Needlesticks: Avoiding the Hazard

Needlesticks: Avoiding the Hazard

During her second day on the job, the newly minted RN was tending to a febrile patient in the ICU and preparing to give him a shot of insulin. Because the patient was thin, she pinched a fold of flesh on his abdomen between her thumb and forefinger, as she’d been trained to do—but when she inserted the syringe it poked right through the patient into her own finger.

“He just looked at me and said, ‘oh, honey,’” the nurse recalled in an anonymous posting in an online discussion board for nurses. “That rang in my head the whole time as I was bleeding the puncture and washing my hands. Oh honey, indeed.”

She’s not alone. Nurses, not surprisingly, comprise the largest percentage of the estimated hundreds of thousands of U.S. health care workers who experience a needlestick injury on the job every year and run the risk of acquiring more than 20 diseases, including Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV).

“Without hesitation, nurses, by far, have the highest percentage of needlesticks and splashes and splatters of any other profession in health care, mostly because they’re at the patient’s bedside more than any other worker,” says Amber Mitchell, DrPH, MPH, CPH, executive director and president of the non-profit International Safety Center.

While no one knows exactly how many needlestick injuries occur nationwide every year, data that the International Safety Center collects annually from about 30 U.S. hospitals and health systems provides a snapshot of the problem. In 2013, a total of 508 percutaneous injuries were reported by network facilities—a sharps injury rate of 21.37 per 100 occupied beds. More than 36% of the injured employees were nurses.

Although those figures represent a significant improvement in injury rates in the 15 years since President Clinton signed into law a federal needle safety bill, the reduction is of little consolation to the nurse who accidentally gets stuck.

needlesticks sidebarTesting and re-testing for infection can last up to six months—and treatments can be grueling. The post-exposure prophylactic treatment sometimes given to prevent HIV infection, for instance, can cause nausea, vomiting, diarrhea, and fatigue. And while the risk of contracting a bloodborne pathogen from a contaminated needle is generally quite small, the mental anguish associated with a needlestick can be enormous. Weeks and months of waiting for test results can cause anxiety, depression, and other psychiatric disorders.

When it comes to needlesticks, there’s no denying that “an ounce of prevention is worth a pound of cure.” With that in mind, here are six strategies nurses can follow to better protect themselves.

1. Use safety devices.

Needlestick rates have declined precipitously since the enactment of the Needlestick Safety and Prevention Act, which requires hospitals and other employers to use safer needles. That said, not all safety devices are equal. Case in point: When Robert Wood Johnson University Hospital in New Jersey switched from using winged blood collection sets with a forward-shielding safety mechanism to one with a quick, in-vein retraction system, needlestick injuries dropped by 70%. Whenever possible, use a needle-free device, but if a syringe is your only option, choose one with a “passive” safety mechanism. Studies show that fewer accidental needlesticks occur with devices that deploy automatically, as compared to those that are manually activated. Whatever device you use, make sure you feel comfortable handling it, and request more training and practice if you don’t.

2. Never recap.

Once upon a time, the practice of recapping used needles was commonplace. While vigorous education campaigns about the dangers of the practice have helped reduce the incidence of recapping-related injuries, it’s still a problem. Recapping is dangerous in several ways: The needle can miss the cap and puncture one’s hand, it can pierce the cap and stab one’s finger, or an ill-fitting cap can slip off creating a hazard. In rare situations where recapping is absolutely necessary, the Occupational Safety and Health Administration (OSHA) recommends using a single-handed scooping method, where the cap is placed on a flat surface and scooping it onto the tip of the syringe. But safety experts say it’s best to avoid the practice entirely.

3. Plan ahead.

Before delivering an injection, envision how you will safely administer the shot and dispose of the contaminated needle. Locate the sharps disposal container—it should be within arm’s length, at eye level, and not overfilled—and explain to the patient everything that you will be doing. Patients are less likely to become startled and make a sudden movement if they are also prepared. If a patient is agitated, combative, or unpredictable, ask a colleague to assist you. Limit interruptions during procedures and dispose of used needles immediately after use only in the approved sharps container.

4. Get involved.

Under the law, hospitals and other health care facilities are required to solicit input from frontline workers like nurses to help evaluate and select safety devices. Your input is valuable and you’ll likely adapt better to technology you’ve had a hand in selecting.

5. Avoid fatigue.

Research shows that working excessively long hours can contribute to job-related injuries like needlesticks. According to one study, needlestick injuries in hospital nurses increased by 16% for every additional 10 hours they worked, and a 2015 study found a 32% increased risk of a needlesticks for newly licensed RNs working overtime. One of that study’s authors, Amy Witkoski Stimpfel, PhD, RN, an assistant professor and researcher at New York University’s Rory Meyers College of Nursing, says shift work contributes to chronic partial sleep deprivation, which can lead to performance impairments. “Our attention lapses – even briefly – and we make mistakes when we are sleep deprived. The slightest lapse of attention can lead to a needle being stuck in the wrong place.”

6. If you get stuck, report it.

Lack of time, embarrassment, and a perceived low infection risk are just some of the reasons nurses often don’t report needlesticks. But the potential consequences of an accidental exposure are simply too big to ignore—and time is of the essence. While the risk of contracting HIV from a contaminated needle is around 0.3% (1 in 300), according to the CDC, risk goes up with a deep injury or when a patient has a high viral load.  Swift reporting of an accidental needlestick provides a better opportunity to get consent from a patient to test their blood for infectious diseases and for you to start on prophylactic therapy, if it’s warranted. PEP must be started within 72 hours after a possible exposure to HIV. If you are accidentally stuck, gently wash the puncture area with soap and water, report the incident to your supervisor, and follow your employer’s procedures.