Noncompliance creates needle safety dilemma

Hospitals finds 72% of devices unactivated

Overall, needle safety devices have a remarkable record of effectiveness, as they reduce needlestick injuries by about 80%. So when Montefiore Medical Center in New York City failed to see a decline in injuries after introducing a new butterfly-type blood collection device, Judith Schrager, RN, MS, then administrative nurse manager of infection control, investigated.

The problem: 72% of 616 butterfly devices retrieved from randomly selected disposal containers had not been activated. A follow-up staff survey revealed that 90% of staff were noncompliant with using the safety feature.1

The predicament faced by Montefiore points out the difficulty in obtaining staff buy-in for some types of safety devices and frustrations in selecting products in a relatively new and evolving marketplace. Schrager ultimately hopes to find the answer in new products that emerge with simpler activation or passive activation. "It’s clear that the legislation is more advanced than the technology," says Schrager, who is now administrative nurse manager in the infectious disease clinic of the hospital’s AIDS center.

Needlestick expert Janine Jagger, PhD, MPH, who is director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville, acknowledges that the selection of needle safety devices can be time-consuming. Even after careful evaluation, the first selection may not work well enough. Jagger suggests sharing experiences with colleagues at other hospitals and seeking solutions that have worked for others. "I just don’t think we can expect to have uniformly outstanding compliance and risk reduction with every single new device that we implement," she says. "This is a trial-and-error process that we’re going through. We need to be communicating our results to other people and listening to what their results are."

Montefiore began by conducting trials of three butterfly devices at four hospital units. All of them received poor reviews, Schrager says. The hospital even waited six more months when the committee learned that another, more user-friendly product was expected to become available. It never came on the market, she adds. "We decided to go ahead and implement the device that got the least negative remarks and also happened to be utilized at neighboring institutions where our residents [went on rotation]," she explains.

The hospital launched an intensive in-service education campaign. With a sustained series of sessions that included all shifts as well as attending physicians, the education programs reached virtually 100% of staff, Schrager estimates. The majority of the users of the butterfly devices was medical students, physician assistants, and residents; most of them were not activating the device, they acknowledged in a survey. "Most of the comments were that they don’t use them because they have to change their technique, [and] they’re not willing to do that," says Schrager. "That’s mostly because it’s an active device, not a passive one."

Part of the problem may be one of poor role modeling. Residents may be influenced by seeing others who do not activate the device, Schrager says. The experience will influence the way selection committees look at new products, Schrager says. And it points out the importance of continually reviewing the technology as it improves. "We concluded that education alone was not sufficient to encourage people [to activate safety devices]," she says. "Truly good protective systems really should be passive so the user doesn’t have to worry about changing technique."

Meanwhile, Montefiore will continue to use the butterfly safety device, hoping that some needlesticks may be prevented among those who do activate them.


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