“Back then, nurses didn’t even wear gloves,” says Cranston, secretary of the Arkansas Nurses Association (ArNA). And needlesticks generally were treated as accidents, not serious health threats.

But times changed, and at one point Cranston considered leaving her chosen profession because of the risks. At that time, she was injured while dropping a needle into a sharps box. Fortunately, the needle wasn’t contaminated with HIV, one of the pathogens that she and other nurses were afraid of contracting at work.

Cranston not only remained a nurse but is now the designated expert on needlestick safety and bloodborne pathogens within the ArNA, her ANA constituent member association (CMA). She and nurses from 16 other CMAs attended a two-day, “train-the-trainer” workshop conducted by the ANA this spring on needlestick safety (the ANA paid for all participant expenses).

“I have a daughter who is going to nursing school, and I want to make the profession safe for her and everybody else who wants to practice nursing,” Cranston says.

Building a network of nurse resources

The major goal of the ANA workshop was to create a solid network of nurses who could be resources on needlestick safety within their CMAs. Specifically, RNs who participated in the workshop are being asked to educate their nurse colleagues about bloodborne pathogen hazards in their workplaces, requirements of the bloodborne pathogens standard of the Occupational Safety and Health Agency (OSHA), and effective methods to evaluate and select safer needle devices.

Further, the ANA wants these nurses to be active in assessing employer compliance with needlestick safety regulations and helping members to enforce it, as well as addressing any gaps in policy that prevent all nurses from being safe.

The ANA and CMA leaders lobbied hard for (and achieved) the passage of federal legislation, called the “Needlestick Safety and Prevention Act of 2000,” which requires health care employers to implement safer needle devices within their facilities. The law, which amended the bloodborne pathogens standard, further requires employers to involve frontline nurses in selecting, monitoring, and evaluating devices used. (Go to www.nursingworld.org/needlestick for more information.) One problem, though, was that this mandate only applied to all private-sector employers and to public-sector employers in the 26 states and territories with state OSHA programs.

Late last year the ANA scored another victory on the safety front when federal lawmakers approved a measure that expands needlestick safety protections to include employees working in public hospitals and particularly targets facilities in states without their own OSHA programs.

Despite the regulatory successes, needlestick injuries are still occurring, partially because many nurses aren’t adequately informed about the OSHA regulations, according to Butch de Castro, PhD, MSN, MPH, RN, the ANA’s senior occupational health and safety specialist and coleader of the recent ANA workshop.

For example, some hospital administrators believe they are complying with the regulations because they purchased safer needle devices 10 years ago, he says. But many of those devices have been replaced with safer technology. Further, the law requires that direct-care providers continue to evaluate safer needlestick devices to ensure their effectiveness.

Meet the nurses

As part of the workshop, participants had to create concrete strategies to address needlestick safety and injury prevention within their home CMAs. The following represents the plans of five nurses, who will continue to have ANA support, and their views on the workshop.

Alabama State Nurses Association (ASNA) member Doris Reed Chandler, MSN, RNC, knows the importance of reinforcing information and keeping current on new technologies and practices. In her own Department of Veterans Affairs medical center, the infection control nurse saw RNs go from routinely injuring themselves recapping needles prior to the needlestick safety law, to sometimes injuring themselves with “safer” retractable needles because they weren’t trained effectively in proper technique. Because they now receive ongoing instruction, Chandler reports a drop in the number of needlesticks over the past three years—with only one in 2004.

Combining her experience and the new information and organizational skills she gained at the workshop, Chandler plans to focus much of her initial efforts on educational activities. Her initial target audiences are ASNA District 2 members, nurses working at another Birmingham hospital, and nursing students at area schools.

“I believe we need to begin at the core and really stress to student nurses the importance of learning proper technique,” Chandler says. “And we need to emphasize reporting even clean needlesticks, so we can determine how they occurred and keep nurses safe.”

For Jerry Nash, BSN, RN, OCN, the ANA workshop came at an opportune time because the Mississippi Nurses Association (MNA) decided to focus on needlestick safety as one of its priorities this year.

“As director of nursing practice for the MNA and a board member, I’m always looking at areas that are of concern to nurses,” says Nash, a charge nurse on a bone marrow transplantation unit. “And at my own facility, I’ve witnessed nurses getting stuck. So it’s natural for me to ask, ‘What if it was me?’”

When Nash returned from the workshop, he conducted a mini-survey on his unit, and some results were troubling. Nearly 70% of the nurses didn’t know what to do if they were stuck. Some said they wouldn’t report getting injured, out of a fear of being reprimanded for using improper technique.

Nash knows he has some interesting challenges ahead, but he says he gained more confidence to speak to his peers after attending the workshop. Nash initially plans to work with other MNA nurses to distribute an assessment tool he received at the training to hospitals throughout the state. The tool will help him collect information on which facilities lack effective, safer needle devices; exposure plans; and other OSHA safety measures.

Montana Nurses Association member Deanna Pihl, BS, RN, CNOR, also sees challenges in maintaining safety, particularly among other health care professionals.

“Practicing safely has been a big issue in the operating room for a long time because there are so many sharps and so much potential for exposure to blood,” says Pihl, an operating room staff nurse. Despite the risk, there are some experienced surgeons and anesthesiologists, for example, who seem resistant to complying with certain aspects of the bloodborne pathogens standard.

In addition to helping nurses create a safer operating room, Pihl wants to determine which health care workers in her state, such as county health care workers, are still not protected, despite the recent regulatory changes. (Montana has no state OSHA program.) She then hopes to work with her CMA and lawmakers to pass a state needlestick safety law.

Other planned activities include presenting at her association’s convention in October, creating informational packets that address sharps safety for CMA distribution, and teaching nurses and other professionals about this issue.

New York State Nurses Association (NYSNA) health and safety specialist Tom Lowe, MPH, RN, COHN-S, attended the ANA workshop to gain a more global knowledge of needlestick safety practices, as well as assistance in organizing a more comprehensive plan to reach nurses statewide.

Since attending the workshop, Lowe has spoken with his New York state OSHA contact to discuss putting out a “shoulder-to-shoulder” statement with the NYSNA that puts health care employers on notice regarding compliance with needlestick safety regulations. The directive also would spell out nurses’ rights and responsibilities as spelled out in the OSHA regulations.

Lowe says he hopes to work with NYSNA members to ensure that they are actively involved in efforts to keep nurses safe, such as participating in their workplace committees that select and evaluate safer needle devices. To that end, he will be conducting workshops throughout the state and updating the continuing education course on the NYSNA Web site.

In Arkansas, Cranston is working with the ArNA to create a task force composed of representatives from each association district to collect information on health care facilities’ policies on needlestick safety. And she wants to offer a continuing education program to RNs, LPNs, and other health care workers based on information she obtained at the ANA workshop.

“Working with sharps will always be a concern for nurses unless we discover a totally noninvasive way of treating patients, like in Star Trek, ” Cranston says. “I don’t think that’s going to happen anytime soon.”

However, the ANA staff hope to conduct more workshops to build an even greater network of needlestick safety experts within its CMAs in the near future.

Susan Trossman is the senior reporter for the American Nurse, published by the ANA.

Return to the 2004 AJN Table of Contents

Return to the AJN Home Page

Search	Contact ANA	Join/Renew Membership	Members Only	Online CE
NursingInsiderSpecial Offersnursesbooks.org © 2008 The American Nurses Association, Inc. All Rights Reserved Copyright Policy | Privacy Statement