If you want to avoid some common pitfalls when implementing safety-engineered sharps in your facility, check out www.cdc.gov/niosh/topics/bbp/safer. This Web site from the National Institute for Occupational Safety and Health (NIOSH), "Safer Medical Device Implementation in Health Care Facilities: Lessons Learned," offers insights from several healthcare facilities on implementing safety devices.

The facilities sharing their experiences include a large hospital chain with a clinical staff of 4,500; a 950-bed academic medical center with two ASCs and a clinical staff of 4,000; and a 300-bed hospital with 2,000 healthcare workers.

NIOSH outlines five steps for developing and maintaining a needlestick-prevention program; for each step, the participating facilities discuss problems they encountered and how they tackled them.

1 Form a sharps-injury prevention team
Administrative and medical staff leadership is vital to sustain the interest and participation of all team members. First, though, educate the leadership. Many administrative and management personnel do not understand OSHA's revised bloodborne pathogens standard, and their lack of understanding could impede the efforts of the sharps-injury prevention team to implement safety devices facility-wide.

Consider forming a separate team for the OR, for two reasons: many available safety devices aren't necessarily applicable to the surgical setting; and the composition, needs and procedures of the OR are unique.

Remember that physician participation does not necessarily mean that they have to attend every team meeting; you can get their recommendations from one-on-one talks, e-mails and reviews of meeting minutes.

If you invite vendors to give product presentations, beware: They may try to extend their stays to make the sale. Set a time limit or, better yet, suggest they meet with one or two team members to show how the product works, then provide enough samples for those team members to demonstrate the product at a meeting.

2 Identify priorities
Separate your institution's exposure data into devices causing high-risk injuries and those causing low-risk injuries. High-risk injuries are the ones from blood-filled, hollow-bore needles. Based on this analysis, give priority to the high-risk devices in scheduling your facility's conversion to safety devices. (An exposure-tracking system such as EPINet is very helpful in this process. Specifically designed for the surgical environment, Access/EPINet-OR is available free at www.med.virginia.edu/ epinet.) Start your safety conversion with a relatively simple device used widely in your facility.

3 Identify and screen safer medical devices
When screening safety devices for possible evaluation, talk to other institutions for their take on products and the quality of service and education provided by companies. Here are other questions to ask:

• Does the vendor guarantee adequate stock to supply the device to the institution without significant backorder? (This is especially important if the product was recently introduced to the market.)
• Can the company provide in-service training to all employees who will need it, at times designated by the institution? (In large facilities, this may mean multiple trainers available over several weeks, including weekends and off-shifts.)
• Can the device can be used facility-wide? (Certain types of devices need to be compatible with other existing products.)

4 Evaluate safer medical devices
Device evaluations should gather information on how the product affects clinical tech-nique; the reliability and ease-of-use of the safety feature; how much training is required for users to feel comfortable with the device; and whether the safety feature allows users' hands to remain behind the sharp as it's covered.

A successful device evaluation will glean information on all these factors from frontline users of the device. An evaluation form should be short and relatively simple to complete - but not so short that you omit information critical for a thorough evaluation.

One facility observed that, during evaluations, users sometimes stopped using the device after one or two times if they did not immediately like it. This occurs more frequently with products that require a significant change in technique. Emphasize to staff that they need to continue using the device until they get past the learning curve. Encourage vendors to visit often during evaluations to troubleshoot and provide any additional training.

Also, facilities advise that evaluations always take longer than anticipated. Allow several months to coordinate and tally the results of large evaluations.

5 Implement and monitor safety devices
When scheduling the implementation of a new safety device facility-wide, allow plenty of lead time for manufacturers and distributors to obtain adequate amounts of the product, and factor in time for possible delays in delivery.

Allow time (three-to-six months) for staff to get past the learning curve after introduction of a new device. Critically review any product complaints received in the early stages of implementing a new safety device; complaints may be related to lack of training or awkwardness using a new product, rather than poor product design.

Once a safety device is implemented, remove as much of the old product as possible. Make unit rounds, using team members whenever possible, to ensure the new device is being used and the safety feature properly activated. Keep an eye out for hoarding; staff may stash old devices so they don't have to adapt to the new one.

Provide training for staff who weren't available for the initial in-services. Develop processes for reporting problems with a new safety device and for requesting exemptions from using it, in cases where a conventional alternative is necessary for reasons of patient safety. (Carefully document those reasons in the facility's exposure-control plan. OSHA does not consider user preference a valid reason for not using a safety device.)

When you're training large numbers of employees on a safety device, consider adopting the "super user" concept. For each clinical area implementing the device, give one person extended training in advance; that person then is a resource for co-workers experiencing problems post-training.

Be patient - and cautious
Implementing safety devices facility-wide is a time-consuming, labor-intensive process --and can be discouraging if you encounter staff who resist changing. After all, you're doing it for their benefit. But it's worth the effort. Safety-engineered sharps have been shown to significantly reduce needlesticks and other percutaneous injuries.1 Keep in mind that even if your facility has fully converted to safety alternatives - a process that can take from one to two years, depending the on size and complexity of your institution - sharps injuries can still occur.

Safety devices don't always work as intended. Staff may let down their guard because they thought the device was "safe" and handled it as though it could not hurt them, or (more commonly) staff may fail to activate the safety feature. Be prepared for these situations and continue to refine your needlestick-prevention program as needed.

Reference
1. Jagger J, Perry J. Comparison of EPINet data for 1993 and 2001 shows marked decline in needlestick injury rates. Advances in Exposure Prevention 2003;6(3):25-27.