How can we prevent injuries through better sharps disposal and overall healthcare waste management? The hierarchy of controls implemented to manage and prevent needlestick injuries, delivers 5 key criteria to drive sharps injury risk reduction. In its hierarchy of most effective to least effective, the ‘elimination of hazards’ is the most effective control, and the adoption of ‘personal protective equipment’ is the least.

MAKE YOUR FACILITY SAFER

Elimination of Hazard

In the context of needlestick injury risk, the elimination of hazards from the patient environment is critical. The most effective adopters of this methodology have executed the following changes within their healthcare setting:

• Use of needle-less IV systems
• Removal of sharps and needles
• Elimination of unnecessary injections

Engineering Controls

Engineering controls are mechanisms that can positively influence the safety of the sharps deposition and staff contact. The most common controls that drive the greatest impact in sharps injury reduction are:

• Needles that retract, sheathe or blunt immediately after use
• Sharps containers that protect users via hand-access restriction design, letter-drop style of deposition, and inbuilt safety mechanisms

Administrative Controls

Administrative controls are directly impacted by the “exposure environment” and committee/departmental focus; ultimately asking the question of how we will ensure we positively direct and reinforce sharps disposal behaviors across leadership, full time staff, and temporary staff. These include:

• Polices limiting hazard risk and implementing universal precautions around bloodborne pathogen exposure
• Needlestick prevention committee
• Allocation of resources that drive healthcare worker safety
• Training and education around the use of safe devices

Work Practice Controls

Work practice controls are executed “in practice” – to dissect this simply, “when you have a sharps in your hand, what do you do?” The basic safety principles that follow the hierarchy of control are as follows:

• No recapping of needles (Studies reviewing implementation of a “no recapping policy” have shown a 2/3^rd reduction in needlestick injuries)
• Place sharps containers at eye-level and at arms reach
• Empty sharps containers before they are full

Personal Protective Equipment

This is your basic ‘occupational risk management’ – removing the barriers and filters that exist between the healthcare worker and the hazard to minimize risk.

• Utilize double-gloves to prevent needlestick injury
• Ensure PPE is utilized during procedure

Review of Hierarchy of Controls pertaining to needlestick injuries

Reducing needlestick injuries by the greatest amount possible, must entail a combination of the following initiatives:

• Elimination of sharps-dependent procedures
• Safer devices including the use of safety engineered sharps containers
• Education of healthcare workers and active elimination of risks

Sharps Injury Controls Resource

Let’s bring this home | Adequate sharps risk management for healthcare workers

Occupational exposure to blood and body fluids (BBF) as well as  percutaneous injuries from sharps, together pose a serious threat to public health. An estimated 30+ million healthcare workers face a pathogen-exposure risk from sharps injuries which, although preventable, are often regarded a systemic part of the job.

The World Health Organization (WHO) estimates 9 percent of healthcare workers face bloodborne pathogen exposure each year², while the Centers for Disease Control and Prevention (CDC) asserts that more than 600,000 sharps-related injuries are incurred by healthcare workers each year.³

Increasing workloads and poor organization have attributed to two-fold increases in sharps injury risk and near-misses to hospital workers⁴ together with an increasing amount of research tying fatigue and stress to sharps exposure rates.⁵  

Sharps injury reduction is not a one-dimensional solution

Ultimately, a sharps exposure reduction solution must look at all facets of sharps injury risk: Adoption of safety engineered devices, use of safer sharps containers with inbuilt safety mechanisms, critical analysis of the exposure environment and identification of hazards, and the ongoing training and education of healthcare staff in proactively managing sharps injury risk. To comprehend and drive sharps injury reduction in healthcare faciliies, we need to look at a broader safety system that drives protection across the full spectrum of sharps management from the healthcare worker through to the laundry worker who could encounter an incorrectly disposed needle in the laundry. If you would like further information on how Daniels can help drive needlestick injury reduction in your facility, reach out to us today…

Resources to equip your facility in safer sharps management practices:

http://www.cdc.gov/sharpssafety/ | Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program

https://internationalsafetycenter.org/use-epinet/ | The International Health Care Worker Safety Center at the University of Virginia

http://www.cdc.gov/niosh/topics/bbp/safer/ | Safer Medical Device Implementation in Health Care Facilities

https://www.cdc.gov/niosh/docs/2000-108/ | NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings 

References

¹ https://www.infectioncontroltoday.com/sharps-safety/using-safer-devices-following-hierarchy-controls-can-cut-sharps-injuries

²Al-Benna S. Needlestick an sharps injuries among theatre care professionals. J Perioper Pract. 2010 Dec;20(12):440-5. PubMed PMID: 21265403.

³https://www.osha.gov/bloodborne-pathogens/quick-reference

⁴Clarke SP, Rockett JL, Sloane DM, Aiken LH. Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses. Am J Infect Control. 2002 Jun;30(4):207-16.

⁵Clarke SP. Hospital work environments, nurse characteristics, and sharps injuries. Am J Infect Control. 2007 Jun;35(5):302-9.