NAPPSI and ICT

Congratulations to Thomas Jefferson University Hospital, winner of the 2006 NAPPSI and ICT Primary Prevention Safety Award. Since early 2000, Thomas Jefferson University Hospital has been using a variety of sharps safety products hospital-wide with a particular focus on using primary prevention technologies (i.e. eliminate the needle, eliminate the risk). The depth and breadth of actions to minimize sharps injuries at this facility demonstrate an extremely proactive and effective sharps injury prevention culture that focuses not only on healthcare worker safety, but also patient safety, improved productivity, and demonstrated cost savings.

The facility prides itself in setting the standard of care for the community through the use of sharps injury reduction products and programs. Clinicians are strongly encouraged to bring to the administration any and all safety products, ideas, or suggestions that will help reduce any remaining sharps injuries. The facility has a standing safety committee that meets monthly to review sharps injury reports and statistics, conduct root cause analyses, and continually look for improvements in sharps safety.

Facility Background

Founded in 1825, Thomas Jefferson University Hospitals now have 925 licensed acute care beds and major programs for a wide range of clinical specialties. The services of this academic medical center are delivered at several locations: Center City, Philadelphia; Jefferson Hospital for Neuroscience, Methodist Hospital, which is located in South Philadelphia; Jefferson HealthCARE and Voorhees, in New Jersey; and several ambulatory care satellites and radiation therapy centers. The hospital has been ranked among Americas Best Hospitals for many specialties by U.S. News & World Report for 17 years in a row.

Formerly a division of Thomas Jefferson University, the hospital was separated from the university to become a founding member of the Jefferson Health System in 1995. The hospital expanded its services to the community with the merger with Methodist Hospital as a Division of Thomas Jefferson University Hospitals in 1996.

With 5,680 fulltime employees and more than 3,000 clinicians, the hospital is affiliated with Thomas Jefferson University, consisting of Jefferson Medical College, Jefferson College of Graduate Studies, and Jefferson College of Health Professions and associated university services.

The primary prevention technologies implemented at the hospitals include:

• Sutureless catheter securement products 

• Needle-free access valves 

• Pulse oxymeters 

• Surgical glues 

• Needle-free IV products 

• Needle-free drug-delivery products 

• Pre-filled syringes 

• Plastic blood-collection tubes 

Using primary prevention technologies wherever possible is a constant goal at this institution. Even before the passage of the Needlestick Prevention Act of 2000, Jefferson was an early adapter of needlestick injury prevention products and implemented safety programs with the full support of the facilitys chief executive officer, who attended their first sharps injury prevention meeting to communicate full support from all levels of hospital administration.

Jefferson is honored to receive this award, says Thomas J. Lewis, president and chief executive officer of Thomas Jefferson University Hospital. Jeffersons sharps injury prevention committee is dedicated to decreasing the incidences of accidental needlesticks, and this award is a reflection of their commitment to the care and safety of our patients and staff.

More recently, Jefferson recognized catheter securement devices as a way to not only reduce sharps injuries from suture needles and IV stylets, but to also improve patient safety, improve healthcare workers productivity, and reduce costs. The use of StatLock® IV catheter securement devices, along with using the Alaris® Smartsite Needle-free System, provides an excellent example of combining two primary prevention technologies, along with the use of a secondary prevention technology (a safety IV catheter, BD Insyte Autoguard®) to maximize healthcare worker safety. This forward-thinking approach was approved from the top down, especially after a cost analysis clearly indicated that the cost of a needlestick injury was more than the increased cost of a safety device. Additional benefits included reducing the emotional trauma suffered by a clinician after a needlestick and being able to provide employees with a safer work environment.

Secondary prevention technologies implemented by the hospital include:

• Safety IV catheters 

• Safety syringes 

• Safety needles 

• Safety blood collection devices 

• Safety lancets 

• Safety scalpels 

• Safety biopsy needles 

• Safety Foley catheter drainage device 

In 1995, Thomas Jefferson University Hospital focused on needlestick injury reduction as one of its performance improvement process projects for the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). With the implementation of a needle-free IV system, the facility immediately recognized the value of using this system. Jefferson reported a 60 percent reduction in IV-related sharps injuries within the first year of implementing these products. In fiscal year 2002, further implementation of the sharps injury prevention products brought another 31 percent reduction in sharps injuries. The following fiscal year an additional 12 percent reduction was realized with the implementation of additional sharp safety devices.

As Jefferson continues to incorporate practices from evidence- based medicine, the hospital has adopted the use of Chloraprep® and BioPatch® to decrease the central venous catheter infection rate and improve the standard of care for patients. Like the Naional Alliance for the Primary Prevention of Sharps Injuries (NAPPSI), Jefferson recognizes that infection control means needlestick safety.

Facility Training and Education

Training and education to prevent sharps injuries begin with all new employees. In using safety devices, the clinician not only needs to know how to use a given device, but also must have a demonstrated competency with the device and needlestick injury reporting systems. Recognizing this, all new nursing education classes include practice sessions to make each nurse comfortable and competent with the new products. An entirely separate orientation session focuses only on safety products and practices. To ensure that all the clinical staff members are able to be trained on any newly implemented safety products, the hospitals education department created various educational methods for use, including in-service training by company representatives, on-line Intranet systems, and instructional manuals.

Jefferson is a teaching hospital, with residents, interns, medical students, and other allied health professional students rotating through the facility. Before any medical student, resident or intern, or new clinical staff member is allowed into the hospital, he or she must attend orientation sessions that include needlestick safety proficiencies, policies, and reporting procedures. This type of educational approach is the result of a unique collaboration between the hospital staff and the university faculty.

Facility Culture

There is a daily review of all reported needlestick injuries within the facilitys department of environmental health and safety. This data is reported to the sharps injury prevention committee, and includes a root cause analysis. It is with that thought that the committee members identify performance improvement, i.e. prevention analysis. Any performance improvement opportunities are then conveyed at all applicable safety committee meetings to prevent further occurrences.

The NAPPSI Clinician Advisory calls upon clinicians to employ both primary and secondary prevention measures to maximize sharps injury protection in the healthcare workplace. Jefferson has taken this advisory to heart. The hospital adopted and reinforced primary prevention strategies long before they became mandatory under Federal law. As a result, thousands and thousands of sharps have been kept out of Jeffersons workplace, and countless sharps injuries have been prevented.

The secondary prevention strategies have rendered what sharps Jefferson must employ safer. The constant staff input and staff education have created a safety environment at Jefferson that is second to none. Congratulations to Thomas Jefferson University Hospital for their wise and widespread implementation of sharps injury prevention technologies. 

The 2006 NAPPSI/ICT Primary Prevention Sharps Safety Award is Sponsored by

B. Braun is dedicated to providing innovative products that help deliver safer patient care, enhance performance and support best practices and compliance. The passive Introcan Safety® IV Catheter is designed to minimize accidental needlesticks without requiring user activation. Using the same passive technology, our Surecan® Safety Huber Needle is designed to protect against accidental rebound needlestick injuries for safe port access. The ULTRASITE® Needle-Free IV System, with positive displacement design, minimizes catheter occlusions while protecting patients and caregivers from accidental needlesticks.

www.bbraunusa.com 

Manufacturer of the BD Vacutainer® and Microtainer® brand and system of products, BD (Becton Dickinson and Company) is committed to identifying and helping to prevent sources of preanalytical error through a combined product and service offering. Products include: BD Vacutainer® Push Button Blood Collection Set, BD Vacutainer® Eclipse Blood Collection Needle with Pre-Attached Holder, BD Vacutainer® Blood Transfer Device, BD Vacutainer® Blood Collection Tubes, BD Vacutainer® Latex Free Stretch Tourniquet and new BD Vacutainer® Alcohol Swabs for antiseptic skin preparation prior to blood collection.

www.bd.com 

A Word About Primary Prevention

The term primary prevention refers to healthcare technologies and practices that reduce or eliminate the use of sharp implements by replacing them with safer technologies and practices (i.e., catheter-securement devices). Primary prevention is the most direct method of preventing needlestick injuries. Simply put, eliminate the sharp and you eliminate the risk.

Primary prevention contrasts with secondary prevention (i.e., retractable needles), an approach that adds protection but still requires use of a potentially dangerous sharp. Several recent studies show that accidents still occur at surprisingly high rates when secondary prevention is used. Possible causes include clinicians failure to activate safety features, failure of the safety features to operate correctly, design problems that make the safety features difficult to operate, and post-usage accidents that occur while the devices are in the waste stream.

The medical device manufacturers and designers that comprise part of NAPPSIs membership have developed primary prevention technologies as a response to the high rate of bloodborne infections from medical sharps injuries. More than 600,000 American medical workers are accidentally injured by medical sharps each year. Annually, about 2,500 sharps injury victims develop either hepatitis B or C, or contract HIV, which causes AIDS.

Source: NAPPSI