Ongoing use of conventional devices and safety device activation rates in hospitals in Ontario, Canada

UK safety-engineered device use: changes since the 2013 sharps regulations

BACKGROUND

The 2013 UK sharps safety regulations require healthcare facilities to use safety-engineered devices (SEDs) to protect staff. The recent increase in UK-reported occupational exposures could indicate increased reporting or increased exposures from suboptimal SED use.

AIMS

To ascertain SED use through examination of sharps container contents in a sample of UK hospitals.

METHODS

Reusable sharps containers (RSCs) were selected from seven UK hospitals in 2013 and seven different hospitals in 2016. At licensed processing facilities, the operator, wearing protective apparel, decanted RSCs, separated hollow-bore needles (HBNs) from other sharps and enumerated HBNs into capped/uncapped non-SEDs, activated/non-activated/tampered SEDs, and blunt draw-up SEDs. Probability, risk ratios (RRs) and 95% confidence limits (95% CLs) were calculated using WinPepi v2.78.

RESULTS

In 2013 and 2016, respectively, 2545 HBNs were categorized from 22 RSCs versus 2959 HBNs from 33 RSCs; 70% of HBNs were SEDs versus 93% (P < 0.001; RR 1.33; CL 1.30-1.37); 32% of activatable HBNs were not activated versus 22% (<0.001; 0.67; 0.60-0.76); 41% of HBNs were discarded 'sharp' versus 20% (<0.001; 0.48; 0.44-0.52); 25% of HBNs were uncapped needles versus 6% (<0.001; 0.22; 0.19-0.26); 5% of HBNs were capped needles versus 1% (P > 0.05); and 1% of SEDs were tampered with in both years (P > 0.05). Hospital practices varied widely.

CONCLUSIONS

SED use and activation have increased significantly since 2013. Of concern is that in 2016, 22% of SEDs were non-activated and 20% of sharps were discarded 'sharp'. Increased training in SED handling, assiduous adherence to safe sharps work practices and a higher level of individual safety-ownership are indicated.

Safety-engineered intravenous catheter utilization among Canadian pediatric anesthesiologists

INTRODUCTION

Compared with other specialties, anesthesiologists are at increased risk of acquiring a blood-borne pathogen (BBP) through needle-stick injuries (NSIs). Safety-engineered intravenous catheters (SEICs) have been designed to reduce NSIs but have not been well received. Our objective was to determine SEIC usage by pediatric anesthesiologists, including availability, utilization, perceived utility, and sources of NSI before and after legislation mandating their use in Canada.

METHODS

After Ethics Committee approval, we conducted two electronic surveys of Canadian pediatric anesthesiologists (CPAs) based in tertiary care settings. Survey responses from May through August 2012 and June through September 2006 were considered. In addition to SEIC use and perceived utility, respondents described factors influencing SEIC adoption and workplace NSIs. Standard metrics of survey validity and reliability were employed.

RESULTS

Completed questionnaires were returned by 154 (69%) and 124 (53%) respondents in 2012 and 2006, respectively, representing 15 of 16 Canadian pediatric tertiary care centres. Reported SEIC availability increased in hospitals (82% vs 98%; difference in proportion 16%, 95% confidence interval [CI]: 9 to 24%; P < 0.001) and in operating rooms (62% vs 86%; difference in proportion 24%, 95% CI: 13 to 34%; P < 0.001) Respondents' report of "routine" personal use of SEICs increased from 43 of 76 (56%) to 112 of 132 (85%) (difference in proportion 29%, 95% CI: 16 to 41%; P < 0.001). Attitudes concerning perceived utility of SEICs remained unchanged and evenly split between respondents. "Awkward handling" remained the primary reason for non-use. In all, 71 (48%) and 60 (48%) respondents reported recent contaminated NSIs in 2012 and 2006, respectively. The majority were related to a needle on a disposable syringe.

DISCUSSION

Despite only moderate perceived utility, SEIC uptake among CPAs is high. However, NSIs remain common. Several opportunities to reduce the risk for work-related BBP transmission among CPAs were evident.

Chinks in the Armor: Activation Patterns of Hollow-Bore Safety-Engineered Sharp Devices

A retrospective review of secondary injury data was used to evaluate the characteristics of percutaneous injuries from safety-engineered sharp devices. Injury rates and safety device activation rates differed by healthcare provider type. Approximately 22.8%–32% of injuries could have been prevented had an available safety feature been activated after use.

Chinks in the armor: percutaneous injuries from hollow bore safety-engineered sharps devices

BACKGROUND

Despite their overwhelming efficacy, safety-engineered sharp devices (SESDs) cause a residual fraction of injuries. Although the fraction of injuries from SESDs is less than that reported for nonsafety devices, it remains a "preventable fraction" and is a sizable target for further advances.

METHODS

A retrospective review of 3,297 percutaneous injuries from hollow bore safety-engineered devices occurring between 2001 and 2009 was conducted examining the Exposure Prevention Information Network (EPINet) needlestick surveillance data.

RESULTS

Nurses sustain 64.6% of all SESD injuries. 42.9% Of SESD injuries occur after device use and are likely preventable through consistent and effective use of safety-engineered technology. Excluding injuries that occurred during device use or between procedural steps, 71.8% (n/N = 28/39) of physician injuries, 58.2% (n/N = 645/1,109) of injuries to nurses, and 45.8% (n/N = 88/192) of injuries to phlebotomists occurred when an available SESD was not fully activated.

CONCLUSION

Passive devices that do not require action on the part of the end user to engage a safety feature currently represent a small portion of the SESD market. Wider dissemination of a broader array of passive SESDs coupled with continual education of end users is essential to an effective sharps injury prevention program.

Conventional and sharp safety devices in 6 hospitals in British Columbia, Canada

BACKGROUND

Reengineered sharp safety devices have been recommended to reduce occupational percutaneous injury risk in health care facilities. We conducted this study just over 1 year after passage of legislation requiring the use of sharp safety medical devices to assess the frequency of safety and conventional sharp device use and whether safety features were being activated to cover sharp points after safety devices were used and before disposal.

METHODS

Approximately equal numbers of sharps disposal containers from various wards in 6 nonprofit adult and pediatric British Columbia hospitals were audited by paired research assistants, wearing protective clothing.

RESULTS

In the 699 audited sharps containers, 7% (1,690/25,910) of all devices were conventional devices, specifically 2% (96/4,702) of all phlebotomy devices, 7% (1,240/17,705) of all syringes, and 10% (354/3,503) of all intravenous catheters. In addition, 94% (4,344/4,602) of all safety phlebotomy devices, 95% (2,955/3,119) of all safety intravenous devices, and 80% (13,050/16,420) of all safety syringes had been activated before disposal.

CONCLUSION

More than 1 year after legislation was passed mandating the use of sharp safety devices in British Columbia hospitals, the risk from sharps remains excessive because of the ongoing use of conventional sharp devices and nonactivation of safety devices.