How We Slashed Our Sharps Injuries

Staff Safety

By: Sheri Tadlock

Published: 12/19/2019

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Best practices are a must. But replacing emails with conversations and blame with caring is what really made our sharps injuries drop.


My mission from hospital leadership: Reduce sharps injuries in our 2 regional hospitals by 5% in a year. We far exceeded our goals, managing a 60% reduction from 2016 to 2018. While the first steps were to educate surgeons and staff about sharps safety, and reinforce and implement best practices, I truly believe that the changes in our follow-up process are what really drove the reduction. Essentially, we went from impersonal electronic communications to judgement-free face-to-face conversations. We made sure we didn't make those who'd been stuck feel like they've done something wrong. Instead, we asked if they were OK and focused on helping them prevent a repeat occurrence. That simple shift from blaming to caring made all the difference. Here's how we made the improvements.

1. Weed out non-safety sharps. We first identified when, where and why we were using non-safety sharps. We replaced non-safety sharps with safety ones where appropriate. If non-safety syringes were used simply to draw medication from a vial and never used on a patient, we allowed their continued use. We remain open to replacing all non-safety sharps, including scalpels, and have trialed all kinds — those with disposable plastic handles, with reusable metal handles, with safety sheaths and with retractable blades.

2. Correct high-risk behavior. The OR was a high-risk population cluster for sharps injuries. We reinforced best practices there:

NEUTRAL ZONE Creating a hands-free area helps reduce injuries that occur by eliminating hand-to-hand sharps passing. OR team members place and retrieve sharp instruments on a brightly colored towel or tray.   |  Pamela Bevelhymer, RN, BSN, CNOR
  • Don't re-use syringes for lidocaine injections. Some doctors want to reload lidocaine into the syringe, because it's quick and efficient and the vial poses no infection threat because it gets thrown away after that procedure. But the syringe has already been in the patient, so it poses a risk to the staff. Explain to your surgeons why it's important to not re-load. And educate your nurses on ways to keep efficiency high after the change. Tell them to have several syringes pre-loaded, or on hand ready to load. Make sure they activate the safety feature when the surgeon is done with it. Reinforce all of this in huddles and time outs.
  • Eliminate hand-to-hand sharps transfers. Create a neutral zone for hands-free passing of instruments whenever possible. Whether it's a brightly colored tray or a towel, have some sort of barrier for the transfer from the surgeon to the scrub nurse, tech or whomever is accepting the sharp. Make sure all parties are communicating about the transfer, and that the recipient of the sharp can pick it up in a safe manner without having to move it to avoid its sharp end. We've instructed our nurses to hold the tray out even if a doctor tries to insist on manually passing a sharp to them.
  • Designate a place for sharps post-use. Have a tray in which to place sharps after use. Make sure the container is big enough so that nothing is protruding from it as you make your way to the disposal box or the reprocessing cart.
  • Explain how to activate the safety features. Data from the American Nurses Association (ANA) shows that nearly two-thirds of nurses have had a sharps injury at some point in their career. The ANA also says safety syringes can reduce needlestick injuries to medical personnel by 80%, and that figure can climb to 90% with worker education efforts. But people need to know how to activate and deactivate the safety features — and actually use them — for these reductions to occur. A recent report by the International Safety Center on 2018 data from the Exposure Prevention Information Network (EPINet) shows that 44% of sharps injuries took place in surgical settings where safety sharps were often used but the safety features had not been activated.
  • Make sharps safety education a part of employee orientation. Even though the sessions include non-medical staff, the 2018 EPINet data shows that 25% of those injured by sharps weren't the people who first used them. That means employees downstream from the procedure, such as central processing or housekeeping employees, got stuck. So they could benefit from learning about what a safety sharp looks like and what disposal units look like, where they're located and for what they're used.

Teach sharps users how to use syringes that require single-handed activation as well as those that retract automatically. They also need to know how to properly use disposal units. I bring safety sharps and a disposal box to the orientation sessions and show them how they're used.

3. Relationship-based care. Our hospital used to send the employee who had a sharps injury an email that noted we were aware of the incident, and attached an informational brochure from the Centers for Disease Control and Prevention. To say the least, I found that to be an impersonal way to address the situation.

We've instructed our nurses to hold the tray out even if a doctor tries to insist on manually passing a sharp to them.

Now, I go see them in person. If it's a younger employee, they might be disappointed in themselves or fearful that their bosses will think they've done something wrong. Sometimes the informal feedback from older colleagues isn't good if they minimize the sticks and chalk it up to an inevitable rite of passage. When we talk, I try to change their feeling that a stick is just part of the job. I explain that HIV and hepatitis B and C are alive and well. I make sure the talk isn't a lecture, but a teaching moment in which I explain sharps injuries are preventable if they keep their focus in that moment, and not think about the 30 other things on their to-do list.

Also, I don't go in with a "I can't believe you had a needlestick" attitude. We accept that it happened, I ask if they're OK and if they have any concerns, and if there's anything they need from me to help to prevent it from happening again.

4. Crucial conversations. When you have these conversations with compassion, it opens up a lot of things. I'm then able to walk through the process with them. I can calm them down, explain that while a sharps injury is reportable to OSHA and that our accreditation hinges in part on how many incidents we have, it's OK. If they're concerned about a potential infection, I explain how the size of the bore of the needle, the amount of blood on the syringe and the length of the time the needle was in the skin are all factors in infection transmissions. It was during these conversations that I realized a lot of younger nurses were never taught how to activate the safety features on sharps in nursing school.

A CUT ABOVE Surgeons have strong opinions about safety scalpels on both sides of the issue. Some models have safety sheaths while others are retractable.   |  Pamela Bevelhymer, RN, BSN, CNOR

5. Just-in-time training. When I realized that these young nurses needed education, I didn't wait for a meeting or a huddle. When one nurse who had more than one stick told me she didn't know how to activate a safety syringe, we gathered 6 nurses right then and there, went to the med room and I showed them how to do it. Then they sent me to a different floor where another handful of nurses needed the same lesson. Just-in-time training is simply providing the training right at the moment that it's needed.

For example, when I was talking with a person with a stick, he explained the syringe plunger to retract the needle was too hard to push and he didn't feel comfortable doing it while it was in the patient. We checked it out and, sure enough, there were several syringes that seemed to have issues with the plunger. We called the manufacturer and got it fixed. I don't think that employee would have reported the issue had we done things the old way. Because I wasn't blaming him in our conversation about the stick, he felt comfortable enough to tell me about the mechanical issue with the syringe.

I believe that a one-on-one conversation makes a person a believer. When you approach someone as a human instead of a statistic, you're creating a healing climate that — while it can't undo a sharps injury — can go a long way to preventing one from happening again. OSM

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