10 Preventing Needlesticks and Other Sharps Injuries… Everything You Need to Know.pdf

10 Preventing Needlesticks and Other Sharps Injuries… Everything You Need to Know

1. Preventing Needlesticks
and Other Sharps
Injuries…
Everything You Need to Know

2. Risks of Seroconversion due to Sharps Injury
from a known positive source
Virus
HBV
Risk (Range)
6-30%*HBV
HCV
HIV
6-30%*
~ 2%
0.3%
(*Risk for HBV applies if not HB vaccinated)

3. What is the Risk for HIV Alone?
•Percutaneous 0.3%
•Mucous membrane 0.1%•Mucous membrane 0.1%
•Non-intact skin <0.1%

4. Occupational HIV Transmission among U.S.
Healthcare Personnel, 1985-2004
•57 documented cases
–i.e., HIV negative at time of exposure and
became HIV positive during follow-up period
•137 other cases
–i.e., No documented exposure and no
known risk factor for HIV infection

5. Occupational HIV Transmission
Documented Cases (n=57)
•50 (88%) involved percutaneous exposures
45 caused by hollow-bore needles, half of
which were used in a vein or arterywhich were used in a vein or artery•5 mucocutaneous exposures
•2 exposure route unknown

6. Preventing
Sharps Injuries Sharps Injuries
is Our Goal!

7. How Do Sharps Injuries Happen?
•Who gets injured?
•Where do they happen?
•When do injuries occur?
•What devices are involved?
•How can they be prevented?

8. WhoGets Injured?
Student
4%
Dental
1%
Housekeeping/
Maintenance
3%
Clerical /
Admin
1%
Other
5%
Occupational Groups
of Healthcare
Personnel Exposed to
Nurse
43%
Technician
15%
Physician
28%
Personnel Exposed to
Blood/Body Fluids,
NaSH June 1995—
December 2003
(n=23,197)

9. WhereDo Sharps Injuries Occur?
•Patient Room 39%
(Inpatient: Medical –ICUs )
•Operating Room 27%
•Outpatient 8%
•ER 8%
•Laboratory 5%
•Other 13%
Source: NaSH, June 1995—December 2003

10. WhenDo Sharps Injuries Occur?
•During use 41%
•After use/before disposal40%
•During and after disposal15%•During and after disposal15%
•Other 4%
Source: NaSH, June 1995—December 2003

11. WhatDevices are Involved in Sharps Injuries?
Six Devices Account for 78% of All Injuries
•Disposable Syringes 30%
•Suture Needles 20%
•Winged-Steel Needles 12%
•Intravenous Catheter Stylets 5%
•Phlebotomy Needles 3%
•Scalpels 8%
Source: NaSH, June 1995—December 2003

12. 15
20
25
30
35
40
Devices that Require Manipulation after Use
are Associated with an Increased Rate of Injury
0
5
10
15
Disposable
Syringe
Cartridge
Syringe
ButterflyIV StyletPhlebotomy
Needle
IV Tubing
Needle
Percentage of injuriesRate/100K devices purchased
Jagger, et al. Rates of needle-stick injury caused by various devices in a university hospital.
NEJM. 1988;319.

13. HowDo Injuries Occur With Hollow-Bore Needles?
During Sharps
Disposal
13%
Access IV Line
5%
Transfer/Process
Specimens
5%
Other
5%
Circumstances Associated with Hollow-Bore Needle
Injuries NaSH June 1995—December 2003 (n=10,239)
During Clean Up
9%
In Transit to
Disposal
4%
Handle/Pass
Equipment
6%
Improper
Disposal
9%
5%
Recap Needle
6%
Collision
W/Worker or
Sharp
10%
Manipulate
Needle in Patient
28%
Disposal
Related:
35%

14. Sharps Injuries Are Preventable
Undetermined
18%
Preventability of Needlesticks in 78 NaSH Hospitals,
June 1995--December 2004 (n=11,625)
Preventable
64%
Nonpreventabl
e
18%

15. What are Strategies to Eliminate Sharps Injuries?
•Eliminate or reduce the use of needles and
other sharps
•Use devices with safety features to isolate •Use devices with safety features to isolate
sharps
•Use safer practices to minimize risk for
remaining hazards

18. Eliminate or Reduce
Unnecessary Needle Use
First Strategy:
Unnecessary Needle Use

19. How Can Needle Use Be Eliminated or Reduced?
•Use needle-free IV delivery systems
•Use alternate routes for medication delivery
and specimen collection when available and and specimen collection when available and
safe for patient care
•Streamline specimen collection systems
•Other ideas?

20. Use aseptic technique when
handling these systems!!!
Needle-Free IV Delivery Systems

21. Use Devices with Safety Features
Engineered to Prevent Sharps
Next Strategy:
Engineered to Prevent Sharps
Injuries

22. Safer Sharps Devices Engineered to
Prevent Sharps Injuries

23. Use Devices with Engineered
Sharps Injury Protection
•Hypodermic Needles
•Phlebotomy Needles
•IV Catheters
•Lancets
•Scalpels
•Suture Needles•IV Catheters
•Winged-Steel Needles
•IV Delivery Systems
•Suture Needles
•Hemodialysis Needles

24. Safety Devices: Key Features
•Are integrated into the device
•Provide immediate protection after use
and throughout disposaland throughout disposal
–Few devices provide protection during use
•Keep the worker’s hands from having to
move in front of sharps

25. Safety Devices: Key Concepts
•Most safety features are not passive
–The user must activate the safety mechanism to ensure
protection
•It is not always obvious how some safety •It is not always obvious how some safety
features work
–Training is necessary
•Safe work practices are important
–Safety devices alone do not completely prevent injuries

26. Sharps Disposal Containers

28. Preventability of Needlesticks in NaSH Hospitals, June
1995—December 2003 (n=10,661)
Safer Needle
Device Available,
Unnecessary
Needle Use, 15%
Undetermined,18%
Improper Disposal,
9%
Other, 1%
Unsafe Work
Practice, 7%
Improper Safety
Device Activation,
6%
Device Available,
26%
Nonpreventable,
18%
Preventable, 64%

29. Injuries Related to Work Practices
•Injuries occur because of the following:
–Passing or transferring equipment
–Recapping contaminated needles
–Colliding with coworkers
–Decontaminating/processing used equipment–Decontaminating/processing used equipment
•Injuries occur from sharps left in unusual places:
–Laundry
–Mattresses
–Tables, trays, or other surfaces

30. The Sharps Safety Continuum
•Prepare to use the device the moment the
sharps are first exposed
•Take precautions while using sharps•Take precautions while using sharps
•Take precautions during cleanup
•Take precautions during disposal

31. Sharps Safety Practices
•Be prepared
•Be aware•Be aware
•Dispose with care

32. •Organize equipment at the point of use
Before Beginning a Procedure
Be Prepared
•Organize equipment at the point of use
•Make sure work space has adequate lighting
•Keep sharps pointed away from the user

33. •Locate a sharps disposal container, or have
one nearby
Before Beginning a Procedure (cont’d)
Be Prepared
one nearby
•Assess the patient’s ability to cooperate
•Get help if necessary
•Ask the patient to avoid sudden movement

34. Be Aware
•Maintain visual contact with sharps during use
During a Procedure
•Be aware of staff nearby
•Control the location of sharps to avoid injury to
yourself and others

35. During a Procedure (cont’d)
•Do not handpass exposed sharps from one
person to another
Be Aware
person to another
•Use predetermined neutral zone for
placing/retrieving sharps
•Alert others when sharps are being passed

36. During a Procedure (cont’d)
•Activate safety feature of devices with
Be Aware
•Activate safety feature of devices with
engineered sharps injury prevention features
as soon as procedure is completed
•Observe audible or visual cues that confirm the
feature is locked in place

37. Clean Up and Dispose with Care
•Be accountable for sharps you use
•Check procedure trays, waste materials, and
During Cleanup
•Check procedure trays, waste materials, and
bedding for exposed sharps before handling
•Look for sharps/equipment left behind
inadvertently

38. Clean Up and Dispose With Care
•Transport reusable sharps in a closed
During Cleanup (cont’d)
•Transport reusable sharps in a closed
container
•Secure the container to prevent spillage

39. Clean Up and Dispose With Care
•Inspect container
While Disposing of Sharps
•Keep hands behind sharps
•Never put hands or fingers into sharps
container

40. •If you are disposing sharps with attached tubing
Clean Up and Dispose With Care
While disposing of Sharps (cont’d)
–Be aware that tubing attached to sharps can recoil and
lead to injury
–Maintain control of both tubing and the device during
disposal

41. Clean Up and Dispose With Care
•Visually inspect sharps container for overfilling
After Disposing of Sharps
•Replace containers before they become overfilled
•Keep filled containers for disposal in a secure area

42. •Handle carefully
Clean Up and Dispose With Care
If You Find Improperly Disposed Sharps in
Work Environment
•Handle carefully
–Keep hands behind sharps at all times
–Use mechanical device if you cannot safely pick up sharps
by hand

43. Sharps Safety Practices
•Be prepared
•Be aware•Be aware
•Dispose with care

44. Sharps Injuries in the Operating Room
•Cuts/needlesticks occur in as many as 15% of
operations
–Risk increases with longer, more invasive, higher blood loss procedures
•Suture needle injuries are most frequent
–Fingers used to manipulate needles and tissue
•Up to 16% of injuries occur while passing sharps

45. Conclusion
Preventing Sharps Injuries
Your RoleYour Role

46. Youare Part of the Prevention
Process when You
•Adhere to safe practices and assist and support
coworkers in safer practices
•Report injuries or blood/body fluid exposures, sharps
injury hazards, and near missesinjury hazards, and near misses
•Participate in training for devices and properly use
sharps safety features
•Participate in surveys (e.g., safety culture) and device
evaluations

47. Always Handle Sharps With Care
Have a Safe Day!