Overview of Current Technology
Thousands of U.S. patents have been issued since 1984 for needles and other medical devices that incorporate injury prevention features. All major medical device companies in the United States have marketed devices with safety features as alternatives to conventional devices. It is estimated that 85 percent of injuries are preventable with currently available technology.
Safety devices shown to decrease risk
Devices with safety features have been shown in numerous studies to reduce the frequency of needlestick injuries, but for many reasons they do not completely eliminate it. In some cases, the safety feature cannot be activated until the needle is removed from the patient. Some healthcare workers may fail to activate the safety feature; users can bypass the safety feature; or the safety feature may fail. It is important to understand the factors that influence the safety of a device in order to plan effective needlestick prevention programs. Devices with safety features can reduce needlestick injuries when used in combination with a comprehensive prevention program.
Improvements in technology
Technology continues to emerge, and many of the sharps injury prevention devices have moved into second- or third-generation technology with continuous improvements in design and performance.
Safety device features 10 times more effective in preventing needlesticks
Knowledge of the most effective designs is important, both to guide the choice for users among available devices and to guide manufacturers in developing new safety technology. According to a recent study by Tosini conducted in 61 French hospitals, safety engineered devices that automatically or semi-automatically activate the safety feature were found to be 10 times more effective in preventing needlestick injuries, compared to fully manual devices requiring active engagement of the safety feature. This is one of the largest multi-center studies comparing one sharps safety device to another. Completely “passive safety devices” do not require any action by the user to engage a safety feature. One example of a passive device is the blunt-tipped suture needle which FDA, OSHA and NIOSH/CDC now recommend for suturing fascia and muscle tissue.
Use of safety devices has risen dramatically in past decade
There has been a dramatic rise in the use of safety devices compared to conventional (non-safety) devices to prevent needlesticks and other sharps-related injuries. According to industry estimates, from 1998 to 2009 the use of safety devices in all US healthcare settings has risen from: 10 percent to 97 percent for IV catheters; 10 percent to 85 percent for phlebotomy devices; and 28 percent to 80 percent for syringes and needles. Hospitals are reported to have a higher rate of conversion to all types of safety devices compared to non-hospital healthcare settings.
Conventional needles may still be needed
For syringes, the conversion rates to safety devices may never reach 100 percent because conventional syringes (non-safety) are still allowed to be purchased and used for procedures that do not result in contamination of the syringe or are not used on patients, e.g., used for sterile medication preparation in pharmacy or for injection into needleless access ports on intravenous lines. Some safety needles are not available in all sizes. It will be important to document those situations where conventional needles and devices may still be appropriate because there is no exposure to blood or other potentially infectious materials or where no alternative exists.
Time investment for product evaluation
Proper evaluation of these sharps injury prevention devices is an important part of the process. Numerous tools are available for conducting evaluations, educating staff on proper use, collecting and analyzing data on effectiveness, and implementing a device facility-wide in all applicable care delivery sites. Front-line workers need to be included in the identification, evaluation and selection of the safety devices. There is no formula for how many devices need to be evaluated or for what length of time. Each facility must determine this based on its own needs and the preferences of the workers.
Cost effectiveness of safety devices
The precise cost of needlestick injuries cannot be quantified in terms of dollars but represent pain and suffering for the worker and the potential for significant losses for an institution. The emotional trauma for the worker, family and friends following a needlestick injury can be devastating. Direct and indirect costs for the facility include post-exposure medical follow-up, lost worker time or replacement costs, disability, and OSHA citations and fines. The organization must also consider the negative impact the event can have on the morale of the workers.
The goal of implementing safety devices is to protect workers from exposure to bloodborne pathogens. It has been suggested that the cost of safety devices may be offset by a reduction in the direct costs associated with post-exposure medical follow-up and treatment of needlestick injuries. However, it is important to note that it remains extremely difficult to show direct cost savings.
Sharps waste reduction strategies
Sharps safety devices from Premier
Many safety devices designed to prevent sharps injuries — including syringes, phlebotomy devices, lancets, vascular access devices, suture needles, and sharps disposal containers — are available through Premier’s contracts with a wide variety of contracted suppliers. Additional information may be obtained at the website from Premier’s electronic catalog, available to Premier members with a password.
OSHA’s Bloodborne Pathogen Standard requires employers to solicit input from non-managerial, frontline workers responsible for direct patient care on the identification, evaluation and selection of effective engineering controls/devices to prevent sharps-related injuries, whether or not they are covered by a group purchasing contract.