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Diligent tracking, analysis and policies can combine to make a huge impact.
Pamela Bevelhymer
OPEN BOOK The keys to preventing sharps injuries can often be found in the logs of previous incidents.
OSHA estimates 5.6 million healthcare workers and related occupations are at risk of exposure to bloodborne pathogens — including HIV, hepatitis B and hepatitis C — due to sharps injuries. While proper handling and passing practices remain important, the best way to protect your surgeons and staff from sticks and cuts is to eliminate the devices that cause them.
Janice Kilby, RN, MAN, MN, CNOR, a practice consultant at Kaiser Permanente Mid-Atlantic States (KPMAS), maintains a log to track sharps injury rates and analyze the nature of each injury. She includes the type and brand of devices involved in each exposure, the department or work area where the exposure occurred and an explanation of how the incident happened. The confidentiality of staff members involved is maintained.
By watching the trends, she identifies who is most at risk for injuries and why they occurred. The log forms the basis of quarterly reviews to determine if the injuries are related to product design, device failure, clinical factors such as sudden patient movement or the activity being performed. Ms. Kilby then designs and implements sharps safety education campaigns based on problem areas or injury types. Recently, for example, she found that about 30% of KPMAS' injuries involved surgeons, and that syringes were involved in 40% of injuries for a variety of reasons: the intricacies involved in giving an injection, difficulty in activating the syringe's safety mechanism and improper disposal of used needles.
The Needlestick Safety and Prevention Act, the law of the land for two decades, requires facilities to trial safety-engineered devices such as sharps disposal containers, self-sheathing needles and safety scalpels annually to identify and implement safe options. This requirement generates conversation and collaboration among physicians, clinical staff and managers to identify procedures during which unsafe devices are used, find safer alternatives, identify and address device usage challenges and, if necessary, file sharps exception requests.
KPMAS's sharps safety council, with support from leadership, mandated that all clinical managers submit sharps exception requests before being allowed to use non-safety-engineered devices within their respective departments. When clinical circumstances require use of non-safety-engineered devices, a surgeon or staff member partners with the department manager to apply for the use of the item.
"Look at the procedure being performed as well as the appropriateness of how the device is intended to be used," says Ms. Kilby. Once an exception is established and approved, she says you should require the user to renew the application for the device every two years, which enables you to determine if newer, safer alternatives have become available. Ms. Kilby says the requirement for those providers to constantly assess safer alternatives leads many to realize that safety-engineered devices not only limit exposure risks for themselves and their colleagues, but are also clinically effective.
As a result of this hard work, the sharps injury rate at KPMAS has trended downward over the past two years and the injury rate among the health system's ambulatory surgery centers dropped by 82% between 2016 to 2020. By implementing a continuous, comprehensive and collaborative safety program, your surgeons and staff can likewise be better protected from sharps injuries and the serious harm they can cause.
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