JCAHO Sentinel Event Alert: Issue 22, Augustt 2001
Preventing needlestick and sharps injuries
The risk of injury from needles and sharps, including disposable needles, over-the-needle catheters, suture needles, lancets and scalpels, continues to expose health care workers to serious and potentially fatal infections from blood borne pathogens such as hepatitis B, hepatitis C, or human immunodeficiency virus (HIV). "Though most organizations believe they are doing what is necessary to prevent injuries, needlestick and sharps injuries continue to occur," says Nancy Quick, CSP, CIH, compliance assistance specialist, Occupational Safety and Health Administration (OSHA). "And, though cost is often cited as a factor for not using safer devices, it is actually a savings when you consider the cost of treating the individual once an injury occurs."1
This issue of Sentinel Event Alert is devoted to increasing organizational understanding of needlestick and sharps injuries and presenting suggestions for preventing their occurrence, as well as advising organizations of the new requirements adopted in the Needlestick Safety and Prevention Act passed unanimously by Congress and signed into law on November 6, 2000.
Risks and causes
While precise numbers are not available, the Centers for Disease Control and Prevention estimates that each year, health care workers sustain more than 600,000 injuries involving contaminated needles or sharps, and approximately one-half of these injuries go unreported. While most needlestick injuries involve nursing staff, other health care workers also sustain injuries. Fortunately, injuries involving patients are less frequent. The Joint Commission's sentinel event database includes two cases--one involving an infant and one a child. Techniques that are used to protect health care workers from needlestick- and sharps-related injuries can also protect patients.
The risk of infection from a contaminated needlestick or sharp is dependent upon the pathogen involved, the severity of the injury, and the availability and use of appropriate prophylactic treatment. Hollow-bore needles-primarily hypodermic needles attached to disposable syringes and winged-steel or butterfly-type needles-are the cause of the majority of reported injuries. Injuries can occur while manipulating the needle in the patient, handling or passing the device after it has been used, recapping the instrument, and transferring a body fluid between containers, or from improper disposal or during clean-up following a procedure.
All health care organizations should have a needlestick prevention program in place as part of their compliance with the existing blood borne pathogen standard established in 1991 by OSHA that requires organizations to use safety-engineered sharps and needleless systems when possible. In addition, in its Preventing Needlestick Injuries in Health Care Settings publication2, the National Institute for Occupational Safety and Health outlines a number of strategies to help prevent needlestick and sharps injuries:
*Eliminate the use of needles when safe and effective alternatives are available.
*Implement the use of devices with safety features and evaluate their use to determine which are most effective and acceptable.
*Analyze needlestick- and sharps-related injuries in your workplace to identify hazards and injury trends.
*Set priorities and strategies for prevention by examining local and national information about risk factors for needlestick injuries and successful intervention efforts.
*Ensure that health care workers are properly trained in the safe use and disposal of needles and sharps.
*Modify work practices that pose a needlestick injury hazard to make them safer.
*Establish procedures for and encourage the reporting and timely follow-up of all needlestick and other sharps-related injuries.
*Evaluate the effectiveness of prevention efforts and provide feedback on performance.
*Encourage health care workers to report any hazards from needles they observe in their work environment and to participate in blood borne pathogen training and follow recommended injury prevention practices, including getting a hepatitis B vaccination.
The Needlestick Safety and Prevention Act
As part of the Needlestick Safety and Prevention Act passed into law in November 2000, new provisions of the blood borne pathogens standard took effect July 17, 2001. The revised provision specifies the types of engineering controls, such as safer medical devices, in the health care setting and adds new requirements for employers. Employers must:
*Review their exposure control plans annually to reflect changes in technology that will help eliminate or reduce exposure to blood borne pathogens.
*Involve non-managerial workers in evaluating and selecting safety engineered devices.
*Maintain a sharps injury log that ensures employee privacy and contains, at a minimum, the type and brand of device involved in the incident, if known; the location of the incident; and a description of the incident.
The Joint Commission requires compliance with "applicable law and regulation" standards in the Governance (GO.2.4) and the Management (MA.2) chapters. In April 2002, JCAHO will begin assessing organizational compliance with the new provisions of the Needlestick Safety and Prevention Act. Accredited health care organizations will find applicable standards in the Environment of Care chapter, the Surveillance, Prevention and Control of Infection chapter, the Care of Patients chapter (TX.3 set of standards - Medication Use), and the Leadership chapter (planning and provision of services, support of quality improvement; and patient, visitor, staff safety). Accredited health care organizations may obtain detailed information about the Needlestick Safety and Prevention Act from the OSHA Web site, referenced below.
1 Occupational Safety and Health Administration, www.osha-slc.gov/needlesticks.
2 Preventing Needlestick Injuries in Health Care Settings, National Institute for Occupational Safety and Health, U.S. Department of Health and Human Service, Public Health Service, Centers for Disease Control and Prevention; www.cdc.gov/niosh,
or by calling 1-800-35-NIOSH.
As chair of my home care agency's Safety Commitee,
we are working on this issue to select newer devices now. I urge that you copy this and distribute to all nurses and use to gain managements attention to improving workplace safety. Karen