Needlestick Prevention Experts Identify Need For Better Safety Syringe Design

Six years after passage of the Needlestick Safety and Prevention Act, nursing and infection control leaders say there is significant room for improvement to protect healthcare workers from needlestick injuries, which can result in exposure to bloodborne pathogens such as hepatitis and human immunodeficiency virus (HIV). Participating in "The Inviro Initiative: Evaluating the State of Needlestick Prevention," sponsored by Inviro Medical (www.inviromedical.com), some of the nation's top experts voiced their current concerns after many successfully lobbied to pass legislation in 2000 designed to address the problem.

During the June 12 program, moderated by Infection Control Today Publisher William Eikost and held in conjunction with the annual meeting of the Association for Professionals in Infection Control, participants identified crucial factors that could further diminish needlestick injuries: better safety syringe design and improved training, as well as enhanced reporting processes and data collection.

"We organized this roundtable event because it's time to take a fresh look at this issue, discuss what has been accomplished, examine best practices and identify future priorities," says Gareth Clarke, chief executive officer of Inviro Medical. "Our recent survey, the 2006 Study of Needlestick Injuries and Safety Devices confirms that needlestick injuries remain a tremendous cause for concern among healthcare workers." (The study can be downloaded at: www.inviromedical.com/needlestickstudy.) The company engineers and markets safe medication delivery systems, including the InviroSNAP! Safety Syringe, the first in a significant new segment -- manually retractable technology -- in the safety syringe market.

Better Safety Syringe Design

In response to legislation that mandates facilities make safety syringes available, many manufacturers created retro-fitted devices, which include the addition of safeguards to the original syringe. Participants in "The Inviro Initiative" indicated that many healthcare workers find these designs -- with add-on pieces -- cumbersome or difficult to operate, and suggested designing a syringe from scratch with input from those who use it. "My grandmother used to have a saying that it's better to prepare and prevent than it is to repair and repent," said Ron Stoker, executive director of the International Sharps Injury Prevention Society. "I think it is important that safety is designed into the syringe to remove the risk of needlestick injury."

"What we need is user-based designs; as long as you are not involving the healthcare worker, you are not going to get the correct designs," said June M. Fisher, M.D., project director of the Training for Development of Innovative Control Technologies Project in San Francisco.

While sharps safety leaders advocate for needle-free vascular access devices, Barbara DeBaun, R.N., M.S.N., C.I.C., director of patient safety and infection control at California Pacific Medical Center in San Francisco, commented, "Nationwide, there has been an increase in bloodstream infections associated with the use of needle-free devices. A lot of the technology that has been designed to prevent needlesticks is great for healthcare workers -- but it's causing a lot of problems in our patients."

Improved Training

To further reduce needlestick injuries, training is absolutely essential and multiple needs exist. It is still important to educate workers about the problems that can result from injuries, stated this group of thought leaders. While patients and caregivers can be rapidly tested for HIV, the insidious nature of hepatitis C makes it more difficult to see a direct and immediate cause and effect. Little money exists for innovative training programs and healthcare workers are often too busy to read professional publications, where coverage of the issue has lapsed due to saturation or lack of reader interest. There also is a need for facilities to better educate healthcare professionals about appropriate procedures to take when needlesticks occur.

While most hospitals inform employees during the orientation process, it is often not retained because they are overwhelmed with information. Roundtable participants further indicated that, interestingly, medical students and residents often have little training in this area.

The emergence of new safety devices compounds the need for training. Several industry leaders said that workers often opt not to use safety syringes - because they don't know how to operate them properly. "If it takes three hours to learn how to use a syringe, you don't want to use it," added Fisher. Manufacturers need to include training as part of their sales process, some say. Even better, however, would be devices that are simple to operate and require minimal training.

Enhanced Reporting

Most experts suspect healthcare workers underreport needlestick injuries due to the time and hassle involved. In busy environments, it may take four to five hours to prepare a report and receive treatment - often in the hospital emergency department -- time many feel they cannot afford when they are needed by patients and colleagues. Some hospitals have improved their processes to streamline the procedure. Angela K. Laramie, M.P.H., of the Sharps Injury Surveillance and Prevention Project, Occupational Health Surveillance Program, Massachusetts Department of Public Health in Boston, reports that many hospital emergency departments have a kit that includes the tubes, orders, testing instructions and a form that goes directly from the ER to the occupational health department for after hours reporting.

Needlestick prevention advocate and Boston College doctoral student Karen Daley, Ph.D. (c), M.S., M.P.H., R.N., shared an additional idea instituted at one hospital and adopted by others. When a needlestick occurs in a busy unit or operating room, the worker places a phone call to report the incident. If HIV prophylaxis is warranted, the post-exposure prophylaxis is brought to the individual. "That's been an important and very effective innovation in post-exposure care that has resulted in improved reporting of injuries," she says. Ease of use of the occupational health system and good communication are crucial. "You have to make it simple, and you have to let people know it's there. The rapid HIV test also has helped drive better reporting."

Improved Data Collection

Regular data collection could provide a tremendous boon to the healthcare industry to help determine how to make further progress on this important issue. It was suggested that an organization such as the American Nurses Association consider conducting regular surveys about training, involvement in selection of devices and quality of devices, for example. "If you did it on an annual basis," said Daley, "you could begin to benchmark some of the quality indicators."

While regulatory agencies attempt to gather certain types of data - particularly about incidence - these efforts have been less than successful in many areas. Massachusetts is one of the states that has made significant strides.

"We're rather proud of the fact that we have 100 percent reporting by Massachusetts hospitals," said Laramie. She credits the establishment of a standard minimum data set as the key factor to success. It complies with federal and state regulations and helped create a surveillance system that is viewed as a model program for other states.

Conclusions

Reflecting on "The Inviro Initiative: Evaluating the State of Needlestick Prevention," Fisher summarized key findings as the need for more and better user-based safer devices, systematic frontline user evaluation and selection based on tasks to be performed, and training for all users of such devices.

Despite articulated needs, roundtable discussion participants said they have seen some progress. "We've penetrated the market to a greater degree with (safety) devices," said Daley. "It doesn't mean we've penetrated them with the best devices, and we don't know if we have better educated people. I think in certain places the culture has changed and that has been happening probably in bigger cities and hospitals."

It's been almost a decade since voices cried out in support of life-saving needlestick legislation and advocacy triumphed with the passing of federal law and OSHA directives.

So what's needed next? Continued product development and a resurgence of dialog to reestablish needlestick prevention as a priority, critical issue.

SOURCE: Inviro Medical