Push gets agencies to switch to safety systems
Push gets agencies to switch to safety systems
For the past year, Lynda Arnold, RN, an activist for needlestick safety and the International Healthcare Worker Safety Center have been targeting hospitals in an effort to increase the number of health care workers using needleless systems and safety devices. (See related story on needlesticks, p. 35.)
For 1997, the focus will turn to home care agencies such as home infusion providers, which Arnold notes may be those most at risk for needlestick injuries.
"Anything that accesses the vein or artery directly is known to be the most dangerous needlestick," says Arnold, referring to the chance of contracting a communicable disease such as HIV, hepatitis B, or hepatitis C through a needlestick.
"Our perspective now is a lot different than the perspective we had four years ago when every needlestick was bad," says Arnold. "It’s easier to start with a smaller subset of devices and procedures known to be the most risky: needlesticks in blood-drawing and intravenous insertion."
Arnold and the Safety Center have thus prioritized their efforts and begun with IV therapy sites first hospitals and now home care agencies by sending informational packets. Each packet contains data on needlesticks, a list of supporting organizations, and a certificate-like pledge for administrators to sign saying they are committed to evaluating and implementing the use of protective IV catheters and protective blood-drawing devices within one year of their signing the certificate. So far, 40% of hospitals who received the packets have committed to switching to safety systems. Arnold hopes for similar results as the focus turns to home care, where the concerns and preventive steps are identical to those in hospitals.
"In my opinion, there should be no difference in precautions that should be taken, whether it is in a hospital, at home, or in an outpatient setting," says Arnold.
The campaign’s primary focus is to promote the widespread use of needleless devices and safety cannulas among at-risk health care workers. Arnold notes that an increasing amount of devices are becoming readily available to health care workers. However, because these devices frequently cost more than those already in use, many agencies hesitate switching. But the cost of switching is minimal when compared to the potential cost of dealing with an infected individual. The average cost to treat each needlestick injury is between $405 and $1,200.1
In addition, in June of last year, the Centers for Disease Control and Prevention published new guidelines for post-exposure management when dealing with the infected blood of an HIV-positive individual.2 Arnold notes that these guidelines call for putting the exposed health care worker on some of the expensive antiviral agents currently on the market.
The guidelines recommend chemoprophylaxis "to exposed workers after occupations exposures associated with the highest risk of HIV transmission," noting that the postexposure prophylaxis should be initiated "preferably within one to two hours postexposure."
The guidelines also recommend using the drug zidovudine for such treatments.
Arnold, who became HIV-positive as the direct result of a needlestick, says that it often takes a story such as her own to attract attention to the problem.
"Once people hear a story like mine, they understand it is better to be proactive than reactive," she says.
However, the problem is much more extensive than HIV infection, although that particular virus often grabs the spotlight.
"A lot of times in the telling of my story people concentrate on the HIV infection, and I push very hard to say, yes I have HIV, but I wouldn’t want hepatitis B and I wouldn’t want hepatitis C either. One case of hepatitis B or hepatitis C is proving very costly. It can certainly tax the workers’ compensation of a smaller agency."
[Editor’s note: To receive a packet from the International Healthcare Worker Safety Center, call (717) 299-0244. There is also a Web site dedicated to the campaign at http://www.healthcaresafety.com.]
References
1. Jagger J, Hunt E H, et. al, Estimated cost of needlestick injuries for six major needle devices, Infect Control Hosp Epidemiol 1990; 11:584-588.
2. Update: Provisional Public Health Service recommendations for chemoprophylaxis after occupational exposure to HIV. MMWR 1996; 45:468-472.
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