Q: What are some specific things that team members in the operating room, sterile processing department and infection prevention department can do to improve sharps safety?
Amanda Heitman, BSN, RN, CNOR
A: Each area is unique, but all should be working together to promote a culture of safety. This not only helps protect patients from exposure but us as health care workers as well.
Communication and education are important to reinforce proper use of handling sharps to help reduce staff injuries. Unfortunately, the risk is always there but implementing processes that help reduce the risk, like single-handed scalpel blade removal devices as those recommended by OSHA, is key.
Infection Control needs to be behind the scenes advocating in their organizations for better safety measures. Monitoring injuries and encouraging staff to report their injuries is also really important. It will be difficult for organizations to help if they do not realize there is an issue. “We don’t have a problem with sharps injuries at my hospital” is a common statement that may not represent reality.
Understanding that there are consequences beyond the costs of the initial scalpel injury or the cost of implementing sharp safety controls is important to consider.
Injured health care workers often suffer from distress, which can impact their families. Case studies have found sharps injuries can cause clinical depression and even PTSD. In addition, staff can suffer from lost income and may become responsible, at least in part, for the financial burden of their therapy. This is in addition to the potential risk of a bloodborne infection. All of these stresses, in turn, may push staff to leave the health care arena all together.
Patients may also be impacted as they may need to undergo blood tests, can have their procedures delayed or cancelled and, in rare cases, can run the risk of an iatrogenic infection.
There are also consequences to the facility. They usually have to bear the costs of the blood tests and treatments and will deal with staffing issues and workers’ compensation. These are sometimes referred to these as “hidden costs” of sharps injuries.
To improve sharps safety, OR, SP and IP departments can also help implement administrative controls. These measures help support higher levels of controls by ensuring people are working within safe systems. Examples include writing policies for sharps safety, ensuring compliance with safe work practices, and implementing sharps injury reporting and investigation processes. Being transparent about incident reports to look at what the issues really are is useful. Try to learn from the issues rather than hiding them. Presenting the issues to your staff and letting them learn from these experiences so they can help prevent those injuries from happening in the future is important.
One specific the OR can implement is the use of a hands-free passing technique, which is shown to prevent 50% of sharps injuries when in conjunction with a scalpel blade remover. Institutions have already implemented other examples of engineering controls for years, like the retractable syringes to avoid recapping needles and using biohazard sharps containers that comply with relevant regulations and standards.
Safety-engineered devices and other engineering controls must be chosen based on clinician feedback. Staff need a voice as they are the ones using these devices every day. Doctors are not always in surgery, but we are as health care providers.
Facilities should also review their devices on a regular basis to make sure that their current practices are effective. Are they still using the device as intended/designed or even using them at all? Also, providing initial and annual sharps safety training on how to use safety-engineered devices must be included. This is also recommended by AORN & AST.
Q: It has been almost a year since OSHA put out their revised statement and we want to help make sharps safety a priority in 2024. Can you describe this revised statement, why it’s important and the importance of sharps safety in 2024?
A: Engineering controls must be used to eliminate exposure from used scalpel blades. OSHA Bloodborne Pathogen Standard 1910.1030
OSHA requires facilities to implement engineering controls in order to eliminate exposure from used scalpel blades. Engineering controls include safety-engineered devices, like single-handed scalpel blade removers.
In February 2023, OSHA published an interpretation letter to clarify engineering controls in regards to scalpel blade removal. They have stated that the use of artery forceps, needle holders and Kelly forceps/grips and similar devices are not considered engineering controls. A single-handed scalpel blade removal device is an engineering control for removing and containing scalpel blades.
By implementing engineering controls this will help further protect staff from the hazard itself, creating a change to the workers environment rather than relying wholly on changing worker behaviour.
We need to rethink how we can integrate patient safety with staff safety.
The World Health Organization (WHO) has stated “No country, hospital or clinic can keep its patients safe unless it keeps its health workers safe. Protecting health workers is key to ensuring a functioning health system.”
In the U.S., 385,000 sharps injuries occur in hospitals every year. These numbers could actually be doubled, as 50% of sharps injuries don’t get reported.
Even one sharps injury to a health care worker is one too many, but unfortunately sharps injuries continue to be overlooked.
Everyone is resistant to change, but we all have the opportunity to support positive change. Here’s what we can do on a personal level, to implement change:
- Make sure that you use safety-engineered devices in practice
- Participate in the evaluation of safety-engineered devices
- Engage with and encourage others to engage with safety training (be a champion, don’t be afraid to be vocal, and help promote change)
- Report all sharps injuries to make sure that the problem is understood
- Talk with your leadership team if you have an idea for how to improve safety
- Provide feedback on safety projects and your hospital’s safety culture
- Join with professional bodies and/or advocacy groups to raise awareness of sharp safety issues (AORN has been doing this for years for smoke evacuation)
Remember, every little contribution matters, and all of this helps to make our health care arena safer for staff, ourselves and our patients.
– Amanda Heitman BSN, RN, CNOR, is a Clinical Nurse Educator with Qlicksmart and a Perioperative Educational Consultant with Periop Anew.
