MORE THAN 4 YEARS have passed since the Needlestick Safety and Prevention Act became law. The revised Bloodborne Pathogens Standard, issued by the Occupational Safety and Health Administration (OSHA), emphasizes using safety-engineered devices to reduce health care workers' risk of needle-stick injuries. Here, we'll update you on recent progress and highlight areas that need improvement.
Declining sharps injury rates
Data on sharps injury rates are limited but encouraging. A multihospital comparison of percutaneous injury (PI) rates for nurses showed a 51% decrease from 1993 to 2001. Analyzed by device category, PI rates decreased substantially for the three hollow-bore needle devices with the highest risk of bloodborne pathogen transmission:
- phlebotomy needles, 70% decrease
- I.V. catheters, 55% decrease
- butterfly needles, 55% decrease.
Among devices analyzed, only suture needles failed to show a major decline in PI rates (5% decrease).
At Memorial Sloan-Kettering Cancer Center, New York, N.Y., researchers compared PI data from 1998 to 2000, before safety devices were implemented hospital-wide, with data from 2001 to 2002, after a near-total conversion to safety devices. The overall PI rate decreased by more than 50%, with injuries from hollow-bore needles falling by 71%. The drop was greatest among nurses (75%).
Survey results published in Nursing2004 (“Needle-Stick and Sharps-Safety Survey: Getting to the Point about Preventable Injuries,” April 2004) were also encouraging. Of respondents who reported using safety devices frequently or all the time, only 21% said they sustained one or more sharps injuries in the previous year; of those who reported seldom or never using safety devices, that percentage was almost double: 41%.
From April 2001, when the revised standard took effect, through May 2002, OSHA issued five times as many citations for failure to use safety devices or other engineering controls than it had issued during the previous decade. With these citations, OSHA's sending the message that halfhearted compliance isn't acceptable.
Safety devices: Continued innovation
The design of sharp medical devices continues to improve. For example, blunt-tip suture needles are now available in a range of bluntness. Substituting blunt-tip suture needles whenever appropriate could reduce suture needle injuries in the OR by as much as two-thirds.
Safety scalpels have also improved. And phlebotomy blood tube holders are available that protect both the front (patient) end and back (tube-puncturing) end of the phlebotomy needle when the safety mechanism is activated.
In some clinical areas, safety-engineered devices may not be available for certain specialized procedures. Anesthesiology is one example: Although limited safety products are available for procedures such as intra-arterial or central venous catheter placement, they haven't been widely adopted. More clinician education may help.
International leader in sharps safety
In the last 4 years, health care facilities in the United States have set a worldwide standard in health care worker safety. As we work toward the goal of 100% compliance with the Needlestick Safety and Prevention Act, let's remember how far we've come—and how many health care workers' lives and careers have been protected by a new generation of safer medical devices.
Jane Perry is director of communications and Janine Jagger is director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville. The safety center is devoted to the prevention of occupational exposures to bloodborne pathogens. For more information, call 434-924-5159 or see Web site below.
SELECTED WEB SITES
Centers for Disease Control and Prevention: Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Programhttp://www.cdc.gov/sharpssafety/
International Health Care Worker Safety Center, University of Virginia http://www.healthsystem.virginia.edu/internet/epinet
National Institute for Occupational Safety and Health: Safer Medical Device Implementation in Health Care Facilities–Sharing Lessons Learned http://www.cdc.gov/niosh/topics/bbp/safer/
Occupational Safety and Health Administration's Hospital eTool http://www.osha-slc.gov/SLTC/etools/hospital/mainpage.html
OSHA, Topics: Bloodborne Pathogens and Needlestick Prevention http://www.osha-slc.gov/SLTC/bloodbornepathogens/index.html
Last accessed on May 6, 2005.
.Jagger J, Perry J. Comparison of EPINet data for 1993 and 2001 shows marked decline in needlestick injury rates. Advances in Exposure Prevention
. 6(3):25–27, April 2003
.Sohn S, et al. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infection Control and Hospital Epidemiology
. 25(7):536–542, July 2004