Archive for: Needlesticks & Sharps Injuries
The following is an occasional series of guest blogs by experts in the medical clinic safety field. If you would like to be featured in this blog as a guest columnist, please email Managing Editor of Safety John Palmer at email@example.com.
In some laboratories, the use of Personal Protective Equipment (PPE) may be confusing to staff. However, a look at OSHA’s Bloodborne Pathogens and Chemical Hygiene Standards should make clear the requirements for proper PPE selection and use.
Both standards speak clearly to the necessity of PPE when working in the laboratory. Different PPE is needed for different tasks. Lab coats are always necessary in the lab for protection against blood and body fluid splashes or chemical splashes. Plastic aprons may also be used as extra protection in areas where gross tissue work is performed. Lab coats should be buttoned, the sleeves should not be rolled up, and they should be knee-length.
Gloves are needed when handling blood, body fluids, or chemicals, but different gloves may be used for different tasks. Many labs are turning away from using latex gloves because of allergic reactions by staff. Nitrile gloves have become the norm in recent years. However, make sure you have the correct gloves for the duties being performed. Some manufacturers make nitrile gloves that act as a barrier against blood and body fluids, but they do not provide protection against chemicals. While these will be fine while running a CBC in hematology, they won’t provide enough protection when changing the stainer. Be sure to use chemical-resistant gloves for this and other tasks (gram stains, handling chemistry reagents, pouring acids, etc.). Check the package if you are not sure about the proper use of gloves.
Goggles or face protection is important PPE that is widely under-utilized. Do you carry open specimens in the lab? What about carrying a rack of specimen tubes to or from an analyzer? That is a task that creates a risk for exposure, and face protection should be used. Are you pouring a chemical? Protection is necessary. Help your staff avoid all exposures to the eyes or mucous membranes.
The OSHA standards mentioned above also require that PPE is removed before leaving the laboratory. Do not wear lab coats or gloves to another location outside the laboratory. Does a procedure need to be performed in another area that requires PPE? If so, bring fresh PPE with you for use in the treatment area and dispose of it before returning to the lab.
In a laboratory, all areas should be considered hazardous, bio-hazardous, or contaminated. Do you have a desk area in the lab where only paperwork is done? I have always said that if there is an area in the lab where there are no patient specimens or chemicals, then one could consider the area “clean.” However, that does not mean that food or drink can be consumed there or that no PPE is needed. Remember, you are still in the walls of a laboratory, and accidents may occur. It is acceptable to label the area as “clean” so that gloves are not needed for the computer or phone, but a lab coat would still be required.
Remember, if an OSHA inspector arrives, he will be looking to see that all aspects of safety regulations are being followed. Keep your employees safe and keep your facility from unnecessary fines by using PPE where and whenever needed.
Dan Scungio, MT (ASCP), SLS, also known as “Dan the Lab Safety Man,” is a Laboratory Safety Officer for Sentara Healthcare, a multi-hospital system in the Tidewater region of Virginia.
Q: What guidance does OSHA give on recapping fill needles?
A: OSHA is pretty blunt about recapping needles – they don’t recommend it!
Let me address the recapping of needles into categories:
A) Contaminated needles
The Bloodborne Pathogens standard section (d)(2)(vii): “Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed…” The violation of the OSHA standard could not only injure staff members but also cost it as much as $7,000 as a serious fine, as classified by OSHA. If an employer continues this practice, it could become a willful fine, which ups the ante to $70,000.
B) Non-contaminated Needles
The standard strictly prohibits bending, recapping, or removal of contaminated sharps unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure. [29 CFR 1910.1030(d)(2)(vii)(A)] The standard does not focus on the recapping of non-contaminated needles. However, the health and safety of both the clinician and the patient are important. It would be important not to recap the needle and risk the health care worker being contaminated with the medication that is in the fill syringe. It is equally as important not to contaminate the needle with the healthcare worker’s skin, because this would provide risk to the patient.
The standard requires each employer to establish an exposure control plan “designed to eliminate or minimize employee exposure.” If the medical practices require recapping or removal of sharps or if no alternative, such as immediate discarding into an approved sharps container, is feasible, the exposure control plan must include a provision for the use of mechanical devices in these circumstances. Although OSHA cannot, of course, approve or endorse particular products, there are a number of acceptable mechanical recapping devices.
Editor’s note: This Q&A was answered by Ron Stoker, executive director of the International Sharps Injury Prevention Society (ISIPS), Harriman, UT. www.isips.org
To put it bluntly, the FDA, CDC, NIOSH, and OSHA want to see more use of blunt-tip suture needles in operating rooms.
The four federal agencies posted a joint announcement on May 30 reminding “health care professionals to use blunt-tip suture needles as an alternative to standard suture needles when suturing fascia and muscle to decrease the risk of needlestick injury.”
More than 10 years after the passage of the Needlestick Prevention and Safety Act phlebotomy procedures still pose significant needlestick risks for healthcare workers. A free webinar for nursing staff will discuss “the most recent needlestick injury data and nurses’ rights under current laws/regulations, as well as provide a review of available safety-engineered technologies and the benefits and limitations of each class of devices.”
Fewer than half of dental school students showed “adequate knowledge of transmission and management” of occupational exposure to bloodborne pathogens according to a study appearing in the April issue of the Journal of Dental Education.
Safe in Common, a non-profit organization established to raise awareness about needlestrick hazards for U.S. healthcare personnel, has launched The Needlestick Safety Awareness Tour.
Progress has been made since the passage of the federal Needlestick Safety and Protection Act ten years ago, yet significant challenges remain in reducing the risk of healthcare worker exposure to bloodborne pathogens, according to a March 8 joint news release by the International Healthcare Worker Safety Center at the University of Virginia and the American Nurses Association.
The two organizations, along with 17 other nursing and healthcare organizations have endorsed a Consensus Statement and Call to Action for future efforts on needlestick prevention.
“We view this as a roadmap for future progress in preventing needlesticks, one of the most serious occupational risks healthcare workers face,” according to Center director and UVa Professor Janine Jagger, MPH, PhD. The eight-page statement provides “a snapshot of where we are now and where further work is needed in order to continue to protect healthcare workers from this risk they face every day in the line of duty,” Jagger says.
The Call to Action focuses on five pivotal areas in need of attention:
- Improve sharps safety in surgical settings
- Understand and reduce exposure risks in non-hospital settings (which include physicians’ offices, clinics, home healthcare, and an array of other settings)
- Involve frontline workers in the selection of safety devices
- Address gaps in available safety devices, and encourage innovative designs and technology
- Enhance worker education and training
A recommendation included in third item on exposure risks in non-hospital settings calls for OSHA to “promote regional emphasis programs that focus on enforcement of the BPS [Bloodborne Pathogens Standard] in non-hospital settings; further, that other relevant groups, such as accrediting and licensing bodies and healthcare and workers’ compensation insurers enhance compliance incentives for non-hospital employers.”
Jordan Barab, Deputy Assistant Secretary of the OSHA, expressed the agency’s support, according to the news release, and noted, “The goal of this consensus statement, which is to continue the progress in reducing the risk of sharps injuries to healthcare workers, is one that is in line with OSHA’s mission.”
“If you broke it, you fix it, and you pay for it,” is the attitude of a couple who are lobbying the Virginia legislature for a law “that would make hospitals financially responsible for the treatment of all hospital-acquired infections,” according to The Daily Progress (Charlottesville), February 21.
As a result of his near death experience from an HAI from spinal surgery, John Muncie and his wife Jody Jaffe hope to acquire support for “John’s Law” which would require Virginia hospitals to cover the treatment costs for all HAIs and serve as an incentive to lower infection rates in healthcare.
The infectious disease specialist at Martha Jefferson Hospital where the surgery was performed says that the infection rate is in line with the national average.
Even though the federal government requires hospitals “to pay for treatment of some hospital-acquired infections for Medicare and Medicaid patients,” Muncie’s proposal would require hospitals to pay for the treatment covered by private insurance, according to the news report.
Law and order has led to a decrease in needlestick injuries among hospital workers.
A multihospital sharps-injury database maintained by the International Healthcare Worker Safety Center at the University of Virginia shows a 38% decline in percutaneous injuries since passage of the Needlestick Safety and Prevention Act (NSPA) on November 6, 2000 and stronger enforcement by OSHA according to “Percutaneous Injuries before and after the Needlestick Safety and Prevention Act,” appearing in the correspondence section of the of the New England Journal of Medicine, February 16.
Along with the decrease, researchers from the safety center tracked “a steep market shift from conventional to safety-engineered devices,” suggesting additional effects from the NSPA.
“Our findings provide evidence that the NSPA contributed to the decline in percutaneous injuries among U.S. hospital workers. They also support the concept that well-crafted legislation bolstered by effective enforcement can be a motivating factor in the transition to injury-control practices and technologies, resulting in a safer work environment and workforce,” conclude researchers Elayne K. Phillips, B.S.N., Ph.D.; Mark R. Conaway, Ph.D.; Janine C. Jagger, M.P.H., Ph.D.
With the report of a 38% decrease in needlesticks, has the passage and enforcement of the Needlestick Safety and Prevention Act met your expectations? Take the OSHA Healthcare Advisor Weekly Poll and let us know.
Healthcare workers giving lots flu shots in clinics during a pandemic are at higher risk of experiencing needlestick injuries, according to a study published in the American Journal of Infection, February 2.
“Needlestick injury surveillance during mass vaccination clinics” looked at needlestick injuries to healthcare workers in the Denver Metropolitan region health department clinics during the H1N1 pandemic. The study found that the injury rate was 4.9 times the mean rate compared that of non-pandemic vaccination clinics from 2003 to 2009.
The study also found an increased trend in needlestick injuries with vaccination inexperience.
“These findings can be used to improve future mass vaccination clinic safety,” the study included.
While still in the first part of the year, the OSHA Healthcare Advisor asked readers to predict how well their facility will do in preventing bloodborne pathogen exposures in 2012. Here are the results.