Sticking with Safety

• By Chuck McCloskey, E. Kyle Steinhauser
• Nov 01, 2003

It is the scenario that home health care workers dread. One minute they are carefully following procedure while giving an infusion or injection, and moments later, they have been accidentally stuck with a contaminated needle. According to the International Sharps Injury Prevention Society (ISIPS), more than three dozen U.S. health care workers a year contract HIV, 2,000 workers a year become infected with hepatitis C, and 400 contract hepatitis B as a result of sharps injuries. Those who do not become infected can spend anxious days awaiting test results, and the treatment costs for prophylactic drugs can run in the thousands. With so much at stake, who is caring for the home health care worker?

On November 6, 2000 President Clinton signed the Needlestick Safety and Prevention Act (H.R. 5178), requiring health care facilities under the Occupational Safety and Health Administration (OSHA) to use "safer medical devices, such as sharps with engineered sharps injury protection." Health care managers were suddenly given the task of not only ensuring that safe practices were adhered to, but also that safe devices were purchased and utilized. Procedures at risk of causing bloodborne contamination needed to be identified so appropriate steps could be taken to manage their inherent dangers through the use of a new generation of safety products.

One area that seemed to need immediate attention was the use of Huber needles in port access. Patients receiving long-term infusion therapy, such as chemotherapy for cancer or antiviral therapy for AIDS, may require an implanted (subcutaneous) port for venous access. The port is surgically implanted under the skin, which eliminates the need for repeated needlesticks into the veins. Implanted ports are the second most frequently used type of vascular access device in home care, and are the least costly to maintain.

To access an implanted port, the caregiver must pierce a silicone septum with a special non-coring Huber needle. Since tremendous force is needed to overcome the resistance of the silicone septum when removing the needle from the port, Huber needles pose a high risk of rebound effect needlestick injury. A recent study found almost half of all needlestick injuries from Huber needles occur while the needle is being withdrawn from the patient.

It is an area of concern recognized by clinicians. "Rebound effect needlestick injuries, resulting from Huber needles, are one of the last serious issues in IV therapy to be addressed by new technology," said Melissa Leone, R.N., BSN, division clinical manager of nursing, Apria Healthcare. "Since an injury sustained from a Huber needle during removal from an IV port carries a high risk of bloodborne contamination, it is important that technology has been developed to protect healthcare workers form this potential for exposure to bloodborne pathogens."

According to the International Health Care Worker Safety Center at the University of Virginia Health System, "improvements in Huber needle design are needed in order to address this cause of high risk injuries that has been overlooked to date. Manufacturers have responded to this call with designs that fall into two categories: passive or active.

Passive safety features remain in effect before, during, and after use. Clinicians do not have to specifically activate them. Passive features enhance the safety design and are more likely to have a greater impact on needlestick prevention.

Active devices require the clinician to activate the safety mechanism. Failure to do so leaves the caregiver unprotected. Proper use by health care workers is the primary factor in the effectiveness of active devices.

An example of the passive design approach is the new Surecan® Safety Huber Needle Infusion Set manufactured by B. Braun. The stainless steel safety clip feature of the product is designed to automatically shield the Huber needle tip as it is withdrawn from the base plate. Compliance is virtually assured since the safety mechanism is automatically activated upon needle withdrawal.

Based on the success of the passive design Introcan Safety® IV Catheter, introduced in January 2000, B. Braun Medical made the decision to incorporate the same patented passive safety clip technology into the Surecan Safety Huber Needle Infusion Set. "The Surecan Safety Huber Needle was introduced to the market in June 2003, and we are very pleased with the positive feedback we have been receiving from hospital, oncology clinic, and home healthcare customers," said Marcus Schabacker, M.D., PhD, corporate vice president, research and development, Medical and Clinical Affairs, B. Braun Medical Inc.

"Our passive design safety products enable health care providers to focus their efforts on patient care, rather than worrying whether or not they have taken the extra step to make a safety needle safe."

B. Braun did not stop at passive design in its efforts to enhance both clinician and patient safety. The Surecan Safety Huber Needle Infusion Set is DEHP-free for compatibility with chemotherapy drugs and lipids, and is latex-free to avoid the risk of allergic reaction. In addition, the Surecan Safety Huber Needle Infusion set is available with ULTRASITE® Needle-Free Valve Y-sites for needle-free Y?site medication injection or blood withdrawal using a simple luer connection. The Surecan Safety Huber Needle Infusion Set is offered with a wide range of Huber needle gauges and lengths, and meets Needlestick Safety Act requirements.

Home infusion therapy is a convenient option for patients since it can enable them to live a less restrictive lifestyle than they would if they were to receive inpatient treatment from a hospital. From the business side of health care, the current trend toward outpatient care to cut costs has made home infusion therapy an appealing option for long-term intravenous delivery of medications, parenteral nutrition and blood products. Through careful management and new technology, we can close the loop by making it safer and more rewarding for the health care worker.

This article originally appeared in the November 2003 issue of HME Business.