Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program

Contents:

APPENDIX B - Devices with Engineered Sharps Injury Prevention Features

Introduction

This section describes various ways safety features have been incorporated into the most commonly used conventional needles and other sharp devices to protect healthcare workers from injury. Factors to consider during device selection, including concerns for patient safety, are provided to help guide the decision-making process. Information provided in this section is intended to help healthcare organizations make informed product choices and does not reflect CDC endorsement or disapproval of any product. Healthcare organizations are also encouraged to look to other literature on these devices.

Definition of an "Engineered Sharps Injury Prevention Device"
This term has been defined by the OSHA and refers to:

• "A physical attribute built into a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, which effectively reduces the risk of an exposure incident by a mechanism such as barrier creation, blunting, encapsulation, withdrawal or other effective mechanisms;

Or

• A physical attribute built into any other type of needle device or into a non-needle sharp, which effectively reduces the risk of an exposure incident."

These engineering modifications generally involve one of the following strategies:

• Eliminate the need for a needle (substitution);
• Permanently isolate the needle so that it is never poses a hazard; or
• Provide a means to isolate or encase a needle after use.

Another type of engineering control is the rigid sharps disposal container that comes in a variety of shapes and sizes. Although not discussed in this workbook, these containers are an important strategy for reducing the risk of sharps injuries and an essential element in a comprehensive sharps injury prevention program. The National Institute for Occupational Safety and Health has published guidance on the selection of sharps containers (116) (www.cdc.gov/niosh/sharps1.html)

Other products have also been developed to promote safer work practices, such as needle recapping devices and IV line stabilizers. These products can have an important role in prevention. For example, fixed needle recappers (i.e., permanently or temporarily attached to a surface) that facilitate safe recapping when a needle must be reused on the same patient during a procedure (e.g., providing local anesthesia) might be considered when no acceptable alternative is available. Also, devices used to stabilize an intravenous or arterial line that provide an alternative to suturing are likely to reduce percutaneous injuries to healthcare providers as well as improve patient care by reducing site trauma and inadvertent line removal and the need to reinsert another catheter. Information on these products is not included in this workbook.

The majority of safety features integrated into devices are active, i.e., they require some action on the part of the user to ensure that the needle or sharp is isolated after use. With some devices, activation of the safety feature can be done before the needle is removed from the patient. However, for most devices, activation of the safety feature is performed following the procedure. The timing of activation has implications for needlestick prevention; the sooner the needle is permanently isolated, the less likely a subsequent needlestick will occur.

A passive safety feature is one that requires no action by the user. A good example of such a device is a protected needle used to access parts of an IV delivery system; although a needle is used, it is never exposed (i.e., unprotected) and does not rely on the user to do render it safe.

Few devices with passive safety features are currently available. Many devices currently marketed as self-blunting, self-resheathing, or self-retracting imply that the safety feature is passive. However, devices that use these strategies generally require that the user engage the safety feature.

Although devices with passive safety features are intuitively more desirable, this does not mean that a safety feature that requires activation is poorly designed or not desirable. In certain situations it is not practical or feasible for the device or for the procedure to have a passive control. Therefore, whether a safety feature is active or passive should not take priority in deciding the merits of a particular device. The relevance of this information is most important for the training of healthcare personnel in the correct use of a modified device and motivating compliance in using the safety feature.

The following Websites provide information on the various safety devices that are currently available. (Need to add the CDC disclaimer)

List of Devices Designed to Prevent Percutaneous Injury and Exposures to Bloodborne Pathogens in the Health Care Setting (Developed by the University of Virginia's International Health Care Worker Safety Center.) www.med.virginia.edu/epinet/

The California List of Needlesless Systems and Needles with Engineered Sharps Injury Protection (Developed in accordance with California Labor Code section 144.7 by the California Department of Health Services (DHS) and the Division of Occupational Safety and Health (Cal/OSHA).) www.dhs.ca.gov/ohb/SHARPS/disclaim.html

The National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI) is a group of health organizations, medical device manufacturers, healthcare professionals, and others working cooperatively to reduce sharps injuries by reducing the number of sharps in the workplace. This Website has links to several manufacturers that include pictures of the various devices available.

The Premier Safety Institute has information on the evaluation of several safety devices products by organization members. www.premierinc.com Needlestick Prevention Device Selection Guide is sponsored by ECRI, an independent non-profit health services research agency.