StatementThe risk of accidental needlestick injury is inherent in the practice of infusion

therapy. Unnecessary needlestick injury is, however, a potentially preventableoccurrence and strategic measures to prevent the unnecessary needlestick shouldbe adopted. It is the position of the National Association of Vascular Access Net­works that any available device that has been shown to reduce the incidence ofneedlestick injury should be adopted to protect the healthcare worker from job­related injuries caused by needles on syringes, intravenous delivery systems andrelated medical devices.

7.JVAD

Exacerbating the issue of exposure isthe fact that up to 500A! of NSI may gounreported (Jagger 1998). It is likely thata small percentage of exposures (5%)may carry a risk of HIV transmission(Bell 1997). The risk of hepatitis C afterNSI is 2.7% to 100!1J, and 500/0 to 80% ofthese infections result in chronic disease(Kelen 1992). NSI with large hollowbore, blood-filled devices used in veinsand arteries have the potential fordepositing a large volume of inoculumduring accidental injury and carry thehighest risk of infection.

National TrendsThe first bloodborne pathogen stan­

dards were published by OSHA (29CFR 1910.1030, 1992) as a result of the

Spring 2000

•arps nJUryreventlon

Review of the Literature

Protecting healthcare workers(Hew) from job-related needle­stick and other sharp deviceinjuries is of critical importance.It is estimated that 600,000 to

800,000 occupational needlestick injuries(NS!) occur annually and these eventscan lead to potentially serious or fatalinfections by bloodborne pathogens(CDC 1997). Bloodborne pathogens aredefined as "pathogenic microorganismsthat are present in human blood andcan cause disease in humans" (OSHA,1998). Documented cases of hepatitis B,hepatitis C, and the human immunode­ficienc.y virus (HIV) have been transmit­ted through occupational exposure andaccidental needlesticks (IppoLito 1997).

potential health risks associated withexposure to blood and other infectiousmaterials that may contain bloodbornepathogens and can be directiy relatedto causing bloodborne diseases. Manytechnologic medical advances havebeen made in the past seven years inan effort to comply with the initialOSHA standard. Results of a survey of400 healthcare workers (HCWs), facili­ties and manufacturers promptedOSHA to update and revise their direc­tives to include emerging technologyand new information on the control ofbloodborne pathogens. The revisedstandards (CPL 2-2, 44D, 1999) do notmandate the use of specific safetydevices, but clearly state that a healthcare facility's Exposure Control Plan"must document consideration andimplementation of appropriate com­mercially available and effective engi­neering controls designed to eliminateor minimize exposure," These engi­neering controls are defined as "thosethat isolate or remove the bloodbornepathogens hazard from the workplace.Examples of these engineering controlsinclude: needleless systems, shieldedneedle devices, blunt needles, andplastic capillaty tubes."

In addition, the National Institute forOccupational Safety and Health(NlOSH), a research arm of the CDC,followed up on OSHA's directives bypublishing a strongly worded "NlOSHAlert: Preventing Needlestick Injuries inHealth Care Settings" (DHHS (NlOSH),1999), The NlOSH Alert urges hospitalsto adopt strategic measures to protecthealthcare workers from job-relatedinjuries caused by needles in syringes,intravenous delivery systems, andrelated medical devices (November 23,1999). NlOSH recommends that the useof needles be eliminated where possi­ble. If safe and effe<:tive alternatives toneedles are not available, devices withsafety features such as shields andsheaths should be used.

The recent additions by both OSHAand the CDC's NlOSH adds furthermomentum to "The Health Care Work­ers Needlestick Prevention Act", HR1899, introduced on May 20, 1999, byRep. Pete Stark (D-Calif.). While thiswas the first Needlestick Prevention Bill

to be introduced into the federal legis­lature, state support for needle safetydevices is escalating rapidly. Most stateshave either proposed or adopted legis­lation that supports both the OSHA andNlOSH recommendations.

Intemational TrendsAlthough international trends toward

safety in vascular access devices are notat the forefront, there have been somerecent sweeping proposals to end theepidemic of unsafe injection practices indeveloping nations. UNICEF, the WorldHealth Organization (WHO), and otherinternational health agencies havebegun a campaign to halt the spread ofinfectious disease by replacing standarddisposable and sterilizable syringes withnew self-<lisabling devices.

WHO has estimated that as many as21 million people a year contract hep­atitis, RN, or other lethal viruses fromunsafe injection practices. Lack ofmoney, political issues, and poor med­ical standards for sterilization haveplaced these nations' citizens in jeop­ardy, many of whom are childrenreceiving immunizations. WHO offi­cials now estimate that 20-80% of allhepatitis B infections in China, India,and Romania are caused by reusedsyringes. The estimated $535 millionannual cost of treating the diseasestransmitted through syringe reuse ismore than 3 times the cost of supply­ing self-disabling syringes to thesedeveloping countries (WHO).

As healthcare providers and manu­facturers, a global perspective of therisk to providers and patients shouldbe advO<.<lted and efforts established tosupport changes in practice in coun­tries without current access to safetyengineering technology.

Implications forPractice and Industry

Developing a comprehensive expo­sure control plan that provides health­care workers with a culture of safetytakes the combined efforts of medicalmanufacturers, healthcare workers,professional organizations, healthcareemployers, unions, and government.The exposure control plan shouldaddress engineering and work practice

controls to reduce or eliminate occu­pational exposure to bloodbornepathogens. A method to evaluate andimplement existing sharps preventiontechnology should be included in thisplan, with an annual review incorpo­rated to reflect changes in technology.

Manufacturing has a responsibility todevelop new technology and improvecurrent technology to eliminate orreduce occupational exposure tobloodborne pathogens, utilizing inputfrom healthcare workers on the frontline. Clinical trials documenting theefficacy of these devices should beconducted and these results madeavailable. It is imperative for manufac­turers to expedite the development ofsafety technologies for all access pro­cedures documented to carry a highrisk to the healthcare worker. Educa­tion on proper use of safety devices iskey to successful implementation.

Practitioners should make the com­mitment to stay informed of legislativetrends, and proactively participate inchanges to clinical practice, that aredesigned to protect and save their ownlives. NSls should always be reportedthrough the proper departments oftheir employers.

Employers have a responsibility toprovide safer needle devices to theirstaff, which should be subject to care­ful evaluation during actual cliniC'al usein order to assure that these product"function as intended. Allowingemployee participation in the evalua­tion process is critical to acceptance ofthe impending changes. Education ofstaff on the rationale for the transitionto safety devices is also critical to thesuccess of the plan. In addition, non­safety products must be removed fromstock in order to allow employees skillacquisition with new devices. Employ­ers should conduct a cost-benefit anal­ysis after implementa[ion, monitoringNSI rate changes, product appropriate­ness specific to area of use, and overalltransition satisfaction among staff. Prob­lem areas should be addressed througheducational means.

Occupational expO.<,ure to bloodbomepathogens for healthcare workers canbe reduced through successful imple­mentation of safer technology.•

8 "'VAC S p r n g 2 0 0 0