Beyond devices: A new level of sharps safety

CDC workbook encourages culture of safety’

You’ve brought in safer needle devices and reduced your needlesticks. Do you declare success? What more should you do?

A new, on-line workbook from the Centers for Disease Control and Prevention (CDC) provides advice and tools to bring hospitals beyond the basics of device safety. It includes 13 forms that help hospitals assess their current needle safety programs and culture of safety and analyze their injuries.

The goal: a "comprehensive approach to eliminating sharps injuries," says Linda Chiarello, RN, MS, epidemiologist with the CDC’s division of health care quality and promotion. Zero tolerance of needlesticks would be a new perspective for most hospitals, she acknowledges, but it would lead to a safety culture that does not simply assume that the injuries will happen.

The workbook provides a step-by-step method to take your sharps safety program to a higher level. "It will help you focus on specific problems within a facility, identify interventions, and measure the impact of interventions," she says. "It’s a very good method for documenting the processes that are being used to improve the sharps injury prevention program."

In fact, needlestick data show devices alone have not addressed the challenges of needlestick prevention. While needlesticks from conventional devices have been reduced by more than half, injuries from safety-engineered devices have increased, according to an analysis of data from the EPINet Multihospital Sharps Injury database of the International Healthcare Worker Safety Center at the University of Virginia in Charlottes-ville.

Similarly, data from CDC’s National Surveillance System for Healthcare Workers (NaSH) showed dramatic reductions in injuries due to the implementation of needleless IV systems. But injuries from safety devices have increased.

"We’ve seen a shift in the proportion of injuries due to safety devices," Chiarello states. "Some of this is attributed to the fact that even though it’s a safety device, the sharp is still exposed when it’s used. [The device] cannot necessarily prevent those injuries during use. There are workers who still don’t activate the safety devices, so as a result, injuries still occur — not due to a flaw in the safety feature but due to the circumstances involved."

Winchester (MA) Hospital used the injury profile worksheet to focus prevention efforts. "We were able to pinpoint more specifically where the injuries occur, and we’ve been able to target those areas with education," says Pat Fleming, RN, COHN-S, manager of employee health services.

For example, she presented data at the department of surgery meeting to heighten awareness about needlesticks from suture needles. The hospital also discovered that employees were not activating the self-blunting needle in phlebotomy because they feared the extra pressure would hurt patients. The hospital ended up switching to a different safety device.

At Quincy (MA) Medical Center, the workbook tools helped identify injuries among nurse technicians who were using butterfly phlebotomy devices. The hospital evaluated and purchased a new device, then focused its education and training efforts on helping the nurse technicians adapt to the change, says Deborah Hylander, RN, CIC, director of infection control, employee health, and workers’ compensation.

Due to that and other interventions, the hospitals’ bloodborne pathogen exposures declined by 50%. The result: Needlesticks among the nurse techs declined by 50%. "[The CDC tools] are like road maps to help you organize what the problems are, help you plan interventions, and do an evaluation," she says.

Hospitals can pick and choose tools from the workbook that would be most helpful, Fleming notes. "It’s a fresh way of looking at things."

The workbook includes:

  • An assessment tool to help facilities determine the current status of their program. Questions can spur dialogue at the facility and even provide a way to focus the attention of administrators and others to the needs of the program.
  • A staff survey to measure the facility’s safety culture. The culture of safety influences work practices, reporting, and other behaviors.
  • Forms to conduct a root cause analysis of injuries and to report a near miss. For example, if a housekeeper sees a needle lying on the floor or on a bed and disposes of it without injury, she can report a hazard observation. Actions can then be taken to prevent future injuries. (See sample form.)
  • Worksheets to identify the top needle safety priorities and to calculate injury rates that take into account unreported events.
  • A survey and worksheet to gather information on the current use of devices and the qualities that are most important in a device.

Editor’s note: The workbook is available at www.cdc.gov/sharpssafety/. A CD-ROM version of the workbook is under development.