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Health & Safety

American Journal of Nursing - October, 2000 - Volume 100, Issue 10

Don't Get Stuck with Unsafe Needles
Instead, get involved in needle device selection

By June Fisher, MD, and Susan Wilburn, MPH, RN

Q. Our state requires frontline health care workers to be involved in decisions to select needles. What can I do?

A. Recent state and federal laws regarding needle devices force a greater number of nurses to take part in the needle selection process. Legislation in 17 states requires the use of safer needle devices to prevent injury. Also, a revision to the compliance directive of the 1991 OSHA (the Occupational Safety and Health Administration) Bloodborne Pathogen Standard, effective November 1999, will guide enforcement of the standard for occupational exposure to bloodborne pathogens and consistent inspection procedures. (OSHA defines a “safer needle device” as one that “incorporates engineering controls to prevent needlestick injuries before, during, or after use through built-in safety features.”)

This past spring, the ANA and the Training for the Development of Innovative Control Technologies (TDICT) Project held regional workshops to educate nurses on selection of needle devices. An 11-step, systems approach was used for exposure control and for the evaluation, selection, and implementation of safer devices. The first two steps are:

STEP One: Get Support

First, ensure administrative commitment and responsibility: leaders and resources must be assigned for a written exposure control plan. The OSHA Standard requires that the employer develop a comprehensive exposure control plan, update it annually, and indicate who’s responsible for coordinating and implementing it. The plan should involve diverse groups of managers and workers.

STEP Two: Create a Committee

After gaining support, establish a multidisciplinary needlestick-and-sharps-injury–prevention committee, required in some states, to bring together various departments such as purchasing, housekeeping, infection control, employee health, risk management, and employee education and training. It’s also important to rely on the expertise of those who use needle devices the most (also required in some states). With frontline staff nurses involved, the most appropriate devices are more likely to be selected, and staff are more likely to accept and use the new devices and practices.

The most effective committees represent labor and management equally, share the responsibility of chairing the meetings, and include the exposure control plan coordinator and representatives from those departments. If the committee becomes too large, designate on-call representatives.

The committee will need access to data—in a way that protects confidentiality—regarding the specific devices involved and the conditions in which each injury took place. And it’s equally important that the committee have final say on device selection to maintain its power.

When committee meetings occur during patient care shifts (they should occur in the workplace, during work hours), adequate nursing staff for patient care must be ensured for the frontline staff’s full attention to the committee. The expertise of its employees cannot be provided without pay or offered at the expense of patients.

Resources

The ANA’s Safe Needles Save Lives Campaign  

TDICT Project  (415) 821-8209, ext 151

NIOSH ALERT: Preventing Needlestick Injuries in Health Care Settings and Guidelines for the Evaluation, Selection, and Implementation of Sharps Containers  (800) 35-NIOSH

OSHA Compliance Directive of the Bloodborne Pathogens Standard  (202) 693-1999

International Health Care Worker Safety Center  (804) 924-5159

More information on the remaining nine steps will be included in future Health and Safety columns and can be found on the ANA’s Web site, http://nursingworld.org/needlestick/nshome.htm.

June Fisher is the founder and director of the Training for the Development of Innovative Control Technologies Project based at the Trauma Foundation, San Francisco General Hospital. Susan Wilburn is the ANA’s senior staff specialist, Occupational Safety and Health.

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