Sharps Injury Prevention Program- “Make Sharp Safety-Priority ONE!”

Objectives Knowledge of sharp safety goals To be able to identify common risk factors & prevention of viral transmission to the healthcare worker Describe safe practices in gloving, handling needles, knife blades and suture needles To change practice-“Make Sharp Safety-Priority ONE!”

Background and Goal CDC estimates needle stick injuries 384,325 per year in hospitals and 590,164 for all healthcare settings Use of safety engineered devices and safer work practices -required under the Needlestick Safety and Prevention Act of 2000 and the revised blood borne pathogens standard, enforced by the Occupational Safety and Health Administration (OSHA) Vanderbilt University Medical Center’s goal is to comply with OSHA’s requirement to eliminate or minimize employees’ exposure to blood borne pathogens

Vanderbilt University Medical Center (VUMC) Anesthesia Department VUMC Occupational Health 2010 Exposure Report- 29 incidences-26 are listed as preventable! 8 occurrences-placing a central line of which 4 involved a scalpel 4 occurrences-reaching into a tray containing sharps 4 occurrences-placing an arterial line 4 occurrences-splash exposures 4 occurrences-placing sharps in sharps container 5 occurrences-recapping, local anesthetic sticks, spinal needles and an electrode from a NIMS endotracheal tube 15 incidences were with a hollow point needle!

Factors for Viral Transmission The specific risk of a single injury depends on a number of factors when the patients harbor the virus of concern. Injuries with a hollow-bore needle Deep penetration Visible blood on the needle Needle that was located in a deep artery or vein Blood from terminally ill patients are known to increase the risk for HIV infection

Risk Reduction Strategies-Gloves Always Glove: Injections, starting or discontinuing IVs, contaminated needle or dressings Double Gloving-if body cavities are involved Monitor gloves periodically for punctures

Needle Sticks Injuries from Needles Occur Most Often When: During use between steps of a multistep procedure Disassembling device Recapping Withdrawing needle from rubber After use, before disposal Putting item in disp. container After disposal, item protruding from disposal container Device left on floor or other inappropriate place Other From U.S. EPINet, 82 healthcare facilities,1998-2002, total cases=687

Risk Reduction Strategies for Drawing Venous and Arterial Blood Syringes should not be used for venous blood drawing; instead, phlebotomy or butterfly needles (with a protective feature) should be used, because they allow blood to be drawn directly into a blood tube. Rationale: Inserting the needle into the tube’s rubber stopper, staff can miss the stopper and stick his or her hand instead, or sustain a rebound stick when pulling the needle out of the stopper.

Risk Reduction Strategies for Drawing Venous and Arterial Blood 2. For arterial blood draws, safety syringes that are specifically designed for performing arterial blood gases (ABGs) should be used. Once the safety feature on the ABG syringe has been activated, the sample should be placed in an ice-filled biohazard bag with a zipper closing. Rationale: Almost half of injuries from ABG syringes (48%) occurred during use of the non safety device.

Risk Reduction Strategies for Drawing Venous and Arterial Blood In the Vanderbilt Operating room, ABGs are drawn and immediately taken to an iL-gem machine located in the OR. The sample is processed and disposed of in the sharps container next to the machine.

Risk Reduction Strategies for Drawing Venous and Arterial Blood 3. Safety syringes, needles and scalpels are also specifically designed to prevent recapping of any sharps device. Never remove a safety device, bend or manipulate a needle or device as this can lead to injury. Rationale: Recapping is the 3rd most common needle stick injury and is a major TOSHA violation ($7,000- $ 70,000 for each recap injury on the sharps log)  

Risk Reduction Strategies for Drawing Venous and Arterial Blood 4. Use of a local anesthetic can help minimize patient movement and thus reduce needlestick risk. Rationale: Needle insertions at the radial artery site (the preferred site for ABGs) can be painful for patients and cause them to move suddenly or jerk their arms—and the caregiver to be stuck as a result.

Risk Reduction Strategies for Drawing Venous and Arterial Blood 5. Use of sharps containers have openings wide enough to accommodate butterfly needles with attached tubing, and make sure containers are replaced before becoming overfilled. Rationale: With tubing attached, these needle devices can be awkward to handle and difficult to get into a sharps.

Injuries from Scalpels Occur Most Often When: Loading or removing a disposable scalpel blade on a reusable knife handle During hand to hand passing of the scalpel Cutting toward the proceduralist or assistants

Strategies to Prevent Injuries from Scalpels Vanderbilt OR’s now use these safety scalpels. Note (left) scalpel in the ‘not in use’ position. Using the thumb retractor (right) exposes and locks the blade and retracts the cover. The surgeon activates the blade when he picks it up from the neutral zone and retracts the blade when he returns it!

Establish a Neutral Zone Most operating rooms (ORs) at Vanderbilt employ a neutral zone. This is an area where the scrub and surgeon place sharps to minimize the passing of sharps between individuals. The green neutral zone pictured is placed on the Patient and is impenetrable.

Establishing a Neutral Zone outside the OR The neutral zone applies to using sharps out of central line trays and spinal trays. Establish a neutral zone so that once you have used a sharp… place it in a separate container or embed in the sharps- Away disposal cup provided. Provide a clear transition zone between clean items on the tray and contaminated items Use a plastic kidney dish for used Arterial lines, IV’s and local anesthetic needles

Suture Risk Reduction Strategies Safe practices for using suture needles Use blunt suture needles when sewing fascia, muscle & peritoneum Pass needles using “hands free” method (see neutral zone). Surgeon states “needle down” when placing in the neutral zone. Scrub then retrieves to the back table Utilize alternatives to suturing, such as tissue adhesives, adhesive strips, staples, and adhesive catheter securement devices, should significantly decrease injury risk International Health Care Worker Safety Center, Univ. of Virginia 28 ADVANCES IN EXPOSURE PREVENTION—VOL. 7, NO. 3, 2005 Blunt Needle

Suture Risk Reduction Strategies Load suture needles using suture packet to assist in mounting Place needle on needle counter with instrument Remove needle from suture before tying

Risk Reduction Strategies implemented by VUMC for Procedure kits The VUMC Product Implementation team is identifying procedure kits for non safety devices. They are in the process of converting all components to safety devices. Keep in mind that there may be some items in the kits that do not have a safety alternative (e.g. the spinal needle). In the meantime, kits with non-safety devices will have baggies attached that contain a safety alternative to the non-safe device inside the kit. These baggies have been discarded and not used in some areas of the hospital. Please use the safety device! This complete conversion is targeted for April 2011.

Summary Always glove: Injections, starting or discontinuing IVs, contaminated needle or dressings Utilize Sharp safety Strategies for Drawing Venous and Arterial Blood Utilize alternatives to suturing, such as tissue adhesives, adhesive strips, staples, and adhesive catheter securement devices, should significantly decrease injury risk International Health Care Worker Safety Center, Univ. of Virginia 28 ADVANCES IN EXPOSURE PREVENTION—VOL. 7, NO. 3, 2005

References National Institute for Occupational Safety and Health, “Preventing needlestick injuries in health care settings,”Publ 2000-108 (Washington DC: US Department of Health and Human Services, November 1999). U.S. EPINet, 82 healthcare facilities,1998-2002, total cases=687 AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting. In 2009 Standards, recommended Practices and Guidelines. 2009; 275-280 “Regulations (Standard-29 CFR) Bloodborne pathogens 1910.1030,” Occupational Safety and health Administration, http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 Anesthesia blood exposures 2010. Valerie Thayer RN, CIC. Occupational Health Specialist. Vanderbilt Occupational Health Clinic.