ARM'S LENGTH Place sharps containers next to each patient care area to make disposals quick and easy.

Zero citations on your OSHA review is nice, but it's really saying something when OSHA commends your sharps safety program. We were delighted to earn OSHA's Safety and Health Achievement Recognition Program (SHARP), a certification reserved for facilities that go above and beyond the agency's standard requirements. What really impressed the OSHA inspectors? Our hands-free instrument passing, double-gloving and use of the latest safety-engineered devices.

• Safety scalpels. We're lucky to work with surgeons who are receptive to adapting their practices to incorporate safety devices. If there are devices they're not used to using, they'll work with them until they are. That includes the oft-maligned safety scalpels that many surgeons still resist using, perhaps because they haven't seriously considered the devices since significant improvements have been made to older, clunky models. Today's safety blades are weighted, well-balanced and available with a wide variety of easy-to-use safety features, including retractable blades and single-handed sheath activation.
  
  You might still experience push-back from surgeons, but we've found that simply making safety scalpels available is one of the keys to getting them used. Our surgeons use retractable scalpels to make small cuts — urologists make small incisions in testicles and ENT docs make small incisions behind the ear for tympanoplasty. There's nothing minor about sharps injury risks. No matter how minor the procedure might seem, we're happy surgeons are willing to employ the safer option.
• No more needlesticks. All of our needles are self-capping, and our IV catheters feature needles that automatically retract into the system after use, which significantly decreases the risk of needlestick injuries.
• Double-gloving. Any patient is potentially an infection risk. Physicians perform initial health histories, but patients might not disclose infections they have, so we treat every patient as if he's infectious. That means all surgeons and staff must protect themselves with proper personal protective equipment. Stock glove sizes to fit every staff member and surgeon.
  Our surgeons double-glove during procedures, which has been shown to reduce the risk of needlestick- and sharps-related injuries. Gloves with indicator systems — a green inner glove worn below an outer glove — can alert staff and surgeons to small breaches that may have otherwise gone unnoticed, further improving the usefulness of double-gloving.

PROACTIVE APPROACH
Work With OSHA to Improve Sharps Safety

LAUDED OSHA commended the Forest Canyon Endoscopy & Surgery Center's sharps program.

Erik Flexman, MHPA, FACHE, CASC, attended the seminars and read the articles. He'd heard the horror stories surrounding OSHA's unannounced inspections of surgery centers and the huge fines levied for deficiencies in sharps safety. So the executive director of the Forest Canyon Endoscopy & Surgery Center in Flagstaff, Ariz., decided to do something unconventional: He got to OSHA before they got to him.

"In our state, you can invite OSHA to inspect your performance in a non-punitive way," he says. "They'll walk you through the things you need to improve and give you an opportunity to fix issues. You should be more than prepared the next time they come to officially inspect your facility."

OSHA notified Mr. Flexman of OSHA's Safety and Health Achievement Recognition Program, a label earned by facilities that excel at safety. After 9 months of intensive training and a formal inspection of the facility, Forest Canyon earned the SHARP certificate.

"If you get the designation, your facility won't be inspected for 2 years," says Mr. Flexman. There's value to it, too, he adds. "It shows you're taking good care of your employees, and you can use it when negotiating with workers' compensation carriers."

What did OSHA want to see? That you're proactively protecting staff by forming safety committees, investigating root causes of injuries and making everyone accountable for on-the-job safety. "Accountability, that was a big one," he says. "We have it noted in our employee handbook: You're responsible for maintaining a safe work environment. If you see something that jeopardizes that, you must report it."

Mr. Flexman encourages you to contact your state's OSHA office and find out if there are programs designed to improve your sharps safety program. "Embracing them as a partner to help you succeed is much more productive than viewing them as an enforcement agency," he says.

— Daniel Cook

• Easy disposal. This was a point of emphasis with OSHA: Have disposal containers installed throughout your facility, ideally within arm's reach of each patient care area, so staff don't have to walk anywhere or reach around someone to dispose of sharps.
• Hands-free passing. Pass sharps during procedures through a clearly established hands-free neutral zone. Establish the neutral zone before the case begins and clearly announce it during the pre-procedure time out. In fact, we note where surgeons like to stand for each procedure on their preference cards and where their preferred neutral zone is.
  Surgeons and surgical techs must remain in constant communication whenever sharps are on the sterile field, and clearly announce when sharps are placed into the neutral zone. Finally, staff must always have the right to refuse sharps that are directly handed to them, and must be empowered to ask passers to set them down in the neutral zone.
• Reviewing the options. Assessing safety devices to remain OSHA-compliant demands more than clicking through company websites or strolling through conference exhibit halls. It demands weekly attention and a total team effort to stay abreast of your sharps safety options. OSHA was impressed with the little things we do to take sharps safety to the next level. We have an OSHA officer who monitors our safety efforts and an infection control specialist who's always monitoring potential exposure risks for employees, which includes managing our sharps program.

She goes to conferences, participates in APIC and CDC webinars, and consults with our suppliers about new products in her constant search for the newest devices designed to keep staff safe.

OSHA's Bloodborne Pathogens Standard (tinyurl.com/4f8mcwb), which incorporates the Needlestick Safety and Prevention Act, requires you to develop a written blood-and-body-fluid exposure control plan and to review and update it annually. You're also required to assess sharps safety devices at least annually. We're always on the hunt for new options, and formally review state-of-the-art technology twice a year to ensure we're not missing devices that would make sharps injuries less likely.

ZONE DEFENSE Hands-free passing significantly lowers risks of sharps injuries.

If there's a new sharps safety device worth checking out, trial it to make sure it's easy to use. Watch the company's product informational video, and compare its actions to their existing product or the device you're thinking of replacing. Truly consider how the purported benefits would stack up in practice. Will the device improve specific practices in your facility? Would it help in areas where you've noticed recent safety deficiencies?

Ask for feedback from members of the frontline staff who will use the devices. That's an OSHA requirement and a good idea. Staff are the ones who'll know if new options outperform the products you're already using.

• Focused improvements. Don't just look at sharps injury rates, drill down to the causes to see if there are patterns of behavior that you can correct or specific specialties that need to focus more on sharps safety. For example, if you notice orthopedics has an unusually high rate of needlesticks, perhaps that group needs to trial blunt suture needles. Focusing your trialing efforts on the surgeons and staff who have the most to gain from using safety-engineered devices can be a compelling sell and might improve frontline compliance. OSM