No Needless Sharps Injuries

Not long after we opened the doors to our small outpatient center in 2004, we experienced our first sharps injury. That was just the wake-up call we needed to ensure the event was a one-off mistake and not an unfortunate byproduct of a busy, growing facility. Since then, we’ve expanded our services to include the treatment of an array of orthopedic conditions, such as total knees and hips, rotator cuff repairs and carpal tunnel release surgery. One thing we haven’t added to our repertoire, however, is more sharps injuries.

If you’re looking to bolster your own sharps safety efforts, here are the key safety components we use to keep our surgery center injury-free:

• Regular audits. Perform a sharps safety audit each quarter to ensure all needle safety and infection prevention policies are being performed correctly and none of your staff become complacent, rush or cut corners — something that’s especially important when cases are on the rise. As cases increase, so does the risk for sharps injuries — all the more reason for quarterly audits.

• Ongoing training. Provide sharps prevention and bloodborne pathogen safety training during new employee orientation, but also provide a yearly refresher course for other staff. Even though our lone sharps injury involved a solid core needle that hadn’t yet come in contact with the patient, we take the risk of bloodborne pathogens very seriously and have a clear-cut post-needlestick procedure as well as a standard reporting protocol.

When it comes to training and educational sessions, try to lean on the expertise of your staff. For instance, many of our nurses have been practicing for more than 30 years. We encourage them to use these trainings as a platform to speak up about what they’ve experienced. Maybe one of your nurses suffered an injury or had a close call at a previous facility and could provide invaluable advice for the rest of the staff. Your frontline staff is a wealth of knowledge and experience; you just need to make sure to provide a safe, welcoming space for them to share their insights.

One last note on sharps safety training: It doesn’t need to be overly complicated, but it should explain to your staff why your protocols and policies are in place — and what the risks are for unsafe practices.  For instance, approximately 385,000 needlesticks and other sharps-related injuries affect healthcare personnel, according to the CDC. If your staff understand why your protocols are in place, they are more likely to follow them. And if you receive pushback from any staff during training, that could be helpful as well. After all, if staff are grumbling over sharps safety protocols, how can you get them onboard and how many other policies are they not going to follow?

After training, we test our employees’ knowledge with a nine-question true or false quiz (see “Test Your Sharps Safety Knowledge” below) led by our administrator and our director of nursing. We use this quiz as another touchpoint to remind staff to be mindful of sharps safety, as these injuries are the number one safety risk for healthcare staff.

• Proper disposal. While most people think of sharps injuries as incidents that occur during handoffs in the middle of surgery, plenty of problems occur during the disposal of these items, as well. That’s why you must ensure sharps are properly disposed of and only placed in puncture-proof sharps containers immediately after use.

Remember, anything that could cut, prick or injure staff — such as a glass ampule — should never be thrown away in the garbage can.  You also want to be on the lookout for corner-cutting during the disposal phase and regularly remind staff not to rush when sharps are involved, as this increases the risk of injury. Recommend that they take a three-second pause to stop and think over their decision when they’re deciding where to dispose of sharps. Just this simple reminder to slow down can significantly reduce the rate of injuries.

For safety purposes, lay out your ORs with a clear path to every sharps disposal container. In pre-op rooms, place sharps disposal containers right next to the beds. Anesthesia carts should also have sharps containers mounted on the sides for easy disposal.

• Safe handling. Staff should be taught how to use all sharps safety devices. For instance, when starting an IV, they should know to retract the needle on a safety-engineered device as soon as the line is established. Providers who use needle drivers to load and unload scalpel blades should always keep the blade’s tip pointing away from them. When it comes to needle safety and recapping needles, they should try to avoid recapping needles whenever possible. Granted, it may be safer to recap the needle than to walk around with it unprotected. That’s why we train our staff to recap using a single hand. Here, a provider sets the needle cap on the table and when it’s time to recap it, they use the single-hand method, which involves scooping and jiggling the cap down the needle, pressing it on using a hard surface and then securing it with their other hand. This method avoids a common cause of needlestick injuries that can occur when staff hold the needle in one hand and try to place the cap on it with the other hand.

• Hands-free passing. Finally, all the sharps in our ORs are kept in a neutral zone located in one corner of the sterile field until the case is complete. A scrub tech may pass them to the surgeon, but a surgeon will never pass them back to the scrub tech; they will always be placed back in the neutral zone. This allows providers to be more aware of when sharps are placed and removed from the designated neutral zone, thus further reducing the risk of sharps injuries.

Preventing sharps-related injuries is a crucial component of staff safety, something that ultimately impacts patient safety, as well. If your staff doesn’t think you are taking the necessary precautions to keep them safe, what will prevent them for searching for employment elsewhere?

Once we decided that one sharps injury was one too many, we made it our mission to meticulously follow the dedicated policies and procedures that have been established for employee safety — and we’ve been injury-free for more than two decades as a result. OSM