Lesson No. 1: Needle safety never stops

Hospitals share advice on progress

Two years after needle safety became a mandate nationwide, hospitals face what may be their greatest challenge: keeping the momentum.

It’s tempting to feel that the job is just about done. Needle safety committee members may start missing meetings. Meetings may be delayed. Newer devices might be overlooked. But the U.S. Occupational Health and Safety Administration (OSHA) requires an ongoing commitment to needle safety. And so should you.

In fact, success in reducing needlesticks in some areas should be an impetus for doing even better, says Paula Bowers, MSN, RN, CNN, CAN, director of the intermediate care unit and progressive care unit at Memorial Hermann Southeast Hospital in Houston.

"The first year when we put the task force together, we were looking at overfilled sharps containers," she says. "We saw a 63% reduction in needlesticks from overfilled sharps containers. When we fixed [that problem], then other things came to light that we had to work on."

Memorial Hermann Southeast Hospital is one of eight hospitals that have shared their "lessons learned" on the web site of the National Institute for Occupational Safety and Health (NIOSH) ( www.cdc.gov/niosh/topics/bbp/safer/). Much of the advice relates to the structure of the committee: how often it meets, how it sets an agenda for action, and who serves on it.

"It’s important for the composition of the committee to reflect administration, management, purchasing, infection control, and the frontline health care worker," says Janice Huy, MS, senior adviser for HIV and health care research at NIOSH in Cincinnati. Top leaders are not always members — but their commitment to the committee’s work will determine your success, Huy advises. That includes the director of nursing, the chief medical officer, and the CEO.

"We found that in a couple cases in which upper management wasn’t included in the very beginning, when they tried to buy the devices, upper management said, Why do we need these?’" she says.

At Memorial Hermann Southeast, the chief operating officer is a liaison member of the committee. He doesn’t attend regular meetings but is available as needed. Other members serve two-year terms. "If you have given all you think you can give to a topic, a fresh set of eyes can rejuvenate the committee," Bowers adds.

The U.S. Occupational Safety and Health Administration requires employers to include frontline workers on the needle safety committees. But when San Francisco General Hospital started the first needle safety advisory committee in 1986, there were no rules or regulations to follow.

The union had conducted a survey and found a large number of housekeepers had been stuck by discarded needles but had not reported their injuries. The joint labor-management committee began talking about work practices and about safer devices.

"I remember saying they don’t exist," recalls June M. Fisher, MD, director of the TDICT Project at San Francisco General Hospital, which focuses on evaluation and training related to sharps safety. "And the response was, Then they should exist.’ That for me was a real turning point. What we used to say to people was, Take your time; be careful.’ People would be angry about that, saying, You’re blaming us.’ We wouldn’t say to a carpenter, We don’t have safe saws; just be careful.’"

Today, needle safety committees ask for new devices when they can’t find what they want. "We’ve had the manufacturers in and talked to them about our needs," Bowers says. "This is an opportunity for us to have an impact on the kinds of devices that come out."

In fact, tracking the constant advance in technology is the core business of the committee. "Until the market stabilizes in this area, they’re going to have to continue to evaluate new devices," says Huy. "I’m hoping, over time, they will all become safer and safer and safer."

The other major role involves careful monitoring of injury reports. For example, at Holy Cross Hospital in Chicago, the needle safety committee learned that employees were using the wrong adapter for the needleless IV system.

"We identified every product we had. We assembled a chart and reference chart for our employees, so they knew what the device was and what the intended use was," says Carol Cagle, MT, SM, infection control manager.

She brought the board to each unit, quizzing the employees on the devices and providing pictorial education. Meanwhile, a phlebotomy technical specialist follows up on needlesticks associated with blood draws to see if further training is needed.

Those efforts, along with the adoption of safer devices, resulted in a 75% decrease in needlesticks since 2001, Cagle adds. "I think it’s important for the committee to celebrate its successes," she says. "That is one of the things that keeps it going. It’s only by vigilant monitoring that you’ll be able to maintain success."

Those on the front lines of needle safety offer these do’s and don’ts for needle safety committees:

Don’t get discouraged.

"Performance improvement is rarely quick," says Bowers. "Sometimes you have to find that silver lining to keep you motivated. You have to stay at it."

Do consider the views of physicians.

In some cases, physicians may want to be on the committee. But even if they’re too busy to attend meetings, you may find other ways to keep them abreast or include them in decision making, Huy says. "Some of our facilities have found that they excluded physicians from the committee because they assumed they would be too busy and wouldn’t want to participate. But then when they tried to introduce the device on the floor, the physicians said, We aren’t going to use this.’"

Listen to your frontline workers.

"[The needle safety committee] should be joint labor-management," Fisher points out. "There should be frontline health care workers there, and it should have authority. If you incorporate health care workers and then you don’t even listen to them, don’t bother."

"Don’t be afraid to challenge your system processes or your hospital administration," Bowers notes.

"If there’s a product out there that can better serve your needs and you can prove it, don’t be afraid to issue those challenges," she adds.

Memorial Hermann Southeast found a sharps container with a lid it felt would be more protective. The vendor wasn’t on the hospital’s contract. Bowers conducted a successful pilot test and did a cost analysis. She found that the cost would actually be comparable to the current containers. "Don’t let the fact that they’re not one of your normal vendors stop you from pursuing [a device] if they have a product you really need," she says. "I didn’t let it stop me."

Editor’s note: Safer Medical Device Implementation: Sharing Lessons Learned is available at www.cdc.gov/niosh/topics/bbp/safer/.