End of the Line

By Ron Stoker

As a young man, I was fascinated with old trains, along with many others of my generation. I would drive dozens of miles to see them.  I participated in the centennial celebration of the driving of the Golden Spike in Promontory Point, Utah, on May 10, 1969.  Even now I enjoy watching old steam engine trains go through rugged mountain passes. 

There is still an old steam engine that takes nostalgia seekers on train trips between Heber City, Utah, just a few miles from Park City, and Provo canyon.  You can take the Heber Creeper, as it is known, down Provo Canyon and back on a 32-mile roundtrip.  The train has a chair car, a snack-bar car, two open-air cars and a caboose with an observation room. This provides lots of room for the 100 or so passengers to move about the train freely.

The train passes through the Heber Valley and snakes along the shore of Deer Creek Reservoir. Often riders are treated to wildlife along the way including hawk, deer and red fox. The train passes the head of the lake at the dam and then down the canyon.  The Provo River runs clear blue-green. It is shallow and rapid with a number of backwater ponds. There seems to be a fly fisherman every couple of hundred feet.  After a little more than an hour we come to Vivian Park. The tracks end abruptly.  The train has to switch around in order to return back up the canyon.   The tracks indicate that we are at the end of the line.

Similarly, we have reached the end of the line in regards to a number of medical devices.  Several exciting announcements from global medical device manufacturers have been announced in the last few months.  During March 2003, Abbott Laboratories announced that it will phase out by all IV sets that contain or require needles as part of Abbott’s healthcare worker safety by June 2003.^[1]  By no longer manufacturing and marketing these products, Abbott expects to be eliminating millions of needles from the U.S. healthcare system protecting healthcare workers against needlestick injury and blood exposure.  Instead of using the IV sets containing needles, Abbott will use a needle-free technology across its entire line of infusion therapy products. 

Abbott has been at the forefront of providing products that offer protection against needlestick injuries. Abbott has a variety of sharps safety products including the LifeShield® Prepierced Reseal and CLAVE® connectors; LifeShield®, Carpuject® and Ansyr(TM) prefilled syringes; VanishPoint® retractable syringes and blood collection devices; ADD-Vantage® System for drug delivery; FirstChoice® Premixes; and the CLC2000® needleless catheter patency device.

BD, also known as Becton, Dickinson and Company, announced plans to discontinue U.S. sales of many conventional needles and other "sharps" devices across a range of product categories.[2] These actions coincided with the second anniversary of the April 18, 2001, compliance date for the Federal Needlestick Safety and Prevention Act, and reflect the significant progress made by U.S. healthcare facilities in transitioning to safety-engineered designs.

BD had already initiated the discontinuation of sales in the United States of many conventional sharps devices across a range of product categories, including IV catheters, winged needle sets, lancets and glass blood collection tubes. BD is communicating the details of these and additional discontinuations to its U.S. customers, including specific products and timelines.

BD has also indicated that it is actively pursuing the transition to safety-engineered devices in countries throughout the world, and it will implement similar actions in other countries as its healthcare facilities reach a high level of transition.   BD has many sharps injury prevention products including the BD Eclipse™ syringe needle, BD™ Blood Transfer Device and the BD SafetyLok™ Blood Collection Sets.

ISIPS, the International Sharps Injury Prevention Society, salutes Abbott and BD in removing standard needle-based products and other conventional sharps from the medical device stream.   Although these products have provided great health benefits to patients in the past, the risk to healthcare workers and others necessitates the removal of these products.

Each year, according to the Centers for Disease Control and Prevention, approximately 600,000 - 800,000 needlestick accidents occur each year to healthcare workers. WHO has estimated that this number is more than three million world-wide. More than 80% of these needlestick injuries could be prevented with the use of safety-engineered products.  These needlestick exposures can lead to more than 28 different diseases including hepatitis B, hepatitis C and Human Immunodeficiency Virus (HIV), the virus that causes AIDS.  The cost of treatment for a single needlestick incident is estimated between $500 and $3,000, and that is without seroconversion to a serious illness. 

Needlesticks and other sharps injuries have occurred ever since the introduction of these sharp products.   Unfortunately, the healthcare community has treated these injuries as “part of the job.” 

In 1978, Dr. Dennis Maki and Nurse Rita McCormick began their groundbreaking research that announced the risk of contracting bloodborne diseases to healthcare workers from contaminated needles.  Maki and McCormick’s work provided warning that medical workers should not recap needles.

The rising specter of HIV and hepatitis epidemics in the mid-'80s changed the cavalier attitude of many healthcare workers.  Many of those injured from sharps injuries died from these deadly diseases.  

In April of 1998 the San Francisco Chronicle ran a series of articles titled “Deadly Needles.”  These articles helped to unify healthcare workers to unite together.  Labor organizations began to become involved. 

In May of 1998, needlestick legislation was introduced in California.  At the end of the summer of 1998, this bill was signed into law, with California becoming the first state to have needlestick prevention legislation.    Many other states followed and now 21 states have enacted similar legislation mandating the use of safer devices. 

In November 2000, President Bill Clinton signed the Needlestick Safety and Prevention Act into law. The Act mandated that the Occupational Safety and Health Administration (OSHA) standards make changes requiring hospitals to record and evaluate needlestick injuries. The revised OSHA Bloodborne Pathogen’s standard mandated the involvement of healthcare workers in the selection of sharps injury prevention products.  It also called for hospitals to use medical devices such as Abbott's or BD’s needleless or protected needle products to help reduce healthcare worker injuries and illnesses caused by needlesticks. OSHA also mandated that all healthcare facilities covered under Federal OSHA law must become compliant with the new regulations. Finally, the directive expressed that all states with state OSHA plans must have enforceable state legislation passed, or must have incorporated the Needlestick Safety and Prevention Act into their own state OSHA plans.

So why are so many hospitals and physician offices still dragging their feet on implementing sharps safety products?   The following are some of the most common reasons that been expressed to me as I have traveled around the country visiting hospitals and clinical offices: 

1. The cost for safety products is prohibitive to the budgets of various departments in the hospital. 
2. It is difficult to train all personnel on the use of new safety products
3. There exists large inventories of non-safety devices that the institution is unwilling to discard.
4. Some of the safety devices are deemed to be of inferior design and administration of the institution is concerned about increased needlestick injuries from the “safety” products.
5. The few numbers of governmental compliance officers implies that no one will be checking up on the institution therefore non-compliance is a calculated risk of not getting caught.
6. There remains physician and nurse resistance to new safety products, who are comfortable with conventional products.

An older friend of mine used to work in the head office of one of the railroads.   On one occasion, years ago, he received a telephone call from one of his colleagues who was a 1,000 miles away and who indicated that a passenger train had arrived without its baggage car.  The patrons were angry.  After searching out the cause it was determined that the train had been properly prepared and delivered but that when it arrived at mid-destination a thoughtless switchman had moved a piece of steel just three inches.  That piece of steel was a switch point, and the car that should have been in one location ended up being more than 1,000 miles away.  

In our professional lives we can change the course of our future by throwing a switch appropriately so that we can propel ourselves into a safer work environment.  Are we throwing switches in our professional tracks that will carry us far away from the healthy futures that we might have had?   Just like real train tracks, the future will be exactly like the past unless we make appropriate changes to take us into healthier habits. 

The efforts of both Abbott Laboratories and Becton Dickinson and Company are a step in the right direction.  It is hoped other medical device manufacturers will follow suit. Hospitals and physician offices should also make sure that they are making the appropriate plans to promote health-worker safety. 

The easiest way of reducing sharps injuries is to remove the sharp.  Called primary prevention, this means to remove as many conventional needles and other sharps as possible.  No needle means no potential needlestick.   For many years there have been very few alternatives to conventional sharps but today’s new safety technologies provide needle-free alternatives that can offer protection from needlestick and other sharps injuries.

Some easy steps can be taken to keep a safe and healthy work environment. 

Hospitals and physician offices should look at all products in every product category that they purchase.  Take a moment to identify all sharps.   Can any of them be replaced with needle-free products?  For example, it is possible to replace standard hypodermic needles used to access IV administration set ports or injection sites with lines that only use needle-free connectors. Under the new needlestick prevention guidelines these needles and injection sites must be replaced with needlefree connectors.[3]  Many of these systems only require a syringe to activate them.  The connectors are durable and easy to clean and provide a barrier to microorganisms.  Most importantly, they replace unnecessary needles.  

Look at innovative new products that you might not have used in the past.  In earlier issues of this column we have looked at safety products that are used to irrigate bloody wounds.  We have examined new methods to protect healthcare workers in labor and delivery suites.   Safety lancets are available to replace conventional lancets that leave a sharp that can injure family members, custodians and waste-care workers.  The key is to look at every sharp as a potential weapon and try to replace it with safety versions if they are available.  Let’s all get on board the safety train!

Footnotes:

Author bio:

Ron Stoker, a frequent contributor to Managing Infection Control magazine, is the Executive Director of ISIPS, the International Sharps Injury Prevention Society.  He is a frequent speaker on sharps safety and occupational blood exposure at national and international events. For more information about ISIPS and sharps safety products, visit www.isips.org, or email Mr. Stoker at ron@isips.org