Audrey Markland, MSN, RN, CNS, nurse educator at North General Hospital, New York, said she wasn't surprised at the alarming news.

She told ADVANCE it wasn't a shock to learn that nearly two-thirds of U.S. nurses worry about being stuck by a needle while on the job, according to the 2008 Study of Nurses' Views on Workplace Safety and Needlestick Injuries, a report released this past summer by the American Nurses Association (ANA) and Inviro Medical Devices.

Markland said she has devoted much time and effort to reducing such events. In fact, at North General, prevention begins the moment new employees walk through the door.

"[We] provide orientation about the infection-control process, reviewing updated guidelines with good visual aids to show what they should and should not be doing in terms of needle safety, and going over Joint Commission-mandated education about OSHA regulations," Markland said. "We make sure new employees are aware of the procedures in place to minimize the risk of exposure to bloodborne pathogens."

Safety Preparedness
But accident prevention requires ongoing education and training, Markland added. Reinforcing a consistent message, listening to nurses' concerns and being vigilant are effective strategies to reduce needlestick injuries and bloodborne diseases for staff, she explained.

"This process is repeated every year during annual competency education and testing," Markland said. "We have to consistently educate our people so they know when to use the equipment and how to use it properly. We begin in orientation, and continue whenever we change to a new product."

Kara Szirotnyak, PhD, RN, COHN-S/CM, patient safety officer at VISN 11, Veterans In Partnership (VIP) Network, Ann Arbor, MI, said a pragmatic educational approach works well within her organization.

"To reduce the incidence of needlestick injuries, we've done a lot of education around the common errors in practice," she said. "When we look at the human factors behind needlesticks, we remind people to look before acting, and to take their time with these procedures. We also know staff who are fatigued are at increased risk, so we try to make sure no one is working too much overtime."

Similarities between needlesticks can suggest a need for additional training, said Sue Quirin, BSN, RN, infection control practitioner at Provena Mercy Medical Center, Aurora, IL. "If there are a number of incidents in one area, it may be an education issue - perhaps nurses are using the equipment inappropriately," she explained. "We can look at process issues, as well - does the layout of the unit promote safe use of needles? Are there problems with a particular device? Are we seeing a trend within certain job roles? We always want to target for zero needlesticks!"

Stopping The Interruptions
The ANA/Inviro study identified several factors behind needlestick injuries to nurses in the workplace: 89 percent of the respondents said increasing workloads affect safety, 84 percent said stress levels affect safety and 82 percent reported they put patient care before their own safety at work.

"Nurses tell me when the nursing unit gets busy and someone is calling them, that distraction can be dangerous for them, as well as for the patient," Markland said. "We educate staff, letting them know they need to leave the nurse to focus [on the patient]." At North General, a buddy system used in high process areas like ICU identifies other nurses who can pick up the slack for a colleague, allowing uninterrupted time for any process involving a needle.

At Southcoast Hospitals System, Fall River, MA, accident prevention is one component of an employee safety program, said Judy Menard, MA, BSN, RN, CIC, director of infection prevention.

"Hospitals today are busy environments, much busier than when I worked at the bedside, with a lot of IV access and IV medications," she said. "Nurses need to know a lot about many things, and preventing needlestick injuries is just part of their many responsibilities."

Needleless Products Beneficial
Menard believes needleless products also can make a big difference in the clinical setting.

"The needleless movement has been a priority for quite some time, and Southcoast Hospitals started many years ago when we went to needleless IV sets, that decrease the number of needles our employees handle during the course of their workday," she said. "And a lot of the needleless syringe technology has been beneficial to us, as well."

At Southcoast, equipment changes are well-considered and evidence-based.

"[We're] a large system with three hospitals, so change is not taken lightly," Menard said. "We look at needlestick safety data to see whether we do have an issue, and then we benefit from collaboration between clinicians, infection prevention, purchasing and pharmacy.

"This multidisciplinary team also helps us make the best decisions around needleless technology," she continued. "It also helps that Southcoast is focused on quality and safety, and [administration] continually supports our initiatives, even though there may be a cost increase associated with our decision."

Infection control practitioner Joan Scabarozi, BS, RN, from Cape Canaveral Hospital, Cocoa Beach, FL, said her facility's nurses use needleless systems most of the time.

"About the only time we use needles around patients is when we administer sub-Q heparin," she said. Nurses may use a syringe and needle to draw up an IV medication from a vial, but then discard the needle in an appropriate sharps container. Once at the bedside, the nurse screws the syringe into the IV tubing, so there's no risk of needlestick injury."