Needlesticks in healthcare: what are the issues and what can be done about them?

Paper Number: ASSE-04-533-1.

Introduction
Job hazard analyses (JHAs), otherwise known as job safety analyses (JSAs), entail the systematic evaluation of each specific job task and the identification of the inherent occupational safety or health hazards associated with that task in addition to the specification of a control for the hazard. One might argue that the main intention of a JHA is to educate a job description in order to improve training, and more clearly specify responsibility for safety while on the job. As a result, JHAs can better protect workers from hazards inherent in their jobs. However, job hazard analyses should not be completed on job descriptions that are too broad (i.e., "helping sick people") or on job descriptions that are too narrowly defined (i.e., "retrieving a pillow").

In the health care industry, conventional wisdom holds that too often, nursing job descriptions are developed without adequate integration of occupational health and safety imperatives. In other words, we suspect that JSAs are not often completed for nurses, by nurses and are therefore not often used to improve or to modify existing nursing position descriptions or training. In addition, it is interesting to note that job related exposure anticipation, recognition, evaluation or control is not a core competency in the National League of Nursing Accreditation Commission standards. As a result, nurses put into impossible situations and often become sick or injured while performing their jobs exactly as they've been trained to, or as they're expected to. For instance, occupational morbidity among nurses includes cumulative trauma disorders due to general ergonomic deficiencies and improper patient transfer techniques and strategies, blood borne pathogen exposures due to improper needle or sharps handling or proper use of defective devices, hazard communication violations due to multiple and consistent exposures to many toxic chemicals and unmanaged occupational stress. Together, these modifiable risk factors account for hundreds of millions of dollars per year in lost productivity and revenue for health care institutions. Consider:

/ The CDC reports that, today, the healthcare industry is the second fastest growing sector in the US, with more than 12 million workers (www.cdc.gov/niosh/topics/healthcare/, accessed 3/04).

/Unlike other hazardous industries such as agriculture and construction, preventable injury rates in health care have increased over the past decade (www.cdc.gov/niosh/topics/healthcare/, accessed 3/04).

/Many OSH issues in the health care industry could be characterized as having substantial behavioral & process components. This provides a clue as to how we train OSH practitioners to better mitigate both frequency & severity of each hazard.

Purpose
This paper focuses on needlestick injuries (NSIs) among nurses in the health care industry as well as the mitigation of NSIs by use of safer needle technology. To better place the urgency of more study regarding safer needle devices, consider the brief analysis below:

In well-designed studies, injuries from contaminated needles and other sharp devices used in health care settings have been associated with transmission of more than 20 different bloodborne pathogens to health care workers (Chiarello, 1992).