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“Cross my heart and hope to die, stick a needle in my eye.” The familiar playground rhyme may be fun for grade school children, but the rhyme is not good risk management policy for health care workers. Every day health care workers put their health and safety on the line, and administrators risk their bottom line, with the threat of needlesticks. Most health care workers report that they engage in what they deem to be “safe” and “risk-reducing behaviors.” However, research indicates that the stress of the job, coupled with a person’s natural tendency to minimize actual risk levels, leaves most health care workers minimizing the significant risk they face every day. Needlesticks – One in a Million? To many health care workers, needlesticks are like “needles in a haystack,” a risk that is always present but not something thought about every day. More than 1 million needlesticks are reported every year in the 8.8 million health care workers. 1 Some suggest that this figure represents only half of the actual number. 2 Until recently, health care workers have based their risk reduction behavior on cues – patient behavior, background, appearance and type of procedure. This approach is becoming more risky. As infectious diseases have spread into the general population, it has become more difficult to identify high-risk incidents. Carriers of HIV and hepatitis, the two deadliest bloodborne diseases, are increasing in prevalence. As many as 30 percent of all patients that are HIV are not aware of their HIV status when in the hospital.
As diseases become deadlier, so do the risks to the health care worker. Once stuck, the health care worker faces a significant risk of infection. For hepatitis, the rate is 3.5 out of 100; for HIV, it is 1 out of 250. 3 Each year, HIV, hepatitis and other bloodborne diseases infect more than 18,000 health care workers. More than 250 die from these infections. Through 1996 there were 51 documented and 108 possible cases of HIV transmission from needlesticks.
The Federal Government’s Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogen Standard has provided the public policy standard by requiring employers to “isolate or remove the bloodborne pathogens hazard from the health care workplace.” Estimates by OSHA suggest that more than $460 million per year is spent in training and equipment. The total direct costs are $3.58 billion. While the average cost of a conventional disposable syringe is $.10 to $.14 per unit, the associated costs such as disposal testing and injury pushes the actual cost to $.75 to $.80. 4 Estimates for individual costs following needlesticks have ranged from $2,800 to $4,000. Legal settlements are driving the costs even higher. A jury recently awarded a 25-year-old medical intern $12 million in damages citing “improper training at Yale.” Lost wages and training costs place needlesticks as a factor that drives up costs for the patient, increasing health care costs for everyone. Not unlike other employee-related costs, it is difficult for even a seasoned risk manager to determine the costs of an employee’s accidental needlestick.
Complex Problem The health care industry has gone through tremendous change in the last 20 years. Managed care has caused health care workers to have to work faster, more efficiently and more cost-effectively. Biotechnology advances have improved treatments, but at a cost of increased complexity. The safety of employees in this dynamic and changing environment continues on the firing line. As these changes occur in the health care industry, some experts suggest that the risk of needlesticks will increase. Recent developments in technology, training and oversight have led to a protracted debate on potential solutions. Safety needles and needleless systems have been suggested as possible solutions.
Simple Solutions, Not Single Solutions There is growing awareness on the part of risk management specialists that the prevention of needlesticks should be considered a part of a much larger risk management plan and require an understanding of the organizational culture and needlestick risk factors. Hospital procedures, culture and buying habits need to be integrated to facilitate the worker’s safety. While equipment can make the difference in reducing the risks, organizational culture and worker attitude also appear to be important factors. In fact, workers facing increased productivity pressures begin to take greater risks and avoid standard procedures and risk prevention. Studies on workplace injuries show that industries with high turnover and absenteeism, health and job stress predict the likelihood of injury. The medical industry, with its high stress, turnover and poor job satisfaction, drastically increases the likelihood of injury. Training employees to recognize and respond to hazards is as important as providing employees with appropriate personal protection. Equally as important is the commitment of management to the process of risk reduction. In some studies, management commitment is the most important factor in reducing occupational injuries. Management commitment can include review of job performance based on safety criteria, keeping detailed safety records, safety inspections, training and compliance studies. Rewarding safe employee behavior can also be a critical factor in reducing occupational injuries. Health care organizations seeking to improve their safety record should follow a number of important steps:
It is becoming more clear to risk managers that information should drive decisions related to needlestick risk management. Up-to-date data that is specific to the type of health care organizations is essential for planners and risk managers. Many decision-makers and authors use old data, in some instances more than 10 years old, and offer solutions with poor or nonexistent proof that the solutions lower costs. This perspective is one-sided and does not recognize the extreme cost of retooling the many plants that manufacture the estimated 4 billion syringes domestically each year. Accounting models to demonstrate cost savings are often dependent on salesperson claims. The key for health care organizations is to work with needlestick risk management consultants who are experts in examining organizational culture, collecting relevant data and monitoring compliance and cost savings. Needlestick risk management is complex and no single solution will solve this problem everywhere. In the patient room, IV equipment can utilize a needleless system. Fortunately, new technology has allowed needleless solutions to be cost-effective and efficient. In the emergency room where time is critical, the retractable needle may offset its high cost very quickly. In the lab, the environment is relatively stable where the patient is fixed in a stationary position. The fixed electrical de-needler is especially suited for safe and quick disposal of the dangerous instrument, allowing movement within the room without high risk. The large complex organization should be analyzed this way. EPINet, organized by Dr. Janine Jagger of the University of Virginia, Charlottesville, studied almost 90 hospitals to determine the statistics relating to sharps incidents. Her findings do not indicate that the solution is singular in nature. Needleless systems, retractable needles and devices that deneedle all play a role in a multi-factorial model of needlestick reduction. Rather than promote specific products or single narrowly applicable solutions, we should address each area of the hospital with the appropriate device or method and create the safest environment for the worker. Cultural changes affected by training and procedural design that reduce exposure are vital for a safe work environment. References:
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