By Don Sadler
It has been two decades since the Federal Needlestick Safety and Prevention Act of 2000 was passed and revisions were made to the Bloodborne Pathogens Standard.
The Needlestick Safety and Prevention Act covers a wide range of areas related to needlesticks and infections from bloodborne viruses, while all U.S. health care facilities are required by law to comply with the regulations of the Bloodborne Pathogens Standard.
Sharps Safety in 2020
So, where do things stand in 2020 with regard to needlestick injuries and sharps safety? Unfortunately, these injuries remain a serious problem in today’s health care environment.
According to Brian Arndt, MBA, BSN, RN, CNML, a consultant for Keith and Company LLC, at least 600,000 sharps injuries still occur in U.S. health care facilities each year. “One study estimated that as many as 50 percent of sharps injuries go unreported, so the total could be much higher than this,” says Arndt.
“We have made progress, but we’re a long way from eliminating sharps injuries,” Arndt adds.
Mary J. Ogg, MSN, RN, CNOR, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN), says that sharps injuries decreased initially after passage of the Needlestick Safety and Prevention Act due to the introduction of sharps injury prevention devices.
“But recent epidemiological data suggests that injuries from sharps injury prevention devices are on the rise,” she says, noting that injuries occur prior to activation of the safety feature. “Injuries from suture needles and scalpel blades have remained consistent over the years with little to no improvement.”
Sharon A. McNamara BSN, MS, RN, CNOR, points to research indicating that a surgeon will sustain a sharps injury during approximately one in every 10 procedures. “These injuries most often occur when surgeons are using suture needles and scalpels,” she says.
Emergency physician Michael Sinnott, MBBS, FACEM, FRACP, who is also the co-founder of medical device manufacturer Qlicksmart, cites research indicating that there are 32 sharps-related injuries for every 100,000 suture needles purchased, 12.6 sharps-related injuries for every 100,000 scalpel blades purchased and 2.65 sharps-related injuries for every 100,000 needles purchased.
“The real difference I’ve seen over the last few years is that clinical staff are now more willing and eager to admit to having suffered a sharps injury,” says Sinnott. “In the past there was a strong tendency to deny such injuries.”
“While sharps safety has become more recognized as an issue, very little has changed,” says medical device consultant Allan Brack. “In my CE talks, between five and eight people admit they have had a scalpel blade cut or needle stick. But when I ask how they changed their practice, I’m met with a ‘deer in the headlights’ look.”
“In short, nothing changed as they believe the hospital will not invest in their safety,” Brack adds.
Preventing Sharps Injuries
During his keynote presentation at the World Health Organization’s First Global Patient Safety Day in 2019, Sinnott outlined a five-step safety program for preventing sharps injuries: awareness, regulatory support, safety equipment, administrative actions and management support.
“This five-step program aligns with CDC and WHO advice for hospitals’ bloodborne pathogens exposure controls,” says Sinnott.
Ogg outlines a similar hierarchy of controls for eliminating sharps injuries.
“This hierarchy starts with elimination of the hazard if possible, followed by the use of engineering controls, work practice controls, administrative controls and use of personal protective equipment (PPE),” she says.
While removing sharp objects from the OR might not seem realistic, Ogg says there are ways to avoid the use of sharps devices.
“These include using alternative closure devices such as skin staplers, adhesive strips and glues and using alternative cutting devices such as the electrosurgical device to make the initial incision,” she shares.
When sharp objects can’t be eliminated, safety-engineered devices such as blunt sutures needles, safety scalpels, safety syringes and needles can help eliminate sharps injuries. “Work practice controls – such as using a neutral or safe zone for passing sharp instruments and devices – help minimize the risk of exposure to blood or other potentially infectious materials by changing the way a task is performed,” says Ogg.
“OSHA recommends isolating hazards using hands-free zones where sharps are placed during handoffs,” he says. “The surgeon would then pick up the sharp instrument instead of being handed a loaded needle driver or scalpel.”
Although it’s at the bottom of the hierarchy, using PPE remains highly effective in reducing sharps injuries.
“It’s also probably the easiest step to implement,” says Ogg. “For example, research has demonstrated that wearing double gloves is highly effective in reducing sharps injuries in the OR.”
Best Practices and Technology Solutions
Best practices regarding sharps safety hinge on mechanical safeties and safe handling, according to Arndt.
“Over the last few years the industry has made progress in safety technologies such as self-sheathing needles, needleless connectors, retraction devices and shielding or blunting,” he says.
McNamara says there is a plethora of technology solutions available to help prevent sharps injuries as well as new ones being developed.
“There are numerous choices with scalpels, for example, such as disposable cartridges for re-useable handles and disposable one-time use scalpels with retractable sheathes,” she says.“The use of passive (or automatic) safety devices can definitely improve sharps safety,” says Sinnott. “For example, a 2019 article from a Scottish anatomy lab named the Qlicksmart BladeFLASK as one of the most important tools in their successful reduction of scalpel injuries, along with a mandatory PPE policy and density of students per cadaver.”
According to Ogg, OSHA can inspect a health care facility at any time for compliance with the Bloodborne Pathogens Standard and impose fines for non-compliance.
“Health care organizations are required to implement appropriate strategies to minimize risk of exposure to sharps injuries,” says Arndt. “In 2017, the penalty was up to $12,675 per violation. An organization in 2016 was fined over $50,000 related to a high number of needlestick injuries.”
McNamara notes that staff participation is crucial to meeting the OSHA requirements.
“Input must be solicited from non-managerial employees responsible for direct patient care to identify, evaluate and select safety engineered sharp devices and work practice controls,” she says. “And safety engineered device product evaluation process must be documented.”
Impact of COVID-19
Ogg notes that the COVID-19 environment has highlighted the importance of worker safety with the use of PPE for respiratory and contact precautions. “To date, there are no published reports of COVID-19 transmission via a blood-borne pathogen exposure.”
Arndt believes that COVID-19 has caused health care leaders to reevaluate everything from basic hand hygiene to supply status and backup equipment.
“The emphasis on health care provider and patient safety is at an all-time high,” he says. “The simple truth is that the health care industry has known for years that we could do a better job with PPE utilization and hand hygiene, but COVID-19 has provided the extra push to really made a difference.”
AORN has produced a set of online implementation tools to help perioperative team members apply AORN’s evidence-based guidelines for sharps safety in their everyday practice. According to Ogg, the Guideline Essentials for Sharps Safety include:
- Gap analysis tools
- Case studies
- Policies and procedures
- Competency verification tools
“The Guideline Essentials also include a quick view of the sharps safety guideline, an implementation roadmap and a power point presentation,” says Ogg.
Visit https://www.aorn.org/essentials to learn how you can obtain a copy of the Guideline Essentials for Sharps Safety.