Over the past decade, needlestick safety has become de rigueur, but according to a new study, nurses are often exposed to blood in their mucus membranes in another way: by inserting a peripheral IV catheter. In addition, most nurses aren't reporting such incidents when they occur.
The study, by the International Healthcare Worker Safety Center at the University of Virginia, finds that half of nurses experience blood exposure on their skin or in their eyes, nose, or mouth at least once a month when inserting a peripheral IV catheter.
Despite the prevalence of such exposure, most of these incidents go unreported. In fact, 69% of the mucus membrane exposures in the study weren't reported. Most nurses—nearly nine in 10—who didn't report the incident said they didn't think the exposure was significant enough to report.
More than a third said they were too busy to report them, and 9% said they were worried about what other people would think.
Janine Jagger, Ph.D., MPH, lead author of the study and director of the International Healthcare Workers Safety Center at UVA, says she was surprised by not only the frequency of blood exposure during both insertion and removal of IV catheters, but that the risk of exposure was about equal during both insertion and removal.
"We just don't talk about removal and the possibility of blood exposure then," she tells HealthLeaders.
She also highlights the finding that eye exposure was among the most frequent types of exposures, so wearing protective eyewear should become standard practice, during both insertion and removal.
"You don't need a large quantity to be an at-risk blood exposure. If one drop of blood goes into the eye that's a serious exposure," she says. "The quantities of blood are small but if you hit the right target, the risk is very real."
Whenever I read a study like this one, I not only want to hear about the findings; I also wonder how nurse leaders can use the information to make their departments safer.
Co-author Jane Perry, MA, associate director of the International Healthcare Workers Safety Center at UVA, weighs in via email:
HLM: What should nurse leaders do with this information?
Perry: They should make sure they are aware of the on-the-ground realities for nurses performing this procedure in their facility on a daily basis. Are there issues or problems they encounter? Any specific issues with the devices used for this procedure? Are there ways to minimize or eliminate such issues?
OSHA requires that employers reevaluate the institutional exposure control plan on an annual basis and look at new technology available that may offer superior protection from sharps injuries and blood exposures. Since placement of IV catheters is one of the higher-risk procedures for blood-borne pathogen transmission, nurse leaders should be particularly vigilant about addressing problems in this area as they arise.
They should be sure to seek input from frontline workers when selecting safety IV catheters, and get their feedback in evaluating device performance.
HLM: Are there steps/policies nurse leaders can put into place based in these findings?
Perry: One area the findings point to where better training, and perhaps more explicit policies, are needed is use of eye protection when performing I.V. catheter procedures. Eye and face protection should always be worn—eye glasses are not enough.
In related news, the American Nurses Association and the Healthcare Workers Safety Center at UVA issued "A Consensus Statement and Call to Action," which calls for further progress on the Needlestick Safety and Protection Act (NSPA). It was endorsed by 19 organizations and calls for:
- Improving sharps safety in surgical settings
- Reducing exposure risk in non-hospital healthcare environments
- Involving healthcare workers in safety device selection
- Improving the range and design of available safety devices
- Enhancing worker education and training
Alexandra Wilson Pecci is an editor for HealthLeaders.
