How We Made Our ASC

The decision to protect your staff from accidental needlestick and sharp instrument injuries may seem like an easy one to make, but switching to needle safety devices and converting your surgery center to a "needle-less" facility may be more time-intensive, expensive, and controversial than you think. It's well worth the effort, though, to obtain the peace of mind that comes from knowing you've done everything possible to safeguard your staff and patients - and, in some states, follow the law.

At our facility, switching to needle safety devices became mandatory as of July 1, 1999, when the California Occupational Safety and Health Standards Safety Needle Law, the first of its kind in the U.S., went into effect. The CalOSHA law is the model for legislation being proposed in 23 other states, as well as a federal bill, the Health Care Worker Needlestick Prevention Act of 1999, so there's a good chance that you soon may have to take the same steps we did to comply with your state's laws. Perhaps my experience in making our center needle-free will be useful to you.

Yellow States = Bill Introduced
Red States = Bill Being Drafted (including Washington D.C.)
Blue States = Bill Passed (including Hawaii)

When I first heard of the proposed law in a CalOSHA consumer affairs bulletin in 1997, we already had a basic needle safety policy and disposal procedure in place. However, the new law mandated that we update those policies and develop a more comprehensive Exposure Control Plan for eliminating or minimizing contact with potentially hazardous sharps. The Exposure Control Plan needed to contain three components:

-- A comparative analysis file, containing all the research that we collected on needle safety devices to help make decisions about which devices to purchase. This file would also contain records of all the safety devices that we evaluated, even if we did not purchase them.

-- A purchasing safety log to document the type and brand of the products we purchased and the rationale behind choosing those brands.

-- A sharps injury log to comprehensively document any sharps-related injuries that occurred in our facility.

The law also required that we review and update the Exposure Control Plan at least once a year to reflect our progress in incorporating needle safety devices.

I started our center's conversion process by calling different companies that manufactured needle safety systems and obtaining samples of a variety of products, including syringes, safety blades, catheters, vial access systems, and suture needles.

I then organized a staff in-service day, where I asked my eight nurses and four technicians to test the products and help me choose which ones to buy. We found that the easiest product to get used to was the administration safety tubing, which had access ports that we could puncture with plastic, rather than a needle. The hardest products to adapt to were the safety catheters, which were significantly more bulky and harder to handle than the standard kind. We couldn't find equivalents for everything we needed, particularly knife blades, but we were able to decide on reasonable replacements for most things, including syringes, catheters, vial access systems, and tubing.

Overall, I estimate that we spent about $10,000 to implement our plan and procure the initial stock of safety devices. The cost of restocking supplies every month probably increased by about 1.5 times (about $1,000 to $1,500 per month).

Choosing the products and updating our exposure control plan was the easy part of our conversion. The difficult part, adapting to the new devices and using them regularly, took more time, particularly since some of the staff did not see the need for the safety measures. One nurse attempted to take advantage of a potential loophole by writing a report trying to prove that safety catheters were not as effective as the standard kind, but she was unable to make an effective argument. After a few weeks, however, the entire staff became more adept, and using the devices became second nature.

The surgeons, however, were another story. Since the surgeons are not technically employed by the center, they are not required to use needle safety devices, and at first, all 15 surgeons, including the five doctors on the board, refused to use them. The orthopedic surgeons, in particular, were the most reluctant - they felt strongly that the new devices would slow them down significantly in the OR. To find a way to give the doctors flexibility while still protecting the staff, I had to create a new policy. This policy, which was formally approved by the board, stated that if a surgeon insisted on using non-safety devices, the following steps would be taken:

-- A sterile bowl would be opened in the surgical field, and all items that were not in compliance with OSHA standards would be placed in the bowl.

-- The surgeon would draw up the medication or irrigation and would complete the administration.

-- The surgeon would then place all items used in the administration back into the bowl, not allowing any staff members to touch the equipment.

-- A staff member would then place the bowl and its contents in a sharps disposal container without touching any sharps.

We still haven't been able to find substitutes for everything, simply because there aren't enough products on the market. Today, even though our center meets CalOSHA standards, we are not immune to accidents. We were reminded of this recently when a scrub tech, bending to put a non-safety knife into a disposal container, lost his grip on the handle. The knife slipped and cut the hand of another nurse. This incident has spurred us to continue searching for new safety devices.

If your facility is not yet needle-less, I'd recommend starting the conversion process even if your state?? ?s laws don't require you to. Your staff and patients deserve to work and be treated in the safest possible environment, and going needle-less is one way to make that happen.

A Sampling of Safety Devices

Of all the instruments in the OR, syringes and catheters cause accidental needlesticks most often, according to data published by the Exposure Prevention Information Network (EpiNet), a network of health care institutions that collect data on needlestick injuries. There are currently a number of safety syringes and catheters on the market, which protect users via either automatic or manual safety mechanisms. In an automatic system, the safety feature engages instantly after use. A manual system requires the user to manipulate the device to activate the safety mechanism.

Retractable Technologies' VanishPoint syringe features an automatic safety system. The syringe has a spring-loaded mechanism that withdraws the needle into the barrel after use. As the plunger pushes the fluid out of the syringe, it also compresses an internal spring. When administration is complete, the spring automatically releases, pulling the needle out of the skin and into the barrel. The used tip is never exposed.

Johnson & Johnson's Acuvance I.V. Safety Catheter also uses an automatic safety system. As you remove the introducer, a rounded-tip cylinder gradually pushes out from inside the needle to beyond the needle tip. Once fully engaged, the needle tip is blunted and non-reusable.

Johnson & Johnson's Protectiv Plus I.V. Catheter Safety System uses a manual safety system. This device features a hollow safety barrel, slightly larger than the needle, which telescopes out to cover the needle. The barrel has a small tab that you push to slide the barrel over the needle. Once the barrel is fully extended, an audible "click" indicates that the needle is fully encased.

The Safetyglide and Safety-Lok injection syringes and Insyte Autoguard infusion syringe from Becton Dickson also feature a manual safety system. The Safetyglide features a plastic cap that slides along the length of the needle to enclose the tip. After withdrawing the needle from the patient, you push the plastic cap forward and lock it into place. The Safety-Lok syringe uses a hollow, plastic barrel that telescopes out to cover the needle. After using the syringe, you push the barrel out to enclose the needle. The Insyte Autoguard infusion syringe allows you to press a button on the needle barrel to retract the needle into the barrel. An audible "click" tells you that the needle tip is protected and can be disposed of safely.