A "culture of safety" is a central value in most healthcare institutions. One crucial piece is protecting employees from the risk of occupational exposures to bloodborne pathogens. Indeed, Occupational Safety and Health Administration (OSHA) requires that engineering and work practice controls be used to "eliminate or minimize employee exposure" to the "lowest feasible extent."
Ten years after passage of the Needlestick Safety and Prevention Act (NSPA), it is time to take stock. How is your institution doing to maintain "continuous quality improvement" when it comes to sharps safety?
In data collected by the University of Virginia's International Healthcare Worker Safety Center over the past two decades from a voluntary data-sharing network of hospitals, a significant drop in needlestick injury rates was observed one year after passage of the NSPA in 2000.
Since then, rates haven't changed very much.1 Such data underscore the need for ongoing efforts and a sustained focus in order to achieve further reductions in sharps injury and blood exposure rates.
For hospital administrators, evaluating the effectiveness of a sharps safety program should begin with an in-depth look at the institution's sharps injury data. In particular, you should review any clinical areas or procedures in which safety devices are not being used.
At this point, use of safety-engineered devices (SEDs) should be the standard throughout the institution; use of non-safety devices should be limited only to procedures for which a safety alternative is not available. OSHA requires that facilities document where and why non-safety devices are used in the institution's exposure control plan.
Problem areas or procedures can be identified using injury data and then root cause analyses to determine if the injuries were related to product design, device failure, user error, or another cause, such as sudden patient movement during a procedure.
This approach was used successfully in a performance improvement project at 537-bed Good Samaritan Hospital Medical Center in West Islip, NY. After an analysis of sharps injury data revealed that a disproportionate number of injuries sustained by phlebotomists involved a safety butterfly needle, a study was initiated that included one-on-one interviews with injured staff.