Getting to the Point of Sharps Safety

Staff Safety

By: Jared Bilski, Joe Paone

Published: 2/11/2020

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There's more work to be done before sticks and cuts no longer occur in today's ORs.


NEUTRAL TERRITORY ?Requiring staff to use a hands-free neutral zone is one of the most effective ways to prevent sharps injuries.   |  Pamela Bevelhymer, RN, BSN, CNOR

For many surgeons, nurses and techs, sharps safety is merely preventative, another necessary precaution in a long line of necessary-but-onerous precautions that are just part of the job. But for Brenda G. Larkin, MS, RN, ACNS-BC, CNS-CP, CSSM, CNOR, clinical nurse specialist with Aurora Health Care in Elkhorn, Wis., sharps safety is personal.

Back in the early 1990s, before the emergence of neutral zones, Ms. Larkin suffered a sharps injury during an orthopedic procedure when a resident absentmindedly placed a needle on the mayo stand. Ms. Larkin, who also serves on the AORN board of directors, reached onto the mayo stand and wound up getting stuck. She received multiple screenings for HIV and Hepatitis B and C, and had to wait a full six months to find out she was infection-free. “I was basically in limbo that whole time,” says Ms. Larkin. “It was emotionally and mentally draining.”

This harrowing experience no doubt impacted Ms. Larkin’s approach to sharps safety at Aurora — an approach that is quite robust. Staff adhere to using a neutral zone — a designated area where sharps must be placed and received — and double-glove with an outer- and inner-glove indicator system. When the white outerglove it pierced or torn, the color of the underglove shows through, letting staff know to switch to a fresh pair.

In addition, surgeons use safety scalpels and the surgical team uses safety needles when they perform injections in the sterile field. “We’ve been using safety scalpels since 2010, and we added safety needles a little more recently,” says Ms. Larkin.

Finally, Ms. Larkin stays abreast of the latest sharps safety products as they hit the market, and incorporates the cutting-edge technology and best practices into her facility’s protocols whenever it’s feasible to do so.

“Staff can’t always go to conferences, so I make it a point to bring back new ideas and introduce them to nurses on the front lines,” says Ms. Larkin. If the product works and there’s staff buy-in, they move on to conducting a trial of the device.

SHARP DRESSED HAND ?Double-gloving gives your staff an extra layer of protection from sharps injuries.   |  Pamela Bevelhymer, RN, BSN, CNOR

Of course, proven best practices such as double-gloving, the neutral zone and safety scalpels need surgeon support to be effective. That’s not always easy to accomplish, especially when it comes to use of a neutral zone. The best way to get your surgeons to stick to your sharps safety protocols often comes down to giving them the “whys” behind your mandates — in as succinct a manner as possible. In other words, the more clearly (and quickly) you can explain the need for your sharps safety protocols, the more likely it is you’ll get buy-in. For her part, Ms. Larkin often uses the SBAR (Situation, Background, Assessment and Recommendation) approach to explain safety protocols because, as she puts it, most surgeons respond best to hard facts backed by clinical evidence.

Room for improvement

Amber H. Mitchell, DrPH, MPH, CPH, president and executive director of the International Safety Center in Houston, Texas, points out that this year is the 20th anniversary of the Needlestick Safety and Prevention Act, which requires facilities to identify, evaluate and implement safer medical devices. This should be a banner year for sharps safety, but there are still big issues going unaddressed in many ORs. Dr. Mitchell says the data her organization has collected reveal the largest numbers of sharps injuries are occurring from suture needles, which account for almost a quarter of all devices used in healthcare settings that cause sharps-related harm.

“Typically, disposable syringes have been the number one device causing injuries year after year, but over the last two to three years we’ve seen suture needles surpass them,” says Dr. Mitchell, who adds nurses typically are injured by disposable syringes, while physicians typically are injured by suture needles.

“There have been a lot of advancements in safer devices for disposable syringes — retracting needles and microneedles — and using oral medications instead of injectables,” she says. “For skin closure, there are all kinds of alternatives — adhesives, zipper closures, staples — but surgeons aren’t evaluating or adopting them. For some reason, the surgical community is slower to adopt innovations for sharps safety than more complicated medical devices such as robotics.”

Why the reluctance? Dr. Mitchell believes some surgeons and surgical teams may be reluctant to adopt sharps safety technologies because they don’t feel comfortable using them. But as with many transitions, this one appears to be generational.

“As we’re starting to see younger surgeons come into clinical and surgical care, they may be more likely to adopt newer technologies specifically for sharps safety because they seem more hyperaware of the risk of infectious diseases,” says Dr. Mitchell.

If suture injuries are usually suffered by surgeons, why don’t more of them seem to care enough to change their practices? “That surprises me,” says Dr. Mitchell. “When I pull up data about sharps injuries in the OR from 2018, sutures were responsible for 45.6% of them,” she says. Furthermore, her data show that 52.8% of all sharps injuries in the OR occur to physicians.

As a result, Dr. Mitchell is concerned about infection risks in the OR. If the surgeon gets stuck with a suture and is bleeding through single or even double-gloves, there is potential cross-transmission of the physician’s and patient’s blood,” she says. “There’s the potential the surgeon could expose the patient to infectious diseases, which is a whole different risk profile for the facility from a liability point of view.”

Dr. Mitchell says sharps injuries to sterile processing personnel usually occur as they are transporting soiled instruments to their area, as well as during the initial washing of the items during the decontamination phase.

Interestingly, she says, “We know from our sharps injury data that almost 25% of all sharps injuries occur to the non-user. That means they’re occurring downstream to environmental service workers, to SPD staffers, to waste haulers.”

Rates of adopting sharps safety technology would improve if surgeons trained with the devices during their schooling, according to Dr. Mitchell.

“That’s another frustration because these newer technologies for sharps safety are typically having no visibility in medical school,” she says. “Unless their attendings or surgical mentors are using them where they’re being trained, young surgeons don’t have access to them.”

Blunted sutures have been around for decades, and even the uptake from sharp to blunt has not been very good, says Dr. Mitchell. That’s somewhat surprising, because there are other benefits to switching out sharp sutures for safer options. Dr. Mitchell says zipper closure manufacturers tout better cosmetic end results, and the products could improve SSI prevention because the zipper allows for fuller closure of the incision — “almost like an adhesive bandage and a zipper all in one,” she says.

Empowered to improve
COVER UP ?While they can be a hard sell, safety scalpels offer critical protection to OR staff who pass sharps to surgeons and dispose of blades after the case.

Dr. Mitchell says facilities that aren’t investigating sharps safety options are at risk of violating the OSHA Bloodborne Pathogens Standard, which requires employers to evaluate commercially available engineered sharps safety controls each year. “My biggest fear for many of these facilities that aren’t adopting safer technologies is they’re not evaluating them on an annual basis, which means they’re at risk of getting an OSHA citation should they be inspected,” she says.

Surgical administrators shouldn’t feel helpless when it comes to eliminating sharps injury risks. Instead, says Dr. Mitchell, they need to leverage their injury data. “There is immediately actionable information in their sharps injury log, which they’re required to keep as part of the OSHA Bloodborne Pathogens Standard,” she says. “That log is an incredibly useful resource. From it, they know what devices are causing the injuries, during what procedures and to whom. They can use that data to address specific actionable interventions.

Using surveillance data in a way that provides a safer working environment for the entire surgical team is the best way to make real change happen.

Information from the sharps injury log that identifies the injuries and the devices causing the injuries feeds into complying with the standard, which also feeds into updating your facility’s exposure control plan.

“It’s a terrific tool immediately available at your disposal,” says Dr. Mitchell. “You can chart your annual progress in reducing sharps injuries as your surgical team adopts safer devices and experiences improvements in reducing injuries over time.” OSM

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