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Safety Devices to Prevent Percutaneous Injuries during Blood Drawing & Intravenous Catheter Placement

I. Sharps Containers

Before the Bloodborne Pathogens standard was implemented, exposures frequently occurred from contaminated needles and other sharps which were disposed of in garbage or left lying around. In a 1981 study of 316 reported needlesticks, conducted before the use of sharps containers, disposing of needles accounted for 24% of injuries, recapping needles 12% and collecting linens and trash, 16%. (McCormick and Maki 1981). Sharps containers have eliminated most of these types of exposures. However many needlestick injuries still occur when closing or trying to fit additional syringes into overfilled sharps containers or when carrying sharps to inconveniently located sharps containers.

II. Safe Medical Devices

Jagger et al.'s landmark study published in 1988, which analyzed needlestick injuries (NSI) from an injury prevention epidemiology perspective, clearly found that such percutaneous injuries could be largely eliminated by emphasizing safer needle devices rather than behavior as a primary prevention strategy. The study suggested that redesigned hollow-bore needle devices which incorporate safety features that eliminate unnecessary needles or shield hands from used needles have the potential to prevent over 85% of needlesticks from those devices.

Source: Jagger, J. et al. 1988. Rate of needle stick injuries caused by various devices in a university hospital. New Engl. J. Med. 319: 284-288

Since 1984 there have been more than 1,000 patents filed in the United States for medical devices that incorporate needlestick-prevention . Most major medical device companies market medical devices which have been modified to include needlestick prevention features.

Examples of types of safe medical devices are listed below:

1. Self-blunting or shielding needles for vacuum tube phlebotomy sets

After the final tube of blood is drawn the needle point is blunted before it is removed from the patient or the needle point is shielded immediately after it is removed from the patient.

A study of phlebotomy needles demonstrated an 82% reduction in needlesticks after the implementation of a blood collection tube holder that incorporated an after-use needle shield.

Source: Billiet LS, Parker CR, Tanley PC, Wallas CW: Needlestick injury rate reduction during phlebotomy: A comparative study of two safety devices Lab Med 22: 120-123, 1991.

The January 17, 1997 MMWR, summarizes a collaborative study by CDC and six hospitals to evaluate safety devices for phlebotomy. The findings indicate that use of two types of safety devices significantly reduced phlebotomy-related percutaneous injuries while having minimal clinically apparent adverse effects on patient care.

2. Retracting or self-blunting butterfly needles

A 25% reduction in needlesticks was reported when a butterfly -type needle which incorporates a protective sliding shield, compared to a conventional butterfly-type needle.

Source: Younger, B. Hunt, EH Robinson C, McLemore C: Impact of a shielded safety syringe o needlestick injuries among healthcare workers. Infect Control Hosp Epidemiol 13:349-353, 1992

3. Retracting finger/heelstick lancets

These devices reduce the likelihood of an injury since the lancet automatically retracts after piercing the skin of the patient.

4. Needle-less blunt cannula or valve systems

These may be used instead of needles for drawing blood samples from venous or arterial lines.

5. IV catheter stylets which employ a protective shield for the stylet before or during its withdrawal from the catheter

A study conducted in three hospitals demonstrated an 83% reduction in the needlestick rate when a shielded stylet safety catheter was used, compared to needlesticks caused by conventional catheters which were used simultaneous in these hospitals. (129)

The New York State trial of needlestick prevention technology study reported a 93% decrease in needlesticks from needles used in intravenous systems when needleless or recessed needle systems replaced conventional, exposed-needle systems.

Source: Chiarello L, Needlestick prevention technology. Testimony presented before the U.S. Congress House Subcommittee on Small Business Opportunities and Energy. Washington DC Feb 7, 1992

The Department of EMS is currently collecting clinical evaluation information on needle stick devices from various centers and vendors and will be evaluating them. Product evaluation will be assembled from a variety of sources and be given opportunities to evaluate these devices.

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