When it comes to needlestick and sharps safety, we've come a long way over the years. But we know that the healthcare community must continue to work together to protect millions of nurses, doctors and other personnel who are still vulnerable to these dangerous workplace injuries.
On May 29, 2013, we’ll be hosting our third online conference to continue raising awareness about the need for better sharps injury prevention strategies. We will also discuss the selection criteria for best-in-class devices, aligned to the procedural-based safety needs of the caregiver.
Last November's "The Unfinished Agenda" online conference was such a successful first event that we wanted to continue the momentum of the conversation. Click here to access our first groundbreaking event that explores needlestick safety from its roots in the HIV/AIDS crisis to where we stand today. On February 5th we hosted the second event "The Unfinished Agenda: Addressing the challenges" as a conversation focused on safety in the operating room. Click here to view the event, which features thought leaders exploring the topics that relate to keeping our work environment as safe as possible.
We appreciate your participation in our online events and the discussions about needlestick and sharps safety that these events foster. The conferences continue to become an outlet for healthcare personnel resources, questions and insightful background about the history of efforts to reduce injuries, the state of our current sharps safety and what we still need to accomplish in the future.
If you would like to be considered as a participant in the upcoming conference, please send a presentation outline to: info@safeincommon.com.
Welcome to the April 2013 edition of SAFETYscribe, an update on Safe in Common's work to eliminate needlestick- and sharps-related injuries. Inside, you will find news about the movement of healthcare personnel and industry leaders who are committed to eradicating sharps injuries and learning about the safest equipment. You'll also find your own stories and hopefully answers to some of your questions about how to implement best practices to create a culture of safety.
Each month we take a look at the numbers that define our lives. This month, we're examining the findings in the newly released "Through the Eyes of the Workforce" study, published by the Lucian Leape Institute at the National Patient Safety Foundation. This 39-page report calls for action on workplace safety based on numbers, such as:
- At one East coast medical center, 62 staff members suffered exposure to blood-borne pathogens in a two-month period; in 90 percent of the cases, personal protective equipment was not used
- 13 percent of the nurses reported unprotected contact with blood-borne pathogens
- 75.9 percent of nurses surveyed by the American Nurses Association indicated that unsafe working conditions interfere with the delivery of quality care
- The prevalence of physical harm experienced by the health care workforce is 30 times higher than in other industries
As part of this report, the Institute quoted a survey across the health care disciplines conducted by the American Society of Professionals in Patient Safety at the National Patient Safety Foundation. Some of the findings include:
- 99 percent of the respondents agreed that there is a link between workforce safety and patient safety
- Only 16.5 percent reported that workforce safety was a focus in their organization's quality and safety initiatives
This look at the balance of patient and workforce safety resonates with Safe in Common supporters. As you review the numbers, consider the final conclusions of the report:
"The health care workforce is at risk. As long as conditions persist that compromise the physical and psychological health of the workforce, progress in patient safety is also at risk, and the pace of progress will continue to be slow. We believe the principles for advancing patient safety apply to workforce safety and require the same."
Dr. Mary Foley, PhD, RN
The Next Step: Revisiting the Unfinished Agenda
Our series of online events, "The Unfinished Agenda," has opened up an important dialogue among the nation's foremost leaders in healthcare worker safety and the frontline personnel who still face very dangerous needlestick and sharps injuries every day.
Our last event was such a success that we are already busy at work planning our next event for May 29, 2013. And once again, we would love your participation—possibly as a presenter and definitely as an attendee!
As you may have experienced during the February event, the series has become a robust and informative source of insight and unity, driven by an unprecedented lineup of experts who are rallying to support safer working environments for all personnel. This event in particular highlighted a deep exploration of some of the most critical needlestick and sharps safety concerns: operating room safety, selection criteria for sharps engineered devices, safety in non-acute areas and how we can use data to improve exposure control plans.
During the last event, more than 1,150 global healthcare leaders and personnel registered to attend - a clear indication the healthcare industry has a demand for unification, education and surrounding protection from needlestick and sharps injuries. As I mentioned, this event convened a panel of experts for an interactive discussion on how to minimize the risk of sharps-related injuries within the operating room (OR) and alternate care settings, the development of optimal selection criteria for engineered sharps devices and the improved use of data to set priorities and improve exposure control plans.
The event was a great opportunity to field a series of topical polls designed to gauge the state of needlestick and sharps injury prevention. Among the findings was confirmation of industry estimates that less than one-quarter of operating rooms are standardized on blunt suture needles and that surgeons dominate the device buying decision.
Their findings include:
- More than 37 percent of attendees said that "the greatest influence for selection of engineering controls for use in the OR" was "surgeons," followed by "collaborative process with all at-risk personnel represented" (33.6 percent), "purchasing/administration" (15.7 percent), "nursing" (9.7 percent) and "anesthesia" (4.1 percent)
- Nearly 62 percent of the attendees said that they are using sharps injury data in making purchasing decisions for medical devices
- In a sign of progress, some 61 percent said that, in 2012, they participated in an engineering control evaluation and/or annual exposure control plan review
Perhaps the most inspiring takeaway from the event was the panel of experts who came together to explore the topics. Such leaders are the champions we need to spark the critical discussion on the wide range of issues that our healthcare personnel face:
| Mary Ogg, MSN, RN, CNOR and Perioperative Nursing Specialist from The Association of Perioperative Registered Nurses (AORN) |
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| Donna A. Ford, MSN, RN-BC, CNOR, Nursing Education Specialist, Division of Surgical Services, Department of Nursing, and an Assistant Professor of Nursing, College of Medicine, Mayo Clinic; AORN National Clinical Nursing Practice Committee |
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| Deborah Spratt , MPA, BSN, RN, CNOR, NEA-BC, CRCST, CHL, Manager of Sterile Processing at the Canandaigua VAMC in Canandaigua NY; AORN President |
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| Angela Laramie, Epidemiologist with the Sharps Injury Surveillance Project in the Occupational Health Surveillance Program at the Massachusetts Department of Public Health |
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| June M. Fisher, MD, Clinical Professor in the Division of Occupational and Environmental Medicine at the University of California San Francisco (UCSF) School of Medicine |
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| Elise Handelman, Former Director of the Office of Occupational Health Nursing at the Occupational Safety and Health Administration (OSHA) |
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| William Hyman, Professor Emeritus of Biomedical Engineering, Texas A&M University, past President of the Healthcare Technology Foundation |
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The online conference series has proven to be a powerful forum to support Safe in Common's ongoing efforts to spark innovation, awareness and change across the healthcare spectrum. Each event continues our mission to unify and educate people about the risks of needlestick- and sharps-related injuries. The results continue to show us that we are unifying and that awareness surrounding the need for needlestick- and sharps-related injury prevention is spreading rapidly throughout the healthcare industry.
An interactive edition of the online conference is available for replay on Safe In Common's YouTube channel. Anyone interested in presenting during the May 29 event is encouraged to send a presentation outline to: info@safeincommon.com.
As Safe in Common continues its mission to unite the healthcare community and spark the changes that will lead to greater protection from needlestick and sharps injuries, we're working with industry leaders and associations who bring expertise from across the spectrum. This month, we posed some of your questions to our colleagues at the Association of Perioperative Registered Nurses (AORN). Mary Ogg, MSN, RN, CNOR , Donna A. Ford, MSN, RN-BC, CNOR, Deborah Spratt, MPA, BSN, RN, CNOR, NEA-BC, CRCST, CHL helped us answer:
Q: What type of gloves should be worn to prevent sharps exposure and ensure sterile processing?
A: According to the Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities, personnel should wear heavy-duty, waterproof and general-purpose utility gloves. The gloves should have an adequate cuff to prevent contact with contaminated water, and reusable gloves should be decontaminated according to the manufacturer's written instructions for use (at least daily and between employees). If the gloves' integrity is compromised through a puncture, peeling or cracking, they should be discarded, and torn gloves should be replaced immediately. Special precautions should be exercised if decontaminating instruments are exposed to chemotherapeutic agents.
Q: What are some statistics related to sharps injuries?
A: In the operating room, non-surgical injury rates have dropped by 31.6 percent, while surgical injury rates have increased by 6.5 percent. Each year, 30 percent of all sharps-related injuries happen in the operating room: 43 percent by suture needles, 17 percent by scalpel blades and 12 percent by syringes. Seventy-five percent of the injuries have also occurred while passing devices (Jagger J, Berguer R, Phillips EK, Parker G, Gomaa, AE. Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation. J Am Coll Surg. 2010; 210(4): 496-502).
Additionally, using blunt needles versus sharp needles reduces the risk of glove perforation by 54 percent and reduces the risk of infectious disease transmission (Parantainen A, Verbeek JH, Lavoie MC, Pahwa M. Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff. Cochrane Database Syst Rev. 2011;11: CD009170. doi:10.1002/14651858.CD009170.pub2).
For more information on double gloving, please read: Tanner J, Parkinson H. Double gloving to reduce surgical cross-infection. Cochrane Database Syst Rev. 2009;3: CD003087. doi:10.1002/14651858.CD003087.pub2.
Q: When will the AORN Recommended Practice for Sharps Safety be available?
A: This will be available electronically during the second quarter of 2013. It will also be available in the 2014 book earlier in the year.
Q: What is the best way to perform a yearly evaluation on sharps safety?
A: An excellent resource is the Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program, which can be found here.
Q: Should a needle holder be used when suturing in the operating room?
A: Needle holders should be used for suturing with curved needles. The use of straight needles (Keith Needles) is discouraged due to the high incidence of percutaneous.
Q: Is there a standard for the use of glove liners?
A: The Cochrane review of double gloving randomized controlled trials by Tanner and included the use of glove liners, cloth gloves and steel weave gloves. The use of glove liners is less common than double gloving and the use of perforation indicator systems. Glove liners and cloth gloves were found to offer additional protection to standard double gloving.
The discussion on needlestick and sharps safety continues with our third online event tentatively scheduled for May 29, 2013. Be sure to check back for more information. Please e-mail info@safeincommon.org with any questions.
The majority of the inquiries are being answered by experts on Safe in Common's website: www.safeincommon.org/blog.
Safer Medical Devices
Tracy Wale, RN, CHSP, President
Compliance Alliance, LLC &
Infection Control Solutions, LLC
For more than a decade now, healthcare providers have been hearing over and over again about the Safer Medical Device Act of 2001. When the Act was signed into law and adopted by OSHA, it was designed to mitigate and/or eliminate needlestick injuries across the healthcare continuum. As a result, healthcare providers were required to evaluate and implement the use of sharps with engineered sharps injury protection (SESIP's). Inpatient medical facilities and their affiliated outpatient facilities (e.g. ASC's) were the first to comply.
I know, for me personally, I equate the use of safety needles/SESIP's with how we converted to glove use in the early 1980's. At first, I did nothing except whine and moan about how difficult it was to perform routine tasks. Now I wouldn't dream of starting and taping an IV or removing dressings without the use of gloves.
The same holds true for SESIP's. At the onset of use, I found them challenging. Now that I exclusively use SESIP's, and have for more than a decade, the thought of handling a contaminated needle that isn't protected makes me more than uncomfortable.
Many share my original angst. Healthcare providers across the spectrum continue to demonstrate similar reluctance as they too are pushed in the direction of safety. Gradually, and not without protest however, outpatient medical clinics began the conversion to SESIP's during this time as well. This has not been my experience with dental providers.
A typical primary care medical clinic will administer 400-800 injections each year to patients, including during influenza season. In contrast, a general dentist will administer between 1500-2000 injections in a typical year. Statistically, this represents a two to three fold increase in potential for contaminated percutaneous injury. This is compounded by my personal observations as a healthcare consultant where I find less than one percent of all dentists use any form of safety needle and less than five percent use safety scalpels.
Where SESIP devices are used both in dentistry and the medical model (e.g., IV catheters and scalpels), they are traditionally well thought out and facilitate transition to the safety device. Comparatively, a very small number of SESIP devices for intra oral administration of anesthetic have emerged over the past decade; and none of these devices have been widely accepted within dentistry.
Part of the challenge revolves around the equipment used in dentistry. Needles used for administration of intra-oral anesthetic are different from a traditional needle and syringe used for percutaneous administration of medication. Dentists and hygienists use stainless steel, sterilized aspirating syringes that are loaded and reloaded with an anesthetic. They differ, however, in that the anesthetic carpules must be penetrated by a two sided needle to access and then administer the medication.
Confident they are in compliance, Dental Healthcare Workers (DHCW) often demonstrate single handed recapping techniques utilizing a variety of recapping devices. Technically, and if actually used single handedly, this process serves to cover and protect the user from the "front end" of the needle, however provides absolutely zero protection from the "back side" of the needle that is also contaminated. Single handed devices are not SESIP's and are not compliant with the Safer Medical Devices Act.
In simple terms, more needs to be done to promote and facilitate development of and conversion to SESIP devices within dentistry. Our dental clients who have switched would never revert. They rode the difficult wave of conversion and both the provider and their staff are exponentially safer as a result.
APIC 2013 - 40th Annual Conference
June 8-13
Fort Lauderdale, Florida
Safe in Common's booth number for the APIC Conference in June is #1231.
Click here to take the Needlestick Safety Pledge and support Safe in Common in its campaign to promote and strengthen the Federal Needlestick Safety and Prevention Act, raise awareness about the importance of needlestick safety and utilize safer engineering controls to protect yourself and fellow healthcare personnel from unnecessary needlestick and sharps-related injuries.
Needlestick Safety Challenges Continue
Safe in Common Crystalizes Call for Unified Protection Against Needlestick and Sharps Injuries
Safe in Common Readies Virtual Conference on Needlestick Prevention
