At Your Own Risk
This article appeared in the April issue of Surgical Products.
What is or isn’t acceptable risk is often a matter of opinion in today’s operating room.
Standards, policy, and practices are established to help define the line between acceptable and unacceptable risk.
However, poor decisions, mistakes and errors happen all the time. Sometimes the consequences are minimal. Other times, however, the price paid for practicing risky behavior is quite significant. This is a fact that always needs to be considered when looking at what is or isn’t acceptable risk when it comes to sharps safety.
“Occupational exposure to bloodborne pathogens from needle stick injuries and other sharp objectives remains a serious problem,” says Patty Taylor, a registered nurse and Vice President of Professional Education and Clinical Affairs for Ansell.
Since passage of the federal Needlestick Safety and Prevention Act of 2000 and the widespread use of safety devices, the sharps injury rate in non-surgical settings has fallen 31.6%; yet, in the same time period, the sharps injury rate has increased 6.5% in surgical settings, with reportedly infrequent use of safety devices, according to a study published in the Journal of the American College of Surgeons.
Sharps injuries occur everywhere in the healthcare environment. However, roughly a third take place in the operating room. In terms of the types of injuries that occur, almost half (43.4%) come from suture needles, says Taylor.
Why the rate of sharps injury continues to rise is not a simple question to answer. In fact, there is a litany of reasons as to why sharps safety continues to be a significant issue in medical facilities around the country.
First and foremost, it’s a problem of denial.
According to Taylor, the prevailing thought among surgeons and hospital staff is that everyone has his or her own way to deal with sharps based on level of comfort and familiarity. Many simply don’t take the occupational risk of dealing with sharps on a regular basis seriously, and it puts them, their colleagues, and their patients at risk.
Taylor also cites a 2008 study of 99 hospitals in Massachusetts that found staff members weren’t always using engineered safety devices even if they were available.
There are a number of viable solutions, strategies, and measures medical facilities and the employees who work there can take to lessen the risk of sharps-related injuries. Some, such as double-gloving and the implementation of blunt-tip suture needles, are obvious options. But that may not be enough.
“Double glove does give you one more barrier,” says Melissa Fischer, clinical specialist at Megadyne. “It’s one suggestion and one part of the total solution.”
Use of neutral zones or hands-free techniques for passing sharps items to eliminate hand-to-hand passing is one very effective technique that isn’t being put to practice nearly enough, says Taylor.
“That’s probably another great way to help reduce some of the injuries, because a lot of them happen because of where the sharp gets placed or because someone is in a hurry and reaches out to grab the sharp instead of the handle or end of the device,” says Fischer.
“It’s not forcing a product change,” she continues. “It’s not making surgeons or nurses use a device that they don’t feel comfortable using.”
Using verbal notifications when passing a sharp device is a simple and cost-free way to improve safety for those facilities that choose not to invest in engineered sharps injury prevention devices.
Enforcement Is Key
Fischer believes it is all a problem of enforcement – or lack thereof. It’s up to management to take the necessary steps to ensure safe sharps handling is taking place in their facility, and she offers one out-of-the-box solution for addressing the problem of enforcement.
“One of the most important things a department can do is bring together a multi-disciplinary team and have everyone handle a sharp, whether it’s a surgeon, scrub tech, or nurse,” says Fischer. “Make them the product selection committee, and have them being the ones who look at all the possibilities out there. If you have a team involved and you have people who are passionate or interested in that project, you are going to get a lot further down the line in terms of getting people to accept that. It’s coming from your peers, and not administration. Despite compliance regulations such as the Needlestick Safety and Prevention Act of 2000 and the 2002 OSHA Bloodborne Pathogen regulation, Taylor says there are many misconceptions out there related to sharps safety. Two of note are that implementing safety devices is expensive and healthcare providers have no input on the selection of these devices.
“By law, healthcare workers who are involved in direct patient care must be solicited for input on the identification, evaluation, and selection of the safest devices,” she says.
Taylor also adds that the cost of one non-infecting sharps exposure will run between $500 for a low-risk exposure and $3,000 for a high-risk exposure because of the reporting, medical testing, precautionary treatments and lost work hours that go along with that exposure. To make matters worse, she says, an infection could lead to costs of more than $30,000.
“The cost of one sharps injury alone can be persuasive enough to use safer sharps practices,” says Taylor.
Staff at medical facilities cannot afford to underestimate the risks and consequences of sharps injuries. The misguided attitudes and actions of some surgeons, nurses, and other hospital personnel as they relate to this critical patient and staff safety issue cannot be overlooked or accepted. Guidelines, whether they are broad or stringent, need to be enforced.
There has to be some flexibility within the departments and within the surgical team to develop a policy that either works best for certain surgical specialties or for that department,” says Fischer.
“But unless there’s a law, rule, fine, or something else behind it, the ball usually doesn’t get rolling,” she continues. “I hate to say it, but you almost have to push people to make a change. Someone has to give them a reason to change.”