# Presentation: 063665

## Needlestick Injury Prevention:Points to Remember

**Needlestick Injury Prevention:****Points to Remember**

- Department of Veterans Affairs
- Veterans Health Administration
- Needlestick Injury Prevention Work Group

## Work Group’s Mission Statement

- 	To provide training to VA healthcare workers in order to reduce occupational needlestick injuries, the main source of bloodborne pathogen exposure for healthcare workers.

## Training Goal

- 	The primary training goal is  the reduction of occupational needlestick injuries.

## Behavioral Objectives

- Define Bloodborne pathogens (BBPs).
- List 3 ways needlestick injuries can occur.
- Describe activities which are high risk for occupational needlestick injuries.
- Describe safer practices designed to reduce/avoid needlestick injuries.

## Current Needlestick Injury Statistics

- Every day, an average of 15 VHA employees receive occupational needlestick injuries.
- Tangible costs for the initial workup and treatment of each needlestick injury average about $750.
- The intangible costs (e.g. emotional stress, decreased employee productivity, etc.) may be even greater.

## Historical Perspectives

- Before 1980, needlestick injury prevention was not as much of an issue (pre-AIDS).
- In the late 1980’s the Centers for Disease Control and Prevention (CDC) introduced “Universal Precautions” to protect healthcare workers from bloodborne pathogens.
- The Occupational Safety and Health Administration (OSHA) published its rule “Occupational Exposure to Bloodborne Pathogens” December 6, 1991 to further protect healthcare workers (29 CFR Part 1910.1030 Bloodborne Pathogens).

## Historical Perspectives  (cont.)

- The Bloodborne Pathogen Rule further reinforced CDC’s recommendations on Universal Precautions, with emphasis on preventing the transmission of HIV, Hepatitis B and Hepatitis C in the workplace setting.
- Specific regulations regarding needle and sharps safety were outlined in the Bloodborne Pathogen Rule to prevent occupational needlestick injuries.
- The first safety products became available for injections and intravenous (IV) administration in the early 1990’s.

## Historical Perspectives (cont.)

- Since then, a multitude of safety products have been manufactured to protect healthcare workers as they perform venipunctures, IV insertions, arterial blood gas samplings, and other high-risk procedures.
- Individual states are passing legislation to mandate the use of safety needle products, with California being the first state to enact such legislation.
- It is anticipated that a similar Congressional bill will also be passed.

## HIV

- HBV

- HCV

## What are Bloodborne Pathogens?

- 	Bloodborne pathogens are pathogenic microorganisms that are present in human blood (including human blood components and products made from human blood) and can cause disease in humans.  These pathogens include, but are not limited to, Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV).

## Risk of Infection Following a Needlestick Exposure

- Hepatitis B:  1.9% - > 40%
- Hepatitis C:  2.7% - 10%
- HIV:		0.2% - 0.44%
- 					Gerberding, New Engl J Med 1995

## Slide 12

## How Needlestick Injuries Occur

- Procedures utilizing hollow-bore needles certainly pose the highest risk for healthcare workers since used needles may be filled with potentially infectious organisms.
- The majority of needlestick injuries occur in relationship to the following procedures: IV insertion, blood collection,  IM/SQ injections, and sharps disposal.
- Re-capping of needles should no longer be an issue, but injuries still occur when people use two hands to re-cap instead of using a one-handed technique or a re-capping device.

## How Needlestick Injuries Occur (cont.)

- At times, healthcare workers take “short cuts” to perform all their duties, especially if there are staffing shortages.  These “short cuts” - such as not fully engaging a safety mechanism - may result in a needlestick injury.
- In the absence of safety products, there may also be an increased risk of a needlestick injury.
- Injuries may also occur when healthcare workers are not provided with adequate training - how to do the procedure and how to use a safety product.

## How Needlestick Injuries Occur (cont.)

- Careless behavior such as throwing a used needle in the trash or leaving it in the bed linens may result in a needlestick injury to another healthcare worker.
- Wearing gloves that are too small or too large may also result in a needlestick.
- Injuries can occur when sharps containers are too full.
- Unexpected or emergency situations such as dealing with a combative patient or during a cardiac arrest increase the chance of an accidental needlestick.

## Slide 16

## Where do Needlesticks Occur?

- The majority of needlestick injuries occur in patient rooms and in the Operating Room.
- But, remember, an injury can occur **ANY** **PLACE** where a needle is used!

##  uch!

** ****uch!**

## Prevention of Needlestick Injuries

- Engineering Controls (Sharps Containers):
- 	1. Perform a walk-through of your facility to assess the locations, emptying schedules, and security of containers.
- 	2.  Does the sharps container require one or two hands to operate?
-     3.  Are the sharps containers  located in  convenient locations and at the proper height?

## Prevention of Needlestick Injuries (cont.)

- Sharps Containers
-     4.  The optimal installation heights for fixed, wall-mounted containers are:
-     **Standing**** ****workstation**:  52-56 inches above the standing surface of the use
-     **Seated**** ****workstation***:  *38-42 inches above the floor on which the chair rests
- 				US Dept of Health and Human Services:
- 				“Selecting, Evaluating, and Using Sharps
- 				Disposal Containers” 1/98

## Prevention of Needlestick Injuries (cont.)

- Procedures:  Receive training and **PRACTICE** before you perform a procedure on a patient, whether or not a safety product is being used.
- Products:  Familiarize yourself with the products before you use them.  If a safety product is used, always use it **correctly** and **consistently** to avoid a needlestick injury.

## Prevention of Needlestick Injuries (cont.)

**ALWAYS** be considerate of others.  Dispose of all used needles and sharps in the appropriate containers.
**Expect** the unexpected.  Have an adequate number of supplies readily available for the procedure and ask for help from a co-worker if necessary.
**Be** **extra** **careful** during emergent situations.  Always keep exposed needles pointed down and away from yourself and others.  Alert co-workers when you have a needle or sharp in your hand.

## Prevention of Needlestick Injuries (cont.)

**Always** wear properly fitting personal protective equipment - gloves, eye protection, etc.
**Never** reach into trash cans, basins or other containers with your hands.  You never know when there might be a hidden needle.
**Never** place trash against your body to compress or secure it!

## Education

- 	Education of healthcare workers is critical in promoting a safe environment.  It should be provided during orientation, annually, and on a “as-needed” basis to all healthcare workers.  Those who actually use needles and other sharp objects should  be given additional training, including “hands-on” sessions in using products.

## Ongoing Monitoring

- There should be ongoing monitoring of your facility’s needlestick injuries.
- By analyzing the data on a routine basis, problem areas - either due to products or behaviors - can be detected quickly and corrective actions instituted.
- Long-term analysis of the data provides  information regarding downward or upward trends in injuries.

## Safety Needle Products

- 	1.  Analyze the needlestick injury data: what procedures are associated with the majority of your needlestick injuries?  If there are limited funds, target your safety products for those highest-risk procedures.
-     2.  Have a coordinated process to review, evaluate and select products. This process should be reflected in your facility’s Exposure Control Plan.

## Safety Needle Products (cont.)

- 3.  Educate, educate, educate prior to implementation.
- 4.  Encourage feedback to SPD and Infection Control regarding new products.
- 5.  Always use the products consistently and properly to prevent accidental needlestick injuries.

## Summary

-      We hope this program has provided you with some insight regarding the importance of needle safety.  You are an integral part in the Department of Veterans Affairs’ mission to ensure a needle-safe environment for patients, staff and visitors.  Therefore, we ask that you do your part to reduce occupational needlestick injuries.

## The following slides will provide you with information specific to your facility.

## The Under Secretary for Health’s Goals for Needlestick Prevention

- Please refer to:
- http://www.va.gov/vasafety/OSHPgmDocs/
- AnnualGoals/MainPageAnnGoals.htm

## Your facility’s policies for needlestick prevention and post-exposure follow-up are found in:

## Who to Contact

- If a sharps container is too full, if there is no sharps container available, etc., please contact:

## Who to Contact

- Do you have questions about HIV, Hepatitis B, and Hepatitis C?  Please contact the following:

## What to Do if You Should Sustain a Needlestick Injury

- The following procedure should be followed:

## Needlestick Injury Statistics

- During the past fiscal year, needlestick injuries have occurred (number/% of total):
- Blood collection:
- IM/SQ injection:
- IV insertion:
- During disposal:
- Medication delivery:
- IV delivery:
- Other:

## Safety Devices

- The following safety devices are available in your facility:

## You may obtain these safety devices through:

## What are your employee rights regarding confidentiality, OWCP and incident investigation following a needlestick injury?

- Please contact the following for more information: