Training tips: Safe sharps and needlestick prevention
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March 1, 2019
It has been almost 20 years since President Bill Clinton signed the Needlestick Safety and Prevention Act. The law, which instructed OSHA to revise its Bloodborne Pathogens standard with a new emphasis on preventing needlesticks, encouraged the use of newer safety devices designed to cap themselves with safety sheaths or to use retractable needles, and healthcare supply manufacturers answered by offering new safety devices. The law also required healthcare facilities to evaluate new sharp safety devices annually.
But despite years of warnings of bloodborne infections and diseases, as well as improved safety devices, about 5.6 million workers are in danger, and many are still suffering sharps injuries in frightening numbers.
The CDC and OSHA, in statistics that were updated only as recently as 2011, both say that about 385,000 needlestick injuries occur every year in hospitals, and up to 600,000 healthcare workers in total get stuck every year—that number may be closer to 1 million when you consider that up to 50% of needlesticks go unreported.
Of those needlesticks, 40% of injuries occur after use and before disposal of sharp devices, 41% of injuries occur during the use of sharp devices on patients, and 15% of injuries occur during or after disposal, according to the CDC. That doesn’t include laboratory workers who suffer injuries such as glass in the eye or other body part when a glass specimen tube accidentally breaks in a centrifuge, the slip of a razor blade while preparing a tissue sample, or other seemingly unlikely accidents involving sharp tools.
The costs for these injuries are staggering. The CDC estimates that testing and follow-up treatment for a needlestick can cost up to $5,000 per worker depending on treatment received—and that doesn’t include lost work time, or the lifetime of treatments and mental anguish if the injury results in a worker contracting a serious disease.
“I had a terrible needlestick during phlebotomy in my college days when I was drawing blood from a dialysis with hepatitis B,” says Peggy Prinz Luebbert, MS, MTASCP, CIC, CHSP, creator of IP-Bootcamp in Omaha, Nebraska. “This was before the days of antibody testing, and I was given the dreadful gamma globulin at the time, which we now know was not effective. Anyway, I lucked out. However, I did have friends in those days who did develop illness, and actually one good friend died from HIV exposure while working in the emergency room.”
Now is a good time to catch up on safe sharps training, since employees are probably giving flu shots or working around glass vials that contain potentially infectious bodily fluids. In these days of safer sharps, it’s perhaps a little lost on today’s younger generation of healthcare workers just how unsafe sharps can be if not used properly.
From just a financial standpoint, needlesticks can be costly, both for workers and employers. If the threat of injury and illness isn’t enough, the threat of fines from OSHA should be. While OSHA surprise inspections are rare, an incident follow-up could mean serious financial consequences.
“If you’re talking about a non-serious [incident], you’re talking about fines that could be potentially less than $1,000,” Luebbert says. “And as soon as you move up the ladder to a willful violation, which is one that you know you’re supposed to do, such as safe sharps, and you don’t implement them, your fines can be up to $70,000 for every incident they see.”
The problem with needlesticks has roots in many places, including the fact that some older healthcare providers refuse to give up habits learned years ago, as well as a confusing and arbitrary OSHA standard that doesn’t clearly define what a “safe” sharp means. There are some ways that you can help control the problems of needlesticks and make your clinic a safer place, though. Here are some of our favorite tips for you to start your own safety program:
Educate your staff on safe sharps and let them have a say. Cost and time are major factors that apparently keep some medical offices from seeking out safer devices to use. This is simply unacceptable. Some experts say conducting an annual sharps survey is a good way to evaluate the different sharps that you use in your facility. They also recommend that offices have an in-service training meeting at least once per year where staff practice using different kinds of needles and sharps to find the ones they feel comfortable working with. This could be as simple as getting samples from different vendors and seeing what works.
There are many kinds of safety sharps on the market, and staff members should take time to understand the nuances of safety needles on the market as well as containers that can be purchased. Items on the market today range from safety needles that have a sliding sheath that can be engaged with one finger, to counterbalanced sharps disposal containers that act like a mail chute and keep the needles safely in a metal puncture-proof container. Let staff inject oranges with different models to figure out which ones they like best. Preferably, the needles should be operable with only one hand, using one quick motion to sheath the needle.
Hold a training session. The key here is to practice, and then practice some more. Start with mandatory orientation for your new employees, and make sure they know your processes for safe sharp usage and disposal, as well as ensuring they fill out the proper paperwork (including signing a form indicating they went through training; it looks good to OSHA).
Next, hold mandatory in-service sessions at least once a month (in addition to the annual in-service sessions mentioned above). Bring in refreshments and rotate training topics from time to time. Discuss concerns: Has it come to someone’s attention that the sharps disposal containers are not regularly emptied? Make a promise to empty them on a schedule and follow through, even if it means hiring a company to handle it.
Don’t be afraid to change the status quo. Some safety experts say it can be difficult to change the culture of a medical office, especially if it’s run by older physicians who have an “if it’s not broke, don’t fix it” mentality. That can often clash with younger staff, who know they should be using safer practices but are afraid to speak out and lose their jobs. But silence can have its consequences.
“I had a phone call about a physician who wears a lab coat every day in a primary care office—he gives his shots, and he had a habit of not engaging the safety on the safety needle, and he puts them in his lab coat pocket,” says Kathy Rooker, owner of Columbus Healthcare & Safety Consultants in Canal Winchester, Ohio. “Well, as he was walking down the hall with his head bent down, looking at a medical chart, he ran into the nurse and the needle stuck her leg. It jabbed right through his lab coat pocket into her upper leg. And that’s an unbelievable accident, but it really happened.”
If you don’t make it easier for younger staff to speak out against unsafe practices, you will suffer—either through financial penalties, or high staff turnover. Change your culture now.
Reassess your garbage. Where does your staff throw used sharps when they are finished? If you’re following OSHA regulations, they are being placed in approved, puncture-proof metal disposal containers. Believe it or not, though, there are still workers who think nothing of throwing used syringes, vials, or even needles away in the regular garbage. And that puts the next handler—usually the one who throws the trash away—in danger.
Make sure all trash receptacles are labeled correctly so that staff know what should and should not go in each bin. Want to have a little fun with it? Dan Scungio, MT(ASCP), SLS, laboratory safety officer for Sentara Healthcare, a multihospital system in the Tidewater region of Virginia, suggests playing a game he calls “Trashketball” with your employees. The game involves setting up three small wastebaskets—one each for chemical waste or regulated medical waste, sharps, and regular trash. Label balls with words such as “broken glass,” “plastic tube,” and “bloody glove,” and let staff take turns throwing the balls into the correct waste stream receptacle. It’s a great way to have fun and to learn something about proper waste management.
Teach them to take their time. When workers are dealing with sharps, especially around a nervous patient or a loud environment, they need to act as if they are handling a deadly weapon—because with enough carelessness, that’s exactly what sharps can be. So, staff need to slow down and be more deliberate with their actions. When giving injections, they should learn how to control their breathing, double-check their actions, check in on their patient (to make sure the patient doesn’t make any sudden moves), and then check themselves and their actions as they are disposing of the dangerous sharps. Did they, for example, put the used needle in the proper disposal receptacle, or is it still sitting on the counter to be disposed of later? Have they checked to make sure the disposal chute is empty, or are they just shoving used needles in without looking? These common mistakes could be avoided by taking a few extra seconds to do some double-checking.
Reduce handling time. Very simply, the fewer hands that touch a used sharp, the less likely it is that someone will get stuck. Safety experts suggest instituting engineering controls that will isolate and remove hazards from the workplace. Teach staff to give verbal announcements when passing sharps. Make sure that the person who is receiving the sharp knows it’s coming; avoid hand-to-hand passage of sharp instrumentation by using a basin or a neutral zone. Also, consider alternate cutting methods, such as blunt electrocautery and laser devices, when appropriate, to take away the sharps. Substituting endoscopy surgery for open surgery when possible has also made for a tremendous decrease of sharps.
Know how to deal with an injury. Clinic staff should be prepared to deal with a sharps injury, should it occur—it should definitely be reported, and treatment should begin as soon as possible to avoid potential exposure to infectious diseases such as hepatitis and HIV.
If you are exposed, experts say the best thing to do is wash it out with soap and water, and then get a stat test for HIV and hepatitis. If HIV is present, preventive drugs can be given, but administration must occur within two hours to be effective. And while some clinics may balk at the cost of installing an eyewash system, it’s a good idea to have one—and OSHA recommends it as well.