Put staff safety first by eliminating needlesticks
Put staff safety first by eliminating needlesticks
Making the switch not that hard or expensive
(Editor’s note: In the first of a two-part series, Home Infusion Therapy Management addresses how easy or hard it can be to switch to safety devices in an attempt to reduce the risk of needlesticks. Next month, we’ll look at the legal issues you should address when considering to make such a switch. How far does your agency have to go to protect its staff?)
The facts are staggering. There are approximately 800,000 needlestick injuries per year in the United States.1 Consider that out of those 800,000 needlesticks, about 2% are HIV contaminated.2 Needlesticks from IV catheters and similar devices that access blood are the most common cause of occupationally acquired hepatitis B virus and HIV. 3
As you might imagine, the above statistics create strong opinions among health care professionals when it comes to worker safety in home infusion agencies. (See story about the threat of needlesticks in health care, p. 36.) Fortunately, those with the strongest opinions appear to be individuals in favor of safer standards and more devices to protect home infusion staff. For some, most frustrating of all is that with the current plethora of safety devices available, needlesticks could virtually be eliminated.
"They are truly preventable," notes Lynda Arnold, RN, an activist for needlestick prevention who became HIV-positive as the direct result of a needlestick. (See related story on push for safety, p. 37.) "Eventually, you won’t see traditional intravenous insertions. In the next couple of years, you will see a complete changeover."
A complete changeover is what many are hoping for when it comes to switching agencies over to safety devices. Many agencies take a big step toward preventing needlesticks but never make the next step of replacing needles with safety cannulas to complete the move.
"I have a real bone to pick with hospitals and agencies that invest thousands of dollars in tubing for needleless systems to eliminate all the sterile needles and then don’t invest in safety cannulas so the bloody needles are eliminated," notes Jim Herbert, RN, CCRN, CRNI, former infusion education coordinator for First American Home Care in Brunswick, GA.
Herbert should know how frustrating this can be. He dealt with the problem first hand when First American was considering switching to the Safesite needleless system but balked at requiring staff to use safety cannulas. Serving on the supply committee, Herbert was forced to try to convince others that both measures, and not just investing in safety tubing, would truly prove effective.
"Their argument was that nurses didn’t like the safety cannulas because there was too much of a learning curve to go from regular cannulas to safety cannulas," says Herbert. (Cost was a major consideration, as the needleless cannulas cost 50 cents to $1 more apiece, while safety tubing was about the same cost, he says.)
However, by doing their homework and shopping around, First American’s supply committee found a product with no learning curve. Herbert, says some safety cannulas require the nurse to slide a plastic piece or sheath over the needle as the canula is inserted, which requires a different technique than if using a regular canula. However, Becton Dickinson makes a product that does not require altering the insertion technique. A simple push of a button retracts the needle out of harm’s way.
"So I made the argument that, sure you’re going to invest all this money to get rid of the sterile needles, so why not invest and get rid of the bloody ones as well?" says Herbert. He ended up getting a compromise. "They didn’t do away with the regular needles but did make the others available."
Herbert says that switching to needleless systems and safety cannulas is the most effective way to eliminate needlesticks. However, he adds that, without staff compliance, converting to safety devices is useless. Compliance often comes down to getting your staff willing to make the switch.
Arnold agrees. "It’s upsetting when you hear stories of agencies that have instituted safety measures and the workers don’t want to comply, or they’ll find ways to disassemble devices," she says.
That’s exactly what has happened at First American. Even though there is literally no learning curve with the new safety cannulas, many nurses have yet to switch. Because the choice of using safety or regular cannulas is available, some nurses have continued to use the standard cannulas, even though no alteration of technique is required when using the safety cannulas.
"Nurses are creatures of habit," says Herbert. "If you give them the option of doing what they’ve done, they’ll do that. I’d prefer to see the agency eliminate the old system altogether and institute the safety measures."
At First American, the IV nurse specialists happily made the switch to the safety cannulas. The non-IV specialists are those less likely to have embraced them, says Herbert. He points out that those individuals are less proficient with IVs and, therefore, less likely to switch to a new and unfamiliar tool. Unfortunately, those are the staff who may be at the greatest risk of a needlestick. Herbert notes that unfamiliarity often leads to confusion and haste when an insertion doesn’t go by the book, which in itself can create problems.
"In some of my classes, students put in an IV and get a blood return and rush to get the canula capped because there’s blood coming out of it," he says. "I explain to them that you could leave it open for a week, and the person won’t bleed to death, so take your time."
Ann Williams, RN, an infusion nurse with Deaconess Home Medical Equipment and Infusion in Evansville, IN, shares Herbert’s opinion of nurses sticking with what’s known and, therefore, comfortable when given a choice. That’s why Deaconess chose the Clave needleless system.
"One of the systems we looked at the Baxter Interlink system could be used with or without needles, which does not force compliance," she says. "If nurses have the option of using needles or not, I felt they were not going to use the needleless systems."
It’s likely that some of your patients or their caregivers provide varying degrees of infusion therapy. You would be remiss in overlooking your patients’ and caregivers’ comfort levels when considering safety devices.
Health Resources Inc. (HRI) in Altoona, PA, recently switched to the Interlink needless system and is looking into safety devices for IV starts and blood draws.
"We switched to make it safer for the nurses and the patients," says Melissa Feather, RN, clinical coordinator for HRI. "A lot of our patients are independent, so it is safer for them and their caregivers."
The HRI staff was pleased with the switch to the Interlink system, which was relatively easy, she says. "We didn’t need an inservice because the Interlink system is a lot like using needles, only it has a blunt tip end," says Feather. "You do everything the same, but instead of a needle, it has a needleless adapter."
Williams says her agency’s switch to a needleless system also was in large part due to patient concerns. "Over the past year or so, we’ve had more people say that they’re afraid of needles," she says. "We’ve also had a time or two that a caregiver or patient had stuck themselves."
Not only did patient concerns play a major role in the agency’s switch, the ease-of-use of the new system was critical, so patients and their caregivers could be educated to use the system.
"I was impressed by the simplicity of it," says Williams. "With other systems, I found you had to put caps on them, and there were a lot of pieces."
For example, other systems Williams looked at required an end cap on the adapter itself. And to guarantee a sterile site, a new end cap always had to be used. In the home, Williams felt that maintaining such a sterile site would be difficult. If a patient set down the cap and reused it rather than placing a new cap, there was a question as to how clean the used cap would be.
Williams found the Clave connector to be nearly identical to needle system adapter plugs at the end of the heparin lock.
"All you have to do is teach the patient to swab the end of the connector [with alcohol], and then they access it with the syringe," says Williams. "They can then use the needleless syringe to access the line."
For HRI and Deaconess, it’s too early to tell what impact the switch will have on needlesticks, which cost HRI several thousand dollars over the last several years. (See chart, p. 39.)
For First American, Sue Beasley, CRNI, divisional vice president for clinical services, says anecdotal evidence shows that the majority of needlesticks are now related to venipuncture rather than infusion. Although safety products also are in use for venipuncture, Beasley notes that most needlesticks occur during the disposal of the safety equipment.
References
1. Jagger J. Preventing HIV transmissions in health care workers with safer needle devices. Sixth International Conference on AIDS, San Francisco, CA, June 22, 1990.
2. Jagger J, Person R D, Universal precautions: Still missing the point of needlesticks. Infection Control and Employee Health 1991;12:211-213.
3. Favero, M S, Preventing transmission of Hepatitis B infection in health care facilities, Infection Control 1989; 17:168-171. Case control study of HIV seroconversion in health care workers after percutaneous exposure to HIV infectious Blood - France, U.K. and U.S. January 1988 - August 1994. MMWR 1995; 44:929-933.
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