Special Report

Bloodborne pathogens: Proof is in the checklist

How safe are you from exposure?

How far has your hospital or home care agency progressed in preventing on-the-job exposure to bloodborne pathogens? Are you safe? The National Institute for Occupational Safety and Health (NIOSH), a Washington, DC-based research branch of the Centers for Disease Control and Prevention, recently issued an alert that emphasizes using needle safety devices to prevent needlesticks, particularly those with the highest risk of transmitting bloodborne infection to health care workers.1

"Identify priorities based on assessments of how needlestick injuries are occurring, patterns of device use in the institution, and local and national data on injury and disease transmission trends," the NIOSH alert states. "Give the highest priority to needle devices with safety features that will have the greatest impact on preventing occupational infection [e.g., hollow-bore needles used in veins and arteries]."

As safer devices are introduced, worker training is essential to ensure proper use, NIOSH emphasizes. Other highlights of the alert are summarized in the following checklist. Use it to determine if your organization is taking the right steps toward better needle safety:

1. Desirable needle device characteristics.

Such characteristics include:

• The safety feature is integral to the device.

• The device works passively (i.e., it requires no activation by the user). If user activation is necessary, the safety feature can be engaged with a single-handed technique and allows the worker’s hands to remain behind the exposed sharp.

• The user can easily tell whether the safety feature is activated.

• The safety feature cannot be deactivated and remains protective through disposal. The device performs reliably and is easy to use and practical.

2. Device examples.

These include:

• needleless connectors for IV delivery systems (e.g., blunt cannula for use with prepierced ports and valved connectors that accept tapered ends of IV tubing);

• protected needle IV connectors (e.g., the IV connector needle permanently recessed in a rigid plastic housing that fits over IV ports);

• needles that retract into a syringe or vacuum tube holder;

• hinged or sliding shields attached to phlebotomy needles, winged-steel needles, and blood gas needles;

• protective encasements to receive an IV stylet as it is withdrawn from the catheter;

• sliding needle shields attached to disposable syringes and vacuum tube holders;

• self-blunting phlebotomy and winged-steel needles (a blunt cannula seated inside the phlebotomy needle advanced beyond the needle tip before the needle is withdrawn from the vein);

• retractable finger/heel-stick lancets.

Check whether your hospital or home health agency has a needlestick prevention program or committee — a good indicator of its commitment to safety. The major task of such a committee should be collecting and reviewing needlestick and blood exposure surveillance data, including types of exposures, job classifications of exposed workers, procedures involved, complete descriptions of devices involved, and whether devices were safety or conventional designs.

The needlestick prevention program should include a component for selecting and evaluating safer products, and ought to have a role in the facility’s product evaluation committee.

3. Evaluation strategies.

When selecting a safer device, identify its intended scope of use in the health care facility and any special technique or design factors that will influence its safety and acceptability. Conduct a product evaluation, making sure that the participants represent the scope of eventual product users.

These steps will contribute to a successful product evaluation:

• Establish clear criteria and measures to evaluate the device with regard to both health care workers safety and patient care.

• Conduct on-site follow-up to obtain feedback, identify problems, and provide guidance.

• Monitor the use of a new device after implementation to determine the need for additional training. Solicit feedback on health care workers’ experience with the device, and identify possible adverse effects of the device on patient care. Ongoing review of current devices and options will be necessary.

As with any evolving technology, the process will be dynamic, and with experience, improved devices with safety features will emerge.

Reference

1. National Institute for Occupational Safety and Health. NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings. DHHS NIOSH Publication No. 2000-108. Washington, DC: November 1999.