There are a great many needlestick prevention devices now on the market, broadly categorised as ‘active’ devices incorporating a shield or cover that is placed by the user, and ‘passive’ devices based upon retractable needles.
Some are undoubtedly better that others. And few are better that the user who can defeat even the best passive devices which may not activate unless used precisely as intended.
That alone creates confusion and an obvious training need for healthcare staff and others; ideally a national standard safety device would be a great step forward since sharps injuries are slightly more common in ‘new’ staff including those moving to a new Trust where they will use a new and unfamiliar range of sharps safety devices.
Other problems arise. There is increasing evidence that some devices, including both the spring loaded passive devices and the manually operated active devices can throw out droplets of blood or other fluids from the needle tip when activated. This can result in wide area contamination with blood and pharmaceutical residues, including cytotoxics, the attendant problem of exposure of staff, and the risk that cleaning failures will result in compromise of PEAT and CQC inspection scores.
A Cochrane systematic review of devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel will be a useful step forward, to separate the good, the better and the best from those devices which simply don’t provide adequate or reliable protection to users.
Lavoie, M.C., Verbeek, J.H. and Pahwa, M. (2014) Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel. The Cochrane Database of Systematic Reviews. 2014 March 9;3:CD009740. [epub ahead of print]
The conclusions are as follows:
For safe blood collection systems, we found very low quality evidence in one study that these decrease needlestick injuries (NSIs). For intravenous systems, we found very low quality evidence that they result in a decrease of NSI compared with usual devices but moderate quality evidence that they increase contamination with blood. For other safe injection needles, the introduction of multiple safety devices or the introduction of sharps containers the evidence was inconsistent or there was no clear evidence of a benefit. All studies had a considerable risk of bias and the lack of evidence of a beneficial effect could be due both to confounding and bias. This does not mean that these devices are not effective. Cluster-randomised controlled studies are needed to compare the various types of safety engineered devices for their effectiveness and cost-effectiveness, especially in low- and middle-income countries.
Well, that’s a start, but doesn’t really advise about one device over any other. As always, the user must decide after careful review and perhaps a cautions trial involving as many possible users as is possible. Regrettably, cost will feature prominently in the decision-making process.
One aspect rarely considered is the cost of disposal, since this will vary tremendously between different devices. This cost should never be placed before safety, but is nonetheless a real criterion for assessment that is often overlooked.
Are disposal costs sufficient to make a difference? The differing complexities of sharps safety devices is manifest is different packaging requirements, generating sometimes a substantial volume of additional non-hazardous but expensive waste. And comparing one sharps safety device over another reveals a substantial size difference between products, sufficient to fill a sharps bin far more rapidly. More plastic to incinerate, or perhaps to recycle? The environmental impact of sharps safety devices will be seen increasingly as a secondary criterion for product selection.