Sharps Safety Matters

By Ron Stoker

During the last few months the global community has prepared to commemorate the first-ever International Sharps Injury Prevention Awareness Month. Activities have been encouraged to increase sharps injury awareness, providing information to healthcare workers to identify safer means of handling sharps, and to make them aware of sharps injury prevention products. 

One of the primary goals of this awareness month has been to make workers aware that most needlestick and other sharps injuries are preventable.  Needlestick injuries have been a danger to healthcare workers and others since the first syringe was used in 1845.  An estimated 12 billion injections are administered each year worldwide.  It is estimated that between 800,000 needle sticks occur in the US each year in health care settings.  OSHA has estimated that one of every seven health care workers are accidentally stuck with a needle each year. From these injured healthcare workers about a 1,000 will develop serious infections such as HIV and the liver-destroying hepatitis C, as well as other diseases.

The word must be spread, as part of this awareness month, that most needlestick and other sharps injuries can be prevented.  It has been estimated that over 80 percent of needlestick injuries can be prevented through the use of safer devices.  Healthcare workers giving medical treatment to others should not have to become patients by receiving injuries from contaminated medical sharps.   These sharps injuries can be avoided.  These injuries are not limited to nurses and physicians.  They also include cleaning staff, housekeeping, EMS/paramedic, law enforcement officials, correctional officers and firefighters. 

The international awareness month has helped to spread the message of sharps injury prevention around the globe. Perhaps next year the name will be changed to International Sharps Injury PREVENTION Month.  Groups from around the world have joined Managing Infection Control and the International Sharps Injury Prevention Society in teaching that needlestick injuries can be prevented. These groups include the Austrian Sharps Injury Project, the Austrian General Accident Insurance Institute, the European Agency for Safety and Health at Work, and the Safety Injection Global Network (SIGN.)

Of course this awareness month has a higher purpose than just making people aware of needlestick and other sharps injuries. That information has been available for some time from a variety of knowledgeable resources including the International Healthcare Worker Safety Center[1], NIOSH[2], and OSHA[3].  This awareness month has been about much more – it has been about preventing future injuries by making people aware of alternative products that can replace standard needles, scalpels, and other sharps. There are alternatives to the unsafe products that have been used in the past.

My grandmother used to tell me “it is better to prepare and prevent than to repair and repent.”   This old adage has great meaning to workers that are at risk of contracting HIV, Hepatitis, and other infectious diseases.  It is much better to identify and use sharps injury prevention products than it is to treat workers that have been accidentally cut or stuck with contaminated sharps.  The cost of testing, even without seroconversion, ranges from $2,500 to $3,500.  The costs can go up to a million dollars depending on the age of the worker if he or she develops hepatitis or HIV.  The emotional toll on those stuck with unnecessary needlesticks is staggering. It can cripple and incapacitate.  

     In an interview several years ago, Bill Charney, health and safety officer at San Francisco General Hospital and a nationally recognized authority on hospital safety, said "If hospitals were sued for millions of dollars every time a nurse got a needle stick and the hospital didn't supply safe needles, you can bet this problem would have gone away years ago."[4]

             Hospitals have a variety of reasons now to use safety products since the passage of State laws[5] regarding safety needle products as well as the federal Needlestick Safety and Prevention Act.  The regulatory and punitive damages are a deterrent to using the same old standard sharps.  However, there is an even more compelling reason for hospitals to use safety products – their workers!

 Much of the world has an urgent nursing shortage that is bound to intensify. The U.S. Bureau of Labor Statistics projects that more than one million new nurses will be needed in the US alone by the year 2010. The U.S. Department of Labor projects a 21 percent increase in the need for nurses nationwide from 1998 to 2008, compared with a 14 percent increase for all other occupations.[6] 

The fear of obtaining an occupational illness from an accidental needlestick is a big concern from many nurses.  In fact, registered nurses report that health and safety concerns play a major role in their decision to remain in the profession or not.  Over 88 percent of nurses reported in a survey that health and safety concerns influence their decisions to continue working in the field of nursing and the kind of nursing work they choose to perform.[7]  The message is clear.  If a hospital wants to hold on to its healthcare work force it will make sure that the staff believes that the hospital has their best interest at heart.  Hospitals will purchase, train, and mandate the use of safety products and will make sure that nursing organizations are aware of this safety focus so that they can retain them.  A nurse that believes the hospital is concerned about her health is more likely to continue working than one that believes the hospital is only concerned about its bottom line.

I have told my teenagers “if you look at your past, then that is your future - unless you make some changes NOW.”   This has a lot of relevance to healthcare workers and others.   We cannot keep doing the same things, the same way, with the same products, and expect different results!  We must use sharps injury prevention products if we want to make a difference with our own health future.

So, how do we break the cycle?  The following suggestions can help healthcare facilities focus on their most valuable resource – their workers!

1.      Replace unnecessary needles and other sharps with needleless products.  This is often referred to as “primary” prevention of sharps injuries.

a.      Use Needlefree connectors 

Standard hypodermic needles have been used for many years to access IV administration set ports or injection sites that connect several IV lines, for example, an intermittent access or "piggyback" system.  When these needles are used on the IV lines, accidental needlesticks can occur during disassembly or disconnection of the IV line.   Under the new needlestick prevention guidelines these needles and injection sites must be replaced with needlefree or needleless connectors.[8]  Needlefree connectors are systems that are only require the male luer of a syringe or a blunt needle to activate them.  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.  

b.      Use Blunt Needle cannulas to access specialty IV valves.  This eliminates the use of sharp needles.

c.      Replace sharp suture needles with blunt-tipped needles whenever possible.   Blunt-tipped needles can be used in many procedures.  They are less likely to cause percutaneous injuries. Studies have indicated a significant decrease in both needlestick injuries and instances of glove perforation as compared to a sharp needle group[9] [10]

d.      Use needlefree jet injection systems that deliver subcutaneous or intramuscular injections of liquid medication through the skin without the use of a needle. 

e.      Laser products are available to obtain blood samples without the need of lancet or needle. They simply use light to obtain capillary blood rather than using a sharp.

f.        Use alternative skin closure products instead of suturing with sharp needles.  Many wounds can be closed using adhesive strips or “super glue” type products.

g.      Non-invasive testing and monitoring can provide a variety of data to a physician without ever having to stick a needle into the patient.

h.      Use catheter-securing products to hold a catheter in place rather than suturing it in place.

2.      Replace Glass Products with Plastic ones whenever possible

Safer alternatives to conventional glass capillary tubes are available. The breakage of glass capillary tubes during use can result in penetrating wounds and the inadvertent blood inoculation to the user.  The risk of acquiring a bloodborne pathogen infection such as HIV, Hepatis B, or Hepatitis C increases with these types of injuries. Other glass products such as lab specimen dishes or phlebotomy tubes should be replaced with plastic as well.

3.       Be Sharps Conscious

Be aware of sharps whenever you are handling them or are around them.  Never hold sharps simultaneously with other instruments.   Surgical staffs should create a neutral zone or Sharps safe zone where the surgical team can place and retrieve sharps.  Whenever possible use safety transfer trays and magnetic drapes to transfer sharps between nurse and surgeon during surgical procedures.

4.      Use Safety sharps injury protection products whenever they are available.

Use retractable or shielded scalpels whenever possible.  Retractable or shielded syringes are available from a variety of vendors.  Safety lancets can obtain capillary blood without the risk of accidental injuries. 

5.      Dispose of all sharps properly.  All sharps disposal containers should have an opening large enough to accept the sharps used during the procedure.  The containers should be puncture proof and should indicate when the container is full and needs to be replaced.  Containers should ideally be within arm’s reach. 

6.      Evaluate new safety products on a routine basis. 

a.      Are you aware that safety products are available to clamp, cut, and remove blood from an umbilical cord without exposing the nurse or physician to unnecessary sharps?  Remove the standard scalpel and needle from the delivery table!

b.      Did you know that puncture-resistant gloves and glove liners could help prevent sharps injuries from bloody bone fragments while performing orthopedic surgical procedures?

c.      Have you used safety suture removal products?  Sharp scissors no longer need to be a part of your suture removal tray.

7.      Learn about new safety products that are introduced into the marketplace. New products can be seen by visiting exhibitors at National Shows, inviting sales representatives to introduce new products, have a safety fair at your hospital, reading journal ads and reviewing informative safety web sites.[11].  Sign up for free newsletters that provide information about new sharps injury prevention products.[12]

8.      Train others to dispose of sharps properly. For example, teach outpatients that use needles and scalpels at home to dispose of them properly.  Home-created sharps products should not just be thrown out with the trash.  This leaves waste management workers exposed to sharps that may be contaminated with HIV, hepatitis viruses, or other bloodborne pathogens.  This is a major problem.  Ben Hoffman, MD, MPH, medical director of Waste Management Inc. said, "There are a couple billion sharps that go into the municipal solid waste stream instead of the medical waste stream. Our people and other people pick that trash up, move it through a chain where it eventually ends up being in a landfill or an incinerator.  In that process, there are multiple opportunities for people to get stuck."    Others have simply flushed the needle down the toilet, apparently not being aware that the needles get into the wastewater stream and can get caught in screens in pumping stations. People have to go in and actually clean those screens off and remove those needles.  Again, this is an unnecessary exposure to contaminated sharps.

 a.      One way to properly take care of sharps generated at home is to incinerate them in a sharps disintegration unit.  Sharps disposal by mail is also a new concept that has recently come to the forefront.  The contaminated sharps are put into a sharps container and mailed to a central incineration point.

              In summary, there are new safety products that are available to use.  Healthcare workers, hospital administrators, risk managers, infection control managers and others must develop a new mindset.  We must recognize that there are alternatives to the products that we have used in the past.  We must change how we look at sharp instruments.  Standard needles and sharps are weapons that can destroy our health and indeed, our lives.  We must look at every sharp that we work with, determine if there is an adequate safety replacement, and then evaluate those safety products.  We should never use standard needles and other sharps if adequate replacements are available. 

Hospitals and clinics should adopt sharps injury prevention products in all departments.  OSHA’s stand on sharps injury prevention is more than the law... it is good business!  A hospital that uses safety products will hold onto its work force when others around it are struggling to find qualified workers. 

We can and must make a difference.   We must demand and expect sharps injury prevention products at our work sites.  Grandma was right, it is better to prepare and prevent than it is to repair and repent.

Author bio:

Ron Stoker is the executive director of the International Sharps Injury Prevention Society (ISIPS). For more information about ISIPS and sharps safety products, visit www.isips.org, or email Mr. Stoker at ron@isips.org.