Perceived barriers to implementation of a successful sharps safety program

AORN Journal,  Feb, 2006  by Andrea M. Hagstrom

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Percutaneous injuries with contaminated sharp objects are the most probable means of bloodborne pathogen transmission, placing physicians, nurses, and OR personnel in the highest risk group for bloodborne pathogen exposure. (1-3) In response to increasing needle sticks and sharps injuries at a large, urban trauma center in the northeastern United States, a nurse educator undertook a quality improvement project to identify OR staff members' perceptions of barriers to successful implementation of a sharps safety program.

BACKGROUND

In 1999, the hospital's occupational health department had performed a root cause analysis in response to increased reporting of needle sticks and sharps injuries in the OR between 1994 and 1999. (4) A retrospective survey of incident reports determined that needle sticks and sharps injuries occurred most frequently during passing or hand manipulation of instruments and sharps (eg, knife blades, needles) and because of inconsistent communication between the surgeon and scrub person during the passing of instruments. (4,5) The occupational health department reported these findings to the hospital's infection control, performance improvement, the environment of care committees, and a needle stick task force was formed of members from each of the committees as well as staff members from the OR. (4)

Task force members established a plan of action that implemented a verbal exchange for the passing of sharps between the scrub person and surgeon to increase OR team members' awareness of sharps injuries. (4) They also designed an inservice program and poster session to increase the OR team's awareness of the risk of bloodborne pathogen exposure as a result of needle sticks and sharps injuries. A written informational communication also was sent to all OR team members, physicians, nurses, and surgical technologists.

At about the same time, the Needle Stick Safety Prevention Act of 2000 revised the 1991 Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. The revision requires hospitals to provide safety devices and sharps injury prevention programs to decrease health care workers' risk of bloodborne pathogen exposure and requires health care workers to use safety-engineered sharps devices. (6)

Needle sticks and sharps injuries at the hospital decreased during calendar year 2000. From 2001 to 2004, however, reporting of needle sticks and sharps injuries in the OR indicated that these injuries continued to persist and occurrences continued to increase. (4,5) Seventeen needle sticks or sharps injuries occurred in the OR in the first quarter of calendar year 2004. The number of injuries in the OR represents 33% of all needle sticks and sharps injuries throughout the hospital. (5) Nationally, 33.3% of needle sticks and sharps injuries occur in the OR setting. (7)

LITERATURE REVIEW

Sharps injuries in the OR setting expose personnel to human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). In 1989, the Centers for Disease Control and Prevention estimated that 12,000 health care workers per year would contract HBV as the result of an occupational exposure; (8) however, the National Notifiable Disease Surveillance System reported a 96% decrease in HBV infections in health care workers from 1983 to 1999. (9) The decline in HBV infections was attributed to inception of standard precautions and the use of HBV vaccines. (8,9) A study published in 2001 found 54 documented cases of medical personnel in the United States and Canada who had contracted HIV as a result of needle stick injuries or other exposure. (8)

The rate of needle sticks and sharps injuries reported in the United States ranges from 380,000 to 500,000 per year. (3,10) The greatest numbers of percutaneous and other injuries that are reported affect surgeons and surgical residents. (2,8,11) Although it generally is agreed that these injuries currently are more readily reported, it is believed that many needle sticks and sharps injuries remain unreported especially by physicians. (1,11-13) The literature indicates that the majority of percutaneous needle sticks and sharps injuries in the OR can be prevented by modifying behaviors and practices, staff involvement in developing and implementing safety programs, and ongoing feedback of sharps injury incidents to the OR team. (1,14-19) Effective safety programs and safety equipment decrease the risk of bloodborne pathogen transmission from patients to health care workers. (1,2,8,14-19) The literature further concludes that implementing safety procedures and use of safety devices alone will not decrease the incidence of needle sticks and sharps injuries in health care workers; successful implementation of safety measures to decrease the number of needle sticks and sharps injuries requires a multidisciplinary approach. (14-19) Several studies emphasize the importance of health care workers' perceptions of the organizational and safety climates of their clinical setting as an indicator of successful implementation. (14,17-19) The results of two studies determined that problems of inadequate administrative support, understaffing, poor morale, and organizational climate influence the possibility of sustaining needle sticks and sharps injuries by hospital nurses. (17,18)