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

 

Part III: Safe Work Practices

Slide 1
Preventing Needlesticks and Other Sharps Injuries…

Everything You Need to Know
Part III: Safe Work Practices
HHS Logo and CDC Logo
A Program designed for: Infection Control & Occupational Health Personnel, Healthcare Administrators, Sharps Injury Prevention Committees
Speaker Notes: [Note to presenter: Feel free to discard slides or information to tailor this slide set to your particular organization’s needs.]

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 safer practices to minimize risk for remaining hazards

Speaker Notes: In Part II of this slide set series, we discussed a primary method of reducing sharps injuries.  Obviously, the risk for sustaining a sharps injury is eliminated when needles or other sharp objects are substituted with alternative needleless systems.  We also discussed many types of safer sharps devices and various methods for isolating sharp objects through engineering controls.
Even when these strategies are used, safe work practices must be employed.

Slide 3
Preventability of Needlesticks in NaSH Hospitals, June 1995—December 2003 (n=10,661)

Pie chart: Undetermined 18%, Nonpreventable 18%, Preventable 64% (Unnecessary needle use 15%, safer needle device available 26%, Improper safety device activation 6%, Unsafe work practice 7%, Improper disposal 9%, Other 1%)
Speaker Notes: Here, data from CDC’s National Surveillance System for Healthcare Workers (or NaSH) show that most, but not all injuries, could have been averted.  This holds true even if unnecessary needle use was eliminated, or if a safer needle device was used.  Smaller, but significant percentages of sharps injuries occurred because safety features were not activated, or improperly activated; safe work practices were not followed, or sharps not disposed properly. 
Many of the injuries classified as “nonpreventable” occurred when the patient moved during procedures requiring a needle.  Preparing and alerting the patient before the procedure may prevent some of these injuries.

Slide 4
Injuries Related to Work Practices

• Injuries occur because of the following:
• Passing or transferring equipment
• Recapping contaminated needles
• Colliding with coworkers
• Decontaminating/processing used equipment
• Injuries occur from sharps left in unusual places:
• Laundry
• Mattresses
• Tables, trays, or other surfaces

Speaker Notes: Many injuries related to work practices occur while sharps are being passed between different individuals, or transferred to a different location.  Additionally, even though the practice of recapping contaminated needles has been discouraged for more than 20 years, approximately 5% of sharps injuries continue to occur due to recapping.  Still other injuries related to work practices occur during collisions between workers and during decontamination or processing of used equipment.
Personnel also continue to be injured by the improper disposal of used sharps.  These injuries occur when sharps are left in unusual locations such as laundry or linens or are stuck in mattresses, left in pockets, or left on tables, trays, or other surfaces.

Slide 5
The Sharps Safety Continuum

• Prepare to use the device the moment the sharps are first exposed
• Take precautions while using sharps
• Take precautions during cleanup
• Take precautions during disposal

Speaker Notes: This slide summarizes the steps along the sharps safety continuum that will be reviewed in detail.
Work practices to prevent sharps injuries are typically present as a list of specific practices to avoid (for example, recapping used needles) or to use (such as, sharps disposal containers).
Data show that the risk of a sharps injury begins at the moment sharps are first exposed and ends once sharps are permanently removed from exposure in the work environment. Therefore, to promote safe work practices, healthcare personnel need to have an awareness of the risk of injury throughout the time sharps are exposed.  They should also use a combination of strategies to protect themselves and their coworkers through the handling of the device. We will now review recommended practices that reflect this concept.

Slide 6
Sharps Safety Practices

• Be prepared
• Be aware
• Dispose with care

Speaker Notes: The recommended work practices that help ensure safety can be simplified into three quick points:

•  Be prepared.
•  Be aware.
•  Dispose with care.

 Slide 7
Be Prepared
Before Beginning a Procedure

• Organize equipment at the point of use
• Make sure work space has adequate lighting
• Keep sharps pointed away from the user

Speaker Notes: Before beginning a procedure that involves the use of a needle or other sharps device you should:

• Ensure that equipment necessary for performing a procedure is available within arm’s reach, and organize the equipment so that the procedure can be done safely.
  
• Assess the work environment before starting and make sure that you have adequate lighting and work space for the procedure.  In cases where low light is needed for the procedure, take steps such as verbal cuing and the use of neutral zones to minimize the risk of injury from passing sharps.
  
• Ensure that the sharp object being used is always pointed away from the user.

Slide 8
Before Beginning a Procedure (cont’d)

• Locate a sharps disposal container, or have one nearby
• Assess the patient’s ability to cooperate
• Get help if necessary
• Ask the patient to avoid sudden movement

Speaker Notes:

• Identify the location of the sharps disposal container.  If moveable, place it as near the point of use as appropriate for immediate sharps disposal.  If sharps are reusable, determine in advance to where sharps will be placed for safe handling after use.
  
• Assess the potential for a patient to be uncooperative, combative, or confused.
• Obtain assistance from other staff or a family member to assist in calming or restraining a patient as necessary.
• Inform a patient of what the procedure involves.  Explain the importance of avoiding any sudden movement that might dislodge sharps for successful completion of the procedure as well as prevention of injury to healthcare personnel.

Slide 9
Be Aware
During a Procedure

• Maintain visual contact with sharps during use
• Be aware of staff nearby
• Control the location of sharps to avoid injury to yourself and others

Speaker Notes: During a procedure that involves the use of needles and other sharps devices you should:

• Maintain visual contact with the procedure site and location of sharps.
• Be aware of other staff in the immediate environment.
• Take steps to control the location of sharps to avoid injury to yourself and other staff.

Slide 10
Be Aware
During a Procedure (cont’d)

• Do not handpass exposed sharps from one person to another
• Use predetermined neutral zone for placing/retrieving sharps
• Alert others when sharps are being passed

Speaker Notes:

• Do not hand pass exposed sharps from one person to another.
• Use a predetermined neutral zone or tray for placing and retrieving used sharps.
• Verbally announce when sharps are being placed in a neutral zone.

Slide 11
Be Aware
During a Procedure (cont’d)

• Activate safety feature of devices with engineered sharps injury prevention features as soon as procedure is completed
• Observe audible or visual cues that confirm the feature is locked in place

Speaker Notes:

• If using an engineered sharps injury prevention device, activate the safety feature as the procedure is being completed.  Observe for audible or visual cues that the feature is locked in place.

Slide 12
Clean Up and Dispose with Care
During Cleanup

• Be accountable for sharps you use
• Check procedure trays, waste materials, and bedding for exposed sharps before handling
• Look for sharps/equipment left behind inadvertently

Speaker Notes: During cleanup following a procedure, you should:

• Be accountable for sharps you use.  You should dispose of any sharp object that you personally use.
  
• Visually inspect procedure trays or other surfaces (including patient beds) containing waste materials for exposed sharps used during a procedure before handling them.
  
• Look for sharps that may have been left inadvertently after the procedure.

Slide 13
Clean Up and Dispose With Care
During Cleanup (cont’d)

• Transport reusable sharps in a closed container
• Secure the container to prevent spillage

Speaker Notes: During cleanup following a procedure:

• Transport reusable sharps in a closed container.
• Secure the container to prevent the spillage of contents.

Slide 14
Clean Up and Dispose With Care
While Disposing of Sharps

• Inspect container
• Keep hands behind sharps
• Never put hands or fingers into sharps container

Speaker Notes: While disposing of sharps:

• Visually inspect the sharps container for hazards caused by overfilling.  You should also make sure the sharps container being used is large enough to accommodate the entire device.
• Keep your hands behind the tip of any sharps.
• Avoid bringing the hands close to the opening of a sharps container.  Never place hands or fingers into a container to facilitate disposal of a device.

Slide 15
Clean Up and Dispose With Care
While Disposing of Sharps (cont’d)

• If you are disposing sharps with attached tubing
• Be aware that tubing attached to sharps can recoil and lead to injury
• Maintain control of both tubing and the device during disposal

Speaker Notes: If you are disposing of sharps with attached tubing, such as a winged-steel or butterfly needle, be aware that the tubing can recoil and lead to injury.  Be sure to maintain control of the tubing as well as the needle when disposing of the device.

Slide 16
Clean Up and Dispose With Care
After Disposing of Sharps

• Visually inspect sharps container for overfilling
• Replace containers before they become overfilled
• Keep filled containers for disposal in a secure area

Speaker Notes: After disposing of sharps, you should:

• Visually inspect the outside of waste container for evidence of protruding sharps. If found, notify safety personnel so they can appropriately dispose of the sharps container.
• Replace sharps containers before they become overfilled.  If a sharps container is overfilled, place a new container and use forceps or tongs to remove protruding devices and place them in the new container.
• Keep filled sharps containers awaiting final disposal in a secure area.

Slide 17
Clean Up and Dispose With Care
If You Find Improperly Disposed Sharps in Work Environment

• Handle carefully
• Keep hands behind sharps at all times
• Use mechanical device if you cannot safely pick up sharps by hand

Speaker Notes: If you encounter improperly disposed sharps in the work environment, handle them carefully.  Keep your hands behind sharps at all times.  Use a mechanical device to pick up sharps if they cannot be handled safely.

Slide 18
Sharps Safety Practices

• Be prepared
• Be aware
• Dispose with care

Speaker Notes: Remember, when using or working around sharps devices:

•  Be prepared.
•  Be aware of the devices, where they are, and who is using them.
•  Dispose of devices in appropriate containers.

Slide 19
Sharps Injuries in the Operating Room

• Cuts/needlesticks occur in as many as 15% of operations
• Risk increases with longer, more invasive, higher blood loss procedures
• Suture needle injuries are most frequent
• Fingers used to manipulate needles and tissue
• Up to 16% of injuries occur while passing sharps

Speaker Notes: [ NOTE to presenter: Depending on the audience, you may want to include discussion of specific work practice controls that are important adjuncts in the operating room setting.]
Operating room procedures often present a special set of work situations and practices.  It is important to note that cuts or needlesticks can occur in as many as 15% of operations.  This risk increases with longer, more invasive, and higher blood loss procedures.  Injuries from suture needles occur most frequently and are involved in as many as 77% of injuries.  These injuries typically occur while using fingers to manipulate needle and tissue during suturing of muscle and fascia.  Up to 16% of OR injuries occur while passing sharps hand-to-hand.

Slide 20
Sharps Injuries in the Operating Room

• Needleless/no sharps alternatives
• Use alternative cutting methods such as blunt electrocautery and laser devices when appropriate
• Substitute endoscopy surgery for open surgery when possible
• Engineering controls
• Use round-tipped scalpel blades instead of sharp-tipped blades
• Use blunt suture needle
• Work practice controls
• Use instruments rather than fingers
• Give verbal announcement when passing sharps
• Use “neutral zone” to avoid hand-to-hand passing of sharps

Speaker Notes: Here are some recommended work practices to adopt in the OR to reduce sharps injuries:
First, there are needleless or no sharps alternatives for some procedures.  For example, it may be possible to use alternative cutting methods such as blunt electrocautery or laser devices.  If possible, endoscopic surgery may be preferable to open surgery.
In addition, there are some engineering controls that may be used in the OR to reduce sharps injuries.  For example, round-tipped scalpel blades may be used rather than traditional sharp-tipped blades.  Also, blunt suture needles have been shown to reduce sharps injuries and protect both personnel and patients.
Finally, follow these practices to prevent sharps injuries:

•  Use instruments rather than fingers to grasp needles, retract tissue, load and unload needles and scalpels.
•  Give verbal announcements when there is a need to pass sharps.
•  Use a “neutral zone” tray or surface to avoid hand-to-hand passing.

Slide 21
Conclusion
Preventing Sharps Injuries

Your Role
Speaker Notes: Preventing sharps injuries requires involvement of staff at all levels.  This next section will focus on the role that you can play in this prevention effort.

Slide 22
You are Part of the Prevention Process when You

• Adhere to safe practices and assist and support coworkers in safer practices
• Report injuries or blood/body fluid exposures, sharps injury hazards, and near misses
• Participate in training for devices and properly use sharps safety features
• Participate in surveys (e.g., safety culture) and device evaluations

Speaker Notes: You are part of the sharps injury prevention process when you:

•  Adhere to safe practices and assist and support coworkers in safer practices.
•  Report injuries exposures to blood or body fluids, sharps injury hazards, and near misses.
•  Participate in training for devices and properly use sharps safety features.  If additional training for staff is needed, request that the vendor be asked to come back to provide training.
•  Participate in surveys and device evaluations  If you have not been involved in the selection process or involved in piloting devices, ask about how that process works.  Find out how you can provide written feedback on the use of new devices.

Slide 23
Speaker Notes: Remember, it takes a team to eliminate sharps injuries.
[Note to presenter:  Feel free to tailor this slide, perhaps using photos of healthcare personnel from your facility.]

Slide 24
Always Handle Sharps With Care
Have a Safe Day!

Speaker Notes: In this, and previous discussions, we have covered information about the distribution of injuries across departments and occupations, as well as devices and procedures associated with sharps injuries.  We have also discussed engineering and work practice controls that can be used to reduce the frequency of sharps injuries.  As noted, it takes a team effort; your role is very important, and your feedback about the use of various work practice and engineering controls is essential to designing a program that will work in this facility.
Thank you for your time and your continued diligence in helping to prevent sharps injuries.