Six months after the Needlestick Safety Act went into effect, surgical facility managers report a generally positive response to the law. They say that most staff are grateful for guidelines designed to drastically reduce the 600,000 to 800,000 needlestick and other percutaneous injuries that occur annually among the nation's 5.6 million healthcare workers-although old habits die hard.

"Our actual compliance is over 50 percent, but it's not yet 100 percent. It's easy to fall back on old habits, especially when we get in a hurry," notes Anita Lawrence, OR Clinical Coordinator for St. Jude's Outpatient Surgery Center, Fullerton, Calif.

Ms. Lawrence and other managers say they've evaluated and purchased new needlestick safety devices, trained staff to use them, and continue to require/encourage/cajole staff to use them. Here are some of the best tips they have to offer to facilitate safer sharps handling.

1. Invest in personal protection. Surgery centers have stocked up on personal protective devices, including face shields, masks with flip-up face shields, goggles and fluid-impervious gowns.

"We offer a choice of masks with face shields or goggles. Most staff and physicians prefer the masks with flip-up shields. They don't like the goggles; the surgeons find them especially distracting," notes Sharon Kelderman, OR Supervisor for Manning Regional Health Center, Manning, Iowa.

One of the keys to compliance is to offer a choice, says Linda Todd, OR Leader, Jamestown Hospital, Jamestown, ND.

"We offer three different kinds of face/eye protection, and the three types are used about equally. It's better to offer choices so people can be as comfortable as possible," Ms. Todd notes.

Offer additional protection when staff members are exposed to more blood and fluids. "We use fluid-control impervious gowns, mostly during GI procedures," says Sheila Stewart, Surgery Coordinator at Chippewa Valley Hospital, Durand, Wis.

2. Explore new devices. OR managers have explored and invested in a variety of safety devices, including safer IV catheters, "point lock" needle devices, needle caddies and mats, vial access devices, knives with retractable blades, special no-splash pouring spouts, and needleless systems.

"We've tried to do away with needles as much as possible. In pre-op and anesthesia, we have a needleless system for all needles and syringes. For needles that have to be used in the field, we have a protective device to cover them," says Marlene Mason, OR Manager at Saline Community Hospital, Saline, Mich.

Along with reducing the number of sharps used, managers praise engineered safety sharps, such as knives with retractable blades.

"The new retractable blade is just great. When you are handling it, it's really just a handle," says Ms. Kelderman.

In general, surgical managers say they haven't had much trouble locating safety devices and receiving approval to purchase them.

"This is all in everyone's best interest. Even from a cost point of view, it costs more to deal with an injury than to prevent it," notes Ms. Lawrence.

3. Crack down on noncompliance. Complying with safety guidelines and using new devices presents a significant challenge. Ms. Lawrence suggests that facilities simply remove old, unsafe devices, and keep only the new devices on hand.

"We have a simple policy: Use it [the safety device], or don't do it. We initially trained two people to use the safety devices very well, and they trained the others. At this point, all our nurses use the new devices," she says.

Surgeons, however, are another story.

"The doctors are different to work with. They are not so quick to change their way of doing things, and we've had to keep some ?old' devices on hand for them. But now the supplies are dwindling, and they will gradually make the switch," Ms. Lawrence says.

4. Pass sharps safely. Most sharps injuries occur in the OR when surgeons and staff pass needles or other instruments from hand-to-hand. The best advice is for the person passing the item to lay it down safely, and then the other person picks it up from there. This is the technique that Ms. Kelderman's staff uses at her facility, although she admits that sometimes the OR team will pass sharps hand-to-hand.

"The nurse or tech will hold the syringe just below the needle, and pass it so the surgeon can take the syringe in his hand," she notes.

Ms. Mason says OR teams in her facility also pass sharps hand-to-hand, but they are considering alternatives, such as "boats" or trays for passing sharps.

Facilities might consider implementing a "pass-free" zone, Ms. Lawrence recommends: "The pass-free zone is where the staff and surgeon lay the items down. We have protective sponges, so the surgeon can insert the items into the sponge. The nurse removes it from there."

5. Handle dropped sharps with care. When a sharp is dropped, many facilities require staff to wear gloves and pick the item up with an instrument. "If anything is dropped, it gets picked up with a needle holder or hemostat," says Ms. Kelderman.

Other ORs vary the protocol based on the type of item. "If a needle or a blade is dropped, it's picked up with a hemostat. A blade with a handle is retrieved with a gloved hand," Ms. Stewart says.

"To pick up a sharp, the nurse or tech wears a sterile glove and holds the point away from her. I would prefer if these would always be picked up with a clamp, but it doesn't always happen," Ms. Lawrence notes.

6. Disarm, then dispose. Surgery centers have strict protocols for sharps disposal. The idea is to "disarm" the sharp before it's disposed of.

"The sharps are placed on the Mayo stand, and no one touches them until the scrub person removes the sharps from the stand. She places these in the red sharps container, and then the container is moved to disposal," Ms. Kelderman says.

"When we turn over the OR, the sharps go right into the needle boxes, and the boxes go into the sharps container in the OR," says Ms. Mason.

7. Practice safe sterilization. When cleaning and sterilizing sharps, facilities stress careful handling and processing.

"Staff in the decontam area must be extra careful. They always process the sharps separately from any other instruments," says Ms. Mason.

"The biggest challenge is to not stick yourself when cleaning or washing the device," Ms. Lawrence adds. "I wear gloves, point the tip away from myself, and flush through with water."

After the sharp has been autoclaved, it's covered with a protector or guard. Still wearing gloves, Ms. Lawrence places the guard on a work surface, and then places the point inside the protector. "After that, we double peel-pack it," she notes.

Perhaps the most fool-proof safety policy is to use only disposable sharps. Says Ms. Stewart: "We don't reuse sharps, so we can't get hurt when cleaning them."

8. Design a sharps injury emergency plan. To comply with the law, all surgical facilities must have a plan to handle sharps injuries. In most plans, the OR manager is informed immediately, and she obtains informed consent from both the patient and employee. Labs are conducted and then repeated in three months.

"The follow-up labs seem to take forever, but you have to be strict about it. You also have to be strict about your reporting and protect patient and employee confidentiality," warns Ms Lawrence.

She notes that in her facility, needlestick injuries are most likely to occur during ophthalmic procedures because they do more of these procedures, and the pace is fast.

"Because ambulatory surgery is so fast-paced, we have a higher rate of injuries than at the hospital," she notes. "We can go six months without any incident, but then we have three needlesticks in a row, especially when the patient census is up. It's a good idea to do a periodic review of injuries and monitor your safety practices."