If you're like the facility managers who responded to our online sharps- safety survey, you've made some progress implementing safety devices - but you still have a way to go. And you may need to focus more effort on the devices that are highest-risk for sharps injuries: suture needles and scalpel blades.

Even though suture needles are the No. 1 cause of needlestick injuries in ORs, our survey (n=55) found that nearly three-fourths (71 percent) of respondents have not reviewed blunt-tip suture needles - and only 2 percent have fully implemented them. Outpatient Surgery safety columnist Jane Perry, MA, notes that studies have shown that using blunt-tip suture needles could reduce injuries in surgical settings by as much as one-third.

Scalpel blades, the second-leading cause of OR sharps injuries, are another device that needs more focused efforts. More than two-thirds (68 percent) of survey respondents either had not reviewed or reviewed but decided not to implement disposable retracting scalpels. Only 14 percent of them have integrated safety scalpels in their facilities.

The National Institute for Occupational Safety and Health outlines five steps for implementing safety devices:

• form a sharps-injury prevention team;
• identify your prevention priorities;
• identify and screen safer devices;
• evaluate safer devices; and
• implement and monitor the devices.

Sounds easy enough but, as is often the case, the devil is in the details. These 10 tips should help you implement safety sharps in your facility.

1. Form a committee
"We have a core panel of users look at a variety of device samples, then select two or three, which are trialed by a select group of staff trials and narrowed down," says Irene Hasenbank, RN, BSN, director of endoscopy services at the Cotton-O'Neill Endoscopy Center in Topeka, Kan.

Her facility's new-products committee includes those from nursing, IV therapy, pharmacy, biomed, health and safety, materials management and surgery. Once the group reviewing new products selects devices, subcommittee members pilot them. Subcommittees, such as the needleless-injection committee, are composed of volunteers - in this case, nurses - who will be working with the safety devices every day.

2. Network with other facilities
When looking to implement new devices, Molly Hicks, RN, chief nursing officer of Surgery Center Southwest in Dallas, Texas, recommends networking with other facilities to see what works, and talking to nurses who have recently attended conferences to find out about new products.

In-house, your nurses and surgeons should be part of device selection, evaluation and review process.

"I solicit comments from those using the devices on daily basis," says Chrissie Stewart, RN, administrator of Cataract Surgical Center of Lubbock in Lubbock, Texas. "How easy are they to use? Are you finding yourself in situations where you or a patient almost got stuck? If so, why? Can you suggest other safety devices we could try?"

3. Facilitate, don't dictate
"The process is a collaboration between those that use the device and me," says Ms. Stewart. "Instead of top-down, it's more of a middle-up process. Many of our nurses work in other facilities, so they may be familiar with safety devices I don't know about. I say, bring me the wrapper, and I'll call the rep. We try them out and see how they compare with the conventional device it's intended to replace." The cost of a device is an important consideration, but ease-of-use is critical. "Even if I have to spend more money up front, if one safety product is more user-friendly than another, I'll buy that one," says Ms. Stewart.

4. Appeal to experience
"The needlestick issue is easy for nurses to identify with," says Ms. Hasenbank. "Many of us have been stuck at least once in our careers. When HIV and hepatitis C became more prevalent, it was easier to get staff to comply."

Appeal to this experience when motivating your staff to make the transition to safety devices, and emphasize that healthcare-worker safety is just as important as patient safety.

5. Training, training, training!
Thorough training (audio-visual aids, articles, hands-on clinical practice and one-on-one teaching) on new devices is key to their successful implementation and acceptance by staff.

If you can, have an infection control expert make a presentation to staff, says Lynda Simon, RN, the nursing administrator at St. John's Clinic: Head and Neck Surgery in Springfield, Mo. "Make sure he discusses the profound changes hepatitis and HIV make on the life of an injured worker and their family," she says.

6. Win over resistors
Staff buy-in is key to your safety sharps program, so finding something the majority of staff likes is important. But what to do with those who resist change? Try a gradual phase-in strategy or bargaining (use a safety device for every conventional sharp device you use). Some may simply need more training on the device to feel comfortable with it.

7. Don't stock conventional sharps
The logic here is simple: If you don't stock conventional sharps, they can't be used.

Note that OSHA says that safety devices aren't necessary for non-patient purposes, such as drawing up medication with a syringe in a pharmacy. So there may still be limited uses for conventional sharp devices in a few device categories. This, however, will be the exception.

8. Check on patient comfort
Ask your nurses for feedback on how comfortable patients are with the safety devices.

"You can't have something as simple as an IV be extra stressful," says Ms. Simon. "We had one product that caused a lot of drag and pain and pressure on the skin (when starting an IV), so it was immediately deemed unacceptable."

Be sure that patient discomfort isn't due to improper technique or lack of training on the part of a healthcare worker who may need further training on how to use the device correctly.

9. Make it mandatory
Once you have written policies standardizing the use of safety-engineered sharps and safe-sharps practices, enforce it by including compliance in annual reviews. "Everybody knows it's something that's expected," says Ms. Simon.

10. Give manufacturers feedback
You may find that product descriptions in catalogs and online don't clearly state whether devices have safety features, and you may end up with a product you didn't want.

Says Ms. Stewart: "I ordered some devices online that I thought would be compliant but were not. I returned them and complained to my rep and the risk manager [at the company]. The response: As long as there is a demand, we will continue to manufacture and distribute non-compliant device. We have to use our purchasing power to leverage manufacturers and distributors."

Many studies show that safer medical devices, when they are part of an overall bloodborne pathogens risk-reduction program, can be extremely effective in reducing accidental sharps injuries.

"Consistency is the biggest key," says Ms. Stewart. "Don't compromise, regardless of the up-front cost. It will pay off."