Addressing the Sticking Point of Needle & Sharps Injuries

Hundreds of thousands of healthcare staff members are hurt every year by needlestick and sharps accidents. How can hospitals and nurses reduce risks? Two nurses share their strategies.

Despite it being nearly 20 years since the signing of the Needlestick Safety and Prevention Act (NSPA) into law, about 385,000 sharps-related injuries occur annually among healthcare workers in hospitals, according to the Centers for Disease Control and Prevention. Accidental needlesticks can expose clinicians to various diseases, such as HIV, hepatitis, diphtheria, herpes, malaria and tuberculosis. Nurses who handle dirty linens and waste containers are at particular risk of these injuries and are encouraged to advocate for the institution of safety measures in workplaces where there is occupational exposure to blood or other potentially infectious materials, as expressed by the NSPA. Even when safety measures are instituted, nurses can never be too careful about taking precautions on a daily basis, say nurses who recently spoke with ADVANCE.

Cindy Rothenberger, DNP, RN, ACNS-BC, an assistant professor of nursing at Alvernia University in Reading, PA, warns nurses in particular about the potential to become lackadaisical about needle handling and disposal to the point that poor habits develop.

“When nurses are busy, they tend to use ‘workarounds’ to get tasks done,” said Rothenberger, who also serves as chairperson on the clinical practice committee for the Academy of Medical-Surgical Nurses, a specialty nursing organization based in Pittman, NJ, that promotes excellence in med/surg nursing through goals focused on workplace advocacy, evidence-based practice, professional development, and organizational health. According to Rothenberger, typical workarounds include not engaging the needle shield or safety device while taping a catheter in place following the initiating of an IV, laying a syringe on a bedside table after administering an injection (and moving on to another task) and/or placing a syringe into a sharps box that is too full. When conducting such duties, Rothenberger urges nurses to remember that “the needle shield should be engaged immediately after an IV is started, that syringes should always be placed immediately into a sharps container following an injection, and that the sharps box should be inspected to ensure that it isn’t more than three-fourths full before disposing of a syringe.”

Other suggestions that Rothenberger offers include not recapping needles when using a syringe or starting an IV; not skipping over the use of personal protective equipment or safety devices supplied by the hospital (even if the nurse’s instinct is that the protective equipment or safety device may take longer to use or make tasks harder to complete); and not preparing syringes in an area that is crowded, noisy, and/or potentially contaminated.

“When nurses are using a syringe or starting an IV, they should use all of the appropriate safety devices available to them, stop what they are doing if they feel rushed or distracted, focus on one task at a time, activate the safety device immediately after using the syringe and put the syringe in the sharps container immediately while being sure to keep their fingers out of the opening to the sharps container,” she added.

Of course, accidents can and will happen despite even the best of preparations and safety protocol. Should nurses be involved in a needlestick, they need to remember that at that point it’s necessary to report the occurrence to their supervisors not only for the sake of prudence, but to ensure that any skin breaks are cleaned and treated appropriately and to minimize ongoing health risks for the nurse and others in the facility space.

“[All nurses] should be aware of the policy for reporting a needlestick injury, and reporting an injury immediately ensures that the nurse receives prompt and complete follow up to prevent an infectious disease,” Rothenberger said. “Reporting the injury also ensures that the hospital is able to track trends in needlestick injuries. The hospital should have a process in place for root cause analysis so that factors that may have contributed to the injury can be identified and reduced. This helps to prevent future injuries.”

At Natchitoches (LA) Regional Medical Center, Jami Bryant, RN, CWCA, infection control and wound care coordinator, said that needlestick injury protocol and occurrence rates are reviewed and evaluated annually in compliance with standards for blood-borne pathogens established by the U.S. Department of Labor’s Occupational Safety and Health Administration.

“Based on any trends, we will trial new products with safety features, such as retractable needles, blunt sutures and needles with sheaths, and we look at all types of needles in these assessments, including blood collection, injection, IV systems and surgical [needles],” she said.

Examples of safety products available to nurses at the medical center, a 100-bed facility that’s affiliated with affiliated with CHRISTUS Health, Irving, TX, include needleless IV systems, safety needles and prefilled syringes, Bryant said.

Ongoing education of needlestick safety is also a common theme for best practices and injury prevention, according to both Rothenberger and Bryant, for newly licensed nurses and experienced nurses alike.

“Nurses may think that going to an in-service education program about needlestick injury prevention is not necessary, but research indicates that participating in education about prevention strategies and the use of safety devices is effective in decreasing needlestick injuries in hospitals,” Rothenberger said. “The education should be done annually, and should include practicing with the devices and personal protective equipment.”

Bryant said that computer-based needlestick training occurs at her facility yearly as well as when new products are brought into the facility, which also typically leads to representatives from respective companies offering product-specific education. Additionally, needlestick safety is a component of any new employee’s orientation instruction, Bryant said.

“We also host a skills fair annually, where we have some educational materials available with examples of safety devices,” Bryant added. “Our policies are also specific on what types of procedures require safety devices, such as accessing a vein or artery, blood withdrawals and administration of medications or fluids. We have also recently made a more robust clinical-orientation process where a ‘subject matter expert’ teaches their particular subject, including the topic of needlestick safety.”

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