Sharps injuries and the risk of occupationally acquired diseases signify one aspect of infection control. Globally, nurses experience most needlestick injuries, and hollow-bore needles are the biggest culprit. Clearly, infusion nurses are specialists who are at high occupational risk for injury. Vascular access devices are the most common cause of nosocomial bloodstream infections with more than 7 million catheters sold annually in the United States alone.1 Percutaneous injuries from sharps used in practice to insert central venous catheters present specific risks. Over the past decade, there have been major efforts to reduce the number of sharps injuries to healthcare workers as the primary route of bloodborne pathogen exposure. Changes in public policy have also produced significant and enforceable prevention and clinical changes while sparking research in the area of sharps injury prevention.
International Sharps Injury Prevention activities were recently commemorated during December 2008, starting with World AIDS Day, December 1. This was the seventh annual award celebration, recognizing key individuals who have made significant contributions in promoting prevention information and strategies to healthcare workers and employers around the globe. Five deserving awardees, including Karen Daley, MS, MPH, RN, FAAN, were selected to accept the prestigious award from the International Sharps Injury Prevention Organization. While serving as president of the Massachusetts Nurses Association, Ms Daley became infected with HIV and hepatitis from a needlestick injury as a frontline caregiver.2 Ms Daley's advocacy was instrumental in the passage of state needlestick injury prevention legislation that spurred passage of the landmark Needlestick Safety and Prevention Act, signed by President Bill Clinton on November 6, 2000.
The federal Needlestick Safety and Prevention Act authorized the federal Occupational Safety and Health Administration (OSHA) to revise the 1991 Bloodborne Pathogen Standard to mandate the use of sharps injury prevention devices. The revised OSHA standard took effect on April 18, 2001, and included 4 major public policy components: adoption of sharps injury prevention devices; maintenance of a log of all contaminated needlestick injuries; inclusion of frontline workers in the identification, evaluation, and selection of safety-engineered devices; and annual revisions to exposure control measures to select and adopt safety devices.3 Although the standard does not include public facilities unless covered by a state-run OSHA department or state law, many states have passed laws to cover public healthcare settings. Massachusetts just passed such a provision for state employees in its House of Representatives in December 2008. The bill is still pending in the Senate. INS nurses may wish to advocate for similar laws in their states.
Primary prevention strategies for safely discarding needles where possible have created safer work environments since 2001. Premier, Inc, is a healthcare alliance serving more than 2000 US hospitals and 53,000 other healthcare sites, with a core purpose of improving the health of communities. Its Web site shares knowledge and references so that hospitals can learn from one another, including sharps injury prevention work plans. Moreover, the site serves as a resource, listing research and journal literature that have been published between 1987 and 2008 pertaining to the review, selection, testing, and evaluation of safer needle devices. Some of these may be of interest to INS members and can be accessed at http://www.premierinc.com/safety/topics/needlestick/device-research.jsp. More scientific data to support the use of innovative methods to further reduce occupational risk to infusion nurses would likely produce additional safety benefits.
Craven & Ober Policy Strategists, LLC, is a full-service Massachusetts-based government relations firm dedicated to credible, assertive advocacy and to the dissemination of reliable public policy information.
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