AMA and needlestick prevention

Bottom line

The American Medical Association scientific affairs committee has concluded that healthcare employers should evaluate the implementation of needlestick prevention devices.

The key element is the requirement to involve frontline healthcare workers in the choice, implementation and review of safety devices.

Reference

L Tan et al. Report of the council on scientific affairs. Preventing needlestick injuries in health care settings. Archives of Internal Medicine 2001 161: 929-936.

This paper is a useful summary of some of the evidence about needlestick injuries, and most recent legislative changes in the USA concerning needlestick injury prevention. The needlestick safety and prevention act was signed into law in 2000. It is not possible to give a comprehensive summary, but some of the major points are outlined below.

Occupational Safety and Health Administration

In the United States, the Occupational Safety and Health Administration (OSHA) has been examining needlestick injuries and their prevention for over a decade. In 1999 a new OSHA compliance directive was issued to improve standards relating to bloodborne pathogens. The new directive reflects the availability of improved devices and better treatment after exposure.

An OSHA request for information resulted in about 400 comments, representing 300 healthcare facilities and 170,000 employees. OSHA observations on the comments about needlestick injuries and safer devices are shown below:

Record keeping for needlestick injuries did not always reflect injuries that might involve exposure to bloodborne pathogens.

Almost all healthcare facilities responding had adopted additional surveillance systems recording all percutaneous exposure incidents, with great variability in content.

The incidence rate of needlestick injuries appears to be declining, with some increasing use of safer devices, particularly in niche applications.

Use of safer devices is an effective and feasible method for controlling needlestick injuries. Nearly all responding facilities indicated that a reduction in injuries occurred following the introduction of safety devices.

Staff involvement in the evaluation and selection of safer devices, and the proper education and training of staff in their use was an extremely effective means of preventing percutaneous injury.

The use of safer devices was not reported to affect delivery of patient care.

Increased costs and staff resistance to change were the two most frequent obstacles to adopting safer needles.

safer devices are generally more expensive than conventional devices, but the total additional cost for a facility is a small fraction of the total costs. Reductions in needlestick incidence will result in substantial financial benefits from reduced post-exposure testing and treatment, as well as health benefits from reduced transmission of disease.

A comprehensive safety and health programme may be the most effective way to reduce the risk of bloodborne pathogen transmission.

Though respondents favoured making safer devices available, some hospitals expressed concern about a broad mandate requiring their use.

New Californian standards

California has its own OSHA, and this state has gone further than the federal government. In 1999 legislation three principal requirements in California are:

use needleless systems, needle devices with engineered sharps injury protection, and non-needle sharps with engineered injury protection
evaluate and select needless systems and sharps devices with active involvement of frontline healthcare providers
maintain a sharps injury log with, inter alia, type and brand of device.

CDC and FDA

The CDC has recommended that needles be eliminated where possible, and otherwise follows the California initiative, but with even more emphasis on carefully tailored programs in each setting, developed with frontline workers input and review.

The National Institute for Occupational Safety and Health has suggested examples of devices that may reduce needlesticks:

Needleless devices, such as connectors for IV delivery systems that use blunt or valve ends rather than needles for attaching one length of tubing to another.

Devices in which safety features are an integral part of the design, such as sheaths or shields over needles.

Devices that operate passively without requiring user activation, such as IV connectors with permanent housings over the needle.

Devices designed so that the user can easily tell whether a safety feature is activated, like a visually obvious needle cover.

Devices in which the safety feature cannot be deactivated and which remains protective throughout disposal.

Devices that perform reliably, are easy to use and practical, and are safe and effective for patient care.

The FDA has not adopted a position on needlestick prevention, but provides criteria for evaluating and authorising them.

American Medical Association

The recommendations of this scientific committee of the AMA is highly supportive of all of this.

Comment

For those interested in needlestick injury prevention, and especially those charged with health and safety, reading this paper is imperative. It concisely records recent changes in the US legislative environment, and probably presages changes in Europe.

The key element that comes though time and again is the requirement to involve frontline healthcare workers in the choice, implementation and review of safety devices. Three cheers.