Comply with regs for needlestick prevention

Do you evaluate and purchase safer needle devices to prevent needlesticks from occurring? Do nurses routinely give input on new devices? And do nurses help to choose which devices are used in your ED? If you answer "no" to the above questions, you’re not in compliance with regulations from the Occupational Safety and Health Administration (OSHA).1

A new compliance directive instructs OSHA inspection officers in enforcement of the Needlestick Safety and Prevention Act. The directive focuses on the requirement that employers select safer needle devices as they become available and involve employees in identifying and choosing those devices. (See "Resources" at the end of this article to obtain a copy of the directive.)

Here are ways to comply:

• Make it easy for nurses to give input about new devices. At Saint Jude Medical Center in Fullerton, CA, nurses are strongly encouraged to give input about new devices. "I tell nurses If you don’t speak up, you may be stuck — no pun intended — with a product that you don’t like,’" says Vicki Cadwell, RN, MS, CEN, CCRN, clinical educator for the ED.

An evaluation form is given to nurses when a new device is given a trial in the ED, says Cadwell. The ED managers and educators encourage nurses to complete the forms, which are sent to the employee health nurse for tabulation, she explains. (See Needlestick Prevention Device Assessment Form and Safety IV Catheter Evaluation Form.) The form asks nurses to rate the inservice for the product, and rate the design in terms of comfort for both the nurse and patient. For intravenous (IV) catheters, nurses are asked to rate the product in terms of ease of insertion.

During one trial period of an IV product that nurses had selected, problems with insertion were reported on the evaluation forms. "Many nurses felt it was not sharp enough. Others felt that it did not thread easily, resulting in more discomfort for the patient and multiple sticks for many patients," says Cadwell. The nurses’ negative responses resulted in discontinuation of use of the product, says Cadwell. "We are now trialing two other IV products," she reports.

• Provide inservicing on an ongoing basis. When a new product is put into use, the manufacturer provides the initial training, says Cadwell. "The company educators go around for several days on all shifts and inservice all the nurses in the use of the product," she says. Each inservice includes a basic overview of the product, its safety features, and tips for successful use, says Cadwell. "They bring in the product and allow staff to practice with it as much as they need to," she explains. "Hands-on practice with immediate feedback is essential to success." However, she notes that with the IV product that is no longer used, nurses gave the inservicing high scores. "They had no problem with the education provided. The issue was with the product itself," she says.

Cadwell addresses ongoing concerns about new products and provides education about efficient and safe use. "I try to become an expert in the use of the product, so when the company support is no longer there, I can be a resource to staff as needed," she says. "If I am unable to answer a question, I contact the company." There have been times when the manufacturer’s clinical educator has returned for additional inservicing, she adds. Cadwell stresses the importance of having inservicing available even after a product is introduced. "Nurses need to feel comfortable asking questions if they’re not comfortable with a product," she says.

• Go "needleless." Barbara Pierce, RN, MN, director of emergency services at Huntsville (AL) Hospital System, reports that the ED has switched to a "needleless" system. "We no longer use syringes that are not protective or IV catheters without protective covers. We only use IV tubing that has ports that cannot be entered with needles," she explains. Doing this has not totally prevented needlesticks, because the ED still uses IV needles and medication needles, she acknowledges. "It has reduced the number of sticks, however," she says.

Before the ED made the switch, a vendor fair was held to demonstrate needleless products to staff and management, says Pierce. Evaluations were filled out, the top candidates brought in samples to be tried by the staff, and cost comparisons were done, she adds. There were several training sessions held on all shifts, and ordering and swapping of inventories took place, says Pierce. "We had intended to use up the old products, but the vendors agreed to take them in exchange," she notes.

Finally, a date was set to "go live," recalls Pierce. "We picked a statistically slower day of the week for the ED to start this, instead of a Monday, weekend, or holiday," she says. On that day, all the old products were removed, and the new products used in their place. "Adapters were available to make sure that there were no problems with the pre-filled drug syringes," she says. "We also coordinated the swap with our prehospital providers, who also went needleless at the same time."

The biggest problem area was hemolysis from drawing blood using the new syringes and supplies, says Pierce. She explains that previously, nurses were drawing blood from a port with a syringe, and had to switch to using a different type of vacutainer adaptor. "We had to work through that with the vendor," she says. "Our hemolysis rate is much improved with some simple technique changes."

Reference

1. Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule. Federal Register 2001; 66 (12):5,317-5,325.

Sources

For more information on reducing needlestick injuries, contact:

Vicki Cadwell, RN, MS, CEN, CCRN, Clinical Educator, Emergency Department, Saint Jude Medical Center, 101 E. Valencia Mesa, Fullerton, CA 92835. Telephone: (714) 992-3979. Fax: (714) 447-6415. E-mail: vcadwell@sjf.stjoe.org.

Barbara Pierce, RN, MN, Director of Emergency Services, Huntsville Hospital System, 101 Sivley Road, Huntsville, AL 35801. Telephone: (256) 517-8202. Fax: (256) 517-2982. E-mail: barbarapi@ECS.hhsys.org.

Resources

Below is a partial listing of resources pertaining to needlestick injury prevention:

• The Occupational Safety and Health Administration (OSHA) has issued a compliance directive on Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens (Directive Number CPL2-2.69). The Nov. 27, 2001, directive guides inspection officers in enforcing the Needlestick Safety and Prevention Act. The directive can be accessed from the OSHA web site: www.osha-slc.gov/OshDoc/Directive_data/CPL_2-2_69.html.

• A publication, How to Prevent Needlestick Injuries: Answers to Some Important Questions, is available free of charge. To order, contact the U.S. Department of Labor, OSHA Publications, P.O. Box 37535, Washington, DC 20013-7535. Telephone: (202) 693-1888. Fax: (202) 693-2498. On-line order form: scripts.osha-slc.gov/PHP/pubrequest/pubrequest.php

• A list of safety devices with manufacturers and product names is available at the International Health Care Worker Safety Center web site (www.people.virginia.edu/~epinet/products.html). Click on the type of device for the listing in that category. For more information, contact the International Health Care Worker Safety Center, University of Virginia Health System, Box 800764, Charlottesville, VA 22908. Telephone: (434) 924-5159. Fax: (434) 982-0821. E-mail: epinet@virginia.edu.

• Sample evaluation forms for various devices including safety syringes, IV access devices, IV medication connectors, and sharps containers for EDs are available on the Training for Development of Innovative Control Technology Project web site (www.tdict.org). Click on "Evaluation Tools," and "Safety Feature Evaluation Forms." For more information, contact the Training for Development of Innovative Control Technology Project, Trauma Foundation Building 1, Room 300, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110. E-mail: info@tdict.org.