American Journal of Nursing 2000 February Volume 100, Issue 2

Preventing Needlesticks in Your Facility

A.
The Occupational Safety and Health Administration’s (OSHA’s) new Compliance Directive for the 1991 Bloodborne Pathogens Standard, issued in November 1999, is one of the latest in a series of victories in securing better protections for nurses from needlesticks. The ANA worked closely with OSHA, as one facet of the association’s “Safe Needles Save Lives” campaign, to advocate the directive.

The directive states that “where engineering controls [safe needle devices] will reduce employee exposure either by removing, eliminating, or isolating the hazard, they must be used.” It follows the passage of landmark state legislation, first in California, then in Texas and Tennessee, that requires the use of safer needle devices by hospitals.

The National Institute for Occupational Safety and Health (NIOSH) also published an Alert, “Preventing Needlestick Injuries in Health Care Settings,” in November. The alert recommends that employers eliminate the use of needles when safe and effective alternatives are available, implement the use of devices with safety features, and evaluate use to determine which are most effective and acceptable.

Also in November, the ANA formed a partnership with the Training for the Development of Innovative Control Technologies (TDICT) Project to develop training materials and workshops for nurses in safer needle device selection and evaluation.

What you should do

Recommendations for choosing appropriate devices include:

• Form a multidisciplinary team to (1) develop, implement, and evaluate a plan to reduce needlestick injuries that includes immediate post-exposure management, and (2) evaluate needle devices that have safety features.

• Analyze sharps-related injuries in your workplace. Data should identify who, when, where, how, and with what device injuries are occurring.

• Develop an exposure-control plan based on assessments of how needlestick injuries are occurring, patterns of device use, and data on injury and disease transmission trends.

• When selecting a device (see sidebar below), identify its intended scope of use and any special clinical or design features that contribute to its safety, efficiency, and user acceptability.

• Evaluate how the device will affect health care worker safety and patient care.

• Train health care workers in the correct use of the new devices and schedule promotions of new products. ANA Safe Needles Save Lives buttons increase awareness.

• Solicit informal feedback and monitor use of a new device to determine the need for additional training and identify possible adverse effects of the device on patient care.

• Conduct an annual evaluation according to the OSHA-required exposure control program.

Resources

Obtain more information on the ANA’s “Safe Needles Save Lives” campaign and device evaluation forms from the TDICT Project on the ANA’s http://www.needlestick.org Web site, or contact TDICT at http://www.tdict.org.

Contact OSHA at http://www.osha.gov.

Contact NIOSH at http://www.cdc.gov/niosh.

Get device-specific epidemiologic data regarding needlestick injuries at http://www.med.virginia.edu/medcntr/centers/epinet/.

Get a list of all safe devices from http://www.ohb.org/sharps.htm.

The ANA and the University of Vermont will hold a satellite teleconference on needlestick injury prevention on May 12, 2000. Watch http://www.needlestick.org for more details.

Desirable Characteristics of Safety Devices

The device is needleless. The safety feature is an integral part of the device. The device works passively (i.e., it requires no activation by the user). If user activation is necessary, the safety feature can be engaged with a single-handed technique, allowing workers’ hands to remain behind the exposed sharp. The user can easily tell whether the safety feature has been activated. The safety feature cannot be deactivated and remains protective through disposal. The device uses needles, it performs reliably with all needle sizes. The device is easy to use and practical. The device is safe and effective in patient care.