Staff Concern Drives Safer Sharps Handling Procedures

Injury rates at Stanford are above the state average for health care workers and 30 percent above the national average for similar teaching institutions, according to a detailed analysis of employee injury data conducted by Occupational Health Services (OHS). The majority of these injuries are blood and bodily fluid (BBF) exposures from sharps injuries, such as needle sticks. In fiscal year 2016, 363 BBF exposures from sharps injuries occurred at Stanford Hospital. This is the third year in a row that the total number of sharps injuries has increased from the prior fiscal year.

At the root of the problem, according to the report, is a common misconception about sharps injuries among SHC staff. “Many believe that needle sticks are an unavoidable part of the job and nothing can be done to prevent them,” said Mary Spangler, MS, NP, Administrative Director, Occupational Health Services. “This belief is not only incorrect, but a dangerous threat to the safety of staff.”

Over a year ago, Occupational Health and Environmental Health & Safety (EH&S) began a detailed analysis of sharps handling practices in the perioperative region after physicians and nursing staff raised concerns regarding inconsistent practices that they suspected were contributing to sharps injuries. Their request for additional safety precautions, Occupational Health’s concern over the increasing numbers of sharps injuries and Environmental Health & Safety’s initiative to reduce employee injury rates drove an in-depth Root Cause Analysis (RCA) to investigate the issue.

New policy implemented

The findings from this investigation led Occupational Health and EH&S to begin working with stakeholders to develop the Perioperative Services Sharps Safety for Procedural Settings Policy. The policy has been approved by both the Operating Room Medical Committee (ORMC) and Perioperative Services Medical Committee (PSMC) and is being implemented. The policy is not a prescriptive document, but rather establishes clinically recognized guidelines for safe sharps handling and use that have been shown to reduce the number of sharps injuries in the perioperative setting.

“The expectation is that physicians and Perioperative Services will adopt this policy and then work with their colleagues to determine how these safe sharps handling practices can be incorporated into the unique nature of their clinical practice,” said Sam Wald, MD, MBA, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine. “There will not be a single solution that will work for everyone. But bringing the staff you work with together to figure out how to improve sharps handling will help ensure that everyone, including the patient, goes home safely at the end of the day.”

Ripple effect of a needle stick

While sharps injuries occur throughout the hospital, 50 percent of them occur in the perioperative region, primarily in the operating rooms. The majority of these OR incidents resulted from practitioners injuring themselves or a colleague, especially in between use of a sharp item, such as when passing a sharp between members of the surgical team. Seventy four percent of the exposures involve suture needles or disposable syringes and 72 percent occur either during use of the item or after use, but prior to disposal. Physicians and nurses are most frequently injured.   

When a needle stick injury occurs, a cascade of effects occur:

• The energy among the surgical team shifts after the needle stick
• Disruption occurs when the exposed team member must scrub out and be replaced
• Additional work is required for the blood draws and patient notification
•  The affected person feels psychological angst awaiting blood draw results
• There are significant effects for the person exposed and their loved ones, especially if it was a high-risk exposure or the patient does not consent to having their blood drawn
• There are potentially life-altering implications should the affected person acquire a communicable disease
• There can be significant psychological effects on a person who accidentally stuck a colleague

Safety is valued by staff

The OHS investigation also discovered that staff members appreciate and prefer working with colleagues who emphasize the safety of the surgical team.

“The colleagues who were most highly regarded during our research actively worked with the team at the start of every procedure to identify what sharps safety practices are most appropriate for the procedure at hand and how they can be implemented for that particular procedure,” said Wald. “In reality, keeping each other safe helps keep the patient safe and ensures that the procedure runs as smoothly as possible.”