Reducing Needlestick Injury to 0% Among the Nurses in the Clinical Setting, Assessment Example

Outline

 Introduction

Literature Review

• Background
• Justification
• Relevance

Tabulated Summary

Aim and Specific Objectives

Practice Assessment Process

• Plan
• Do
• Study
• Act

Conclusion

Appendix

Abstract

According to the National Institute of Occupational Health and Safety over 8 million health care workers in the United States of America are at risk of needle stick infections from the health care settings in which they function. There are no accurate figures to determine the extent of damage done to individuals affected from needlestick and other percutaneous injuries. Tentative estimates indicate that there are some 600,000 to 800,000 injuries occurring annually (Henry and Campbell, 1995; EPINet, 1999). 50% of these cases go unreported. Further estimates suggest that about each health care worker gets about 30 needle stick per 100 hospital bed daily (EPINet, 1999). Most reported cases emerge from ‘nursing staff; but laboratory technicians, doctors, housekeepers, and other healthcare workers are at equal risk and suffer as a consequence of needle stick in the execution of their duties. Frequently transferred blood borne pathogens include the hepatitis B virus (HBV); hepatitis C virus (HCV) and the human immunodeficiency virus (HIV) (NIOSH, 2012). These circumstances surrounding needle stick among nurse functioning in clinical settings has forged considerations for reducing needlestick injury to 0% among the nurses in the clinical setting

Introduction

The seriousness related to consequences of needle stick injuries in clinical settings across the world cannot be overestimated. A surveillance of needle-stick injuries amongst student

Nurses at the University of Namibia revealed that in 2008 17% of them sustained needle-stick injuries from which just 55% reported. Additionally, on these 55% occasions whereby student nurses were injured, they were not supervised by a registered nurse (Small et.al, 2011).

Consequently, the team recommended alluding to the three phases of Haddon’s matrix, (pre-injury, injury and post-injury) that it be mandatory for students be supervised by registered nurses when functioning in clinical settings. Further, measures taken to reduce the incidence were adopted. These included completion of reflective exercises, sessions sensitizing students to the dangers of needle stick before placement in clinical areas and supportive clinical interventions by utilizing independent student counselors (Small et.al, 2011).

Small (2011) further contended that as of 1980 the possibility of being

infected with the human immunodeficiency virus (HIV) if accidentally a needle stick occurs could be devastating. The possibility of becoming infected with Hepatitis B (HBV) and Hepatitis C is also likely. Therefore, needle stick ought to be eliminated from clinical settings for nurses’ safety (Small et.al, 2011). Importantly, this study drawing from evidence based interventions aims to explore ways in which needle stick among nurses could be reduced to zero when functioning in clinical settings.

Importantly, in my clinical setting ROOT Causes for needle stick injury that occurred on in-patient wards for year 2011 and 2012 reads as follows:

Hand movements ======== 5. 3

(- own hand movement 5. 1)

(- hands coincided with another staff===== 0. 2

Patient factor ========= 4. 4

Knowledge deficit (wrong technique) ======= 3. 3

No immediate disposal of sharps============== 7. 4

Improper disposal of sharps============== 1. 1

TOTAL====================== 20 15

Literature Review

This literature review was derived from searching yahoo and goggle data bases for studies reporting evidence based practice related to needle stick injuries. As such, it embraces a collection of peer reviewed literature pertaining to needle stick in injuries in clinical settings. It will include a background to the phenomenon occurring from a clinical nursing perspective; justification and relevance will be explored. Keywords needle sick, nurses and clinical setting will be used in accessing appropriate documents for this project.

Background

Moazzam Zaidi, Salem A. Beshyah and Robin Griffith (2010) investigated ‘Needle Stick Injuries: An Overview of the Size of the Problem, Prevention & Management.’ The researchers contend that according to World Health Organization estimates some 3,000,000 health care providers are exposed to body fluids due to needle stick accidents yearly. This accounted for 57 documented cases of HIV in 2001; 2000 workers infected with hepatitis C and 400 with hepatitis B. 20 other infectious agents have been identified and documented as being prevalent in the clinical environment. They include various forms of bacteria, fungi and parasites. These researchers concluded that 80% of all these needle stick incidences could be avoided only if there were safer techniques when administering injections or entering the veins of patients (Zaidi et.al, 2010).

Similarly, Rahul Sharma (2010) studied ‘Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi, India.’ The researchers advanced that ‘because of the environment in which they work, many health care workers are at an increased risk of accidental needle stick injuries (NSI)’ (Sharma et .al, 2010).

Consequently, they discovered from the sample selected that 79.5% of health care workers reported having had one or more needle stick during practice years. As such, this is an average of 3.85 per health care worker CW (range 0-20). 72 (22.4%) reported had injuries within the last month. Fatigue was blamed for 50% of these injuries. Further reports showed where 34.0% occurred during recapping. When the accident happened 60.9% of nurses washed the site of injury with water and soap while (14.8%) did nothing about it. Just a mere 7.8% of the health care workers took any post-exposure prophylaxis measures against HIV/AIDS. Recapping of needles after procedures was the most common cause for needle sticking incidents (Sharma et .al, 2010).

The Prevalence of Needle Sticks Injury among Medical Students in Melaka, Malaysia, A Cross Sectional Study conducted by Kye Mon Min Swe (2012) revealed that

needle stick injury prevalence was 7.2% and occurred mostly during Medicine

posting at a rate of 48.5%. They concluded that the incidence among medical students was not as high as it was with other health care workers such as nurses (Swe et.al, 2012).

‘Needlestick and sharps injuries among health care workers at public tertiary hospitals in an urban community in Mongolia’ was the theme of a study conducted by Mayo Kakizaki (2011) and a group of other researchers. In July, 2006 they surveyed 621 health care workers from two public tertiary hospitals in Ulaanbaatar, Mongolia. They found that needle stick and sharps injuries to be a common public health issue at these institutions across the country. (Kakizaki et.al, 2011).

In response the researchers recommended that promoting adequate working conditions, eliminating excessive injection use, and adherence to universal precautions could be beneficial in reducing incidences generally. They acknowledged that percutaneous exposures to blood and body fluids through contaminated needle sticks and sharps is a leading occupational hazard, which leads to morbidity and mortality among nurses and all categories of health care workers (Kakizaki et.al, 2011).

Justification

Justifications for ‘Reducing Needlestick Injury to 0% among nurses in the clinical settings’ has been aptly represented in Prüss-Ustün’s (2005 ) ‘Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers.’ Researchers revealed after conducting studies in 14 geographical regions ‘16,000 HCV, 66,000 HBV, and 1,000 HIV infections may have occurred during the year 2000 worldwide among health care workers. This was due to their occupational exposure to percutaneous injuries’ (Prüss-Ustün et.al, 2005). This represents HCV 39%, HBV 37%, and HIV 4.4% respectively (Prüss-Ustün et.al, 2005).

Wicker (2008) further advanced that there is a very high incidence of needlestick injuries in routine hospital procedures, which occurs on a daily basis. It has been argued that this rate has a strong relationship to the medical discipline of the health care institution. As such, implementing safety measures could beneficial. The researchers cited 34% (n = 191/561) of all needlestick injuries could have been avoided had safety measures and devices been in place. From the sample studied safety devices were available for merely 35.1% (n = 197/561) of all staff disciples. This study examined the ‘Prevalence and prevention of needlestick injuries among health care workers in a German university hospital’ (Wicker et.al, 2008).

Relevance

Marie Fullerton and Veronique Gibbons (2011) tried establishing the relevance of reducing needle stick injuries to zero among nurses in clinical settings to advance studies regarding ‘Needlestick injuries in a healthcare setting in New Zealand.’ The researchers aimed at quantifying the extent to which needlestick underreporting has affected the designing strategies to address the irregularity. They examined factors which can create underreporting, and to undermine the relevant risk management strategies (Fullerton & Gibbons, 2012).

These researchers discovered that underreporting rate for needlestick injuries was 33%. This was consistent with international figures. 17.8% were doctors who sustained one or more needlestick injuries in the past year. In comparison to nurses 7.6% and midwives 6.7%. The recommendation is that health care staff inclusive of nurses ought to be sensitized regarding the nature of needle sticks injury and the potential consequences since this is relevant in reducing the incidences if they are reported (Fullerton & Gibbons, 2012).

Lin Yang and Barbara Mullan (2011) similarly researched ‘Reducing Needle Stick Injuries in Healthcare Occupations’ through an integrative review of literature. The researchers contend that there are very little studies pertaining to interventions designed to reduce injuries in health care settings. More importantly, the study recognized the importance of using effective strategies to decrease healthcare occupational injuries (Yang & Mullan, 2011).

Precise conclusions point towards ‘insufficient studies using a combination of both safeguards and educational interventions in surgical and nonsurgical settings’ (Yang & Mullan, 2011). The recommendation leads to more research evaluating these two types of interventions form the perspective of randomized controlled trials and other designs (Yang & Mullan, 2011).

Literature Review Summary

Background

Justification

Relevance

Aim and Specific Objectives

Aim

Reducing needlestick injury to 0% among the nurses in the clinical setting

Objectives

• Sensitizing nurses to the risks and dangers of needle stick injuries
• To educate nursing staff regarding reporting needle stick injuries
• To implement strategies that would ensure a greater degree of safety when needles are used in clinical settings
• To implement measures that would limit use of needles

Practice Assessment Process

The foregoing literature review presented a wealth of evidence that nurses are most vulnerable to needle stick injuries that any other health care providers in the clinical setting. However, the difficulty lies in available implication stogies that would transfer evidence into practice. Yang and Mullin (2011) correctly cited in their research that there are very little studies pertaining to interventions designed to reduce injuries in health care settings (Yang & Mullin, 2011). This is what makes a project such as the one under review relevant and unique.

Supportively, Allison Metz, Karen Blase and Lillian Bowie (2007) posit that one of the greatest challenges facing Advanced Nursing Practitioners is implementing a new program or practice. They further advance that constraints arise when there is insufficient information regarding strategies that promote effective and efficient program implementation (Metz, 2007).

Importantly, form research studies they discovered that implementation strategies are available only on paper and their relevance to real life situations may be obsolete. Essentially, they merely describe interventions without providing applications as to resources and activities required to execute them (Metz, 2007). It is from the premise of insufficient along with inadequate strategies that this project of reducing needle stick injuries to 0% among nurses in the clinical setting will be embraced.

Quality Improvement Cycle

This quality improvement cycle will encompass three aspects of the implementation management technique embodied in Plan-Do- Study/Check and Act. In the planning portion supplemental objectives relating to the overall aims and objects listed in the previous section will be designed. The ‘Do’ aspect pertains to the implementation process which means making the product by translating evidence into practice. Importantly it would be necessary to collect and chart data in this section (Moen & Norman, 1999).

Study/check requires evaluation of the implementation process or project based on the data retrieved from the ‘Do’ portion of the management strategy employed. ‘Act’ requires instituting corrective measures or re-doing the entire plan of action (Moen & Norman, 1999).

Plan

Do – Implementation

Before this plan is implemented a survey would be conducted sensitizing nurses to changes that would occur within a few months to a year regarding how they view incidences of needle stick injuries in the clinical setting. A sample of 25 nurses in a medical surgical clinical are the expected participants. Please see appendix 1&11 for questionnaire details.

 Objective 1

Sensitizing nurses to the risks and dangers of needle stick injuries

Goals

• To review the protocol for application of evidence based practice of needle use safety in clinical settings.

Process

Before implementation of clinical information system which would facilitate the venture nurse will be scheduled for release weekly in batches of 10n for the workshop intervention. Facilitators would be Nursing Educators; Epidemiologists; Researchers of

Evidence Based Practice protocols

• To align nurses’ awareness to the importance of adherence to protocol for their personal safety.

Process

Data regarding incidences of needle-stick injuries in the clinical nursing settings will be an introductory feature highlighting how adherence to protocol could reduce or eliminate such incidences since they are preventable would be offered. This would create the workshops content (Godin et.al, 2000).

Objective 11

To educate nursing staff regarding reporting needle stick injuries

Goals

• To inform nurses through dissemination programs where, when and how to report needle stick injuries occurring in the clinical setting.

Process

During weekly release sessions for sensitization workshops facilitators will conduct sessions related to reporting of incidences should they occur. Even though the aim is reducing injuries to zero the only reliable data to show that this has been achieved is through reporting. Hence, this is the strategy behind insisting that nurses report incidences. Further reports have been that health-care workers are complacent and perceive needlestick injuries as an inevitable to handling sharp devices, As such, injuries go unreported; the dysfunctional practice continues and morbidity as well as mortality are the consequences (Trim, 2004)

• To facilitate the process through strategic interventions

Process

The process informing this goal is implementing a clinical information system that would enable tracking of unreported cases. Inaccurate assessment of source-patient risk factors seemed to be a major reason for underreporting. Nash and Goon (2000) reported that ‘only 5% of needlestick injuries were reported because the health-care worker’s decision to report was influenced by judgments made about the source-patient’s lifestyle’ (Nash & Goon, 2000). Facilitators will address these issues in the workshop sessions.

Objective 111

To implement strategies that would ensure a greater degree of safety when needles are used in clinical settings.

Goals

To reorient nurses in the alternatives that would reduce injuries.

Process

Alternative that would reduce injuries include the way nurse administer medications. This includes inappropriate holding of the syringe, needle, and skin of the patient as well as the rotating used in plunging needles. This reorientation would begin while awaiting a task force report on better practices.

• To train nurses regarding best practice interventions in holding needles safely during execution of a procedure.

Process

This follows orientation, which is exposing nurses to strategies that would reduce needle stick injuries to zero. The content transmission includes avoidance in recapping of needles. Simply discard after use. Avoiding the using of hollow-bore needles because they are responsible for of 62% of injuries, especially the hypodermic type, attached to disposable syringes. Butterfly needles also predispose to injuries. These require special holding techniques when administering injections (Chiarello, 2005).

Objective 1V

To implement measures that would limit use of needles

 Goals

To initiate change by lobbying for less use of injections, having to, stick patients often.

Process

According to the National Institute for Occupational Safety and Health care Intervention, needle stick injuries should aim at eliminating the use of needles where safe and effective alternatives are available. Subsequently, implementing the use of devices with safety features is beneficial. Evaluating their use to determine which are most effective and acceptable for the particular health care setting should be the follow up measure (Lawrence et.al 2007).

As such, in implementing clinical information system designed informing nurses regarding the best strategies to develop during a venipuncture procedure or injection intervention could be very useful. This system will would eliminate guessing what are the best devices to be used for specific procedures. It facilitates real time interventions.

Study/Check

Ultimately, after the 1 year implementation of this reducing needle stick injury to zero plan, an evaluation process will follow. It is expected to assess the extent to which workshops; proposed legislation change and task force evidence based interventions were able to reduce needle stick injuries to zero. There will be three set of data to be interpreted; first responses from questionnaires; then stakeholders’ reaction to proposed legislation change and finally task force recommendations.

Act

Act will redesign this project based on nurses’ responses prior to workshops and after the first years’ task force reports. Adjustments will also be made to the legislative proposal for changes to replace needles with safer devices in clinical settings. There should be more detailed information after the data has been processed from these three major sources used in initiating the implementation process. No one knows as yet what these results.

Conclusion

This proposal for reducing needle stick injuries to zero has been preceded by a brief literature review detailing evidence that the cited dysfunction is a justifiable case for intervention and its relevance has been clearly articulated. Subsequently, applying the PDS/CA management mechanism a plan of action aiming to reduce needle stick injuries to zero was embarked upon.

Four objectives were designed and the process through which they could be achieved was discussed. Expected outcomes are based upon responses of nursing to the first phase of workshop orientation and pro-posed evidence base changes. Further support has been solicited through a task force for supplying more pertinent data for legislative considerations in the practice of nurses’ needle use in clinical settings (Institute of Health Care Improvement, 2013).

References

Chiarello, L (2005). Selection of needle-stick prevention devices: a conceptual framework for approaching product evaluation. Am J Infect Control, 23(6),386–395.

EPINet (1999). Exposure prevention infor-mation network data reports. University of Virginia: International Health Care Worker Safety Center.

Fullerton, M., & Gibbons, V. (2011). Needlestick injuries in a healthcare setting in New Zealand. The New Zealand Medical, 124(1335).

Godin, G., Naccache, H., Morei, S., & Ebacher, M-F. (2000)Determinants of nurses’ adherence to universal precautions for venipunctures. American Journal of Infection Control 28: 359-364.

Institute of Health Care Improvement ( 2013). Plan-Do-Study-Act (PDSA) Worksheet. Retrieved January 13^th, 2013 from http://www.ihi.org/knowledge/Pages/Tools/PlanDoStudyActWorksheet.aspx

Kakizaki1, M. Ikeda, N. Ali,M. Enkhtuya, B. Tsolmon, M. Shibuya, S., Kuroiwa, C (2011). Needlestick and sharps injuries among health care workers at public tertiary hospitals in an urban communityin Mongolia. BMC Research Notes, 4(184).

Lawrence, L. Delclos, G. Felknor, S. Johnson, C. Frankowski, R. Cooper, S., & Davidson A (2007). The effectiveness of a needleless intravenous connection sys-tem: an assessment by injury rate and user satisfaction. Infect Control Hosp Epidemiol 18(3),175-182

Metz, A. Blasé, K., & Bowie, L. (2007). Implementing Evidence based Practices: Six ‘Drives’ of Success. Research to Results Trends. Retrieved January 12^th 2013 from http://www.childtrends.org/files/child_trends2007_10_01_RB_6successdrivers.pdf

Moen R., & Norman., C. (1999). Evolution of the PDSA cycle. Retrieved13 th January, 2013from http://pkpinc.com/files/NA01MoenNormanFullpaper.pdf

Nash, G.F., Goon, P. (2000).Current attitudes to surgical needlestick injuries. Annals of the Royal College of Surgeons of England 82: 236-237.

NIOSH (2012). Alert. Preventing Needlestick Injuries in Health Care Settings. Retrieved January 11th, 2013 from http://www.cdc.gov/niosh/docs/2000-108/pdfs/2000-108.pd

Prüss-Ustün, A. Rapiti, E., & Hutin, Y (2005). Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. American Journal of Industrial Medicine 48 (6): 482–90

Race, P. ( 2003). Designing Effective Workshops. TechDis

Sharma, H. Rasania, S. Verma, A., and Singh, S (2010). Study of Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi,

India. Indian J Community Med, 35(1), 74–77.

Small, L., Pretorius, L., Walters, A., & Ackerman, M. (2011). A surveillance of needle-stick injuries amongst student nurses at the University of Namibia. Health SA Gesondheid, 16(1), 507-515

Swe, K. Zin, T. Bhardwaj, A. Abas, A., Barua, A. (2012). The Prevalence of Needle Sticks Injury among Medical Students in Melaka, Malaysia, A Cross Sectional Study. European Journal of Scientific Research 71(2), 214-220

Trim, J. ( 2004). Raising awareness and reducing the risk of needlestick injuries. Nursing times.net

Wicker, S. Jung, J. Allwinn, R. Gottschalk, R., & Rabenau, F. (2008). Prevalence and prevention of needlestick injuries among health care workers in a German university hospital. Int Arch Occup Environ Health, 81 (3), 347–54

Yang, L., & Mullan, B (2011). Reducing Needle Stick Injuries in Healthcare Occupations: An Integrative Review of the Literature. ISRN Nurs. Retrieved on January 11^th, 1012 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169876/

Zaidi, M. Beshyah, S., & Griffith, R.(2010). Needle Stick Injuries: An Overview of the Size of the Problem, Prevention & Management. Ibnosina Journal of Medicine and Biomedical Sciences, 2(2), 53-61

Appendix 1

Pre-implementation Questionnaire (self-administered)

Biographic data

Age:                         Sex:                  Years Of Service:          Category of nurse: RN, LPN, CNA

Needle Stick injury Information

Have you been ever stuck by a needle during years of practice? Yes/No

If you have been stuck how many times? ……….

Have you reported it?

What do you know about reporting needle stick injuries:-

• Nothing
• Very little
• Quite a lot

What do you know about evidence based protocol regarding needle stick injury?

• Nothing
• Very little
• Quite a lot

Are you willing to change your attitudes and intervention practices regarding needle stick injuries? Yes/ No

Appendix 11

Workshop Questionnaire (self-administered)

Biographic data

Age:                         Sex:                  Years Of Service:          Category of nurse: RN, LPN, CNA

Content

Was the information clearly transmitted by the facilitator? Yes/ No

What did you like best about the presentations?

• Facilitators approach
• Content
• Needle stick injuries data
• Evidence- based applications

What was you level of understanding

• Very good
• Good
• Poor
• Did the information inspire you make a change towards perceiving needle stick injures? Yes/ No