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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Needlestick injuries, infections decline, but challenges remain in OR, non-hospital setting

In a “call to action,” sharps safety experts are targeting gaps in needlestick prevention and seeking to spur a new commitment to make improvements.

“Over the past 25 years, there’s been such tremendous success in reducing health care workers’ risk of bloodborne pathogens,” says Janine Jagger, Ph.D., director of the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville and a pioneer in sharps safety. “It’s a question of finding gaps [in compliance] and trying to plug up those gaps.”

Sharps safety experts cite several remaining barriers and arising new challenges, including reducing the risks of injuries and blood exposures in the surgical setting:

1. Improve sharps safety in the surgical setting. Sharps injuries in the OR actually rose during the time that injuries from needles and syringes were declining dramatically. Surgeons have been reluctant to use blunt suture needles or safety scalpels, Jagger says. “It all comes down to getting surgeons on board. If they’re not onboard nothing’s going to happen,” she says.

Still, hospitals and surgery centers should adopt policies that mandate safety. “Most of the injuries in the OR occur to the OR staff and not to the surgeon,” says Jagger. “The surgical equipment that the surgeon chooses has the major effect on the risk of everyone else in the room.”

Surgeons should work with nurses and other OR personnel “to develop sharps safety standards and practices that are consistently implemented and followed in all surgical environments,” according to the consensus statement. The experts also called on OSHA to monitor compliance in ORs.

The American College of Surgeons has issued statements encouraging safer practices, including double-gloving, passing instruments in a neutral zone, and using blunt suture needles. The consensus statement gives OR personnel some additional leverage, says Jagger. ”It gives them a new opportunity to raise the issue and to focus on its importance,” she says.

2. Increase use of safety devices in non-hospital settings. The use of sharps safety devices is commonplace in hospitals, but not as consistent in non-hospital settings, such as clinics, physician offices and home health. In fact, the needlestick surveillance programs focus on hospitals; much less is known about compliance elsewhere. Market data from device manufacturers indicates less use of safety needles in non-hospital settings. The sharps safety experts recommended more research from the National Institute for Occupational Safety and Health and special enforcement programs from OSHA. “There’s less compliance because there’s less enforcement [in smaller settings],” Jagger says.

3. Ensure that frontline workers are involved in selection of safety devices. The Bloodborne Pathogen Standard requires employers to solicit the input from frontline workers when they select sharps safety devices. Yet it is hard to keep tabs on the compliance with this provision. The experts note that it is “not consistently” followed. “At a time when the pressure to reduce healthcare costs is intense, it is important to keep these user-oriented questions at the forefront of device selection,” the experts said in the consensus statement.

4. Continue innovation in safety design. When needle safety became law in the United States, device manufacturers responded quickly and developed more effective and innovative designs. “It’s really quite amazing. The technology they’ve brought forward is really good technology,” says Jagger. But even 11 years after the revised Bloodborne Pathogen Standard was released, there are devices for which there is no safety version. “I think that as we bring new information forward about gaps we have, the medical device industry is likely to respond very well again,” she says.

5. Enhance education and training. Teaching hospitals have higher needlestick rates than non-teaching hospitals. That indicates a need to improve training, the safety experts said. Failure to activate a safety device also may reflect a lack of training in how to use the device. The Bloodborne Pathogen Standard requires annual training that includes “an opportunity for interactive questions and answers with the person conducting the training session.”