Among
nurses,
since
injuries with disposable
hypodermic needles are
the most frequent, it is
important that users are
evaluating devices and
implementing ones that
they have deemed the
most effective.
—
as results from root cause analyses
need to be brought to the attention
of direct care staff for feedback as well
as management and administration
as part of efforts to reduce worker
injury and exposure risk.”
Daley emphasizes that infection
preventionists can also help reduce
occupational exposures and SIs by
promoting employer compliance with
legal requirements under the NSPA
which revised the 1991 Bloodborne
Pathogens Standard: “Federal OSHA
regulations require that healthcare
employers provide safety-engineered
Amber Hogan Mitchell, devices to prevent SIs; review and
DrPH, MPH, CPH update exposure control plans to
reflect changes to safer and more
effective technology to reduce injuries; maintain a sharps
injury log; and seek input from direct users of sharps on
engineering and work practice controls.”
The ANA’s SIP Stakeholder Group, which is comprised of
sharps safety experts and advocates, is currently focused on
a variety of strategic activities to help reduce SIs, Daley says.
“Efforts include promotion of safe OR pilots, simplification and
standardization of acronyms and terminology used relative to
safety-engineered sharps devices and updating of the 2010
Consensus Statement recommendations,” she adds.
One of the issues that the ANA’s SIP Stakeholder Group
and others are working on is addressing inconsistent and
confusing terminology used to describe devices with sharps
injury-prevention features.
“There are a variety of terms used to describe devices
with engineered sharps injury prevention features,” confirms
Laramie, “ranging from the OSHA phrase ‘sharps with
engineered sharps injury protections’ to ‘safety-engineered
devices- or the colloquial ‘safety devices.’ The broad term
‘safety device’ doesn’t explain how it is safer or for whom the
safety feature is intended (patient? healthcare worker?). This
becomes more confusing in the international realm, where in
addition to needing devices that have sharps injury prevention
features for healthcare workers and the general public, reuse
prevention features are also important.”
As the NSPA first noted, “Since publication of the BBP
standard, a wide variety of medical devices have been
developed to reduce the risk of needlesticks and other sharps
injuries. These ‘safer medical devices’ replace sharps with
non-needle devices or incorporate safety features designed
to reduce the likelihood of injury.”
In 1998, OSHA solicited information on occupational
exposure to bloodborne pathogens due to percutaneous injury
and based its recommendations in part on the responses to
its inquiry into what was happening in healthcare facilities.
Congress was prompted to act in response to growing concern
over bloodborne pathogen exposures from sharps injuries
and in response to recent technological developments that
increased employee protection.
The revised standard added “Sharps with Engineered Sharps
Injury Protections” and defined this term as “a non-needle
sharp or a needle device used for withdrawing body fluids,
accessing a vein or artery, or administering medications or
28
other fluids, with a built-in safety feature or mechanism that
effectively reduces the risk of an exposure incident.” As
the NSPA noted, this term encompassed a broad range of
devices that make injury involving a contaminated sharp
less likely, and includes syringes with a sliding sheath that
shields the attached needle after use; needles that retract
into a syringe after use; shielded or retracting catheters used
to access the bloodstream for intravenous administration of
medication or fluids; and intravenous medication delivery
systems that administer medication or fluids through a
catheter port or connector site using a needle that is housed
in a protective covering.
The revised standard also added the term “Needleless
Systems,” which was defined by the NSPA as “a device that
does not use needles for: The collection of bodily fluids or
withdrawal of body fluids after initial venous or arterial access
is established; the administration of medication or fluids; or
any other procedure involving the potential for occupational
exposure to bloodborne pathogens due to percutaneous
injuries from contaminated sharps.” Needleless systems,
according to the NSPA, provide an alternative to needles
for the specified procedures, thereby reducing the risk of
percutaneous injury involving contaminated sharps. Examples
of needleless systems include intravenous medication delivery
systems that administer medication or fluids through a
catheter port or connector site using a blunt cannula or other
non-needle connection, and jet injection systems that deliver
subcutaneous or intramuscular injections of liquid medication
through the skin without use of a needle.
The NSPA modified the definition of “Engineering Controls”
to include as examples “safer medical devices, such as sharps
with engineered sharps injury protections and needleless
systems.” This change clarified that safer medical devices are
considered to be engineering controls under the standard. The
term “Engineering Controls” includes all control measures that
isolate or remove a hazard from the workplace, encompassing
not only sharps with engineered sharps injury protections and
needleless systems but also other medical devices designed
to reduce the risk of percutaneous exposure to bloodborne
pathogens. Examples include blunt suture needles and plastic
or mylar-wrapped glass capillary tubes, as well as controls that
are not medical devices, such as sharps disposal containers
and biosafety cabinets.
The revised Exposure Control Plan requirements outlined
by the NSPA made clear that employers must implement
the safer medical devices that are appropriate, commercially
available, and effective: “No one medical device is appropriate
in all circumstances of use. For purposes of this standard, an
‘appropriate’ safer medical device includes only devices whose
use, based on reasonable judgment in individual cases, will
not jeopardize patient or employee safety or be medically
contraindicated. Although new devices are being continually
introduced, OSHA recognizes that a safer device may not be
available for every situation. If a safer device is not available
in the marketplace, the employer is not required to develop
any such device. Furthermore, the revised requirements are
limited to the safer medical devices that are considered to be
‘effective.”’’ For purposes of this standard, an ‘effective’ safer
medical device is a device that, based on reasonable judgment,
will make an exposure incident involving a contaminated sharp
less likely to occur in the application in which it is used.”
march 2020 • www.healthcarehygienemagazine.com