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Reducing sharps injuries

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April 2003

Since OSHA adopted new regulations in 2001 requiring health care institutions to move to safer medical devices, hospitals, clinics, laboratories, and others have developed plans to comply.

These plans typically establish a multidisciplinary task force, which must include workers who use the devices, to evaluate new technology for sharps safety and make recommendations. The plan must be updated and the technology re-evaluated annually.

The Association for Professionals in Infection Control and Epidemiology, supported by the vendor Portex, recognizes outstanding sharps safety ideas in a recently inaugurated contest. Brenda Beauchamp, Portex’s marketing director for global needle safety, says the contest started in 2001, after the OSHA regulations became effective.

“We want to inspire people involved in sharps control who aren’t usually recognized,” she says. “You don’t have to invent some fancy new device. It’s how you implement your plan, it’s how you teach your workers, it’s how you evaluate these devices ... Everything you do is important.”

Here are comments from two of last year’s winners in the second annual Sharps Safety Initiative:

Eulin Kuranga, infection control coordinator at McCullough-Hyde Memorial Hospital, Oxford, Ohio, helped set up a team that devised and implemented a new safety plan for the 60-bed rural hospital.

“We involved everyone,” says Kuranga, including nursing, the lab, radiology, anesthesia, surgery, ambulatory care, materials management, employee health, infection control, human resources, and administration.

Employees who had to use the sharps tested options covering intravenous catheters, needleless IV administration, phlebotomy, and injections. Those four were identified as high-risk devices based on rates of injury for the previous four years.

After the evaluations, the safety group selected approved devices, and employee training began. “We did the trials with different safety devices. Then we went through and trained people,” Kuranga says. Problems were tracked to the device or to the training.

“You don’t just evaluate devices. You also evaluate your training and your education,” Kuranga notes. Each time new workers come onboard is an opportunity to do so. In addition, all workers are retrained on safety devices at least once a year.

“The practice of sharps safety is never completed,” she says. “It involves continuous surveillance and education.” However, it’s much easier to make changes when those who use the devices can make comments and recommendations, she adds.

Sharps injuries at McCullough-Hyde have dropped from a high of 15 in 1995 to only two each in 2001 and 2002, after the new program was initiated. Injuries had averaged seven each in 1999 and 2000.

Vicky Allen, RN, employee health nurse at Thomas Hospital, Fairhope, Ala., helped implement a new safety plan at that 150-bed hospital. She says the primary impetus for the plan was OSHA’s mandate for implementing safer devices.

Clinical staff evaluated different brands of safety syringes, blunt tip syringes, and safety IV catheters and made recommendations to the hospital’s safety control committee. “Lab personnel also selected, evaluated, and implemented safety devices for phlebotomy procedures, including syringes, butterflies, and Vacutainers,” Allen says.

At first, she adds, employees were given the option of using safety or nonsafety devices, but most of them continued to use nonsafety products because that’s what they were familiar with. Then safety devices were made mandatory, and all nonsafety devices were removed. “Exposure rates [from needlestick injuries] dropped significantly,” Allen says.

She agrees with Kuranga that new devices must be evaluated and training provided continually. “We’re just going through now [in February] and re-evaluating our devices,” she says. “Technology changes every day, and we must provide opportunities for staff to evaluate better safety devices.”

Thomas Hospital may soon switch to a new IV catheter because patients and nurses have expressed dissatisfaction with the one they’re now using. “The nurses are having to stick patients more than once,” Allen says. “We’ve had a rep here demonstrating a new product and giving us some samples. We’re going to see if nurses prefer it over the other one.”

In 2002, Thomas Hospital’s average rate of needlestick injuries was 3.7 percent per 100 occupied beds, down from 5.7 percent in 2001 and 8.35 percent in 2000. “Our benchmark is five percent,” says Allen, “so we’ve been able to stay below that for the past 12 months. We’re happy with that, and so are our employees.”