U.S. Needlesticks Down; European Union Gets Aggressive
Needlestick safety experts from around the world assembled earlier this month in Charlottesville, Virginia, home of the International Healthcare Worker Safety Center (IHWSC). The two-day event commemorated the tenth anniversary of the Needlestick Safety and Prevention Act, which was signed into law in 2000 mandating OSHA to revise the Bloodborne Pathogens Standard to require healthcare facilities use sharps with engineered sharps-injury protection features. The event included 11 presentations by exposure prevention researchers and authorities from around the globe. The consensus, echoed by the director of the U.S. National Institute of Occupational Safety and Health John Howard MD, MPH, JD, LLM, was that while we have come a long way in reducing needlesticks, we have a long way to go.
"You still have to get people to make a behavioral change," said Howard. "That's part of our future challenge."
According to most of the presenters, the 2000 law has led to a 34 percent reduction in needlesticks in the U.S. Among all healthcare professions, nurses experienced the greatest declines (62 percent) while needlesticks in the operating room has increased, primarily due to the continued use of conventional sutures and scalpels. Exposure from needles used in phlebotomy, regardless of the profession of the individual, decreased 60 percent. It was reported that in the U.S., 87 percent of the needles used in phlebotomy are safety needles, reflecting a 13 percent non-compliance rate with the OSHA standard.
International speakers from Italy, Kenya, and India reported on progress, and the lack thereof, in their countries toward needlestick safety and legislation. A landmark directive adopted by the European Union in May, culminating years of work by many of the presenters, calls for member states to adopt needlestick legislation in their countries within three years. By 2013, each country within the European Union will not only have to implement safer devices, but will have to mandate needlestick prevention education.
Coming in December: Phlebotomy Channel™
Years in the making, the Center for Phlebotomy Education will officially launch the Phlebotomy Channel™ next month, an online portal for streaming videos and other training materials that can be accessed from any computer with an Internet connection.
Facilities and schools that want their staff and students to view any of the Center's Applied Phlebotomy training videos at their convenience can simply purchase access to the Phlebotomy Channel™ for a specified number of viewings of the titles they want to assign. The facility/school will receive a unique login/password combination to distribute to their staff/students to view at their convenience from any computer with high-speed Internet access. The Phlebotomy Channel™ eliminates the necessity to own the physical DVDs and risk their loss or damage.
Soon after its launch, the Center will begin adding narrated slide presentations of their Director's most popular lectures to the growing library of educational offerings. More details will be included in next month's issue of Phlebotomy Today-STAT!
Study Assesses Hemolysis in Pediatric Draws
A study recently published in the peer-reviewed journal Clinical Laboratory Science set out to measure the quality of samples drawn from pediatric trauma patients by venipuncture versus line draws.(1) Researchers at Rady Children's Hospital in San Diego, a Level 1 pediatric trauma center, measured the frequency of hemolyzed samples according to collection method, collector, and type of container to identify issues resulting in unusable samples.
The authors noted that 90 to 95 percent of delays in diagnosis are attributable to errors in the preanalytical phase of laboratory medicine. Researchers hoped the results of the study would help identify the necessity for procedural changes in blood collection practices to improve sample integrity. A total of 221 blood samples were drawn by venipuncture using syringes coupled with 21-, 22-, 23-, and 25-gauge needles (30%) or through existing lines via syringe (70%). Samples drawn were transferred into tubes with a safety transfer device.
The overall hemolysis rate was found to be 13 percent while two percent were clotted. Of those samples drawn through an existing IV line, 16 percent were hemolyzed as opposed to only six percent of samples drawn by venipuncture. The authors concluded that their practice guidelines should recommend venipunctures be performed on their pediatric trauma patients whenever possible rather than line draws. This conclusion echoes the same recommendation to become the standard of care in a study published in 2008 in the Journal of Emergency Nursing.(2)
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 11th year of publication, are reading about this month:
For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.
Q: Do you have a source for what the average bruise rate should be when performing phlebotomy?
A: A Q-Probe published in 1991 examined patient satisfaction and complications among 30,000 patients (80% survey return rate).(1) The survey gathered data on the size (average: 15.1 mm) and frequency (16.1%) of bruising and the number of attempts by phlebotomists per patient (1.03). Ninety-three percent of venipunctures were eventually successful (4.9% not attempted). But it doesn't state how many attempts were made before they were successful.
A CAP Q-Probe conducted in 1992 addressed the level of recollects at 70 hospitals: 95% were collected on first attempt; 2.8% required two attempts; 0.8% required three attempts and 1.1% required four or more sticks.(2) Unfortunately, this data is a bit dated. We haven't seen any more recent studies published. I hope this helps.
Each month, PT-STAT! will publish one of the hundreds of phlebotomy FAQs in the growing database of questions and answers available in Phlebotomy Central, the members-only section of the Center for Phlebotomy Education's website. For information on joining Phlebotomy Central, click here.
Last month’s survey polled visitors to our website regarding their hand hygiene practices. When asked “Do you routinely wash your hands or use an alcohol-based gel between patients?” 90 percent said “yes” while 10 percent said “no”.
Of those who indicated that they do not routinely cleanse their hands between patients, the predominant factor or obstacle was a lack of time (57%). Twenty-two percent of this group cited the harshness of frequent cleansing on their hands, while 14 percent identified not having handwashing facilities/gels available as the primary barrier to compliance. Seven percent expressed skepticism over the necessity to cleanse hands when gloves are changed between patients.
Healthcare workers should be mindful that even when gloves are worn, they do not afford total protection against hepatitis B and herpes simplex viruses. Gloves should never be considered completely impermeable or used as a substitute for proper hand hygiene.(1)
According to the CDC’s Guideline for Hand Hygiene in Health-Care Settings, “Failure to remove gloves after patient contact or between ‘dirty’ and ‘clean’ body-site care on the same patient must be regarded as non-adherence to hand-hygiene recommendations.”(2) It also violates OSHA regulations.
For U.S. facilities subject to OSHA, employers are to provide handwashing facilities which are readily accessible to employees. When not feasible, the employer must provide an acceptable alternative, such as antiseptic hand cleanser in conjunction with cloth/paper towels. Employers must ensure that employees wash their hands immediately or as soon as feasible after glove removal.(3)
To stress the importance of handwashing, one respondent shared the following teaching moment: “…I used to teach my students to wash when possible. When students kept asking why they couldn’t just use the gel cleansers, I started to bring in a sample of mud. I had them put their hands in the mud, then apply the cleanser – no towels were given. It was obvious the dirt was still there – just wetter than before! I then placed a plate of cookies in front of the class and asked how many wanted to wash before having a cookie. It was one of the most effective lessons I gave!”
What Would You Do?
Each month, What Would You Do? presents a different case study, then asks readers to contribute their ideas as to how each situation would best be handled. The following month, selected responses will be chosen by the editor and published (sender will be identified by first name and state only). The most accurate, well written response will receive a free download from the Center for Phlebotomy Education’s To the Point® library of articles. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.
Readers who responded to last month’s scenario viewed the situation as a call to action. Some stated they would immediately begin looking for a different school. Others would voice their concerns directly to the program’s department head. Several individuals responded that they would share information from OSHA’s website with the instructor.
One reader shared a similar experience. “I am a phlebotomy instructor and have encountered this very situation! I informed my supervisor that if they wanted me to teach the students about safety devices they would have to provide me with them. They did.”
Another reader, Robin, would make the point with the instructor that safety is one of the main concerns during healthcare procedures and that it should be practiced from the beginning of the training program. “…If a student is taught about all aspects of safety in blood drawing from the start, they will more likely practice it in the future.”
Brenda from Nevada described her response this way: “…In this case I would just inform the teacher that I felt that I am at as much risk being in class as working, so I would insist on the safety measure. If she still stated that the cost was too much, I myself would offer to pay for the safety device. Nothing is more important than to be safe while drawing. You cannot take back an illness that you acquire through an accidental needlestick, even if you are just in school.”
Mary from North Carolina had this to say: “I cannot imagine knowingly subjecting any student to unsafe practices. While OSHA regulations address employee safety, standard of care and best practices govern instruction in the classroom/lab setting, especially with regard to invasive procedures.” Mary is correct that OSHA jurisdiction extends only to employees in the workplace. It does not extend to students if they are not also considered employees; to state, county, or municipal employees; to healthcare professionals who are sole practitioners or partners, or to the self-employed.(1)
For her unwavering dedication to blood collection safety, Brenda will receive a free download from our To the Point® library of articles.
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