Joint Commission targets needle safety in surveys

Agency issues first-ever alert on worker safety

If a federal law and regulation weren’t enough to compel needle safety, the Joint Commission on Accreditation of Healthcare Organizations in Oak Brook Terrace, IL, has turned up the heat with an announcement: Compliance with needlestick safety rules could affect your accreditation.

In its first-ever sentinel event alert to address worker safety, the Joint Commission informed hospitals that in April 2002, its surveyors will begin assessing organizational compliance with the Needlestick Prevention and Safety Act.1 The alert, sent to hospitals around the country, greatly raises the profile of needle safety and ensures that surveyors will ask about exposure control plans, needlestick laws, and the effectiveness of new devices.

The alert might seem almost an afterthought after so much activity on needlestick prevention in the past two years. But needlestick expert Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville, estimates that, except for needleless IV infusion systems, fewer than 50% of sharps devices in use have safety features. "I’m very concerned that in some quarters the law is not really being taken seriously," she says. "In some cases, it’s [apparently] being viewed as optional."

While lauding the Joint Commission’s action, some worker advocates questioned why the agency gave hospitals a grace period to comply. "The big question for us is why April 2002 if the law has gone into effect already?" asks Karen Worthington, MS, RN, COHN-S, occupational safety and health specialist with the American Nurses Association (ANA) in Washington, DC.

Whenever the Joint Commission incorporates new regulations beyond the agency’s own standards, hospitals receive some time to gear up, notes Richard J. Croteau, MD, executive director for strategic initiatives at the Joint Commission. "Just because something is published in the Federal Register, it doesn’t always get to the people who actually need to implement change in an organization," he says. "We’ve found the sentinel event alert to be very effective in getting the message to the right people," Croteau explains.

The message about safer sharps might seem loud and clear. But the actual implementation of devices varies greatly among hospitals and within a single institution. Needleless IV systems have received the greatest acceptance, while blunt or retractable devices meet significant resistance in operating rooms. (See Hospital Employee Health, September 2001, p. 104 and February 2001, p. 18.) For hollow-bore needles, which pose the highest risk of transmission of bloodborne pathogens, reliable estimates of safety vs. conventional devices in use are not available.

In an on-line survey of 4,826 nurses conducted by the ANA, 18% reported that their facilities do not provide safe needle devices for injections, IV insertions, and phlebotomy procedures.2 (See "Noncompliance creates needle safety dilemma," in this issue.) "I hope that in another year the 20% [figure in the survey] on needlestick devices is a lot lower," Worthington says.

Time is up

Hospitals have had several years to phase in safer devices. In 1998, California became the first state to mandate the use of safety devices, and other states quickly followed with similar laws of their own. In 1999, the U.S. Occupational Safety and Health Administration (OSHA) issued a compliance directive to inspectors, clarifying the importance of "engineering controls."

The Needlestick Prevention and Safety Act passed Congress with bipartisan support and was signed into law late last year. The revised bloodborne pathogens standard implementing the law became effective on July 17, after OSHA completed a 90-day education and outreach program. States with state occupational health and safety plans were required to apply equivalent or stricter rules by Oct. 18, 2001.3

A Joint Commission alert may seem almost belated. But for hospitals and other facilities that rarely see an OSHA official, the Joint Commission is a much more compelling presence. "It puts the issue out in front of every accredited facility," says Joint Commission spokeswoman Janet McIntyre. "It really does put them on alert that this is an important issue."

In some hospitals, the alert also may be an internal tool to gain support for the switch to new devices. "This may be a great tool for me to use when I speak with the OR physicians," commented Joyce Cain, RN, manager of the employee Health Clinic at Piedmont Hospital in Atlanta, who is working with different physician groups that have resisted using new devices.

In special cases, if physicians insist that patient care would be compromised on a particular procedure without the conventional device, the law and OSHA rules allow for exceptions. But safer devices must be carefully evaluated, with input from frontline health care workers. "I’m just going to give it to them straight," says Cain. "I’m not telling [the physicians] how to practice, but they need to adopt safer devices."

What will the Joint Commission be looking for as evidence of compliance with the law and OSHA regulations? (For a recap of the requirements, see "OSHA’s Needle Safety Basics," in this issue.)Clearly, hospitals will need to have the basic, required documentation:

  • an exposure control plan that is updated annually and shows consideration of new devices;
  • a needlestick log that protects worker privacy but includes details on exposures and devices;
  • evaluation panels that have considered more than one device and that include frontline health care workers. 

But when the Joint Commission surveyors begin focusing on needlestick safety next April, they won’t necessarily expect an entire, hospitalwide conversion, Croteau says. "We would expect them to do an organizationwide assessment of the risks," he says. "Based on that, they’ll make decisions about implementing change. We understand that they may not and perhaps should not make a change throughout the entire organization [for a particular device]."

Start with pilot tests

The Joint Commission encourages using pilot tests to introduce significant changes, Croteau says. For example, new disposal containers could be used in one or two units before being implemented throughout the hospital. The Joint Commission traditionally focuses on patient safety, and its sentinel event alert points out that patients may be at risk from unsafe needles, as well. The alert cites two cases, involving an infant and a child, of needlestick injuries among patients. Those cases involved needles left in patient beds. "Techniques that are used to protect health care workers from needlestick- and sharps-related injuries can also protect patients," the alert notes.

References

1. Joint Commission on Accreditation of Healthcare Organizations. Sentinel Event Alert: Preventing Needlestick and Sharps Injuries. Issue 22, August 2001. Web site: www.jcaho.org/edu_pub/sealert/sea22.html.

2. American Nurses Association. Health and Safety Survey, 2001. Web site: www.nursingworld.org.

3. U.S. Occupational Safety and Health Administration. Web site: www.osha-slc.gov/needlesticks.