Needlestick Injuries

In response to a rise in the number of needlestick injuries in its OR, Connecticut-based Hartford Hospital conducted a study to determine and better understand staff members’ perceived barriers to safety and discovered that communication problems with physicians and feelings of powerlessness among nursing staff were lead factors. The study, led by perioperative services nurse educator Andrea Hagstrom, prompted the formation of a staff-led safety committee and a physician-led initiative to gain practice change buy-in. The efforts have empowered nurses to enforce the new safety practices and improved the hospital’s needlestick injury rates.

Immediately following the passage of the Needlestick Safety and Prevention Act, Hartford Hospital updated its needlestick safety procedures and experienced a decrease in related injuries. However, needlestick injury rates began to worsen after the initial safety blitz, especially in the OR, where 33% of hospitalwide needlestick injuries occurred in the first quarter of 2004, compared with 25% in 2002. In a continued effort to reduce needlestick injuries, Hartford in 2004 implemented a hospitalwide campaign to promote a newer type of safety needle, including inservices on how to use it. However, physician compliance with the new policy was lower in the OR than in other areas of the hospital, and nurses “felt that surgeons were not aware that we were trying to implement a new practice,” Hagstrom said. As a result, Hagstrom decided to study staff perceptions to pinpoint the reasons for the problem. After gaining approval for the study from the hospital’s institutional review board and apprising hospital leaders of the project, Hagstrom gathered a group of five perioperative RNs and seven certified surgical technologists to participate in focus group discussions. During four one-hour sessions, Hagstrom asked participants to describe their risk of exposure to needlestick injuries in the OR, their power to implement practice changes to prevent needlestick injuries, and their perceived barriers to successful practice changes.

Barriers included:

• inadequate horizontal and vertical communication,
• powerlessness,
• resistance to change,
• intimidation,
• inconsistencies in practice,
• negative attitudes,
• inexperience of medical and nursing staff members, and
• time constraints.

In addition to forming the Sharps Safety Committee, Hagstrom has targeted physicians’ resistance to practice change with robust quantitative and qualitative reports to the OR’s leading physician group. Hagstrom noted that she did not gain much support when she first went to the group with needlestick injury data a year and a half ago. But she said she persisted “like a dog with a bone” to bring the compliance issue to the forefront of the physicians’ agenda. Once Hagstrom brought the results of her own research and an extensive literature search—including information from the Occupational Safety and Health Administration—the physicians heeded her call for change. The physicians group has since started needlestick safety education projects of its own, stressing the topic in mass communication to physicians and inviting Hagstrom to present more information almost quarterly. Because these efforts were “generated within their community,” OR surgeons have increased compliance with safety procedures, and sharps injuries in the OR have decreased, Hagstrom said. However, she noted that more research must be done to ascertain just how effective these efforts have been in addressing needlestick safety.

To see the full article:
Andrea M. Hagstrom (2006). Perceived Barriers to Implementation of a Successful Sharps Safety Program. AORN Journal. 83(2):391-397.