vein or an artery," she says. "Those are the needles that absolutely need to be a safety device if they are at all available. That needs to be a No. 1 priority."
Injury logs will point you to your problem areas. If you show a significant decline in needlesticks by implementing safety devices, you may quickly justify the expense of the new technology, notes Culver.
"The cost to an institution of needlesticks certainly makes the case for safer needle devices," she says. The cost, of course, goes beyond dollars. "Believe me, that employee is just as emotionally upset if it’s a low risk of transmission," she says.
ECRI, a technology assessment firm in Plymouth Meeting, PA, has developed a cost analysis worksheet as part of its Needlestick-Prevention Device Selection Guide. (See a sample copy of the worksheet, inserted in this issue. For more information on the ECRI report, see related article on p. 54.)
Here are some issues to keep in mind as you analyze the cost-effectiveness of safer needle devices:
• Safety devices aren’t always more expensive than the conventional version.
At Emory, Culver was paying $28.98 for a box of 50 conventional winged steel needles, while a box of 100 bluntable needles cost $31.50. "[It was] literally half of the cost of an inherently unsafe product," she says.
Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville, notes that the costs of both conventional and safety devices can vary widely. "There’s no generalization that can be made on the cost of implementing safety devices," she says.
• Consider disposal, storage, and other related costs when selecting safety devices.
Some safety devices with shields may be bulkier than their conventional version. That means they will require more storage space and will fill up disposal containers more quickly.
"If you’re using [incineration] for disposal, you need to at least consider if your volume is going up [and] whether or not your incineration costs are going to go up," says Keller.
When comparing safety devices, consider everything that will be necessary to use the product properly, advises Keller. "Sometimes you have to purchase accessories that you wouldn’t otherwise have to be purchasing, such as a customized disposal container," he says. "In some cases, you would have to have a special needle holder that you wouldn’t otherwise need."
In some cases, ECRI recommends disposing of the "reusable" tube holder of a safety device because of an exposure risk from the distal (tube-puncturing) end of the needle.
"That adds to your cost in two ways," he says. "That tube holder is a fairly large device that will go into a disposal container, which will make your disposal costs go up."
• Remember that a safe environment has benefits that are hard to quantify.
More than half of needlesticks are unreported, studies indicate. When you focus on needle safety, a greater awareness among employees may at least temporarily lead to a rise in reporting of needlestick injuries.
While that may mean higher treatment and testing costs, the emphasis on safety will pay off in the long run, says Gina Pugliese, RN, MS, director of the Premier Safety Institute, a health care alliance in Chicago.
"You have to look beyond cost and look at other things that are associated with it — the culture of safety and how important it is to give a message to your workers that you believe in safety," she says.
That emphasis on safety can pay off in better employee morale and greater attention to safety guidelines overall, Pugliese says. Ultimately, that will mean fewer injuries and lost work days, she predicts.
1. Culver J. Preventing transmission of blood-borne pathogens: A compelling argument for effective device-selection strategies. Am J Infect Control 1997; 25:430-433.