Nurses still stuck with unsafe needles

Conventional devices still widely used

Many nurses still do not have access to sharps safety devices, and conventional devices are available in most health care facilities, according to a survey conducted by Nursing2004.1

Nurses also report inadequate training, which may contribute to continued injuries from safety devices.

Despite the progress made in almost four years since Congress mandated for safety-engineered sharps in all aspects of health care, much work remains to be done, says Jane Perry, MA, director of communications for the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville.

Perry and center director Janine Jagger, PhD, MPH, provided analysis of the survey for the nursing journal.

"There is still a significant portion of hospitals that either are only partially converted or use very few safety devices at all, if any," Perry points out. "I would suspect that it would be unusual to find hospitals that are 100% converted to safety."

That echoes what other needle safety experts find in training sessions and site visits around the country. June Fisher, MD, director of the Training for Development of Innovative Control Technology (TDICT) Project of the Trauma Foundation at San Francisco General Hospital, asserts that health care workers need better training and access to better devices.

"This is consistent with what we hear in our training," she says. "It tells you that the job is not done and we need more resources."

Last fall, Nursing2003 asked readers to respond to questions about needlesticks and safety devices. Most of the 498 respondents were employed at hospitals (60%), but they also worked in long-term care (13%), home health care (8%), physician offices (6%), and outpatient/clinics (5%).

They are not a random sample and may not be representative of all nurses, the journal noted, but their responses do shed light on practices at health care facilities around the country.

Among the findings:

  • Almost one-third (64%) of nurses said conventional devices still are readily available in their facilities.
  • 13% of nurses said they used safety devices for few or no procedures, and another 27% said they used them for some but not all procedures.
  • 18% of injuries in the safety-device group occurred after use of the device, which indicates that the safety feature was not activated or failed.
  • One in four nurses said they received inadequate training or no training at all.
  • One-quarter of nurses said they had at least one needlestick in the past year, but 42% said they did not report their needlesticks.

"There are injuries that continue to occur with safety devices," Perry notes. "A significant proportion of those are from nonactivation of the safety mechanism. If the safety mechanism isn’t activated, it basically negates the purpose of the device."

Health care workers need to feel comfortable with the devices through proper training, she says. Only about half (53%) of nurses said they received training on newly introduced sharps devices.

"I think the message that needs to stay in the forefront is that the aim is for 100% conversion to safety, not 75% or 80%," Perry explains. "Hospitals need to continue to direct resources and attention not only to purchasing the devices and evaluating and implementing them, but to the training as well."

In comments, nurses also expressed concern about the safety features. One reported that a sheath on a syringe slipped. Another complained that it takes too much force to activate the retractable feature on a syringe.

Other inconsistencies were found

There are other inconsistencies, as well. Pre-filled syringes may come with different types of safety mechanisms, creating confusion for nurses. One manufacturer of the flu vaccine packaged it with conventional devices, Perry notes.

There are times that conventional devices are necessary because no safety-engineered version is available, Fisher adds. But those conventional devices should not be stocked side-by-side with safety devices, making it easy for health care workers to select one without protection, she says.

Manufacturers also should get more input from nurses, the end-users, to help them design more acceptable products, Fisher says.

Reference

1. Perry J, Robinson ES, Jagger J. Nursing2004 needlestick and sharps-safety survey: Getting to the point about preventable injuries. Nursing2004 2004; 34:43-47.