Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program

 

Part II: Safer Sharps Devices

Slide 1
Preventing Needlesticks and Other Sharps Injuries…

Everything You Need to Know
Part II: Safer Sharps Devices

HHS Logo and CDC Logo
A Program designed for: Infection Control & Occupational Health Personnel, Healthcare Administrators, Sharps Injury Prevention Committees
Speaker Notes: Part II of this presentation discusses the use of safer sharps devices to prevent needlesticks and other sharps injuries.

Slide 2
What Strategies Exist to Eliminate Sharps Injuries?

  • Eliminate or reduce the use of needles and other sharps
  • Use devices with safety features to isolate sharps
  • Use safe practices to minimize risk for hazards

Speaker Notes: The prevention of sharps injuries is a priority at __________ [your facility name].

There is a hierarchy of priorities for sharps injury prevention. The first priority is to eliminate and reduce the use of needles and other sharps wherever possible. The next priority is to isolate the hazards and thereby protect otherwise exposed sharps, through the use of engineering controls. Finally, regardless of whether an engineering control is available, safe work practices are always necessary to reduce sharps hazards in the workplace.

 Slide 3
First Strategy:

Eliminate or Reduce Unnecessary Needle Use

Speaker Notes: As stated earlier, the first strategy in the hierarchy of sharps injury prevention is to reduce, if not eliminate, the unnecessary use of needles or other sharps objects when appropriate.

 Slide 4
How Can Needle Use Be Eliminated or Reduced?

  • Use needle-free IV delivery systems
  • Use alternate routes for medication delivery and specimen collection when available and safe for patient care
  • Streamline specimen collection systems
  • Other ideas?

Speaker Notes: There are several ways that needle use can be eliminated or reduced. One way is the implementation of needle-free IV delivery systems that do not require, and in some instances, do not permit needle access. The majority (approximately 85%) of US hospitals have eliminated unnecessary use of needles through implementation of these devices.  This strategy has largely removed needles attached to IV tubing, such as those for intermittent (piggy-back) infusion and other needles used to connect and access the part of the IV delivery system. Such systems have demonstrated considerable success in reducing IV-related sharps injures.

Slide 5
Needle-Free IV Delivery Systems

IV delivery systems use valved ports and connectors, pre-pierced septa using blunt cannulas, or recessed protected needle connectors

Speaker Notes: Here are two examples of  needle-free IV delivery systems. As you can see all connections are made without the use of needles. Some systems use blunt cannulae (lower right) that enter the system through pre-pierced ports. Still other systems have recessed needles for system connections. 

[Note to Presenter: Discuss the safer IV delivery system that is used in your facility.  When available, include a picture or have samples of the system on display.]

Slide 6
Needle-Free IV Delivery Systems

Use aseptic technique when handling these systems!!!

Illustration of needle-free  IV connector

Speaker Notes: Some needle-free systems have been associated with bloodstream infections in patients.  Therefore it is important to understand the infection control measures that should be adhered to, particularly the need for aseptic technique, when handling these systems.

Slide 7
How Can Needle Use Be Eliminated or Reduced?

  • Use needle-free IV delivery systems
  • Use alternate routes for medication delivery and specimen collection when available and safe for patient care
  • Streamline specimen collection systems
  • Other?

Speaker Notes: To eliminate or reduce needle use:
?  Use an alternate route for medication delivery and vaccination when available and safe for patient care.  For example, oral medications should be given when appropriate.
?  Streamline specimen collection systems to identify opportunities to consolidate and eliminate unnecessary punctures.  Use a strategy that is good for both patients and healthcare personnel.
?  Are there other ways that you can think of? [Note to presenter: encourage discussion.]

Slide 8
Next Strategy:

Use Devices with Safety Features Engineered to Prevent Sharps Injuries

Speaker Notes: The needs of patient care suggest that it will never be possible to eliminate the use of all needles and other sharps devices.  Therefore, devices with engineered, or built-in sharps injury protection features aim to reduce the hazard to healthcare personnel.

Slide 9
Safer Sharps Devices Engineered to Prevent Sharps Injuries

A picture displaying a variety of safer sharps devices engineered to prevent sharps injuries.

Speaker Notes: This slide displays a variety of safer sharps devices engineered to prevent sharps injuries. On the left you see a variety of devices with the needle exposed in the before-use position.  On the right you see that sharps are protected after use.  The safety features include hinged caps [Note to presenter: point to devices #2 and # 7 from the top], sliding sheaths [Note to presenter: point to devices #3, 4, and 6 from the top], and retracting needles [Note to presenter: point to devices #1, 5, and 8 from the top]. Another type of safety feature, not shown here, is a bluntable phlebotomy or butterfly type needle. 
Additional strategies for needle protection are likely to evolve.

[Note to Presenter: Identify whether any of these devices are currently in use or being evaluated by your facility. If other products are available, provide samples of them. Alternatively, create a slide with pictures of the devices used in your facility.]
[Disclaimer: The devices pictured in this slide are meant to serve as examples of devices that are currently available. This is not an exhaustive list, nor is it meant to favor one device over another. CDC and OSHA do not approve, endorse, register, or certify any medical devices.]

Slide 10
Use Devices with Engineered

Sharps Injury Protection

  • Hypodermic Needles
  • Phlebotomy Needles
  • IV Catheters
  • Winged-Steel Needles
  • IV Delivery Systems
  • Lancets
  • Scalpels
  • Suture Needles
  • Hemodialysis Needles

Speaker Notes: Today there are devices with engineered sharps injury protection for all of the major device categories, including those listed on this slide.

Slide 11
Safety Devices: Key Features

  • Are integrated into the device
  • Provide immediate protection after use and throughout disposal
  • Few devices provide protection during use
  • Keep the worker’s hands from having to move in front of sharps

Speaker Notes: One of the key features of these devices is that the safety features are part of the device itself. Furthermore, safety devices have the ability to provide immediate protection at the point of use and throughout the disposal process. Keep in mind, few devices provide protection during use of the device on the patient. Another safety feature is that the user’s hands can remain behind the exposed sharp when activating the safety feature, thus reducing the opportunity for injury.

Slide 12
Safety Devices: Key Concepts

  • Most safety features are not passive
  • The user must activate the safety mechanism to ensure protection
  • It is not always obvious how some safety features work
  • Training is necessary
  • Safe work practices are important
  • Safety devices alone do not completely prevent injuries

Speaker Notes: There are several things you need to be aware of about safety devices. One is that most safety features are not passive; that is, the user must activate the safety feature after use to ensure the protection of him/herself and others.

Also, it is not always obvious how some safety features work. Training is necessary. If you do not know how to use a safety feature, ask either your supervisor, infection control practitioner, or education coordinator. A coworker may also be able to instruct you on the proper use of the saftey device.

Remember -- when you are working with any sharps device, safe work practices are still a very important part of sharps injury prevention. We’ll talk about this issue shortly.

Slide 13
Injuries with Safety Devices in NaSH Hospitals, June 1995—December 2003 (n=1,723)*

Before activation was appropriate 39%, Not activated 27%, Improperly activated 7%, During activation 19%, Safety feature failed after activation 3%, Other 5%.

*73 records do not indicate the time of injury with respect to safety feature activation

Speaker Notes: Between June 1995 and December 2003, CDC collected information from NaSH hospitals on approximately 1,700 injuries with safety devices. As you can see, almost 40% [Note to presenter: point to the red segment] occurred before activation of the safety feature was appropriate, usually during use of the sharp; 34% [Note to presenter: point to the blue segments] occurred because the user either did not activate, or improperly activated the safety feature. Nineteen percent [Note to presenter: point to the yellow segment] occurred while the user was activating the safety feature. In only a small minority of cases (green segment) did the safety feature itself fail.

Slide 14
Sharps Disposal Containers

A picture of 5 rigid sharps disposal containers.

Speaker Notes: Other engineering controls for sharps injury prevention are rigid sharps disposal containers. These come in a wide variety of sizes, shapes, and options for fixation and portability and should be selected based on the need in a given area. Location is key to the success of this intervention. Research shows the closer the container is to the point of use, the lower the risk for sharps injury. Although these containers are effective in preventing the penetration of sharps through the side wall, overfilling can provide opportunity for injury and should be avoided.
[Note to presenter: Consider replacing the picture on this slide with a picture of the actual sharps disposal containers used at your facility.]

Slide 15
What Strategies Exist to Eliminate Sharps Injuries?

  • Eliminate or reduce the use of needles and other sharps
  • Use devices with safety features to isolate sharps
  • Use safe practices to minimize risk for hazards

Speaker Notes: We’ve talked about the prevention of sharps injuries through the elimination and reduction of sharps use and the implementation of various safety devices and sharps containers.  However, safe work practices also are needed to minimize the risk for sharps injury.  We’ll talk about work practice controls in Part III of this presentation.

 

Date last modified: April 16, 2008
Content source: 
Division of Healthcare Quality Promotion (DHQP)
National Center for Preparedness, Detection, and Control of Infectious Diseases