Next generation of sharps safety

by Charlotte Guglielmi, RN, BSN, MA, CNOR

Nurses and healthcare providers across the country recently celebrated the 10-year anniversary of the Needlestick Safety and Prevention Act (NSPA). The Act, which requires employers to track sharps injuries and to provide safer sharps devices, including self-covering needles, was designed to protect the well-being of healthcare workers who routinely face danger from potentially contaminated sharps. The anniversary presents a good reminder to further review and possibly revise strategies and practices that can reduce the risk of accidental needlestick in all hospital settings, especially in the OR.

The signing of the NSPA did drive many efforts to reduce the risk of accidental needlesticks. And the efforts, supported by many hospitals, regulatory organizations, regional and national professional and trade associations in healthcare, and individual champions of sharps safety, have led to some positive results. Over the past decade the incidence of accidental sticks in non-OR hospital settings in the United States decreased by 31.6 percent.¹ These results, published in the April issue of the Journal of the American College of Surgeons (JACS) prove that products and strategies that are designed to reduce the risk of accidental stick, when properly applied and maintained, work.

The statistics related to accidental sticks in the OR are not as encouraging. According to the study, in the decade following the signing of the NSPA, sharps injuries in surgical settings actually increased by 6.5 percent.² These findings indicate that safety policies in many hospital operating rooms are not being adhered to or possibly are not enforced and, as a result, the surgical team members and their patients remain at risk for injury and the possible contraction of serious viruses or diseases. The report in JACS provides substantial support for stronger efforts to develop and monitor improved OR safety standards.

Understanding and Improving Sharps Safety

While efforts to address this issue are underway in many facilities on an independent basis, there are several states that are also working to understand and improve sharps safety by conducting their own research and by establishing either hospital based, or regional standards and guidelines. For example, the Massachusetts Department of Public Health recently launched the “Occupational Health Surveillance Program.” This program found that 32 percent of sharps injuries in Massachusetts hospitals occurred in the operating room. Based on these findings, as a next stage in this effort many Massachusetts hospitals are considering a range of options to improve OR safety with an emphasis on building awareness of the risks and the evidence-based solutions.

Many healthcare advocacy organizations are also involved. The Council on Surgical and Perioperative Safety (CSPS), a coalition of seven societies that make up the surgical team,³ has developed a set of Safe Surgery Principles, including the recommended use of established measures to prevent injury during perioperative care. Recommendations included readily achievable goals such as double-gloving, use of blunt suture needles for fascia closure, and establishment of a neutral zone to limit hand to hand passing of sharps instruments.⁴

At the Association of PeriOperative Registered Nurses (AORN), prevention of sharps injuries is a top-priority in its safety education efforts for the OR professional. AORN recently invited leaders from different OR disciplines to discuss why the neutral zone is not used, double gloving is not utilized, and needlestick injuries remain vastly underreported. Their expert opinions, published in the October, 2010 issue of AORN Journal, included a range of specific actions that OR teams can consider right now to improve sharps safety. Among the recommendations, OR safety experts strongly endorse expanded use of available safety devices and techniques, proactive and ongoing education for all members of the perioperative OR team, improved reporting, and broader awareness of sharps risks and safer sharps practices in the OR. The authors also consistently highlight the critical need for OR safety programs to involve the entire surgical team and the support of senior hospital management.

Improving Best Practices

These leaders have continued their work as a task force collaborating with AORN in the development of a Sharps Safety Tool Kit, due for release in March. The tool kit will include educational tools and guidelines for ORs to achieve target goals in sharps safety. The kit will also include data on the costs associated with the treatment of healthcare workers who sustain an injury from a needlestick.

The AORN Sharps Safety Tool Kit will provide templates for surgical teams to use to test new products designed to reduce the risk of accidental sticks, including safety scalpels and blunt suture needles. OR teams will be better able to review and assess products and procedures that can reduce sharps risks, and can then be positioned to present a case in support of new strategies based on the findings. The educational materials in the kit are also designed to encourage teamwork and interdisciplinary action to improve OR safety by engaging all members of the OR team. Other resources in the kit include examples of sharps policies and guidelines for clinical educators to use when doing evaluations.

In addition to information and best practice guidelines, efforts to develop an effective safety program in the OR also require that facilities be prepared to dedicate the time and resources necessary to assess risks and to review how sharps injuries are occurring. Facilities need to understand fully who is sustaining the majority of sharps injuries and how and when these events occur. They also need to establish a sharps safety program that recognizes and incorporates proven effective advances in technology and procedures. Strategies to support these efforts at different hospitals might include establishing a separate committee to evaluate safety products or developing and implementing new safety training for perioperative team members.  This process must also include educating more practioners about the consequences of needlestick injuries with an accurate assessment of the risk of exposure to bloodborne illnesses.

Another key consideration is more accurate reporting of sharps injuries. Available data suggests that needlestick injuries are widely underreported. To improve safety many hospitals must also work to evaluate the reporting system for accidental sticks. For many busy and pressured hospital workers, sharps’ reporting is often considered an unacceptable time burden. As a result, they decline to report an incident following established procedures. To address this issue, some hospitals have successfully streamlined and simplified reporting procedures designed to make the process easier. This often includes establishing a 24/7 reporting mechanism and limiting the necessary paperwork.

Increasing Focus

Any effort to improve standards in OR sharps safety requires the active support and collaboration of all members of the perioperative team. While it is important to recognize that the majority of accidental sticks in the OR affect nurses, all team members are at risk and are in a position to improve safety. Many professional societies are also positioned to work together to help establish a platform of sharps safety that can be tailored to meet the needs of each OR team member, and new safety products have been engineered that are clinically relevant to each member.

Advances in technology are also now clearly positioned to play a role in success. Safety devices such as blunt suture needles and safety scalpels have recently been engineered to provide improved safety while meeting or exceeding established standards in performance. Blunt point suture needles are now able to penetrate muscle and fascia effectively while reducing the risk of accidental needlestick.⁵ The use of these needles has been shown to reduce the risk of needlesticks by 30 percent.⁶ Advances in product engineering are helping OR teams, especially surgeons, to overcome perceptions that products designed to reduce the risk of needlestick require substantial modifications in surgical technique.

As hospitals continue to work to identify strategies to reduce the risk at the local level, the issue of accidental needlesticks in the OR promises to be an increasingly important focus in healthcare in the years ahead. Earlier in 2010, the International Healthcare Worker Safety Center sponsored a meeting of leaders from healthcare and industry to outline strategies for success in sharps safety. The meeting, entitled “Tenth Anniversary of the Needlestick Safety and Prevention Act: Mapping Progress, Charting a Future Path,” included updates and presentations from a diverse range of OR safety experts including John Howard, MD, MPH, JD, LLM, Janine Jagger, MPH,PhD, Ramon Berguer, MD, FACS, Mark Davis, MD, Gina Pugliese, RN, MS, and many others.

The fact that sharps injuries in the operating room can affect patient and healthcare worker safety is well established. Data related to cost of care for workers affected by sharps injuries indicates that preventative measures can represent a workable and cost-effective strategy to help hospitals improve safety, reduce infection rates, and reduce costs. According to available data, the cost of treatment to manage exposure from a needlestick injury ranges from $71 to $5,000.⁷ OR teams should recognize that they have access to products and procedures that are proved to reduce risks, backed by significant data on sharps injuries in the OR and the support and active efforts of many professional societies working to promote education and awareness.

References

1. Jagger, J, Berguer, R, Kornblatt Phillips, E, et al. Increase in Sharps Injuries in Surgical Settings Versus Nonsurgical Settings after Passage of National Needlestick Legislation. Journal of the American College of Surgeons. Volume 201, Issue 4, Pages 496-502 (April 2010).
2. Jagger, J, Berguer, R, Kornblatt Phillips, E, et al. Increase in Sharps Injuries in Surgical Settings Versus Nonsurgical Settings after Passage of National Needlestick Legislation. Journal of the American College of Surgeons. Volume 201, Issue 4, Pages 496-502 (April 2010).
3. Council on Surgical & Perioperative Safety. http://cspsteam.org/. Accessed November, 24, 2010.
4. SPS Safe Surgery Principles: Sharps Safety #5. Council on Surgical & Perioperative Safety. http://cspsteam.org/sharrpssafety/sharpssafety.html. Accessed November 27, 2010.
5. Perry, J. Safety scalpels and sutures have come a long way: Safety-engineering devices feel better, cut better- and still reduce injury and infection in the OR. Outpatient Surgery Magazine. May 2009.
6. Jagger J, Bently M, Tereskerz P. A study of patterns and prevention of blood exposures in OR personnel. AORN J 1998; 67: 979-990.
7. O’Malley, EM “Costs of Management of Occupational Exposures to Blood and Bodily Fluids,” Infect Control Hosp Epidemiol 2007; 28: 774-482.

Charlotte Guglielmi, RN, BSN, MA, CNOR, and AORN president, is the perioperative nurse specialist at the Beth Israel Deaconess Medical Center in Boston, where she has been a perioperative nurse for 34 years. She received her diploma in nursing from Quincy City Hospital School of Nursing, Quincy, Mass., her BSN from the University of Massachusetts, Boston and a MA in Ministry from St. John’s Seminary, Brighton, Mass. Ms. Guglielmi has published several articles and book chapters and has given multiple presentations on the local, regional, and national levels. She is the AORN representative to the American College of Surgeons Committee on High Performance Teams and the Council for Surgical and Perioperative Safety. She was the 2001 recipient of the AORN Award for Outstanding Achievement in Perioperative Clinical Practice.