Background
Objectives
Methods
Study population and recruitment
Interview session # | Position/area of expertise | Organization |
---|---|---|
1. | Infection preventionist | Private HHC agency A in Massachusetts (MA) |
2. | Safety and health officer | Labor Union in MA |
3. | Safety and health officer | Labor Union in MA |
4. | Education program coordinator | Private HHC agency B in MA |
5. | Hospice clinical services coordinator | Private HHC agency A in MA |
6. | IV therapy/clinical services coordinator | Private HHC agency A in MA |
7. | Education program coordinator | Private HHC agency C in MA |
8. | Clinical coordinator | Private HHC agency C in MA |
9. | Pharmacist | Pharmacy owner in a MA town/city |
10. | Physician, community outreach and prevention specialist | Non-government organization (NGO) in MA |
11. | Diabetes awareness/ environmental health and safety services (2-person interview) | NGO on environmental services outside MA |
12. | Sharps injury prevention specialist | Independent specialist outside MA |
13. | Executive director | Sharps manufacturer A outside MA |
14. | Chief executive officer | Sharps manufacturer B outside MA |
15. | Clinical manager | Sharps manufacturer C outside MA |
16. | Clinical specialist | Sharps manufacturer C outside MA |
17. | Diabetes care manager/diabetes educator | Healthcare organization in MA |
18. | Physician and founder of an NGO for sharps injury prevention | Independent specialist outside MA |
19. | Diabetes educator | Healthcare organization in MA |
20. | Founder of an NGO for sharps injury prevention | Independent specialist outside MA |
21. | Director | Sharps manufacturer D outside MA |
22. | Primary care physician | Healthcare organization in MA |
23. | Health agent | MA town/city |
24. | Occupational and environmental health consultant | Independent specialist outside MA |
25. | Pharmacist/ academic pharmacy researcher | University outside MA |
26. | Public health nurse manager & public health director (2-person interview) | MA town/city |
Data collection
The first level of interview themes coded | |
---|---|
● | Participant occupation or expertise |
● | Recent or important events related to sharps injuries, BBP exposures or preventive interventions |
● | Sharps injury prevention developments in HHC or general |
● | Sharps flow into the home |
● | Procurement of sharps by HHC agency |
● | Sharps exit homes – sharps disposal practices |
● | Insurance carriers coverage for sharps |
● | Physician’s influence on sharps choice |
● | Pharmacy’s role in sharps safety |
● | Re-use of sharps |
● | Participant advice to various stakeholders and needs assessment on improving sharps safety |
● | Other information (subcoding for such sub-themes as sharps devices and technology, agencies/organizations mentioned, medications requiring sharps use, specific case descriptions, missed information added by participant) |
Data analyses
Results
Flow of sharps into the home
Use of sharps in the home
Absolutely, oh yes, sadly they do. . . to save money. . . I mean, if you’re a diabetic and you’re on a budget and you have to give yourself three or four shots a day, they’ll use that same needle, most of these people don’t see how that needle deteriorates every time you use it, and don’t understand the chance of infection . . . diabetes is an expensive disease.
And then something around these lancet pens. . . it looks like an insulin pen, but it’s triggered with a spring loaded device. And they’re nasty. Because you’ve got to take the cap off. And then literally with your fingers, you have to go in and pull out this lancet. I mean, you could do it with tweezers. You could do it with forceps if you had them. And it’s tiny. . . But patients use [lancet pens] over and over and over again. . . they save on the cost of the lancets.
Flow of sharps from the home
They have people flushing these down the toilet, and they were ending up on the racks of the sewer plant. So Wastewater Plant is willing to provide collection to try to keep them out of the sewer system because it’s an occupational hazard to their employees, because they have bar racks that pick up things like hypodermic needles like this and they have to actually break them off and put them in bags . . .wastewater workers are trying to keep the hypodermics out of the sewer.
Location of the most effective intervention points in the sharps HHC systems map
Sharps injury prevention/control method | Intervention examples cited both in the study interviews and literature | Study interviews: citation frequency on interventions | Literature evidence on interventions | |
---|---|---|---|---|
Elimination/ substitution | Beginning | ● Eliminate unnecessary injections/unnecessary sharps | High (60% or more) | |
- e.g. needleless IV-systems | ||||
● Apply needleless medication alternatives | ||||
- e.g. jet injectors, aerosols via inhalation, mucosal vaccines tablets, transdermal patches | ||||
Engineering controls | Beginning and middle | ● Design and use sharps with injury prevention features | High (60% or more) | |
- e.g. existing retracting, sheathing, blunting technologies | ||||
- e.g. new sharps innovations | ||||
● Design and use sharps disposal containers | ||||
Administrative controls | Middle | ● Promote and educate on safe use of sharps devices | High (60% or more) | |
● Promote and educate on safe sharps disposal container use and community disposal practices | ||||
● Implement and annually review a BBP exposure control plan | ||||
● Ensure work practices in line with an exposure control plan | ||||
● Minimize re-use among home users when possible | ||||
Personal protective equipment | Middle and end | ● Use gloves/double-glove | Moderate (less than 50%) | |
●Use puncture resistant gloves | ||||
● Apply protective clothing | ||||
- Goggles, face shields, masks, gowns | ||||
- Other barriers/ filters |
Discussion
Preventing sharps injuries at the beginning of the systems: needleless treatment methods
Importance of SIPFs and impact of public policy
Re-use of sharps
Sharps disposal in communities
You know, the FDA has to clear these drugs with something called a 510 K pre-market notification process. But why can’t they also require, alert the drugging effort to provide a list of the community drop-off centers or kickback programs or hey, call 1–800, US-FDA and we’ll tell you based on your zip code where your local drop-off point is.