A needleless intravenous system: an effective risk management strategy.

Abstract

Historically, healthcare workers have not taken accidental needlesticks seriously and often have not even reported them. In the last five years, healthcare workers' awareness that needlesticks are a serious source of workplace exposure to hepatitis B virus (HBV) or the human immunodeficiency virus (HIV) has resulted in far more reported needlestick injuries. The risk of seroconversion following a needlestick with HIV-infected blood is approximately 1 in 300.1 Along with the risks of HIV and HBV numerous other infections can be transmitted by needlesticks. There is also the psychological effect on healthcare workers who may fear the possibility of contracting an infection every day while at work. In October 1989, at Columbia Hospital in Milwaukee, Wisconsin, a 394-bed facility, a needlestick task force was formed to address the number of employee needlestick occurrences reported to the occupational health department Members of the task force included an infectious disease physician and representatives from the infection control department, emergency department, pharmacy, operating room, intensive care unit, occupationalhealth department, laboratory department, housekeeping department, infusion therapy team, and materials distribution department. The goal of the needlestick task force was to reduce the number of blood exposure needlesticks to employees. The first strategy to reduce needlesticks was to re-educate staff to practice safety by avoiding recapping and properly taping all connections with needles on intravenous tubing lines and intravenous piggyback lines. This attempt was unsuccessful. Healthcare workers continued to have needlestick injuries bec us changing their clinical practice was too difficult. Studies have indicated that healthcare workers, in gene al, are not compliant with intravenous needle safety issues such as recapping and p operly taping intravenous lines. In a report on the epidemiology of hospital sharps injuries, Dennis G. Maki, MD, states, As have others, we have come to the conclusion that the greatest impact in reducing sharps injuries in HCW (healthcare workers) might be achieved by innovative technology-based approaches to prevention that implicitly reduce the risk of injury, despite carelessness or apathy on the part of an HCW ...analogous to mandating airbags in cars. Making impervious disposal units conveniently available was a first step. However, we need far more: systems that permit vascular access in drawing blood in which the user is implicitly shielded from contact with the used needle such as 'needleless systems' for administrating parenteral medications.2 Having learned this, the next step for the task force at Columbia Hospital was to investigate new products designed to eliminate needlestick injuries. After many months of testing and evaluating new roducts, a needleless intravenous system was approved. The product consisted of a reflux valve that locks on the end of the angiocatheter and a protector needle that can be used with the reflux valve on a rubber port anywhere on the intravenous line. The plastic reflux valve is accessible only by intravenous tubing or syringes without needles. Once the initial venipuncture is performed, the intravenous tubing system is completely needleless. Intravenous piggyback medications are con-