Technology & Teamwork Drive a Sharps Safety Program

Occupational exposure to bloodborne pathogens from needlesticks and other sharps injuries is a serious problem, but it is often preventable. The Centers for Disease Control and Prevention (CDC) estimates that each year 385,000 needlesticks and other sharps-related injuries are sustained by hospital-based healthcare personnel. Sharps injuries are primarily associated with occupational transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), but they may be implicated in the transmission of more than 20 other pathogens.¹

The CDC, in its Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program,¹ says that an effective sharps injury prevention program includes several components that must work in concert to prevent healthcare personnel from suffering needlesticks and other sharps-related injuries, and this program should be integrated into existing performance improvement, infection control and safety programs. A good program should also be based on a model of continuous quality improvement.

The CDC’s workbook recommends specific organizational steps for developing and implementing a sharps injury prevention program, including administrative and organizational activities, beginning with the creation of a multidisciplinary working team and also including conducting a baseline assessment and setting priorities for development of an action plan. The program also recommends these operational processes:

1. Institutionalize a culture of safety in the work environment,
2. Implement procedures for reporting and examining sharps injuries and injury hazards,
3. Analyze sharps injury data for prevention planning and measuring performance improvement,
4. Select sharps injury prevention devices (e.g., devices with safety features), and
5. Educate and train healthcare personnel on sharps injury prevention.
6. Industrial safety experts agree that safety-engineered devices and work practices alone will not prevent all sharps injuries; significant declines in sharps injuries also require:

Education

• A reduction in the use of invasive procedures
• A secure work environment
• An adequate staff-to-patient ratio
• Simultaneous implementation of multiple interventions, including: formation of a needlestick prevention committee for compulsory in-service education programs; outsourcing of replacement and disposal of sharps boxes; revision of needlestick policies; and adoption and evaluation of a needleless IV access system, safety syringes and a prefilled cartridge needleless system

The CDC’s workbook notes, “The limited successes of implementation of work practice and engineering controls in reducing bloodborne pathogen exposures has led to the examination of organizational factors that could play an important role in reducing occupational exposures. One organization level factor, known as a safety culture, has been found to be notably important. Some industrial sectors are finding that a strong safety culture correlates with: productivity, cost, product quality, and employee satisfaction. Organizations with strong safety cultures consistently report fewer injuries than organizations with weak safety cultures. This happens not only because the workplace has well-developed and effective safety programs, but also because management, through these programs, sends cues to employees about the organization’s commitment to safety. The concept of institutionalizing a culture of safety is relatively new for the healthcare industry and there is limited literature on the impact of such efforts. However, a recent study in one healthcare organization linked safety climate (a measure of overall safety culture) with both employee compliance with safe work practices and reduced exposure to blood and other body fluids, including reductions in sharps-related injuries. A second study in one healthcare organization, also noted correlations between specific dimensions of safety culture (such as perceived management commitment to safety and job hindrances) and compliance with standard precautions and accidents and injuries. Additionally, a recent study examining a statewide sample of healthcare personnel further indicated that greater levels of management support were associated with more consistent adherence with universal precautions (specifically, never recapping needles), while increased job demands was found to be a predictor of inconsistent adherence.”

Selection of Sharps Injury Prevention Devices

The CDC’s workbook says that the process of selecting engineered sharps injury prevention devices gives healthcare organizations “a systematic way to determine and document which devices will best meet their needs. The selected devices must be acceptable for clinical care and provide optimal protection against injuries. The selection process includes collecting information that will allow the organization to make informed decisions about which devices to implement. The more this process can be standardized across clinical settings, the more information can be used to compare experiences among healthcare facilities. A key feature of the process is an in-use product evaluation. A product evaluation is not the same as a clinical trial. Whereas a clinical trial is a sophisticated scientific process requiring considerable methodological rigor, a product evaluation is simply a pilot test to determine how well a device performs in the clinical setting. Although the process does not need to be complex, it does need to be systematic.”¹

The CDC Workbook outlines an approach for selecting a product for implementation:

1. Organize a product selection and evaluation team
2. Set priorities for product consideration
3. Gather information on use of the conventional device
4. Establish criteria for product selection and identify other issues for consideration
5. Obtain information on available products
6. Obtain samples of devices under consideration
7. Develop a product evaluation survey form
8. Develop a product evaluation plan
9. Select and Implement the preferred product
10. Perform post-implementation monitoring

References

1. CDC’s Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program http://www.cdc.gov/Sharpssafety/

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