The Life You Save May Be Your Own or Your Coworker's

Julie Reyes, DNP, RN

The infant was fretful and screaming after she gave him his injection. Since she did not bring the portable sharps container to the isolette, she quickly recapped the used syringe, and in her haste, she poked her finger with the needle. She grabbed some gauze and wrapped her finger before she bundled him up tightly to soothe his agitation. Born to an addicted mother, the baby was constantly irritable and had tremors - swaddling him seemed to comfort him some. The nurse, however, will not find comfort so easily.

As a transport RN, he was doing his morning check off in the ambulance. He saw the sharps container needed to be changed out and when he went to grab the container, he was poked with a dirty sharps. Whoever put in the last syringe did not dispose of it properly and the needle was sticking out of the top.

She was deaccessing a mediport without assistance from another coworker to help hold the child still. The child hit her hand and she stabbed herself with the needle.

He was disposing of the biohazard waste. During a code, someone had thrown sharps into the biohazard bin. As the bin was emptied, a needle poked through the box and stabbed his hand.

The surgeon dropped the sharps during handoff, slicing the first assistant's finger. An anesthesiologist left an ART line induction needle on the bed and an OR tech was stabbed by the needle while transferring the patient to the stretcher.

The horror stories are miles long. The lives of those who are on the receiving end of a sharps injury are now at risk for life-threatening health problems. Hepatitis C, Hepatitis B, and HIV are a very real result of a sharps injury that could absolutely have been prevented. The CDC estimates an average between 600,000 to 800,000 needle sticks (NS) occur annually (roughly 1/2 of all NS injuries go unreported). The statistics for contracting an infection are also staggering:

The CDC reports:

1 in 300 injuries from NS will result in HIV infection
5.4 in 300 will result in Hep C infection
69 - 186 out of 300 will result in Hep B infection

Unfortunately, the numbers in these statistics will place nurses at a higher risk than other health care employees. Nurses are by far the highest risk group!

Here are the collected stats for the highest risk groups from the CDC:

Nurses (44%)
Residents (10%)
Physicians (9%)
Housekeeping (5%)
Students (2%)

Sharps, NS injuries, and bloodborne exposures are all mandated reportable injuries to OSHA each year. Hospitals and clinics can be fined hundreds of thousands of dollars for violations for failing to protect staff for injuries related to sharps or needlesticks. In fact, did you know that OSHA has a Needlestick Safety and Prevention Act?

This act (in summary) requires certain employers to:

Have an exposure control plan that is reviewed and updated as needed to reflect changes in technology, etc., as well as document consideration and implementation of appropriate commercially available and effective safer medical devices;
Maintain a sharps injury log that includes incident information (i.e., the type and brand of device used, where the injury occurred, and an explanation of the incident); and
Encourage injured health care workers input on engineering and work practice controls
Requires such modifications of the standard to:

be in force until superseded by regulations promulgated by the Secretary of Labor under OSHA; and
take effect without regard to specified procedural requirements.

So, how can you make a difference at your job to decrease the incidence of bloodborne exposures, sharps and needlestick injuries?

Let's start with the basics:

Protect yourself, your coworkers, and your patients!

Whenever possible, use sharps with safety features
Wash your hands at least 15 seconds before and after you care for your patient
Always wear gloves if blood or body fluids are present
Use gowns and face and eye protection
Always properly dispose of sharps in the proper container

Additional resources and information:

The CDC has created a Stop Sticks Campaign you might want to implement at your place of employment. The goal is to reduce sharps injuries and help organizations create a culture of safety. To find more information on this campaign that you can customize to the needs of your place of employment, visit CDC - Stop Sticks - NIOSH.

Now, ask yourself ...

As a nurse or student nurse, what are your thoughts on sharps safety?
Were you aware of the statistics listed above?
Were you aware of the infection risks from a sharps/NS injury?
What have you seen at your place of employment that would be an example of a safety of culture or a lack of safety?
What do you think would improve practice at your place of employment?
Do you have any stories (good or bad) to share?

Remember, this life you save may be your own!

References

Bloodborne pathogens. - 1910.1030 | Occupational Safety and Health Administration

Summary of H.R. 5178 (16th): Needlestick Safety and Prevention Act - GovTrack.us

CDC - Stop Sticks - NIOSH