In 2009, the Harrogate and District NHS Foundation Trust (HDFT) converted to safety-engineered medical devices to help protect staff from needlestick injuries. Here ANDREW JACKSON, laboratory manager; and ANNIE BURNS, senior phlebotomist, discuss why conversion makes good business sense and ensures the hospital is pioneering its way towards early compliance with the new EU Directive on sharps and injury prevention.
Needlestick injuries are one of the most-frequent occupational hazards faced by nurses, phlebotomists, doctors and other healthcare workers. Such injuries are particularly dangerous in view of the potential for transmitting any one of more than 20 life-threatening blood-borne pathogens, including Hepatitis B, Hepatitis C, and HIV1.
EU Directive 2010/32/EU2, implementing the Framework Agreement On Prevention From Sharp Injuries In The Hospital And Healthcare Sector , which must be implemented into national law by EU member states by May 2013, mandates new worker safety standards. The directive specifically refers to: “eliminating the unnecessary use of sharps by implementing changes in practice and on the basis of the results of the risk assessment, providing medical devices incorporating safety-engineered protection mechanisms.” A new report from MindMetre Research3 reveals that a third of NHS trusts have already improved healthcare worker safety by implementing a partial or total ‘safety device only’ policy.
Making the change
In April 2008, one of our ward phlebotomists suffered a needlestick injury while using a standard BD PrecisionGlide Multiple Sample Needle (MSN), which was treated and reported in accordance with our infection control policy. We had recently had a couple of other incidents of a similar nature, and, as the welfare of our staff is very important, we looked for a solution that would help improve safety at the hospital.
We contacted BD, a medical technology company, and decided to trial the recently-introduced BD Eclipse Safety needle with the ward phlebotomy team. The device was an immediate hit with the phlebotomists, who found it simple to use, safer than the conventional device we were previously using, and very effective.
The BD Eclipse Needle has a safety shield which is easily activated with one hand immediately following withdrawal of the needle. Once the shield is locked into position the needle-holder assembly can be safely disposed of. An important success factor was that staff could use the device without altering their working practices.
Initially we only used the needle on the wards as the risks were greatest there, but following another needlestick injury in April 2009 in the outpatient department phlebotomy room, where we were still using the non-safety needles, we made the switch to BD Eclipse for the entire phlebotomy service.
However, this decision left the trust with a dilemma. While the phlebotomy service was using the safest products to protect themselves, other colleagues around the trust were still using conventional needles. After speaking to infection control and occupational health colleagues, it was felt the trust should roll out the safety products trustwide at the earliest opportunity. Since the needles are more expensive than the standard MSN, we needed to submit a business case to the executive management team.
Securing the funding
At the time, there were on average 27 sharps injuries of all causes each year at HDFT, and approximately 40-50% of these were venepuncture-related injuries. Each injury had cost the trust up to £415, meaning all sharps injuries were costing roughly £11,000 a year. The business case described how we had trialled the needles on the wards and that, as a result, there had been no venepuncture-related sharps injuries there over the last 12 months. It included a comparison of the current spend on the standard needles with the same number of the BD Eclipse devices, and estimated that the trustwide switch would cost an additional £5,500 a year for the same number of needles. We concluded that by reducing venepuncture-related sharps injuries, based on the current sharps injury data, the project was, at the very least, likely to be cost neutral.
The calculated cost of each sharps injury (£415) included the occupational health staff time; HIV, Hepatitis B and Hepatitis C testing of source patient and staff; and post-exposure prophylaxis and Hepatitis vaccination. However, it did not include the hidden costs of lost staff time, training investment, recruitment, or of course the psychological impact on individuals affected, all of which should also be taken into account. The calculation also did not take into account any further costs should a member of staff contract a blood-borne virus from a needlestick injury.
Therefore the conversion to the BD Eclipse was not just cost neutral, by helping prevent sharps injuries, and therefore all the associated costs, there were definite potential costs savings to the project. The proposal was accepted by the executive management team and funding was approved.
We communicated our plans and the reasons behind the change widely around the trust, including clinical areas, supplies, infection control and occupational health. The we asked supplies to build up some stocks of BD Eclipse in preparation for the ‘go live’ date, which was set for early June 2009.
Our BD representative designed a poster to be used throughout the trust and also delivered training to every clinical area over a three-day period. This free training was invaluable as it offered the opportunity to remind staff about the correct order of draw and the mixing requirements of the various tubes.
Following the smooth transition, the trust has also switched to the BD Preset Arterial Blood Collection Syringes, which use the same style safety shield, and the BD Vacutainer Safety-Lok Blood Collection Set.
The project has been a great success as we have virtually eliminated venepuncture-related needlestick injuries across the trust. In 2010, there was just one venepuncture-related sharps injury. Prior to the conversion, this figure had been as high as 13.
When asked how the BD Eclipse Needle compares to the conventional device, one phlebotomist at the trust commented: “I don’t know how we managed with the old one”. Everyone feels they are simple to use and that the switchover was easy.
In November 2010, the Health & Safety Executive inspected our trust in relation to the management and prevention of sharps Injuries. It made positive comments about the implementation of safety needles in general and commended us for using incident and trend analysis to identify higher risk areas in need of additional control measures.
As part of the Transforming Community Services agenda, Harrogate & District NHS Foundation Trust recently took over much of the local community services for North Yorkshire. We are now in discussions with our colleagues about the introduction of safety devices throughout the community services so that all of our staff have access to the safest products. Once again, we will be looking to work with BD to deliver a smooth and effective implementation programme.
1. European Parliament, Preventing needle-stick injuries in the health sector, 11th February 2010 Click here
2. Council Directive 2010/32/EU, Official Journal of the European Union, L134/71 click here
3. The Point of Prevention - A research report assessing UK NHS Trusts’ attitudes to healthcare worker safety and safety-engineered medical devices in light of the recent EU Directive on sharps injury prevention. MindMetre Research, October 2011