Sharp contrast: Needle safety success, failure

Many disposed with protective measure unused

Though they are now flooding into the nation’s hospitals by regulatory edict, needle safety devices can lead to widely divergent results when actually implemented in clinical practice. That finding was illustrated in starkly contrasting research reported recently in Toronto at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).

The good news was reported by Meryl H. Mendelson, MD, epidemiologist at Mount Sinai Medical Center in New York City. The center implemented an intravenous catheter device designed to prevent needlesticks, and the injuries were virtually eliminated.¹

They first established a baseline rate of 6.6 needlesticks per 100,000 IV catheters used with their conventional equipment. That rate plummeted to three injuries per 100,000 devices, as there was only one needlestick with the new device during a three-month pilot period.

Workers had received training over the prior two months in use of the device, which involves pushing a button to retract the needle as it is removed from the patient’s arm. The one reported needlestick involved a nurse who chose not to activate the device and was subsequently stuck with the exposed needle.

"We saw an immediate reduction in injuries related to IV catheter stylets, with an overall compliance with activation of 91%," Mendelson told SHEA attendees. "This marked a highly significant reduction in these injuries."

IV catheter needlesticks are considered high-risk for transmission of bloodborne pathogens, thus some infections may have been prevented by implementing the device, she noted. "Even further reduction in injury can be realized with increased compliance," she says.

But poor compliance with activation of such devices — whether due to workers’ attitudes or product design flaws — can thoroughly undermine a needlestick reduction effort. For example, a butterfly needle safety device met with considerably less success in another clinical trial, reported Judith Schrager, RN, an epidemiologist at Montefiore Medical Center in the Bronx, NY.²

The hospital has about 250 sharps injuries a year, and conventional butterfly needle devices were accounting for about 20% of those. The majority of injuries occurred after use during disposal. The safety design implemented requires the worker to pull on the IV tubing to activate the device and cover the needle.

"Inservice was provided around the clock, seven days a week for all at-risk staff members," she said. "On a fixed date a one-to-one product substitution was implemented, resulting in a $300,000 per annum direct cost increase."

Less-than-impressive results

However, after following the injuries over the next year, researchers found 48 needlesticks with the new devices — a drop of only four injuries from the previous year.

Opening sharps containers, researchers retrieved 616 of the butterfly safety needles. They found that 44 (72%) had not had the safety shield activated. The workers chose to leave the needle bare in disposing it rather than activate the device.

"Noncompliance was related to poor design issues in the safety device," Schrager said. "Staff could easily demonstrate on demand — but not in actual use — how to activate the butterfly. But they had difficulty in actual practice. Not all devices work in every setting."

Despite the dismal outcome, the hospital continues to use the device because of an ethical quandary, she explained. Some workers clearly mastered the device, activating and disposing of it properly. Should they now be denied use of the product? For now, the hospital says no.

References

1. Mendelson MH, Lin-chen BY, Finkelstein-blonde L, et al. Evaluation of a safety IV catheter (IVC) Abstract 238. Presented at the Society for Healthcare Epidemiology of America. Toronto; April 2001.

2. Schrager J, Raffa R, Currie BP. Documented lack of efficacy of safety butterfly needle device. Abstract 239. Presented at the Society for Healthcare Epidemiology of America. Toronto; April 2001.