Despite safety gains, sharps discarded improperly
Survey’s findings disturbing’
Sharps safety is widespread in U.S. hospitals, thanks in large part to the Needlestick Safety and Prevention Act in 2001. However, a recent study shows a persistent hazard: A high proportion of sharps are being discarded unsafely.1
"It is disturbing that 39.9% of conventional needles were capped prior to discard, and 42.5% of all devices were discarded as a "naked" sharp," the researchers concluded. "It is worrisome that 12 years after [the Needlestick Act], 64.3% of healthcare professionals placed themselves at risk by recapping or discarding naked needles.
The findings were revealed in a study of five health care facilities in central Florida, investigators audited sharps container contents.
"That 40% of all discarded sharps were naked is both surprising and disturbing, but it does need the caveat that it is a sampling from one region and from one state, and it is devoid of the clinical reasons why SED may not have been used," says Terry Grimmond, FASM, BAgrSc, a consultant microbiologist and the study’s author, based in Hamilton, New Zealand.
"I haven’t met a hospital occupational health manager who did not have sharps injury reduction high on their agenda," Grimmond says. "All are passionate in their endeavors to reduce sharps injuries. It is, however, a constant battle."
The Association of Occupational Health Professionals in Health Care (AOHP) conducted a survey of members in 125 hospitals across the country and found little change in the number of needlesticks despite initial progress after the adoption of the needlestick safety law in 2001. (See HEH, February 2014, p.13.)
At an AOHP national meeting in September 2013, around 200 occupational health managers said more than 80% of needles at their facilities were safety engineered devices, which raises questions about the Florida survey, he says.
"It may be true that more than 80% of needlestick procedures have a safety engineered device available, but the survey indicates not all are being used, and some are used incorrectly," Grimmond says. "Currently, I would think industry has developed safety engineered devices for more than 90% of sharps procedures."
Hospitals should reinforce sharps safety through education and especially focus on interns and staff during periods of stress and heavy workloads. Some hospitals are moving away from the practice of "See one, do one, teach one," in terms with safety devices, he says.
Instead, they will follow a training model that relies on helping staff practice until they can do it without risk. Then there is annual follow-up to see if there are any issues or need for additional practice and training, he adds.
"Education is vital and competency-based and repetitive education is very effective," Grimmond says. "However, the literature is clear that stressed and/or overworked staff is at greater risk of sharps injury."
"Overworked’ doesn’t just apply to the sharps users and handlers, it also applies to the occupational health department," Grimmond notes. "Many are under-resourced to apply all the strategies they know work."
U.S. hospitals may make needle safety devices available for all procedures for which there are available commercial products, but clinical situations and provider preferences may trump safety in certain procedures. For instance, some surgical staff members are not comfortable using blunt suture needles for closures, despite strong evidence that using these can cut sharps injuries by half, Grimmond says.
Hospitals are prohibited by OSHA from rejecting safety devices solely on cost, but cost does appear to remain a factor, he adds.
"I know cost is still a factor in needle safety adoption or at least in the selection of perhaps a superior, more expensive [devices]," Grimmond says.
Hospitals that have the best possible practice in sharps safety go beyond mere OSHA compliance, he notes.
Best possible practices include moving from active needle safety devices to passive or semi-passive devices in specific procedures. Others include investigating every sharps injury immediately after it occurs and quickly determining the reason for the injury, Grimmond says.
"Other strategies are mandatory post-sharps injury re-education, a mandatory two-year review of a staff member’s competency, mandatory electronic education, and involving the injured person’s manager in the investigation," he says.
It’s also important to provide transparency with sharps injury incidence via overt hospital-wide publication of the hospital’s record and to publicly praise departments for having zero sharps injuries for a month, quarter, and year, he adds.
"Other studies I have conducted confirm that sharps container-related [needlesticks] account for 5% — 10% in the U.S., and I am researching how we may improve sharps container design so as to eliminate containers as a source of [sharps injuries]," he says.
- Grimmond T. Use and activation of safety engineered sharps devices in a sample of 5 Florida healthcare facilities.
J Assoc Occ Hlth Prof 2014;34(1):13-15.