Infection Control Today - 05/2002: Open Forum

Why Do We Need to Know About Primary Prevention?

By Marilyn Hanchett, RN, PhD, CPHQ

Triggered by the HIV/AIDs crises and supported by federal mandates, thesafety movement in healthcare has fostered the rapid development of safetytechnology. Those who have practiced since the introduction of the firstOccupational Safety and Health Administration (OSHA) initiative have seen andmost likely used safety products designed to make the use of needles or otherssharps safer than they had been prior to the 1990s. These new safety productshave had an undeniable impact on helping protect healthcare workers againstexposure incidents.

However, while professional and administrative attention has been focused onthe use of these new devices, another generation of safety technology isemerging. Unlike the first generation of safety products, the new technology isseeking to eliminate the use of needles and/or sharps. And in cases wherecurrent technology cannot yet eliminate needles and sharps, it seeks to reducethe frequency with which they must be used. Specifically, the next generation ofsafety technology intends to increase safety by removing the potentialhazard rather than making contact with the hazard less dangerous.

In fact, the new technology is evolving so quickly that it is now possible todifferentiate among the categories of safety products. According to the NationalAlliance for the Primary Prevention of Sharps Injuries (NAPPSI), devices thatuse a needle or other sharp component with some sort of protective mechanism toprevent any injury can be described as secondary prevention. That is, thesafely technology is secondary to the continued use of the needle or sharpcomponent. Conversely, devices that completely eliminate the use of needles orreduce the frequency with which they must be used are known as primaryprevention. The primary focus of this technology is the elimination, or in caseswhere they cannot yet be eliminated the reduced use, of the actual needle orsharp component.

For example, a safety syringe uses a secondary prevention mechanism toprevent the needle from injuring the clinician once the injection is completed.However, a needleless injector is an example of primary prevention, since noneedle is used within the device. Both products inject medication, but theexposure risk to the clinician differs significantly between the two systems.

The impact of primary prevention is already surfacing is many areas ofhealthcare. Suture needles, a common cause of needlestick injuries in surgery,can now be replaced by surgical adhesives or sealants that require no needles,at least for superficial closures. Management of diabetes mellitus shows similarnew and emerging options. For example, blood glucose monitoring, which fordecades was based on urine testing or painful finger sticks, can now be donewithout the use of needles. Current research in the United States isaggressively pursuing needle-free options for insulin administration fordiabetic patients.

Infusion therapy, one of the most frequently required invasive treatments inacute care, is an important area for primary prevention. IV-securing devices,developed within the past 10 years, are now used to not only prevent catheterdislodgement, but to reduce the frequency of IV restarts within a facility. Itis significant that most hospitals do not measure how often IV catheters must bereinserted; however, recent studies conducted within large health centers haveshown that an IV securement device can reduce the frequency of IV restarts bymore than half. By reducing the need to reinsert IV catheters, the number ofpotential needlestick exposures to the clinician is dramatically decreased. Forthis reason, IV securement devices are classified as a form of primaryprevention.

At this time, both primary and secondary prevention devices are available.Both types of devices should be included in order to have an optimum safetyprogram in your healthcare facility. Selection of products from among the manyprimary and secondary prevention choices must be based on the types of careprovided and the exposure risk potential associated with that care.

There is no exact formula for a sharps prevention program. Every healthcareprovider must develop a program based on its special characteristics, but allproviders can draw from basic principles in designing a sharps safety program.These include

• A needle and sharps injury prevention program requires the combined use of both primary and secondary prevention products.

• Product evaluation and selection must be revised regularly in response to the dynamic and progressive nature of safety technology.

• Clinician education about and participation in the sharps safety program are fundamental in creating the safest possible workplace.

The continuing evolution of safety products challenges us to design betterprograms and to examine our fundamental attitudes toward injury prevention.Everyone working in healthcare today has organized their beliefs, behaviors andopinions on the fact that alternatives to needles and sharps have been, untilvery recently, unavoidable. When the use of needles is widespread andalternatives nonexistent or unknown, it is difficult to imagine any needle-freetreatments. However, the emergence of primary prevention technology urges us todo exactly that -- to imagine, understand and pursue a workplace safer than ithas ever been before. While this may sound futuristic, current examples ofprimary prevention technology remind us that previously unheard of breakthroughsin safety products are indeed a reality.

NAPPSI has been formed to help device manufacturers, clinicians, healthcareorganizations and providers obtain state of the art information about primaryprevention strategies and establish dialogue about evolving technology. WhileNAPPSI is organized to foster primary prevention, the organization acknowledgesthat the use of primary and secondary prevention products are essential toprevent sharps-related injuries. Since many clinicians remain unaware of new anddeveloping primary prevention devices, NAPPSI offers many educational tools at www.nappsi.org.

There are many stakeholders in the healthcare safety movement, but personalsafety rests largely with the individual. Users of sharps must be the foremostadvocates of their own safety, based on a full understanding of options inpreventing unnecessary and deadly injuries. The new and emerging productspresented by primary prevention offer an important addition to the range thesafety choices, but clinicians must know about them and call for their use, asappropriate, for the safety movement to achieve its most critical and enduringimpact. Primary prevention supports us in our struggle to reach this yetunrealized goal and that is why we all need know about it.

Marilyn Hanchett RN, PhD, CPHQ, is a published author and a nationalspeaker for NAPPSI. She can be reached at mhanchett@ktis.net.