Keeping sticks low is an endless challenge

Evaluate new devices, monitor work practice

No more needlesticks. That is the ambitious goal set by the Centers for Disease Control and Prevention (CDC) as one of its "healthcare safety challenges." But for many hospitals, dramatic reductions in sharps injuries have given way to a stabilizing level or even increases in needlesticks.

The work of continuing to decrease needlesticks is indeed a challenge.

"Once you've made a big push to get the devices in place, it's easy to think, 'We've taken care of that,'" says Jane Perry, MA, director of communications for the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville. "This is not something you can just do once and it's done."

Of course, the U.S. Occupational Safety and Health Administration's bloodborne pathogens standard requires hospitals to update their exposure control plan every year and to evaluate new technology.

To keep needlestick rates low, a simple annual review isn't enough, sharps safety experts say. Many employee health professionals monitor their sharps exposures monthly or quarterly. That can lead to quality improvement projects to address the cause of injuries, says Melanie Swift, MD, medical director of the Vanderbilt Occupational Health Clinic at Vanderbilt University in Nashville, TN.

"You need a good system to electronically track how your injuries are happening," she says. "It's just a continual process."

More acceptance of blunt suture needles

Syringes remain the major source of injury (39%), either because they were not safety-engineered, the safety feature was not activated, or for some other reason a stick occurred during or after use, according to the recently released 2004 EPINet data. EPINet is a network of 41 hospitals coordinated by the International Healthcare Workers Safety Center at the University of Virginia in Charlottesville.

The operating room remains a primary location for sharps injuries (30.4%) and one in five sharps injuries involves a suture needle.

Blunt suture needles may finally be gaining acceptance. As Hospital Employee Health previously reported, the American College of Surgeons, OSHA and the National Institute for Occupational Safety and Health have issued statements encouraging the use of blunt suture needles.

Vanderbilt has begun using blunt suture needles routinely for muscle or fascia, says Swift. The hospital first conducted a trial with the blunt suture needles, then made the change hospital-wide.

"In the past, there was a lot of resistance from surgeons and others who used them. But this time around, our surgeons have been very receptive," she says.

Younger surgeons, in particular, are more open to the change, she says. "They're a little less inclined to hold nonevidence based opinions about their preferences," she says.

When an employee has multiple sticks

At Upper Chesapeake Health in Bel Air, MD, Vickie Bands, MSA, RN, director of community outreach and occupational health, keeps a close eye on sharps injuries. She reports needlesticks every month to the Infectious Disease Committee and employee health nurses investigate the causes. They also educate employees about needle safety. The hospital's OR manager also tells employees about OR exposures in a quarterly newsletter.

Bands and her colleagues recently noticed that several employees were injured while activating a safety device. The hospital is now evaluating a retractable needle to see if it would reduce the risk of injury and be acceptable to employees.

After a stick, the employee health nurses ask the injured employees for their opinion: "Were you not trained? Were you not comfortable with it? Do you feel it's not a good safety device?"

"We feel we need to do everything we possibly can [to reduce sharps injuries]," says Bands.

Yet the device is not always the problem. Addressing the issue of work practice can be especially challenging, she says.

Recently, a scrub tech had three sharps injuries in the past six months — and failed to follow hospital policy on prompt reporting. The tech had not complied with the no-pass zone — which provides a neutral place to pass sharps — and hadn't told a charge nurse about the injury until after the surgical case was over, Bands says.

On a case-by-case basis, situations like that will be referred to human resources, says Bands. For example, the scrub tech met with the OR director and human resources and received a written warning. If she has another exposure and fails to follow policy, she could face disciplinary action. The message is not a punitive one for those have multiple sticks, says Bands; it's an emphasis on safety.

"You need to be as worried about you as we are," she says.