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Needlestick Prevention Experts Identify Need For Better Safety Syringe Design, As Well As Improved Training And Reporting
“The Inviro Initiative” Gives Voice to Industry Thought Leaders and Advocates
ATLANTA – August 30, 2006 – Six
years after passage of the Needlestick Safety and Prevention Act,
nursing and infection control leaders say there is significant room for
improvement to protect healthcare workers from needlestick injuries,
which can result in exposure to bloodborne pathogens such as hepatitis
and human immunodeficiency virus (HIV). Participating in “The Inviro
Initiative: Evaluating the State of Needlestick Prevention,” sponsored
by Inviro Medical (www.inviromedical.com),
some of the nation’s top experts voiced their current concerns after
many successfully lobbied to pass legislation in 2000 designed to
address the problem.
During the June 12 program, moderated by Infection Control Today
Publisher William Eikost and held in conjunction with the annual
meeting of the Association for Professionals in Infection Control,
participants identified crucial factors that could further diminish
needlestick injuries: better safety syringe design and improved
training, as well as enhanced reporting processes and data collection.
“We
organized this roundtable event because it’s time to take a fresh look
at this issue, discuss what has been accomplished, examine best
practices and identify future priorities,” says Gareth Clarke, chief
executive officer of Inviro Medical. “Our recent survey, the 2006 Study of Needlestick Injuries and Safety Devices
confirms that needlestick injuries remain a tremendous cause for
concern among healthcare workers.” (The study can be downloaded
at: www.inviromedical.com/needlestickstudy/.) The company engineers and markets safe medication delivery systems, including the InviroSNAP!® Safety Syringe, the first in a significant new segment – manually retractable technology – in the safety syringe market.
Better Safety Syringe Design
In
response to legislation that mandates facilities make safety syringes
available, many manufacturers created retro-fitted devices, which
include the addition of safeguards to the original syringe.
Participants in ”The Inviro Initiative” indicated that many healthcare
workers find these designs – with add-on pieces – cumbersome or
difficult to operate, and suggested designing a syringe from scratch
with input from those who use it. “My grandmother used to have a saying
that it’s better to prepare and prevent than it is to repair and
repent,” said Ron Stoker, executive director of the
International Sharps Injury Prevention Society. “I think it isimportant
that safety is designed into the syringe to remove the risk of
needlestick injury.”
“What we need is user-based designs; as
long as you are not involving the healthcare worker, you are not going
to get the correct designs,” said June M. Fisher, M.D., project
director of the Training for Development of Innovative Control
Technologies Project in San Francisco.
While sharps
safety leaders advocate for needle-free vascular access devices,
Barbara DeBaun, R.N., M.S.N., C.I.C., director of patient safety and
infection control at California Pacific Medical Center in San
Francisco, commented, “Nationwide, there has been an increase in
bloodstream infections associated with the use of needle-free devices.
A lot of the technology that has been designed to prevent needlesticks
is great for healthcare workers – but it’s causing a lot of problems in
our patients.”
Improved Training
To further
reduce needlestick injuries, training is absolutely essential and
multiple needs exist. It is still important to educate workers about
the problems that can result from injuries, stated this group of
thought leaders. While patients and caregivers can be rapidly tested
for HIV, the insidious nature of hepatitis C makes it more difficult to
see a direct and immediate cause and effect. Little money exists for
innovative training programs and healthcare workers are often too busy
to read professional publications, where coverage of the issue has
lapsed due to saturation or lack of reader interest. There also is a
need for facilities to better educate healthcare professionals about
appropriate procedures to take when needlesticks occur.
While
most hospitals inform employees during the orientation process, it is
often not retained because they are overwhelmed with information.
Roundtable participants further indicated that, interestingly, medical
students and residents often have little training in this area.
The
emergence of new safety devices compounds the need for training.
Several industry leaders said that workers often opt not to use safety
syringes – because they don’t know how to operate them properly. “If it
takes three hours to learn how to use a syringe, you don’t want to use
it,” added Fisher. Manufacturers need to include training as part of
their sales process, some say. Even better, however, would be devices
that are simple to operate and require minimal training.
Enhanced Reporting
Most
experts suspect healthcare workers underreport needlestick injuries due
to the time and hassle involved. In busy environments, it may take four
to five hours to prepare a report and receive treatment – often in the
hospital emergency department – time many feel they cannot afford when
they are needed by patients and colleagues. Some hospitals have
improved their processes to streamline the procedure. Angela K.
Laramie, M.P.H., of the Sharps Injury Surveillance and Prevention
Project, Occupational Health Surveillance Program, Massachusetts
Department of Public Health in Boston, reports that many hospital
emergency departments have a kit that includes the tubes, orders,
testing instructions and a form that goes directly from the ER to the
occupational health department for after hours reporting.
Needlestick prevention advocate and Boston College doctoral student Karen Daley, Ph.D. (c), M.S.,
M.P.H., R.N., shared an additional idea instituted at one hospital and
adopted by others. When a needlestick occurs in a busy unit or
operating room, the worker places a phone call to report the incident.
If HIV prophylaxis is warranted, the post-exposure prophylaxis is
brought to the individual. “That’s been an important and very effective
innovation in post-exposure care that has resulted in improved
reporting of injuries,” she says. Ease of use of the occupational
health system and good communication are crucial. “You have to make it
simple, and you have to let people know it’s there. The rapid HIV test
also has helped drive better reporting.”
Improved Data Collection
Regular
data collection could provide a tremendous boon to the healthcare
industry to help determine how to make further progress on this
important issue. It was suggested that an organization such as the
American Nurses Association consider conducting regular surveys about
training, involvement in selection of devices and quality of devices,
for example. “If you did it on an annual basis,” said Daley, “you could
begin to benchmark some of the quality indicators.”
While
regulatory agencies attempt to gather certain types of data –
particularly about incidence – these efforts have been less than
successful in many areas. Massachusetts is one of the states that has
made significant strides.
“We’re rather proud of the fact
that we have 100 percent reporting by Massachusetts hospitals,” said
Laramie. She credits the establishment of a standard minimum data set
as the key factor to success. It complies with federal and state
regulations and helped create a surveillance system that is viewed as a
model program for other states.
Conclusions
Reflecting
on “The Inviro Initiative: Evaluating the State of Needlestick
Prevention,” Fisher summarized key findings as the need for more and
better user-based safer devices, systematic frontline user evaluation
and selection based on tasks to be performed, and training for all
users of such devices.
Despite articulated needs,
roundtable discussion participants said they have seen some progress.
“We’ve penetrated the market to a greater degree with (safety)
devices,” said Daley. “It doesn’t mean we’ve penetrated them with the
best devices, and we don’t know if we have better educated people. I
think in certain places the culture has changed and that has been
happening probably in bigger cities and hospitals.”
It’s
been almost a decade since voices cried out in support of life-saving
needlestick legislation and advocacy triumphed with the passing of
federal law and OSHA directives. So what’s needed next? Continued
product development and a resurgence of dialog to reestablish
needlestick prevention as a priority, critical issue.
# # #
About Inviro Medical
Founded
in 1988, Inviro Medical is a medical device company that engineers and
markets safe medication delivery systems. After years of research to
develop its patents and refine its product designs, the company is
addressing the growing $1.6 billion safety syringe market and
introducing its breakthrough technology in North America. Headquartered
in Atlanta, Inviro Medical is becoming a leading industry champion in
the quest to protect healthcare workers, patients and the environment
with innovative medical devices. For more information and to download a
copy of the Inviro Medical 2006 Needlestick Study, visit www.inviromedical.com.
Participants in “The Inviro Initiative: Evaluating the State of Needlestick Prevention”
- Lisa Black, PhD (c), MS, RN
Assistant Professor at the University of Nevada, Reno, Orvis School of Nursing, Reno, NV
- Karen Daley, PhD (c), MS, MPH, RN
Boston College Doctoral Student, Stoughton, MA
- Barbara DeBaun, RN, MSN, CIC
Director, Patient Safety & Infection Control, California Pacific Medical Center, San Francisco, CA
- June M. Fisher, MD
TDICT Project Director (Training for Development of Innovative Control Technologies Project), San Francisco, CA
- Lynn Hadaway, M.Ed., RNC, CRNI
Executive
Director of NAPPSI (National Alliance for the Primary Prevention of
Sharps Injuries) and President of Lynn Hadaway Associates, Milner, GA - Nancy L. Hughes, RN, MHA
Director, Center for Occupational and Environmental Health, American Nurses Association, Silver Spring, MD
- Angela K. Laramie, MPH
Sharps
Injury Surveillance and Prevention Project, Occupational Health
Surveillance Program, Massachusetts Department of Public Health,
Boston, MA - Ron Stoker
Executive Director ISIPS (International Sharps Injury Prevention Society), South Jordan, UT