The Cornerstones of Effective Sharps Safety

Four key best practices represent a starting point for OR staff to build policies and prevent future injuries.

Behind every needlestick or sharps injury is a story of how it came to happen. Understanding this story, through reporting and auditing of the incident, allows healthcare workers to learn from the event and continuously work to promote safe practices.

Incident still fresh

Jennifer Yorke, MBA-HCM, BSN, RN, recalls one incident where a colleague pricked themselves while trying to recap a clean needle. Industry best practices say to avoid recapping needles, especially by hand. Even an uncontaminated needle presents a dangerous scenario that could lead to accidental punctures of the fingers or hand. Ultimately, a hospital incident report noted the staff member was not following protocol.

“We keep tracking injuries and educating the staff on the importance of sharps safety,” says Ms. Yorke, director of nursing for perioperative services at Kaiser Permanente Panorama City (Calif.) Medical Center. “Our goal is to have zero sharp injuries — we’re obviously always going to strive for that — but accidents happen.”

Incident report reviews

Taking time to review the incident and reinforce safety procedures is one way to keep a future one from happening. That’s why at Kaiser Permanente, sharps prevention efforts include reviewing incident reports — often in partnership with risk management colleagues — for opportunities to improve workflow or reinforce best practices.

The Centers for Disease Control and Prevention reports approximately 385,000 sharps-related injuries occur each year for hospital-based healthcare personnel (osmag.net/cdcsharp). Sharps-related injuries may occur before, during and after procedures — from the moment an instrument is picked up and passed until its eventual disposal. And it could be a blade, lancet, syringe, needle or other sharp tool that requires safe handling. With so many precise tools required throughout healthcare settings, it’s no wonder sharps injuries remain a concern: 25% of nurses report feeling at significant risk for needlesticks and other sharps injuries, according to 2020-2021 survey findings from the American Nurses Association (osmag.net/ANAstudy). However, that represents a drop of 30% from the previous study, suggesting current safe-handling practices are doing more to establish trust and keep workers safe.

Four key best practices

Creating a safe workplace and working toward reducing sharps-related injuries starts with developing a set of standard, institutionally supported best practices. A committee featuring a cross-section of staff can assist in designing and implementing a sharps injury prevention program. After all, even though nursing staff are most at-risk for sharps injuries, laboratory techs, physicians and even environmental services staff can be impacted.

While gathering information from your own staff helps to identify the policies that will best serve your organization, the cornerstones of effective sharps safety generally come down to following these best practices:

• Neutral zone passing. An area that is designated for sharps to be placed or retrieved;
• Safety scalpels. Surgical tools that feature a fixed blade and a retractable sheath when possible;
• Double-gloving. Donning two pairs of gloves reduces the risk of sharps injuries as well as exposure to bloodborne infections; and
• Blunt-tip suture needles. These items reduce or eliminate the chance of needlestick thanks to a non-bevelled tip.

At Kaiser Permanente, where policies are reexamined and updated every two years, healthcare leaders have adapted the neutral zone passing practice to make it even more effective in their OR. Unique to Kaiser Permanente are two types of neutral zones: a pink transport tray for safe passing of any sharps in use, and a non-traveling orange landing strip for placement.

The two areas assist during transfer and storage, times when staff are at heightened risk for injury. “It’s understood as a designated space where contaminated and sharp surgical instruments are safely placed during a surgical procedure,” says Ms. Yorke. “The neutral zone is crucial for maintaining a safe and sterile environment and helps mitigate the risk of sharps injuries to the team.”

Our goal is to have zero sharp injuries — we’re obviously always going to strive for that.
Jennifer Yorke, MBA-HCM, BSN, RN

The OR is typically a high-risk area, and in addition to sharps injuries, staff must remain careful to avoid falls and overexertion. On a monthly basis, the hospital’s risk department reviews any injuries and assesses the OR environment. Thanks to an increased focus on safety, Ms. Yorke says the hospital recently recognized the OR as a “medium” risk environment, instead of “high.” Hospital stats back this up. After updating policies in 2020 to incorporate the use of neutral zone trays, sharps injuries dropped from four to two, says Ms. Yorke. In 2023, she adds, there has only been one.

Creating an open dialogue

Encouraging strong communication and creating a sense of situational awareness are crucial to the success of Kaiser Permanente’s neutral passing zone practice. Before surgery starts, the OR team verbally identifies and confirms the use of sharps in each area. Then, whenever a sharp is being passed, the individual holding it will say “sharp” aloud.

“When you’re in a restaurant, and they come out really fast with a whole bunch of trays in their hands, they’ll say ‘corner.’ I always noticed that, like, ‘OK, I just wanna make sure everybody’s aware that I’m coming around the corner,’” says Ms. Yorke. Similarly, verbal cues in the operating room ensure “everybody is in tune.”

This focus on empowering the team through communication extends beyond final verification to everyday operations, with staff members encouraged to speak up and contribute to any processes, Ms. Yorke says.

One example of this is the role of safety champions, or individual staff members who hold volunteer leadership positions focused on various elements of safety operations. These champions are leaders within their spheres, but do not hold management positions. They are go-to individuals who can assist in training or answer questions and concerns. Speaking of the OR safety champion, Ms. Yorke notes, “She embodies everything safety in the OR, and she helps promote safe behaviors, raising awareness about potential hazards, encouraging reporting, auditing and inspecting and coming up with preventative measures.”

Preventing sharps injuries altogether

NEUTRAL ZONES The combination of a pink transport tray and orange landing strip help Kaiser Permanente OR teams manage safe passing of sharps.  |  Jennifer Yorke, MBA-HCM, BSN, RN

Training and practice may only go so far. Perhaps the best way to avoid needlestick or sharps injuries is to limit the use of sharps. By avoiding using a sharps device when it is not necessary, potential hazards and injuries may be eliminated altogether. Among the cornerstones of effective sharps safety is the use of blunt-tip suture needles, and this represents a call to think of ways to perform tasks without a sharps device or to select a device with lower risk.

Amanda Parsley, RN, OR manager at Ascension Saint Thomas DeKalb Hospital in Smithville, Tenn., says her team uses safety knife handles and blades as well as blunt sutures as much as possible. By finding safer sharps devices that align with the needs of a procedure, providers may still achieve their desired result while also controlling exposure and protecting staff. Another example from Ascension Saint Thomas is the use of blunt trocars for laparoscopy procedures.

Controlling what devices are used and how they are accessed also plays a role in effective sharps safety. Safe transport and disposal help to create a secure environment before and directly following a procedure. In addition to using safety needles for injections, Ms. Parsley also shares that tools are locked and properly disposed of after use. Keeping a sharps container near a workstation encourages immediate disposal of sharps after a procedure.

In the Ascension Saint Thomas OR, workers use needle sharps counters within the designated sterile field. Then, used sharps are safely transported to the large sharp containers to complete the disposal process. An overfilled container can increase the risk of needlesticks or cuts, so using and collecting the containers for disposal avoids these potential hazards.

Protect your team

When it comes to sharps injuries, everyone in a surgical setting is at risk. Indeed, across the healthcare industry, there is a need for increased sharps injury education and prevention. There is the potential for sharps injuries anywhere these instruments are used, including office-based and urgent care centers.

For Ms. Yorke and Kaiser Permanente, protecting the entire team means everyone plays a role in minimizing or mitigating any risk of injury. Seeing her team working together and feeling empowered to take ownership of a sharps safety protocol gives her a sense of pride. “We have that ethical responsibility to make sure that the patients are safe and the whole team is focused on safety and quality,” she says. OSM