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| According
to Barbara DeBaun, RN (center), director of infection
control for California Pacific Medical Center in
San Francisco, training nurses on the new sharps
has been one of the challenges of implementing needle
safety standards. Barbara Friedman, RN (left), and
Gila Tint, RN (right). |
When President Clinton signed the Needlestick Safety
and Prevention Act into law Nov. 6, 2000, some saw it
as a tremendous opportunity for health care workers.
Others viewed it as a daunting challenge.
Laurie Gibson, RN, figured it was both. Under the law,
each facility had to implement an exposure-control plan,
review and (if necessary) purchase safer devices, create
a log to document all future exposure incidents and
meet CDC recommendations for post-exposure follow-up.
Gibson's small, nurse-run clinic Community Health Services
in Scottsdale, Ariz., managed by the Arizona State University
College of Nursing, already had an exposure-control
plan in place thanks largely to her efforts. Because
of her previous exposure to sharps (via immunizations,
blood draws and fingersticks for hemoglobin and cholesterol
testing), as well as her involvement in purchasing equipment,
Gibson had emerged as an ideal candidate to formulate
the plan.
But if the Scottsdale clinic was ahead of the game,
it still wasn't necessarily in full compliance. So efforts
were bumped up a notch. Gibson asked suppliers to send
new equipment with built-in safety features. She and
another nurse practiced first, then demonstrated the
devices to the rest of the staff.
Some of the sharps drew pointed criticism. "One
device had a sliding sheath, and it involved moving
your thumb closer to the needle," Gibson said.
"That didn't make sense to me. Another, when the
needle retracted [into the syringe], it made a loud
click. I didn't think that patients would respond well
to that."
Fortunately, other pieces of new equipment made a better
impression. In performing hematocrit testing on preschoolers
(largely to gauge anemia), the Scottsdale clinic had
used glass capillary tubes, which drew blood from the
finger through capillary action. Gibson didn't like
having breakable material next to the skin of young
children, nor did she care for the tube-sealing method,
which, to her mind, required too much manipulation.
After the new guidelines went into effect, the clinic
purchased a HemoCue machine that avoided these potential
hazards.
Other new purchases were equally advantageous. "HemoCue
also introduced us to a lancet that's a marvelous little
tool," Gibson said. "You put the lancet device
next to the spot where it will penetrate the skin, and
you click the top. It pokes the finger, and the needle
is immediately withdrawn into the housing. And it looks
like a colorful Lego. It's nonthreatening."
Gibson's Scottsdale clinic is not alone in its learning
curve. After passage of the needlestick safety act,
hospitals, clinics, doctors' offices and nursing homes
across the nation hustled to comply with the new sharps-related
standards by April 18, 2001.
No one working on a hospital floor questioned the need
for such legislation. The CDC estimated an annual rate
of more than 380,000 percutaneous injuries from contaminated
sharps in American hospitals. For all health care settings,
the yearly figure was anywhere from 600,000 to 1 million.
The American Nurses Association estimates that 1,000
or more health care workers contract serious infections
each year from contaminated sharps. Hepatitis C and
HIV, neither thwarted by any known vaccine, remain omnipresent
concerns.
Has the workplace become safer for nurses since the
passage of the Needlestick Safety and Prevention Act?
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