It’s Long Past Time to Prevent Sharps Injuries

Staff Safety

By: Danielle Bouchat-Friedman | Senior Editor

Published: 8/5/2021

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Surgical facilities need to implement safety-engineered devices that protect staff from scalpels, syringes and suture needles.


Last year marked the 20th anniversary of the Needlestick Safety and Prevention Act, landmark legislation that was intended to eliminate the sharps injuries that continue to occur today. In fact, OSHA estimates 5.6 million healthcare workers and related occupations are at risk of occupational exposure to bloodborne pathogens, including HIV, hepatitis B and hepatitis C.

Something needs to change. Safe sharps handling practices are important, but the best way to protect your surgeons and staff from sticks and cuts is to eliminate the devices that cause them.

• Identify the issues. Janice Kilby, RN, MAN, MN, CNOR, a practice consultant at Kaiser Permanente Mid-Atlantic States (KPMAS), worked with colleagues to establish a multidisciplinary sharps safety council, which develops and maintains comprehensive programs aimed at eliminating occupational exposures to bloodborne pathogens throughout the health system. “We track sharps injury rates and analyze the nature of each injury, including the device, profession and job function involved,” says Ms. Kilby.

She suggests maintaining a sharps injury log, which OSHA says should include the type and brand of devices involved in exposures, the department or work area where exposures occurred and explanations of how the incidents happened — while maintaining the confidentiality of the staff members involved. Use the log to conduct quarterly reviews of your facility’s sharps injuries to determine if they were related to product design, device failure, clinical factors such as sudden patient movement or the activity being performed. Then design and implement sharps safety education programs and campaigns based on problem areas or injury types. By analyzing the trends on a regular basis, you’ll identify who’s most at risk for injuries and why they occurred — the information you’ll need to implement safer practices.

“We found that about 30% of sharps injuries involve surgeons, because they perform delicate procedures in the surgical field,” says Ms. Kilby. “We also discovered that syringes are involved in 40% of injuries, because of the intricacies involved in giving an injection, activating the syringe’s safety mechanism and properly disposing of the used needle.”

Deborah L. Spratt, MPA, BSN, RN, CNOR, CHL, a perioperative consultant at St. James Hospital/University of Rochester (N.Y.) Medicine, hopes sharps safety is addressed at all facilities with yearly education, regardless of the number of exposures they record. “Our experience showed that it was only when an organization identified a significant number of injuries that they created a group to actually work on solutions,” she says.

Ms. Spratt believes facility leaders should proactively promote sharps safety and the use of safety-engineered devices instead of waiting for injury rates to climb before taking action.

• Require exceptions. The Needlestick Safety and Prevention Act requires your facility to trial safety-engineered devices — such as sharps disposal containers, self-sheathing needles and safety scalpels — on an annual basis in order to identify and implement safe options. Requiring your staff and surgeons to opt out of using sharps safety devices helps to increase compliance with this element of the legislation.

 

6 Ways to Improve Sharps Safety
IMPLEMENTING CHANGE
SKIN IN THE GAME All clinical team members who are exposed to sharps should be trained on the appropriate handling and disposal of the devices.

A consensus statement published in 2020 by the International Safety Center  includes six data-driven policies that healthcare facilities can implement to ensure compliance with sharps safety regulations: 

1. Ensure leadership, management and frontline staff work cooperatively to select devices with sharps injury prevention features, and develop sharps safety standards and practices that are consistently implemented and followed in all clinical environments. 
2. Provide annual documentation for opt-out policies that details the rationale for not using safety-engineered devices, as well as alternate procedures or practices to mitigate sharps injury risk. 
3. Maintain a sharps injury log and conduct reviews of recorded injuries at least annually. Share a summary of the findings with all surgical personnel and use the information to identify areas for continuous quality improvement and ongoing compliance with sharps safety practices.  
4. Involve frontline workers in the selection and evaluation of devices with sharps injury prevention features, and conduct regular and systematic assessments of devices currently in use. Weigh the effectiveness of various safety-engineered features for specific applications, and keep user feedback at the forefront of device selection. 
5. Provide feedback from frontline staff to supply manufacturers and distributors in order to emphasize the importance of having access to procedure kits that include devices with sharps injury prevention features. 
6. Conduct annual training on sharps safety and the appropriate use and disposal of sharps devices for all potentially exposed workers. Such training provides a forum for addressing questions and issues that arise as new devices are introduced.

These policies are not intended to identify one method of addressing harps safety as better than or more effective than others, notes Deborah L. Spratt, MPA, BSN, RN, CNOR, CHL, a perioperative consultant at St. James Hospital/University of Rochester (N.Y.) Medicine, who contributed to the consensus statement. “They are intended to be part of a comprehensive program,” she says. 

— Danielle Bouchat-Friedman

ON RECORD Sharps safety policies should be based on information compiled in a comprehensive injury log.

For example, KPMAS’s sharps safety council garnered support from the health system’s leadership to mandate that all clinical managers submit sharps exception requests before being allowed to use non-safety-engineered devices within their respective departments. This requirement generates conversation and collaboration among physicians, clinical staff and managers as they work together to identify procedures during which unsafe devices are used, find safer alternatives, identify and address the challenges involved in using safety devices and, only if necessary, file a sharps exception request. 

When clinical circumstances require the use of a non-safety-engineered device, a surgeon or staff member should work in partnership with their department manager to apply for the use of the item. “To approve a sharps exception, 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 approval is given for the use of a particular device, require the user to renew the application for the device every two years. “They need to provide another round of justification for the use of the non-safety device,” says Ms. Kilby. The two-year limit also ensures you have the opportunity to determine if newer, safer alternatives have hit the market since the exception was approved.

The sharps exception program at KPMAS has increased the use of safety-engineered devices throughout the health system. “The program’s success is due, in large part, to the work of our inventory management department,” says Ms. Kilby. “They were instrumental in removing all unapproved sharps from regular rotation. They continue to stock only safety sharps — devices with engineered safety features — or alternative devices that have been approved for use through the exception process.”

• Prepare for pushback. Convincing your staff to switch up their use of sharps is no easy feat. “Practice change is difficult,” says Ms. Spratt. “I find that younger practitioners are more willing to think about sharps safety for the benefit of the entire clinical team,” says Ms. Spratt.

The next generation of surgeons might be more willing to use safety-engineered devices, but it helps to have established and respected physicians onboard with your efforts to use safer sharps devices. Ms. Kilby admits some physicians weren’t interested in changing their clinical routines when the sharps exception program was launched five years ago. “Physicians who were used to using syringes without safety mechanisms complained about making the switch,” she says. “So, we partnered with physicians who championed sharps safety and who were in full support of the exception program. They talked to their colleagues about the importance of using safe devices and helped us achieve full implementation of the safety-engineered needles.”

Ms. Kirby says a sharps exception program will ultimately force the hands of providers who hesitate to make the switch to safety devices. Requiring them to constantly assess safer alternatives will show them safety-engineered devices not only limit exposure risks for themselves and their colleagues, but are clinically effective.

Promising results

KPMAS’s sharps safety council also rolled out online and face-to-face sharps safety education campaigns throughout the health system. The campaigns — which focused on clinical departments that had the highest injury rate — included dissemination of posters and flyers, monthly sharps safety tips and conversations with individual providers. Two sharps safety online training modules are now mandatory for all clinical staff to complete annually.

The group’s efforts appear to be working. The sharps injury rate at KPMAS has been trending 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 demonstrating a similar commitment to prevention through the implementation of a continuous, comprehensive and collaborative safety program, your surgeons and staff will be protected from sharps injuries and the serious harm they cause. OSM

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