Of course, the most effective method of reducing needlestick injury rates is to find ways to eliminate the sharp, eg special suture needles (eg known as blunt sutures) that can be used for certain tissues in OR procedures. Needleless IV connectors have been very effective in eliminating the need for needles to access an IV line or tubing and have resulted in dramatic reduction in the number of needlesticks associated with these procedures.

There have been some excellent advances in the technology as it’s evolved over the last ten years, with devices becoming more intuitive and easier to operate. Some even operate passively, which means there is no step required beyond the clinician’s usual technique to activate them (although some clinicians do not prefer these devices, and in some cases, selecting the passive device may mean compromising other important device features). There is also reason to be happy that over 95 percent of the hospital-based market has been converted over to using safety devices for IV catheters – although it’s not 100% which is what our goal should be.

Finally, we have moved practice away from use of needle-based systems for injecting medications through IV lines. Now there are several generations of IV tubing access ports which provide clinicians with the option of using a luer slip or luer lock syringe or IV line for injections. It will take a few years for us to understand which of these provides the best features, including reduction of risk of catheter thrombosis, and prevention of catheter related infections.

Phlebotomy safety devices and other safety equipment related to blood drawing and safety IV catheters have had the biggest impact in reducing the risk of bloodborne pathogen transmission to healthcare workers, because these are the highest-risk type of devices.

Another problem is many hospitals don’t put this decision in the hands of the bedside caregivers like the law calls for. They may make decisions above the level of the bedside people who are actually using these devices. The law did say that people who are using the devices should make the decisions about the device they’re using or would prefer to use.

Increasing needlestick safety in operating rooms. Sharps injury rates in surgical settings have increased 6.5 percent since adoption of the Needlestick Safety and Prevention Act in 2000, according to a study published in the Journal of the American College of Surgeons (April 2010). A 2008 Massachusetts study of sharps injuries sustained by hospital workers at 99 hospitals showed that injuries occurred most frequently in operating rooms (32 percent).

Standardizing safety devices in kits rather than charging a fee to include a safety device in a kit, and calling it "custom." The medical device industry should be held accountable for such blatant exclusions that put health care workers at risk. The users of the kits must reject the products until safety engineered devices are routinely provided without extra fees.

Using the safest technology. The Massachusetts study also revealed that devices with engineered safety devices aren’t always being used, even though they are available. More than half of reported injuries involved devices without engineered sharps injury prevention features. For example, hypodermic needles/syringes lacked engineered sharps injury prevention features in 27 percent of injuries associated with these devices, even though hypodermic needles/syringes with engineered safety features had been available on the market for more than a decade.

Handling the sharp device after use. More safety precautions and procedures must be put in place for handling the sharp device after it has been used. The Massachusetts study revealed that more injuries occurred after use of the device (1,543, or 49 percent, compared to 1,355, or 43 percent). Of injuries that occurred after use, 38 percent were before disposal and 11 percent were during or after disposal.  

Involving frontline healthcare workers. By law, non-managerial health care workers who are involved in direct patient care must be solicited for input on the identification, evaluation and selection of the safest devices. This is not always occurring in health care settings. A lack of documentation showing employee input on the analysis of engineering and work practice controls is one of the common reasons for an OSHA citation for violation of the Bloodborne Pathogens standard. And in a 2008 ANA national survey of nurses on workplace safety and needlestick injuries, 66 percent said they do not have the opportunity to influence the selection of sharps safety devices in their workplace.

Improving compliance in outpatient and community settings, such as home health enterprises, nursing care facilities, and private clinics. In one recent year, OSHA issued 36 percent of its bloodborne pathogens violation citations to skilled nursing homes, 21 percent to physician offices and clinics, and 14 percent to general medical and surgical hospitals.  The 2008 ANA national survey of nurses on workplace safety and needlestick injuries revealed that nurses who work in outpatient settings had less access to safer devices. Since there are more health care workers practicing in non- hospital than in-hospital settings, data collection must be improved in these community-based and outpatient settings.

Tracking actual incidence rates to gauge improvement and identify problems that must be addressed. The 2008 ANA national survey of nurses on workplace safety and needlestick injuries found that 64 percent of nurses had been accidentally stuck by a needle while working.

I think [another] critical area that needs attention is the non-hospital setting. It just is an area where we don’t have much data in terms of surveillance data on needlesticks and studies that look at the risk to healthcare workers in those settings. And really that’s where healthcare is heading in terms of where the majority of care is going to take place.

In addition, many hospitals and facilities have exemption lists for safety devices – that is, specific types of devices or procedures for which no safety alternative is available or what is available is not deemed satisfactory by the clinician. These exemption lists should be reviewed every year and emerging technology tracked to see if safety alternatives have become available. This is what should happen – but I’m not sure if it necessarily is.

Conceivably these lists could just go on from year to year being approved. I think there needs to be ongoing attention paid to what’s coming out in terms of technology and whether safety alternatives have been developed and continued contact between the facilities and manufacturers about what is needed.

There are also exposures to sharps and blood that are not related to needles and venous access which I think need improvement – such as in the operating room. How do you protect people against suture needlesticks, accidents with blades and other sharp instruments? It still remains a big issue, there isn’t adequate technology. In the short term, we will have to adapt our workflow in the OR to reduce the potential for inadvertent contact, while the technology is developed to further reduce the risk. Interestingly, it is believed that over three quarters of the sharps injuries in the OR do not occur to the primary user of the device (usually the surgeon).

This statistic also should remind us of the downstream risks for people handling the waste. If sharps end up in the wrong container and an injury occurs because a sharp poked through a trash bag, or punctured the container. Then this means an injury is to someone who never had contact with the patient. It speaks to having those folks who are still part of the chain of contact be involved in upfront discussions and decision-making along with the healthcare workers, and also receive appropriate education and training.

A culture of safety also involves providing adequate training so health care workers know how to use sharps devices properly and how to incorporate the safest procedures into their work practices.

Nurses can help foster a culture of safety in their work environment by educating their peers on the safest practices and discouraging their colleagues from cutting corners on safety measures, even if it adds time or inconvenience to a procedure. For example, one study showed that establishing a safe neutral zone for the passing of sharp devices can significantly reduce injuries.

Nurses also can become involved in their employers’ safety committees that evaluate the safety of medical devices on the market for purchase.

It’s very important that leadership follows through and has a method whereby [needlestick injuries] can be reported quickly, and [the healthcare worker] can be seen quickly, whether it’s going to the emergency department or employee health. So that it’s not seen as a time waster, but that it is expedited and they’re taken care of immediately.

If sharps injuries continue to occur, the leadership of the hospital needs to absolutely take the responsibility and accountability if surgeons do not change their technique. They need to take some aggressive action and a root cause analysis should be done on every needlestick or sharp injury that occurs and there must be some ramification for the surgeon not using appropriate safety precautions.

• They want to retain the weight & feel of the metal handle that "I’ve used for years and I’m used to".

• Safety Scalpels are bulky and the safety sheath blocks or impairs my field of vision of the surgical sight.

• Safety Scalpels are not equipped with premium sharp blades so they consider them "dull".

• Staff get complacent when they use safety devices raising the risk of injury because they’re not as careful when handling the units.  

The lack of an acceptable safety device has been compounded by the lack of enforcement and mandated compliance with existing regulations. As everyone is aware, OSHA requires facilities to review, trial, select and "USE" the devices available on the market to prevent sharps injuries. AORN and The American College of Surgeons have recommended the use of safety engineered devices and compliance with the Neutral Zone/Hands Free Technique (ST-58). Despite these guidelines and regulations, adoption rates remain low and facilities continue to be fined for not fully implementing the required safety devices.

There is change in technique, so one of the things that is particularly important is that teaching institutions for new residents include this in their repertoire of skills, learning to suture with blunt needles, number one, and also learning to do surgery with double gloves. Surgeons that have gotten used to it have said it’s just a matter of getting used to the change, that it really doesn’t impact their ability to do surgery and can funcion as well as they did with single gloves.

• Education from safety officers or manufacturers so all remain on the same page and mandate.

• Device Posters on Safety Products as every day reminders.

• Remove non-safety, non-compliant devices.

• Make Safety Products mandatory.

All facilities need to present a "win-win scenario" for the entire surgical team. For example, it is important to verbalize the limitations of safety scalpel handles / safety scalpels in a variety of surgical procedures. On the other hand, this does not negate the relevance of implementing a Neutral Zone or Hands Free Technique for those procedures.