Factors Associated with Use of Safety-Engineered Needles and Hands-Free Techniques: Current Practices among Operating Room Nurses
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Date
2016-03-29
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Johns Hopkins University
Abstract
Background – Injuries from contaminated needles and other sharp medical devices continue to present serious occupational health concerns for healthcare workers. This poses significant risk of infection from potentially life-altering bloodborne pathogens (BBPs) such as Hepatitis B (Hep B), Hepatitis C (Hep C) and the Human Immunodeficiency Virus (HIV). Previous research has shown that while percutaneous injuries (PIs) in nonsurgical hospital settings have decreased by approximately 31.6% over the period from 1993 through 2006, there was an opposing trend in surgical settings. (Jagger et al., 2010) According to researchers, PIs in the operating room (OR) increased by 6.5% during the same time period. (Jagger et al., 2010) Hypodermic needles are among the devices most commonly associated with PIs and safety-engineered needles are commercially available and effective at reducing needle sticks. In fact, the researchers attributed much of the successful sharps-injury reduction in non-surgical settings to an increased use of sharps with engineered sharp-injury protections (SESIPs) such as safety-engineered hollow-bore, hypodermic needles. (Jagger et al., 2010)
The US Department of Labor, Occupational Safety and Health Administration (OSHA) requires use of engineering and work practice controls to eliminate or minimize exposure to bloodborne pathogens. There is evidence that use of a hands-free passing technique (HFT), a work practice that eliminates the hand-to-hand passing of contaminated instruments during surgical procedures, has had success in reducing sharps injuries when used regularly. [Folin, 2000; Stringer et al., 2002; Stringer et al., 2006; Stringer et al., 2009(a); Stringer et al., 2009(b)] Yet, among surgical staff, compliance with use of such safer work practices with demonstrated success appears to be lower than expected.
Objectives – The purposes of this study were to: 1) characterize safety behaviors among OR nurses practicing in the United States through evaluation of their work environment and their level of compliance with the use of safety-engineered hollow-bore needles and their practice of hands-free technique while passing contaminated sharps in the OR; 2) assess the influence of various individual-level and organizational factors associated with the two safety practices; and 3) discuss possible intervention methods to increase compliance of the two safety measures of interest among surgical nursing staff.
Methods – We conducted a descriptive correlational study using a cross-sectional survey that was administered to currently practicing operating room nurses who were members of the Association of peri-Operative Registered Nurses (AORN). We gathered demographic information as well as information regarding the work environment and safety practices related to sharps used in ORs. A modified PRECEDE behavioral model was used to demonstrate how predisposing, enabling and environmental (i.e., organizational) factors affect behavior among OR nurses. In this study, the Health Belief Model (HBM) was used in the assessment of associations between individual-level perceptions (i.e., perceptions of susceptibility, severity, barriers to use, and perceptions of benefits) and the nurses’ intention to use of safety-engineered needles and HFT. Chi square and logistic regression analyses were used to evaluate the associations between the independent variables (e.g., demographic characteristics of respondents, work practices, facility policies, training experiences, etc.) and the nurses’ use of safety engineered hypodermic needles and hands-free passing techniques in the OR.
Results - The reported rates of use of SESIP needles and of HFT were largely infrequent—rates of regular use were reported to be 46% and 42%, respectively. The PRECEDE factors identified as the strongest independent predictors of SESIP needle use were: low perceived barriers (e.g., not interfering with procedures), high views related to enabling factors (e.g., high perception of one’s skills in using SESIP needles) and environmental factors (e.g., mandatory policy to use), and training. Similar findings were identified with HFT use; however, an additional construct, high perceptions of benefits to the use of HFT also emerged as a significant independent predictor of HFT use. Training on how to use SESIP needles was found to have a significant direct effect on SESIP needle use—those who reported receiving training were three times more likely to use SESIP needles compared with those who were untrained. Other work practices/policies found to be strongly associated with increased use of SESIP needles and HFT include: the practice of announcing sharps transfers and avoiding recapping used needles; and inclusion in the decision of SESIP selection.
Conclusions – This study supports findings of other studies that show the influence of perceived barriers, enabling factors, existing institutional policies and training on compliance with safety practices. (Stringer et al., 2009(b), Stringer et al., 2011; Osborne, 2003(a); Gershon, 1995) Among the important findings in this study was that the awareness of existing institutional policies was associated with a five-fold increase in the nurses’ compliance with each of the two safety behaviors. The next step should be to identify interventions that are aimed at designing methods of worker education that take into account individual level perceptions and behaviors, such as barriers and enabling factors, and at increasing the existence and awareness of effective mandatory use policies at the institutional level.
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Keywords
Sharps injuries, needlesticks, blood borne pathogens, operating room, HFT, hands-free passing, SESIP, safety-engineered needles, needles, nurses