Canadian Intravenous Nurses Association

Mandatory Use of Safety Devices

for the Prevention of

Sharps Injury and Exposure to Body Fluids

Statement

Health Care Workers that practice with infusion therapy are at greater risk of a
needlestick injury or exposure to body fluids. Needlestick injuries and exposure
to body fluids can result in life threatening illness, financial, social and emotional
costs to the healthcare workers and the health care system. Most injuries and
exposures are preventable through the development of strategic plans that
include the use of safety engineered sharp, needle free infusion and catheter
securement devices. It is the position of the Canadian Intravenous Nurses
Association that every employer protects their healthcare workers from job
related injury through mandating the use of available devices that have been
shown to decrease needle stick injuries and exposure to body fluids.

Literature Supporting Potential Harm

Far too often, healthcare workers are being injured by contaminated medical
supplies either through sharps injuries and/or exposure to body fluids. Healthcare
workers can and do contract potentially harmful and/or fatal blood borne
infections, that are preventable. Health care workers affected by sharp injuries
and body fluid exposures include nurses, physicians, laboratory personnel, and
environmental services staff.

The Centre for Disease Control Hospital Infections Program, estimates that
600,000 to 800,000 occupational needlestick injuries occur annually. It also
estimated that 86% of needlestick injuries can be avoided by eliminating
unnecessary needles, using needles with safety devices and using safer work
practices (CDC, 1993-1995). Ippolito (1997), has found that transmission of
Hepatitis B, Hepatitis C and Human Immunodeficiency Virus (HIV) has occurred
in healthcare workers through occupational exposure. The risk of infection post
sharp injury from a positive source HIV is 0.3%, Hepatitis B 30%, and Hepatitis C
3%. (NIOSH, 2000) Other diseases that can be contracted include: tuberculosis,
syphilis, malaria, herpes, diphtheria, and typhus (HCHSAO). Unfortunately, 60%
of exposures go unreported (Alliance, 2002).

In Canada, healthcare workers incur more than 69,000 sharp injuries per year,
190 injuries per day, with nurses’ accounting for 58% of the total (Alliance, 2002)
(Health Canada, 2000).The Canadian Centre for Occupational Health and Safety
affirms that some hospitals are revealing that “one third of nursing and laboratory
staff suffer such injuries each year (HCHSAO, 2004)”. Activities that put health
care workers at risk include but are not limited to injections, intravenous insertion,
blood collection, cleaning/ collecting of instruments and operative or treatment
procedures.

The risk of infection varies due to the severity of the injury, the immune status of
the worker and the pathogen involved. Hepatitis C is ten times more
transmissible than HIV and there is no vaccine available. Chronic infection
develops in almost 75% of the cases (CDC, 1998b). In the United States, the
Centre for Disease Control estimates that 12,000 health-care workers become
infected with the Hepatitis B virus each year as a result of exposure to blood, of
these, 500 to 600 of them require hospitalization and over 200 die each year
(CCOHS, 1999). To date, one case of HIV in Canada can be connected to a
needlestick injury.

Supporting the Mandatory Use of Safety Devices

Needle stick injuries and exposure to body fluids will affect the healthcare worker
and his/her families’ quality of life. Healthcare workers face uncertainty in the
possibility of contracting an incurable disease that may include physical,
psychological, emotional and financial burdens to themselves and their families.
The cost to the healthcare system, although secondary, will increase from
treatment, job replacement, Long Term Disability, Employment Insurance and
potential lawsuits.

Using sharps safely has shown to decrease exposure among healthcare

workers. Currently the laws in the United States of America that mandate the use
of safety devices and equipment, have demonstrated success. Many institutions
have implemented these safety changes, of those who complied with these
mandated changes, one-quarter of the actual workplaces reported a 51%
reduction in injuries (Alliance, 2002).

Therefore, in order to protect and improve healthcare workers’ health and safety,
it is important that a change of practice must occur. Upon review of the literature
and the statistics, The Canadian Intravenous Nurses Association (CINA)
supports the use of safety-engineered devices in providing this type of protection.

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Legislation and policies that mandate the use of safety engineered sharp
devices, needle free infusion devices and catheter securement devices are
necessary. These will provide the impetus for protection of healthcare workers
within occupational health and safety standards.

Primary Prevention Devices

Primary prevention device technologies include safety engineered sharps

devices, which provide shielding or passive protection of sharps that include
retractable needles in intravenous (IV) cannulation systems, or in intramuscular
syringes. Needle free infusion devices, that provide needless intravenous access
(luer loc)/blunt cannulation and needless valves/access ports and connectors.
Closed infusion systems that decrease the number of connection steps in setting
up of intravenous line. Catheter securement devices that prevent needlesticks by
reducing unplanned catheter restart and prevent exposure of body fluids.
(NAPPSI, 2004). Education and training in using these devices is essential to
ensure that the safety product is used appropriately and meets its goal of
protecting staff.

The current health and safety regulations in Canada need to be re-examined and
changed in order to meet the current needs in the healthcare industry. No longer
should healthcare workers be at risk when there exists proven ways to eliminate
these hazards by using safety-engineered sharp, needle free and catheter
securement devices. The laws should mandate all healthcare employers to
provide these safety-engineered devices such as needle less systems that are
approved by Health Canada.

Recommendations

CINA believes that nurses and health care workers should not suffer from sharp
injuries and exposure to body fluids. CINA encourages all nurses to demand that
employers institute a Primary Prevention Program in their workplace for sharps
safety and exposure to body fluids. CINA believes that safety devices need to be
effective in preventing accidental injuries, by using primary prevention devices.
We believe that employers must educate employees on how to protect
themselves against sharp injuries/exposure to body fluids and to ensure safety
engineered devices be utilized correctly, throughout their organization. CINA
encourages nurses to lobby their employers and government agencies to protect
health care workers and their patients from illness and death as a result of
exposure to diseases from needle stick injuries and exposure to body fluids.
.
CINA supports and endorses the position paper from the Alliance for Sharps
Safety and Needlestick Prevention.

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 References

Alliance for Sharps Safety and Needlestick Prevention. (2002). Improving

Canadian health care worker safety: The case for mandatory implementation of
safety-engineered sharps devices and exposure control plans. Position Paper.
Toronto: Canada, 4-25.

Canadian National Occupational Health and Safety Resource, (1999).

Hepatitis B. Resource Paper. 1-6.

Canadian National Occupational Health and Safety Resource Needlestick

Injuries. (2000), 1-7.

CDC, Centres for Disease Control and Prevention, (1993-1999). Evaluation of

safety devices for preventing percutaneous injuries among health care workers
during phlebotomy procedures. MMWR 4. Minneapolis St. Paul, New York City
and San Francisco, 6(2), 21-25.

Centre for Disease Control and Prevention, (1998). Recommendations for

prevention and control of Hepatitis C virus (HCV) infection and HCV related
chronic disease. MMWR 47. (RR-19), 1-39.

Getting the facts about sharps and injury prevention pamphlet. Health Care
Health and Safety Association of Ontario. Ontario,1-10.

Health Canada. Update: (2000). Surveillance of health care workers exposed to

blood/body fluids and blood borne pathogens. CCDR 2001. 27, 201-12

Health care sector environmental scan and trend analysis 2005-2009. Summary
Report February Health Care Health and Safety Association of Ontario.
(2004),18-28.

Ippolito, G., Puro, V., et al. (1997). Prevention, management and

chemoprophylaxis of occupational exposure to HIV. International Health Care
Worker Safety Center, University of Virginia, Charlottesville, VA. 12.

National Alliance for the Primary Prevention of Sharp Injuries. (2004).

WWW.NAPSSI.Org. Primary Prevention Devises.

NIOSH. (2000). Recommendations to protect health care workers. HHS (NIOSH)

Publication, 108 (11), 23-99.

US Department of Health and Human Services, (2000). Preventing needlestick

injuries in health care settings national institute for occupational safety and health
(NIOSH). NIOSH ALERT. Publications No. 2000-108.