Hospital studies consistently show safety-engineered devices reduce needlestick injuries
Plebotomists and safety managers in clinical laboratories across the nation will welcome the results of several studies on phlebotomy needlestick injuries. Evidence is accumulating that use of safety-engineered devices (SED) contributes to fewer reports of accidental needle sticks.
Some experts consider this to be one more example of how focused, concerted attention to a problem in medical laboratory safety standards can encourage innovative solutions. Several hospital studies show a significant reduction in phlebotomy needlestick injuries (NSI). These studies tracked needlestick injuries following passage of legislation in 2000 and the requirement of safety-engineered devices (SEDs).
As all clinical laboratory managers know, phlebotomy procedures not only affect patient satisfaction, they carry risk for needlestick injuries. In a study of 90 facilities from 1993 through 2001, the International Healthcare Worker Safety Center hsc.virginia.edu/epinet/ found 94% of NSIs involved blood-filled needles, according to an article in Medical Laboratory Observer (MLO). This scenario presents the highest risk of bloodborne pathogen transmission.
This prevalence of NSIs led the Occupational Safety and Health Administration (OSHA) to publish its Bloodborne Pathogens Standard in the early 1990s. It also was one reason why Congress voted to enact the Needlestick Safety and Prevention Act (the Act) in 2000. The Act mandated the use of SEDs.
Another study of workers in 87 hospitals showed a whopping 59.9% reduction in phlebotomy needlestick injuries following the passage of the Act. The study compared data from 1993 through 2000 against data from 2001 through 2004.
The most significant effect of the Act, stated another MLO article, was that it led to a 34% reduction in accidental needlesticks in the United States. It also contributed to a 60% decrease in needle exposures during phlebotomy procedures.
Phlebotomy procedures are recognized to be high risk for NSIs. For this reason, selection of appropriate safety-engineered devices is a critical factor, according to the MLO article. Use of SEDs because of the Act has significantly reduced these traumatic—and potentially costly—injuries.
Various SED Technologies Have Advantages/Disadvantages
SEDs are either “passive” or “active,” depending on the method for activating the safety feature, the MLO article explained. The safety feature of “passive” SEDs activates automatically during use. “Active” SEDs, on the other hand, involve post-extraction user-activated safety features. In a third technology, the safety feature may be incorporated into the holder to which the SED is attached for the blood draw.
A disadvantage of the manual shielding safety device, the MLO article stated, is that the safety feature can only be activated after fully withdrawing the needle. Semi-automatic SEDs can activate while the needle remains in the vein. According to the article, a recent study showed that these in-vein activation devices reduced NSIs by 88%, with zero incidents in the last 21 months of the study.
A 61-hospital French study from 2005 through 2006, showed a connection between lower incidence rates of NSIs in conjunction with the use of passive safety devices. The study, which evaluated self-retracting lancets for capillary blood collection, showed that the lowest incidence of NSI was associated with the use of passive SED technology. The study did not evaluate passive venous SEDs.
Passive SEDs do have drawbacks, however, the article noted. They may offer less control to the user than active devices. Depending on the circumstances, the manually-activated SEDs may offer advantages to the phlebotomist. Attaining optimal venous access may require the ability to manipulate the device. This could be impeded in the event of premature activation of a passive safety device, which could require a second stick. In this situation, the active SED could be preferable, the article stated.
Involving SED Users Is Critical in Product Selection
In their observations, the MLO articles stressed two points: (1) no single safety device is suitable in all situations, and (2) the importance of involving the healthcare workers who use the SEDs when choosing the appropriate device for a given clinical setting. In fact, according to MLO, OSHA requires that frontline workers be engaged in an annual review and evaluation of available safety devices.
Providers should select SED products based on clinical environment and procedure complexity, the MLO advised. In order to meet the demand for products to cover multiple circumstances, vendors are developing portfolios of mixed passive and semi-automatic SEDs.
The higher costs of SEDs may bias providers toward conventional devices, the article noted. Adoption of SEDs in non-hospital environments, such as clinics, private physicians’ offices, and long-term care facilities, lags behind that of hospitals.
The devastating toll of NSIs on healthcare workers and their families must be factored into decisions regarding the purchase of SED products, the article urged. The cost of even one NSI incident will typically include extra staffing costs, as well as OSHA fines and potential labor union action and litigation.
The good news is that, since passage of the Needlestick Safety and Prevention Act (NSPA) in 2000, the number of needlestick injuries is falling. Use of safety-engineered devices, despite their additional cost, is contributing to this improvement in the safety of phlebotomists and patients.
Going forward, clinical laboratory managers and pathologists may want to access some of these studies to incorporate into phlebotomy training programs and professional education. It is also important for medical laboratories and hospitals to include staff involvement in device selection, evaluation and related training. These are all important steps to insure that the laboratory organization is in compliance with OSHA and other relevant regulations.
—Pamela Scherer McLeod