Look closely before buying sharps safety devices
By Michael Garvin
University of Iowa Hospitals and Clinics
Iowa City, IA
(Editor’s note: This is the second of a two-part article on reducing sharps injuries, and the associated costs, in health care facilities. Last month’s article examined how common and costly such accidents are, and how they might be prevented.)
Health care facility risk managers should consider several important factors when evaluating safety blood collection devices. A device’s design will greatly affect its safety efficacy, and ultimately, its costs savings for the hospital.
Some of the best advice on reducing sharps injuries comes from Janine Jagger, PhD, MPH, director of the Health Care Worker Safety Project at the University of Virginia Medical Center in Charlottesville, and nationally known for her work on accidental needlesticks. Jagger’s work at the University of Virginia has identified four characteristics that should be designed into a safety device. According to her study, the ideal safety device would satisfy the following criteria1:
1. Eliminates the need for clinician’s hand to be placed in front of sharp needle tip.
2. Integrates into the device’s design and is not an accessory.
3. Activates before disassembly and remains in effect after disposal. It should not be able to be deactivated.
4. Simple to use and requires little training.
Apply guidelines to available products
These four requirements can serve as guidelines as hospitals determine how to best use their limited resources. A brief look at the products currently available in terms of these criteria can help hospitals identify the best value in a phlebotomy safety device.
Jagger’s first requirement is important because many clinicians reuse phlebotomy holders, for as many as 100 blood draws. This means that each needle must be removed from the holder after blood is drawn. If a specialty sharps container is not used, the needle must be recapped and manually unscrewed prior to disposal. Unfortunately, the clinician must place his hand in front of the sharp needle to accomplish this task, increasing the chance of contact with the contaminated needle tip. Manufacturers Sage Products and Post Medical were the first to market products that make disposal of the sharp needle easier. Sage has an "auto drop" system, which requires the phlebotomist to load small disks onto the needle holder before each blood draw. The disk is then triggered by pressure against a special sharps container, also manufactured by Sage.
Post Medical introduced a sharps container that can automatically unwind or unscrew the needle, once it is pushed against the sharps container.
Most recently, Bio-Plexus in Toland, CT, has offered another alternative to facilitate needle disposal. The advantage of this product is that it can be used with any sharps container. Specialty sharps containers are costly and often fill quickly, adding to waste disposal costs. Bio-Plexus’ product is the "Drop-It" holder, which allows the phlebotomist to release a used needle at the push of a button. The used needle is discarded in any sharps container. The Drop-It holder is the same size as a standard holder, so it creates no additional waste.
The second requirement for an effective safety blood draw set is that the safety component is an integral part of the design. Bio-Plexus also manufactures a product that meets Jagger’s second requirement. The Punctur-Guard safety blood collection needle features a blunt needle that is concealed within a sharp exterior needle, which is available in standard needle lengths and sizes. The Punctur-Guard needle goes into the patient’s arm with the blunting needle retracted, similar to a standard needle insertion. Just before the needle is withdrawn, the phlebotomist can activate the blunting member, making the needle safe, or blunt. Becton Dickinson, Winfield (Ryan), and Concord Portex all offer a different approach. These three companies make "outer sheath" devices which, when combined with standard unsafe needles, constitute another safety alternative. With outer sheath devices, a plastic accessory is moved to cover the sharp needle tip after the needle is removed from the patient’s arm. The entire mechanism, including the plastic accessory, is then discarded. In the Bio-Plexus Punctur-Guard design, there are no additional disposal costs to consider.
Of the four companies mentioned, Bio-Plexus is the only one that makes a phlebotomy safety device that is safe prior to removal from the patient’s arm. Because of the way phlebotomy procedures are performed, this is an important feature. As Jagger has described the process, "After withdrawing a needle from a patient, the health care worker must apply pressure to stem the bleeding at the puncture sight. This leaves only one hand free to activate the safety device."2 Unfortunately, many accidental needlesticks occur during this critical moment, when the phlebotomist must simultaneously salve the wound, comfort the patient, and handle a sharp device. Many patients experience panic at this point, and may jerk or flex their arm, jostling the needle that has just been withdrawn. In the worst cases, this confusion can cause an accidental needlestick to the phlebotomist.
Minimize exposure time’
Devices that eliminate this problem are worthy of serious consideration. Many health care professionals describe this priority as the need to minimize "exposure time" to the contaminated sharp needle. Since outer sheathing devices are deployed some time after the needle is removed from the patient, they reduce but do not eliminate exposure time. Studies at the University of Iowa Hospitals and Clinics (UIHC) indicated that the likelihood of an accidental needlestick immediately following a blood-drawing procedure is seven times greater than either before the procedure or during disposal. During trials at the UIHC, the Bio-Plexus Punctur-Guard needle proved that it was disarmed during the blood draw procedure. It virtually removed risk for employees by eliminating exposure time.
Jagger’s third requirement is supported by the advice of Mary G. Chamberland, MD, MPH, deputy chief of the HIV/AIDS branch of the hospital infection program at the CDC. "Check to see that the safety feature cannot be deactivated," she warns. "Those workers are going to be smarter than you."3 Many "outer sheath" devices can be dismantled so that the original unsafe needle is restored, but any safety efficacy is eliminated. As Chamberland has noted, "Acceptability of the device to the end user may be the single most important evaluation criterion, a situation not unique to safe needle devices."
An irreversible safety device that is simple and easy to use, as Jagger recommends, can be implemented quickly in any phlebotomy setting. The products made by Becton-Dickinson, Winfield (Ryan), Concord-Portex, and Bio-Plexus are all simple to use. Of these four varieties, however, only the Bio-Plexus Punctur-Guard needle is impossible to deactivate. Once the needle is blunted, it remains safe during withdrawal from the patient’s arm and disposal.
Hospitals need to consider current data pointing to the dangers of hollow-bore, blood-filled needles. Well-designed safety devices, implemented in areas of highest risk, have the potential to save money as well as lives. Advances in technology, such as self-blunting needles, may assist hospital liability specialists in their efforts to manage the occupational risk of accidental needlesticks.