Transcript SAFE INJECTION PRACTICES & NEEDLE STICK

Safe Injection Practices
Speaker
 Sue Dill Calloway RN, Esq. CPHRM
 AD, BA, BSN, MSN, JD
 President
 Patient Safety and Healthcare
Consulting
 5447 Fawnbrook Lane
 Dublin, Ohio 43017
 [email protected]
 614 791-1468
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Identify Risks for Transmitting Infections
 Hospital and ASC in Colorado where surgery tech
with Hepatitis C infection steals Fentanyl and
replaces it with used syringes of saline infecting 17
patients as of December 11, 2009 and 5,970
patients tested (total 36 for 3 facilities)
 Kristen Diane Parker in 2010 gets 30 years for
drug theft and needle swap scheme
 Worked at Denver’s Rose Medical Center and
Colorado Springs’ Audubon Surgery Center
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1 www.krdo.com/Global/link.asp?L=399119
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Infection Control
 The CDC says there are 1.7 million healthcare
infection (HAI) in America every year
 There are 99,000 deaths in American hospitals every
year
 Leadership need to make sure there is adequate
staffing and resources to prevent and manage
infections
 Healthcare-Associated Infections (HAIs) are one of
the top ten leading causes of death in the US
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www.cdc.gov/ncidod/dhqp/hai.html
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Infection Control
 There have been more than 35 outbreaks of viral
hepatitis in the past 10 years because of unsafe
injection practices
 This has resulted in the exposure of over 100,000
individuals to HBV and 500 patients to HCV
 This includes inappropriate care of maintenance of
finger stick devices and glucometers
 Includes syringe reuse, contaminations of vials or IV
bags and failure of safe injection practices
 Source: APIC position paper: Safe injection, infusion, and medication
vial practices in health care
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Infection Control Back to Basics
 It is important to get back to basics in infection
control
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 Education and training is imperative to learn each
person’s role in preventing infections
 What practices and constant reminders do you
use to remind staff during patient care
encounters?
 New needle and syringe for every injection
 Single dose saline syringes
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1 http://www.jcrinc.com/infection-prevention-back-to-basics/
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What is Injection Safety or Safe Injection Practices?
 The CDC says it is a set of measures taken to
perform injections in an optimally safe manner for
patients, healthcare personnel, and others
 A safe injection does not harm the recipient, does
not expose the provider to any avoidable risks and
does not result in waste that is dangerous for the
community
 Injection safety includes practices intended to
prevent transmission of infectious diseases between
one patient and another, or between a patient and
healthcare provider, and also to prevent harms such
as needle stick injuries
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CDC Injection Safety Website
 The CDC has an injection safety website
 Contains information for providers
 Injection Safety FAQs
 Safe Injection Practices to Prevent Transmissions
of Infections to Patients
 Section from Guidelines for the Isolation
Precautions to Prevent Transmission and more
 www.cdc.gov/ncidod/dhqp/injectionsafety.html
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CDC Guidelines
 CDC has a publication called 2007 Guideline for
Isolation Precautions: Preventing Transmission of
Infectious Agents in Healthcare Settings
 Has a section on Safe Injection Practices (III.A.1.b.
and starts on page 68)
Discusses four large outbreaks of HBV and
HCV among patients in ambulatory facilities
Identified a need to define and reinforce safe
injection practices
www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf
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Lumbar Puncture Procedures
 CDC investigated 8 cases of post-myleography
meningitis
 Streptococcus species from oropharngeal flora
 None of the physicians wore a mask
 Droplets of oral flora indicated
 Lead to CDC recommendations of 2007
 Later related to not wearing a mask when
anesthesiologists put in epidural lines for pain relief
on women in labor
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CDC Guidelines
 Recently, five cases where anesthesiologist inserts
epidural line in OB patients without wearing a mask
 January 29, 2010 CDC MMWR at
www.cdc.gov/mmwr/preview/mmwrhtml/mm5903a1.htm
 CDC made recommendation in June 2007 after
several reports of meningitis after myelograms
 Bacterial meningitis in postpartum women and
Ohio woman dies May 2009
 Streptococcus salivarius meningitis (bacteria that
is part of normal mouth flora)
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Wear Mask When Inserting Epidural/Spinal
Hospital in NY
–Enhanced hand hygiene
–Maintenance of sterile fields
–Full gown, gloves, and mask
–No visitors when epidural put in
CDC has only identified 179 cases of post
spinal (including lumbar punctures) world
wide from 1952 to 2005
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CDC Guidelines
CDC identified four outbreaks in
Pain clinic
Endoscopy clinic
Hematology/oncology clinic
Will discuss major findings later
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CDC Guidelines
Primary breaches
 Reinsertion of used needles into multidose vials
 Used 500cc bag of saline to irrigate IVs of
multiple patients
 Use of single needle or syringe to administer IV
medications to multiple patients
 Preparing medications in same work space
where syringes are dismantled
 Remember OSHA Bloodborne Pathogen
standard (sharps containers at the bedside)
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What to Do?
Use only single dose vials and not
multidose vials when available
This includes the use of saline single dose
flushes
Single use of a disposal needle and syringe
for each injection
Prevent contamination of injection
equipment and medication
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What to Do?
Wear masks when inserting epidural or
spinals
Discard used syringe intact in appropriate
sharps container
Make sure sharps container in each patient
room
Do not administer medications from single
dose vials to multiple patients or combine
left over contents for later use
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What to Do?
 If multiple-dose vials are used, restrict them to a
centralized medication area or for single patient
use
 Never re-enter a vial with a needle or syringe
used on one patient if that vial will be used to
withdraw medication for another patient
 Store vials in accordance with manufacturer’s
recommendations and discard if sterility is
compromised
 Mark date on multi-dose vial
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What to Do?
 Do not use bags or bottles of intravenous solution
as a common source of supply for multiple patients
 Follow the CDC 10 recommendations
 Maintaining clean, uncluttered, and functionally
separate areas for product preparation to minimize
the possibility of contamination
 CMS Hospital CoP requirement, tag 501
 TJC 2010 MM.05.01.07
 Clean top with Bleach wipe after each use
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A Scary Study
 The CDC says a survey of US Healthcare found
that 1% to 3% reused the same syringe and/or the
same needle on multiple patients
 This is what lead to the Nevada patients being
exposed to HIV, HCV, and HCB
 40,000 patients were notified who has anesthesia
injections from March 2004 to January 11, 2008
and 115 patients infected with HCV
 Clinic reused syringes in colonoscopies and other
gastrointestinal procedures
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Please Ask Me
 The Ask Me Program and the Nevada Medical
Association posts information on their website
 The Nevada State Health Division has
encouraged patients to ask several questions prior
to a surgical procedure
http://health.nv.gov/docs/030308PressRelease.pdf
 Can you assure me that I am safe in your facility
from the transmission of communicable diseases?
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Please Ask Me Program
 How does the staff at this facility conduct
sterilization of diagnostic equipment after each
patient use?
 Are single or multiple dose vials used at the
facility? Are label instructions followed specifically?
 Are syringes and needles disposed of after each
use?
 Has your facility ever received a complaint of the
spread of an infectious disease to another patient
as a result of staff practices?
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CDC Injections Safety for Providers
 The CDC also issues Injection Safety for Providers
 Issued March 2008 at http://www.cdc.gov/ncidod/dhqp/ps_providerInfo.html
 Notes several investigations leading to
transmission of Hepatitis C to patients
 Thousands of patients notified to be test for HVB,
HCV, and HIV
 Referral of providers to the licensing boards for
disciplinary actions
 Malpractice suits filed by patients
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CDC 10 Recommendations
 The CDC has a page on Injection Safety that
contains the excerps from the Guideline for
Isolation Precautions: Preventing Transmission
of Infectious Agents in Healthcare Settings
 Summarizes their 10 recommendations
 Available at
http://www.cdc.gov/ncidod/dhqp/injectionSafetyPr
actices.html
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CDC Safe Injection Recommendations
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Use aseptic technique to avoid contamination of
sterile injection equipment. Category 1A
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Do not administer medications from a syringe to
multiple patients, even if the needle or cannula
on the syringe is changed.
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Needles,cannula and syringes are sterile,
single-use items; they should not be reused for
another patient nor to access a medication or
solution that might be used for a subsequent
patient.1A
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CDC Safe Injection Recommendations
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Use fluid infusion and administration sets (i.e.,
intravenous bags, tubing and connectors) for
one patient only and dispose appropriately after
use
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Consider a syringe, needle, or cannula
contaminated once it has been used to enter or
connect to a patient's intravenous infusion bag
or administration set 1B
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CDC Safe Injection Recommendations
Use single-dose vials for parenteral
medications whenever possible 1A
Do not administer medications from singledose vials or ampules to multiple patients or
combine leftover contents for later use 1A
If multidose vials must be used, both the
needle or cannula and syringe used to
access the multidose vial must be sterile 1A
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CDC Safe Injection Recommendations
Do not keep multidose vials in the
immediate patient treatment area and store
in accordance with the manufacturer's
recommendations;
 Discard if sterility is compromised or
questionable 1A
Do not use bags or bottles of intravenous
solution as a common source of supply for
multiple patients 1B
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CDC Safe Injection Recommendations
Wear a mask when placing a catheter or
injecting material into the spinal canal or
subdural space
 Example, during myelograms, lumbar puncture
and spinal or epidural anesthesia. 1B
Worker safety; Adhere to federal (OSHA)
and state requirements for protection of
healthcare personnel from exposure to
blood borne pathogens 1B
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CDC has Injection Safety FAQs for Providers
 CDC has another resources with frequently asked
questions
 What is injection safety?
 Incorrect practices identified in IV medications for
chemotherapy, cosmetic procedures, and
alternative medicine therapies
 Available at
http://www.cdc.gov/ncidod/dhqp/injectionSafetyFA
Qs.html
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CDC has Injection Safety FAQs for Providers
 Also puts patients at risk for bacterial and fungal
infections beside HIV and Hepatitis
 Single dose vials do not contain a preservative to
prevent bacterial growth so safe practices
necessary to prevent bacterial and viral
contamination
 Proper hand hygiene before handling medications
 Make sure contaminated things are not placed
near medication preparation area
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CDC has Injection Safety FAQs for Providers
 Single use parenteral medication should be
administered to one patient only
 Pre-filled medication syringes should never be
used on more than one patient
 A needed or other device should never be left
inserted into a medication vial septum for multiple
uses
 This provides a direct route for microorganisms
to enter the vial and contaminate the fluid
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CDC has Injection Safety FAQs for Providers
 Multi-dose Vials
 The safest thing to do is restrict each medication
vial to a single patient, even if it's a multi-dose
vial
 Proper aseptic technique should always be
followed
 If multi-dose medication vials must be used for
more than one patient, the vial should only be
accessed with a new sterile syringe and needle
 It is also preferred that these medications not be
prepared in the immediate patient care area
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CDC has Injection Safety FAQs for Providers
 To help ensure that staff understand and adhere
to safe injection practices, we recommend the
following:
 Designate someone to provide ongoing
oversight for infection control issues
 Develop written infection control policies
 Provide training
 Conduct performance improvement
assessments
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USP 797
 USP published a revision to the USP general
Chapter of 797
 These standards apply to pharmacy compounded
sterile preparation
 This includes injections, nasal inhalations,
suspensions for wound irrigations, eye drops etc.
 Applies to the pharmacy setting as well as to all
persons who prepare medications that are
administered
 And it applies to all healthcare centers
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USP 797
 This chapter includes standards for preparing,
labeling, and discarding prepared medications
 Pharmacies compound sterile preparations under
laminar flow hoods with stringent air quality and
ventilation to maintain the sterility of the drug (ISO
class 5 setting)
 If prepare outside the pharmacy then environment
has particulates and microorganisms increasing the
potential for contaminating the vial, IV solution or
syringes
 Need to wash hands before preparing medication outside the
pharmacy
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USP 797
 Want to prepare IVs and piggybacks in the
pharmacy when at all possible
 Breathing over the sterile needle and vial stopper
can create the potential for microbial contamination
 USP exempts preparation outside the pharmacy for
immediate use
 1 hour limit from completing preparation and this includes
spiking an IV bag
 Cost of medication disposal can be daunting if case not
started within one hour which is why should consider
pharmacy preparing under ISO class 5 environment
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USP 797
 This way the drugs used for surgery are prepared
by properly trained, cleansed, and garbed
personnel to prolong the usability of the immediate
use compounded sterile drugs (CSD)
 These can be stored for 48 hours
 Another option is to located a manufacturers
injectable product (prepackaged syringe) that is
discarded according to manufacturer expiration
date
 APIC supports preparing parenteral medication as
close as possible to the time of administration
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USP 797 APIC Recommendations
 Make sure only trained staff are preparing medications
 Need to prepared in a clean dry workspace that is free
of clutter and obvious contamination sources like water,
sinks
 Medications should be stored in a manner to limit the
risk of tampering
 Should verify the competency of those preparing
medications and monitor compliance with aseptic
technique
 28 day discard date on multidose vials even though
CDC says manufacturers recommendations
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APIC Recommendations
 APIC issues recommendations and key talking
points for hospitals and healthcare facilities
 http://apic.informz.net/apic/archives/archive_27223
5.html
 The infection preventionist at our facility has
designed a coordinated infection control program
 This is protect everyone coming in to our facility
 Our program implements evidenced based
practices from leading authorities including the
CDC
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APIC Recommendations
 Cleanse the access diaphragm of vials using
friction and a sterile 70% isopropyl alcohol, ethyl
alcohol, iodophor, or other approved antiseptic
swab
 Allow the diaphragm to dry before inserting any device
into the vial
 Never store or transport vials in clothing or pockets.
 Discard single-dose vials after use
 Never use them again for another patient
 Use multi-dose medication vials for a single patient
whenever possible
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APIC Recommendations
 Never leave a needle, cannula, or spike device
inserted into a medication vial rubber stopper
because it leaves the vial vulnerable to
contamination
 even if it has a 1-way valve
 Use a new syringe and a new needle for each
entry into a vial or IV bag
 Utilize sharps safety devices whenever possible
 Dispose of used needles/syringes at the point of
use in an approved sharps container
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Blood Glucose Monitoring Devices APIC
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APIC Key Talking Points
 This program includes
 Rigorous hand hygiene practices
 Monitoring the cleaning disinfection, and
sterilization of equipment and instruments
 An Exposure Control Plan that serves to
minimize bloodborne pathogens such as HIV,
Hepatitis B and C by patients and staff
 As part of this program there are measures to
prevent the re-use of items designed to be used
only once such as needles and syringes
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A Patient Safety Threat-Syringe Reuse
 CDC published a fact sheet called “A
Patient Safety Threat- Syringe Reuse”
 It was published for patients who had
received a letter stating they could be
at risk due to syringe reuse
 Discusses the dangers of the reuse of
syringes
 Discusses that multidose vial be
assigned to a single patient to reduce
the risk of disease transmission
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Anesthesia Delivery
Nevada clinics started with Lidocaine 1 cc
and Propofol 9ccs in one syringe
Clean needle and syringe initially
If patient needed more used clean needle
but used old syringe
If medication left in the single dose Propofol
vial used to sedate the next patient
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Anesthesia Delivery
Propofol is single dose medication and
preservative free
 Bought 20-50cc vials but only used 10-15cc per
patient
 Clinic had not had full inspection by state surveyors
in 7 years
 Identified a number of infection control problems
with ASC
 CMS has new freestanding ASC CMC CfCs May
18, 2009 and revised December 30, 2009
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Never Event: Unsafe Injection Practices
The CDC has a website entitled “ A Never
Event: Unsafe Practices”
Has a power point presentation and an
audio presentation
Available at
www.cdc.gov/ncidod/dhqp/COCA_Unsafe_I
njection_Practices.html
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Hematology Oncology Clinic
 Has an outbreak of HCV among outpatients 3-00
to 7-01
 Reported to Nebraska Health Department
 99 patients with clinic acquired HCV after having
chemotherapy
 All were genotype 3 a which is uncommon in the
US
 Related to catheter flushing
 Source: Macedo de Oliveira et al., Annals of
Internal Medicine, 2005, 142:898-902
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Hematology Oncology Clinic
 Nurse drew blood from the IV catheter
 Then she reused the same syringe to flush the
catheter with saline
 She did use a new syringe for each patient
 However, she used solution from same 500cc bag
for multiple patients
 Oncologist and RN license revoked
 Never use an IV solution bag to flush the solution
for more than patient
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Other Cases
 Patient in US gets malaria from saline flush
 Emerging Infectious Diseases, Vol 11, No. 7,
July 2005
 Oklahoma Pain Clinic where anesthesiologist filled
syringe with sedation medication to treat up to 24
patients and injected via hep lock
 71 patients with HCV and 31 with HBV
 25 million dollar settlement
 Source: Comstock et al. ICHE, 2004, 25:576-583
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Other Cases
 19 patients get HCV in New York in 2001 from
contamination of multi-dose anesthesia vials
 CDC MMWR September 26, 2003, Vol 52, No
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 NY City private physician office with 38 patients
with HBV
 Associated with injections of vitamins and
steroids
 Gave 2 or 3 in one syringe
 Source: Samandari et al. ICHE 2005 26 (9);745-50
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Bacterial Outbreak Due to Unsafe Needle
7 patients get serratia marcescens from
spinal injections in a pain clinic
 Source: Cohen Al et al. Clin J Pain 2008;
24(5):374-380
Several other studies where patients got
infection from joint and soft tissue injections
Got staph aureus
 In 2003 and 2009
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Dialysis Facilities
 CDC issues MMWR report April 2008
 Dialysis units must follow CDC guidelines to
receive Medicare payments for outpatient services
 Recent outbreaks of HCV and other bacterial
infections
 From reentry into single dose medication vials to
more than one patient
 CDC recommends to use single dose vials
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Dialysis Facilities
 If multi-dose then should be assigned to one
person
 Should be prepared in a clean area separate
from potentially contaminated surfaces
 Medications should be prepared in clean area
removed from the patient treatment area
because surfaces are subjected to frequent
blood contamination
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Injections Safety and Recent Outbreaks
 The CDC website has a slide presentation
called “Injection Safety & Recent Outbreaks”
 From APIC North Carolina October 5, 2009
 Has 48 slides
 Available at
http://www.cdc.gov/ncidod/dhqp/injectionsafet
y.html
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WHO Injection Safety
 The World Health Organization also
has resources on injection safety
 Recently had 10th annual meeting of
the Safe Injection Global Network
(SIGN)
 Has revised injection safety
assessment tool
 73 pages document
 http://www.who.int/injection_safety/en/
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WHO Safe Injection Tool
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WHO
 Also has a 51 pages document
 Covers the 2008 conference
that was held in Moscow
 Additional information about
the Safe Injection Global
Network (SIGN)
 Includes a report of the SIGN
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One and Only Campaign
 Educational awareness to improve safe practices
in healthcare
 One needle, one syringe, and only one time for
each patient
 To empower patients and re-educate healthcare
providers
 Has free posters
 Coalition partners include APIC, AANA, CDC.
AAAHC, Nebraska Medical Association, Nevada
State Department of Health etc.
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http://oneandonlycampaign.org/
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Advancing ASC Quality
 ASC Quality Collaboration has ASC tool kit for
infection prevention
 Includes one on hand hygiene and safe injection
practices
 Includes a basic and expanded version of the
toolkit
 These are available at
http://www.ascquality.org/advancing_asc_quality
.cfm
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The End
Questions
 Sue Dill Calloway RN, Esq. CPHRM
 AD, BA, BSN, MSN, JD
 President
 Patient Safety and Healthcare
Consulting
 5447 Fawnbrook Lane
 Dublin, Ohio 43017
 614 791-1468
 [email protected]
 Avoiding Needlestick Follows
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Avoiding Needle Stick
Injuries
Speaker
 Sue Dill Calloway RN, Esq. CPHRM
 AD, BA, BSN, MSN, JD
 President
 Patient Safety and Education
 5447 Fawnbrook Lane
 Dublin, Ohio 43017
 614 579-1481
 [email protected]
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OSHA
 Ten years after the Needlestick Safety and
Prevention Act was signed into law
 Which is part of the OSHA Bloodborne Pathogen
Standard (29 CFR 1910.1030)
 OSHA announces a regulatory review of the law
 Has this standard had a impact on healthcare
worker safety?
 Recent article says sharps in non-surgical setting
has declined by about 32%
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1 Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings versus non-surgical settings after passage of national
needlestick legislation. J Amer Col Surg 2010; 210:496-502
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OSHA
 Safely engineered devises have resulted in 74%
decrease in injuries in phlebotomy
 However, this is not true in the surgery operating
room where adoption of blunt suture needles and
other sharps safety measures have lagged
 Sharps injury has increased from 1993 to 2006 by
6.5%
 This regulation remains the most frequent cited
standard in OSHA inspections of hospitals
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OSHA
 Inspectors were most likely to cite for failing to have
an adequate exposure control plan or failing to
update the plan to reflect changes in technology
 The standard requires employers to review their
exposure control plans annually
 Hospitals also were cited for failing to provide
safety-engineered devices
 Or failing to document that employees had been
offered the hepatitis B vaccine
 The same types of violations are being seen by
ASCs
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www.osha.gov/SLTC/bloodbornepathogens/index.html
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Needlestick Safety and Prevention Act
 The Occupational Exposure to Bloodborne Pathogen
Standard was first published in 1991
 Passed because of concerns to healthcare workers
of things such as HIV, hepatitis B and C who were
exposed to blood or other potentially infectious
materials
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saliva, blood, semen, cerebrospinal fluid, amniotic, synovial, pleural, pericardial, peritoneal etc
 Employer needed an exposure control plan on details
on employee protection measures
 Engineering controls included safer medical devices,
such as needleless devices, shielded needle devices
and plastic capillary tubes
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Needlestick Safety and Prevention Act
 Despite these advances with non-needle devises
needlestick and sharps injuries continued
 OSHA said there were nearly 600,000
percutaneous injuries involving sharps so Congress
passed the Needlestick Safety and Prevention Act
which became effective April 18, 2001 (passed
November 6, 2000)
 Still requires employers to adopt engineering and
work practice controls that would eliminate or
minimize employee exposure from hazards
associated with bloodborne pathogens
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Needlestick Safety and Prevention Act
 Need to pull out your exposure control plan every
year
 Need to do an annual review
 Need to update to reflect changes in technology
that help to eliminate or reduce exposure to
bloodborne pathogens
 Take into consideration new safer devices designed to
reduce needlestick injuries
 Document consideration and use of appropriate
safer devices
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Sample Model Plans from OSHA
www.osha.gov/Publications/osha3186.html
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Needlestick Safety and Prevention Act
 List employees involved and describe how input
was requested or present minutes of meetings
 Employers need to get input from employees
responsible for direct patient care (non management
such as nurses) on evaluation, identification and
selection of effective and safer devices
 Employees selected should include those exposure
in different areas like peds, geriatrics, nuclear
medicine etc.
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Needlestick Safety and Prevention Act
 Engineering controls include things that isolate or
remove a hazard from the workplace
 Such as sharp disposal containers and self-sheathing
needles
 Sharps with engineered sharps injury protection
(SESIP) includes nonneedle sharps or needle
devices with safety features including
 Syringes with a sliding sheath that shields the attached needle after use
 Needles that retract into a syringe after use
 Shielded or retracting catheters
 IV delivery systems that use a catheter port with a needle housed in a
protective covering
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Needlestick Safety and Prevention Act
 Needless systems include IV medication using a
port with non needle connections or jet injection
system that deliver liquid medicine under the skin or
through a muscle
 Employers must keep a Sharps Injury Log for the
recording of percutaneous injuries from
contaminated sharps
 Remember that sharps containers must be easily
accessible to employees and located as close as
feasible to the immediate area where sharps are
used
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www.cdc.gov/niosh/sharps1.html
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www.osha.gov/SLTC/bloodbornepathogens/index.html
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Sharps Safety
 Have a policy and procedure on sharps safety
 Include safety measures to prevent injury during
perioperative care
 Use double gloving, blunt suture needles for fascial
closing and neutral zones, when appropriate, to
avoid hand to hand passage of sharps
 Include references position statements in P&P and
where these are located1
1
www.cspsteam.org/sharpssafety/sharpssafety.html
/ 136
Blunt Tip Suture Needles
 Surgical personnel are at risk of bloodborne injuries
from sharp surgical instruments
 OSHA has document on the “Use of Blunt-Tip
Suture Needles to Decrease Percutaneous Injuries
to Surgical Personnel: Safety and Health
Information Bulletin”
1
 Sharp tip suture needles are the leading source of
percutaneous injuries to surgical personnel causing
51 to 77% of these incidents

1 http://www.cdc.gov/niosh/docs/2008-101/
137
138
Sharp-tip Suture Needles
 Suture needle injuries can occur when surgical
personnel;
 Load or reposition the needle into the needle holder
 Pass the needle hand-to-hand between team members
 Sew toward the surgeon or assistant while the surgeon or
assistant holds back other tissue
 Tie the tissue with the needle still attached
 Leave the needle on the operative field
 Place needles in an over-filled sharps container or
 Place needles in a poorly located sharps container
139
National Associations Blunt Tip Suture
 American College of Surgeons ACS) recommends
in 2005 the universal adoption of blunt-tip suture
needles for suturing fascia
 Also encourages further investigation of their appropriate
use in other surgical applications
 AORN endorsed this ASC statement in support of
blunt-tip suture needles where effective and
clinically appropriate
 Other organizations endorse such as ASA, ASPAN,
AANA, American Association of Surgical PAs, and
the Association of Surgical Technologists
140
141
Blunt Tip Suture Needles
 Blunt tip suture needles can be used to suture less
dense tissue such as muscle and fascia
 59% of the suture needle injuries occur when
suturing muscle and fascia
 Multiple studies have reported the effectiveness of
blunt tip suture needles in decreasing percutaneous
injuries
 OSHA and NIOSH strongly encourage their use
when feasible and appropriate
142
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AORN 2010 Page 697 Perioperative Standards and
Recommended Practices
144
ACS www.facs.org/fellows_info/statements/st-52.html
145
146
147
148
www.cdc.gov/sharpssafety/
149
Free Workbook from the CDC
150
151
International Sharps Injury Prevention Society
www.isips.org/
152
www.jointcommission.org/SentinelEvents/SentinelEventA
lert/sea_22.htm
153
http://www.tdict.org/
154
155
156
www.healthsystem.virginia.edu/internet/epinet//
157
158
159
160
http://nursingworld.org/MainMenuCategories/OccupationalandEnvir
onmental/occupationalhealth/SafeNeedles.aspx
161
162
163
www.cdc.gov/niosh/topics/bbp/ndl-law.html
164
www.facs.org/about/committees/cpc/preventingsharpsinjuries.pdf
165
166
167
168
169
170
Resources
 Jagger J, Bentley M, Tereskerz P. A study of
patterns and prevention of blood exposure in OR
personnel. AORN J. 1998; 67(5):979-81, 983-4,
986-7
 Berguer R, Heller PJ. Preventing sharps injuries in
the operating room. J Am Coll Surg. 2004;
199(3):462-7
 Makary MA, Al-Attar A, Holzmueller CG, Sexton JB,
Syin D, Gilson MM, Sulkowski MS, Pronovost PJ.
Needlestick injuries among surgeons in training. N
Engl J Med. 2007 Jun 28; 356(26):2693-9
171
Resources
 Davis MS. Advanced Precautions for Today's OR:
The Operating Room Professional's Handbook for
the Prevention of Sharps Injuries and Bloodborne
Exposures, 1st ed. Atlanta; Sweinbinder; 1999.
 American College of Surgeons (ACS). Statement on
blunt suture needles. Bull Am Coll Surg. 2005 Nov;
90(11):24. Available from
http://www.facs.org/fellows_info/statements/st52.html
172
Resources
 Association of Perioperative Registered Nurses
(AORN). AORN Guidance Statement: Sharps Injury
Prevention in the Perioperative Setting. In: 2005
Standards, Recommended Practices, and
Guidelines. 2005; 199-204.
 Available from www.aorn.org/about/positions/pdf/SECTI-2esharpssafety.pdf
 Centers for Disease Control and Prevention (CDC).
Evaluation of blunt suture needles in preventing
percutaneous injuries among health-care workers during
gynecologic surgical procedures-New York City, March
1993-June 1994. MMWR Morb Mortal Wkly Rep. 1997;
46(2):25-9.
 http://www.cdc.gov/ mmwr/preview/mmwrhtml/00045660.htm
173
Resources
 CFR (Code of Federal regulations). Title 29 Part
1910, OSHA. Washington, DC: U.S. Government
Printing Office, Office of the Federal Register
 Dauleh MI, Irving AD, Townell NH. Needle prick
injury to the surgeon-do we need sharp needles? J
R Coll Surg Edinb. 1994; 39(5):310-1.
 Jagger J, Berguer R, Phillips EK, et al. Increase in
sharps injuries in surgical settings versus nonsurgical settings after passage of national
needlestick legislation. J Amer Col Surg 2010;
210:496-502
174
Resources
 Davis MS. Advanced Precautions for Today’s O.R.
In: The Operating Room Professional’s Handbook
for the Prevention of Sharps Injuries and
Bloodborne Pathogen Exposures. Atlanta, GA:
Sweinbinder Publications LLC; 2001.
 Aarnio P, Laine T. Glove perforation rate in vascular
surgery—A comparison between single and double
gloving. Vasa. 2001;30(2):122-124.
 Berguer R, Heller PJ. Strategies for preventing
sharps injuries in the operating room. Surg Clin
North Am. 2005;85(6):1288-305, xiii.
175
Resources
 Caillot JL, Cote C, Abidi H, Fabry J. Electronic
evaluation of the value of double gloving. Br J Surg.
1999;86(11):1387-1390.
 Dauleh MI, Irving AD, Townell NH. Needle prick
injury to the surgeon—Do we need sharp needles?
J R Coll Surg Edinb. 1994;39(5):310-311.
 Eggleston MK Jr, Wax JR, Philput C, et al. Use of
surgical pass trays to reduce intraoperative glove
perforations. J Matern Fetal Med. 1997;6(4):245247.
176
Resources
 Evaluation of blunt suture needles in preventing
percutaneous injuries among health-care workers
during gynecologic surgical procedures—New York
City, March 1993–June 1994. MMWR Morb Mortal
Wkly Rep. 1997;46(2):25-29.
 Gerberding JL, Littell C, Tarkington A, et al. Risk of
exposure of surgical personnel to patients’ blood
during surgery at San Francisco General Hospital.
N Engl J Med. 1990;322(25):1788-1793.
177
Resources
 Hartley JE, Ahmed S, Milkins R, et al. Randomized
trial of blunt-tipped versus cutting needles to reduce
glove puncture during mass closure of the
abdomen. Br J Surg. 1996;83(8):1156-1157
 Hollaus PH, Lax F, Janakiev D, et al. Glove
perforation rate in open lung surgery. Eur J
Cardiothorac Surg. 1999;15(4):461-464.
 Jagger J, Bentley M, Tereskerz P. A study of
patterns and prevention of blood exposures in OR
personnel. AORN J. 1998;67(5):979-981, 983-974,
986-977.
178
Resources
 Jensen SL. Double gloving—Electrical resistance
and surgeons’ resistance. Lancet.
2000;355(9203):514-515.
 Laine T, Aarnio P. How often does glove perforation
occur in surgery? Comparison between single
gloves and a double-gloving system. Am J Surg.
2001;181(6):564-566.
 Mingoli A, Sapienza P, Sgarzini G, et al. Influence
of blunt needles on surgical glove perforation and
safety for the surgeon. Am J Surg.
1996;172(5):512-516; 516-517.
179
Resources
 Montz FJ, Fowler JM, Farias-Eisner R, Nash TJ.
Blunt needles in fascial closure. Surg Gynecol
Obstet. 1991;173(2):147-148.
 Naver LP, Gottrup F. Incidence of glove
perforations in gastrointestinal surgery and the
protective effect of double gloves: A prospective,
randomised controlled study. Eur J Surg.
2000;166(4):293-295.
 Quebbeman EJ, Telford GL, Hubbard S, et al. Risk
of blood contamination and injury to operating room
personnel. Ann Surg. 1991;214(5):614-620.
180
Resources
 Rice JJ, McCabe JP, McManus F. Needle stick
injury. Reducing the risk. Int Orthop.
1996;20(3):132-133.
 Stringer B, Infante-Rivard C, Hanley JA.
Effectiveness of the hands-free technique in
reducing operating theatre injuries. Occup Environ
Med. 2002;59(10):703-707.
 Tokars JI, Bell DM, Culver DH, et al. Percutaneous
injuries during surgical procedures. JAMA.
1992;267(21):2899-2904.
181
Resources
A recent CDC presentation on Unsafe
Injection Practices, along with audio and a
transcript of the presentation are available
at:
www.cdc.gov/ncidod/dhqp/COCA_Unsafe_
Injection_Practices.html
Re: infection control and injection practices
www.cdc.gov/ncidod/dhqp/ps_providerInfo.
html
182
Resources
 Re: protecting patients from bloodborne
pathogens in healthcare settings
www.cdc.gov/ncidod/dhqp/bp_patient.html
 Re: prevention of surgical site infections
www.cdc.gov/ncidod/dhqp/gl_surgicalsite.html
 Re: hand hygiene in healthcare facilities
www.cdc.gov/handhygiene/
183
Resources
 Re: healthcare facility physical environment and
infection control
 www.cdc.gov/ncidod/dhqp/gl_environinfection.
html
 CDC’s home page for infection control provides
links to additional information:
 www.cdc.gov/ncidod/dhqp/index.html
184
Resources
 Mast ST, Woolwine JD, Gerberding JL. Efficacy of
gloves in reducing blood volumes transferred
during simulated needlestick injury. J Infect Dis
1993;168(6):1589-92.
 Henry K, Campbell S, Collier P, Williams CO.
Compliance with universal precautions and needle
handling and disposal practices among
emergency department staff at two community
hospitals. Am J Infect Control 1994;22(3):129-37.
185
Resources
 Vaughn TE, McCoy KD, Beekmann SE, Woolson
RE, Torner JC, Doebbeling BN. Factors promoting
consistent adherence to safe needle precautions
among hospital workers. Infect Control Hosp
Epidemiol 2004;25(7):548-55.
 Clarke SP, Rockett JL, Sloane DM, Aiken LH.
Organizational climate, staffing, and safety
equipment as predictors of needlestick injuries
and near-misses in hospital nurses. Am J Infect
Control 2002;30(4):207-16.
186
Resources CDC Training on Hepatitis
www.cdc.gov/hepatitis/Resources/Professionals/TrainingReso
urces.htm
187
Resources
 Danzig LE, Short LJ, Collins K, et al.
Bloodstream infections associated with a
needleless intravenous infusion system in
patients receiving home infusion therapy.
JAMA 1995;273(23):1862-4.
188
Resources
 Patel PR, Larson AK, Castel AD, et al. Hepatitis C
virus infections from a contaminated
radiopharmaceutical used in myocardial perfusion
studies. JAMA 2006;296:2005--11.
 CDC. Recommendations for prevention and
control of hepatitis C virus (HCV) infection and
HCV-related chronic disease. MMWR 1998;47(No.
RR-19).
 Williams IT, Perz JF, Bell BP. Viral hepatitis
transmission in ambulatory health care settings.
Clin Infect Dis 2004;38:1592--8.
189
Resources
 Comstock RD, Mallonee S, Fox JL, et al. A large
nosocomial outbreak of hepatitis C and hepatitis
B among patients receiving pain remediation
treatments. Infect Control Hosp Epidemiol
2004;25:576--83.
 Krause G, Trepka MJ, Whisenhunt RS, et al.
Noscomial transmission of hepatitis C virus
associated with the use of multidose saline vials.
Infect Control Hosp Epidemiol 2003;24:122--7.
190
The End
Questions
 Sue Dill Calloway RN, Esq. CPHRM
 AD, BA, BSN, MSN, JD
 Medical Legal consultant
 5447 Fawnbrook Lane
 Dublin, Ohio 43017
 614 791-1468
191