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NAPPSI has launched a nationwide campaign to protect medical residents
and interns from suture needlesticks, which are an all-too-common
source of bloodborne pathogen exposure. The campaign, known as PAIRSS
(Protecting America's Interns and Residents from Suture Sticks)
is described in this article from the newsletter of the National
Association of Residents and Interns, a NAPPSI member.
By Gregory Schears, M.D. and Alvin Yamamoto, M.D.
The practice of medicine brings with it a number of occupational
hazards. Among them is exposure to bloodborne pathogens through
an accidental needlestick. The bad news is such exposure can prove
immensely debilitating and even fatal. The good news is that this
occupational risk, once thought to be unavoidable, can now be eliminated
through the use of recently developed, easy-to-use safety devices
that are required by new federal and state laws. Knowledge about
this new needlestick safety technology could save your life or the
life of a colleague.
In support of the nationwide effort to reduce residents’ and
interns’ exposures to accidental needlesticks, NARI is an
active member of the National Alliance for the Primary Prevention
of Sharps Injuries (NAPPSI). A non-profit organization composed
of clinicians, professional clinician organizations, and medical
device makers, NAPPSI stresses the value of primary prevention –
approaches that reduce the likelihood of a sharps injury by taking
sharps out of the system. It’s a simple but powerful idea:
Eliminate the needle and you eliminate the risk.
There are numerous means by which physicians can incur a needlestick
or other sharps injury. Among the most dangerous are injuries that
can occur during securement of such catheters as central venous
lines, arterial lines, or peripherally inserted central catheters.
NAPPSI is conducting a nationwide Internet survey on residents'
and interns' experiences with accidental needlesticks incurred while
suturing catheters. To relate your experiences and participate in
the survey, access to www.NAPPSI.org and click on “Needlestick
Survey.”
Fortunately, devices that replace suture for securing catheters
have been proven to stabilize catheters at least as effectively
as suture, while eliminating the all-too-common needlestick danger
associated with suture. There are patient-safety benefits, too.
These sutureless securement devices (also known as adhesive anchors
or adhesive locking devices; the most widely used is StatLock, made
by Venetec International) also have patient safety benefits and
have been recognized by the CDC, which recently stated, “Sutureless
securement devices can be advantageous over suture in preventing
catheter-related BSIs.” (Morbidity and Mortality Weekly Report,
Aug. 9, 2002)
It is vital for physicians to recognize there is an alternative
to suturing in catheters, because suture needles are implicated
in more sharps injuries than any other device. During placement
of the aforementioned catheters, residents and interns are exposed
to such needlesticks far more than has been previously recognized.
Our research demonstrates the risk of accidental needlestick from
suture needles during the catheter securement process is consistently
more than 1 percent (that is, 1 potential exposure to bloodborne
pathogens per 100 catheters secured), and as high as 2 percent (Journal
of Vascular and Interventional Radiology, January 2002; also National
Patient Safety Foundation/JCAHO “Spotlight on Solutions: Compendium
of Successful Practices” 2001). According to anecdotal hospital
reports, in some places the risk is in excess of 5%. Needlestick
safety authorities report that accidental needlesticks are routinely
underreported, especially by physicians.
The consequences of such a needlestick can be serious for you. If
the patient is infected with Hepatitis B, Hepatitis C or HIV, the
clinician who is stuck while securing a catheter may have to undergo
an extensive course of post-exposure prophylaxis. You must also
take special precautions to avoid infecting other patients as well
as friends and family members, over a period of some months. If
lucky, you won’t become infected. If unlucky, your entire
life may be changed. Indeed, there are documented cases of medical
sharps injuries that have proven fatal.
Consider this experience related by an anesthesiologist at a prestigious
Pennsylvania medical school:
“The patient was a 40-year-old prison inmate who required
a general anesthetic for the placement of an AV shunt to allow hemodialysis
access to treat his renal failure. He was an IV drug abuser, lacked
peripheral venous access, and needed a central line for the anesthetic
to begin. I elected to place the line personally rather than let
an inexperienced resident risk injuring themselves. After successfully
placing the line I sustained an accidental needlestick from the
dirty 'Keith' needle while securing the line … The patient
was known to be end-stage AIDS (HIV positive), and also Hepatitis
B and Hepatitis C positive.
“I went to employee health and started the triple therapy
for HIV. It made me sick to my stomach and I could only stand to
take it for 4 weeks. For a full six months, I felt I couldn't be
intimate with my wife, or kiss my son... Has it changed my practice?
You bet. I moved from the hospital where 40% of our patients were
prison inmates. I don't sew in central lines anymore, preferring
instead to use an adhesive locking device. The ready availability
of such devices will, I am convinced, prevent accidental needlesticks
from occurring.”
Federal law now requires healthcare facilities to regularly evaluate
and adopt devices that reduce sharps exposure. They also require
facilities to involve frontline healthcare workers such as resident,
interns and nurses in the device selection process, as part of an
annual review of the institution’s Exposure Control Plan.
If you work at a facility where central lines and other catheters
are routinely secured into place with suture, be aware of two things:
1.) There is a proven, effective alternative available in the form
of a sutureless catheter securement device.
2.) Government mandates require that hospitals evaluate and adopt
technology that reduces needlestick exposure. Indeed, in passing
the federal Needlestick Safety and Prevention Act, the congressional
authors wrote, “catheter securement devices can reduce the
risk of needlestick injuries."
Sutureless securement devices are just one of many primary-prevention
approaches that protect interns and residents against sharps injuries.
For more information on these technologies and NAPPSI’s other
efforts, access www.NAPPSI.org or call 858-350-8623.
Gregory Schears, M.D. is a pediatric intensivist and anesthesiologist
at the Mayo Clinic, in Rochester, Minn. He has conducted extensive
research on safety issues associated with vascular access. Alvin
J. Yamamoto, M.D. is a PGY-2 resident in diagnostic radiology at
U.C. San Francisco and participated in a study of safety issues
associated with vascular access. As published in the Associations
Digest for the National Association of Residents and Interns
(NARI) Winter 02/03
As part of its efforts to protect residents and interns
against accidental needlesticks, NAPPSI is gathering information
on the prevalence of such sharps injuries. If you have experienced
a sharps injury related to catheter securement using a suture needle,
please take a moment to record your experience as part of this survey.
To do so, access the NAPPSI Web site at www.NAPPSI.org
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