The Piercing Issue of sharps safety

Edition: October 2005 - Vol 13 Number 10
Article#: 2243
Author: Repertoire

Since late-2001, safety sharps, or needleless alternatives to traditional sharps, have been required by law. Virtually all distributors have reaped huge rewards for selling them, at least in the acute care market. In fact, sales of needles and syringes are booming. This year, needles and syringes comprised the largest product category sold by distributors, edging out point-of-care testing reagents and supplies, and gloves.

Nobody knows for sure the exact percentage of accounts that use safety sharps, because there are hundreds of products (lancets, scalpels, needles, catheters, etc.) going to several medical market segments. Overall, one large distributor that services all three markets has seen 40 percent of total sharps revenue in the safety category.

But one thing is clear: Physicians’ offices lag behind other market segments in the conversion process. One distributor group admitted that only about 25 percent of ambulatory medical market business consists of safety needles, since many physician offices are outright ignoring the law. The big jump in safety products is due to the acute care market.

For instance, virtually every hospital and other acute care facility that uses IV systems has converted to needleless (safety) versions of them, eliminating needlestick injuries caused by needles used to connect IV lines.

But, doctors’ offices don’t use these products, and it appears that most don’t want to use safety versions of the sharps they do use. In fact, when the American Medical Association heard that manufacturers were planning to discontinue needleless IV catheters, the organization that represents individual physicians wrote letters urging manufacturers to keep making conventional sharps. Despite this, manufacturers such as BD have eliminated conventional IV systems containing needles.

Needles and syringes

Physician offices use more needles than any other medical sector. Hospitals and long-term care facilities usually administer medications through IVs, not through needles and syringe combinations.

Distributors continue to face uphill battles convincing physician offices that “it’s the law” to switch to safety needles. “You can lead a horse to water, but you can’t make him drink” describes the conversion process from traditional sharps to safety sharps for physician office accounts.

Even though physician offices are aware of the OSHA regulation that plainly requires safety needles, the conversions still haven’t been made. Why? Less OSHA inspectors perform fewer inspections and must use their time wisely, so they focus on the industries likeliest to suffer workplace injuries. In healthcare, this boils down to hospitals and long-term care facilities.

A pointless question: needleless syringes

If the majority of needle users physicians can’t be convinced to switch to safety needles, it’s naïve to believe they will open their wallets and flock to buy needleless syringes. That’s why the major needle manufacturers aren’t hopping on the needleless syringe bandwagon, yet. That most doctors won’t buy these devices now is not only bad news for the medical supply business, but also for the 10 percent to 20 percent of the U.S. population who are needlephobic.

Needleless syringes work by propelling liquid medication at a high speed through a tiny orifice into the patient. There are no sharps to accidently stick a healthcare worker, and no sharps waste to pay to haul off.

Insulin is the most common drug that is currently administered via this method, but Bioject will soon deliver needleless injections for other liquid medications such as vaccines, local anesthesia, live viruses, morphine and more. Expect future products to be sold in a prefilled needle-free device to obviate the need to draw it up into a syringe at the time of the injection. This procedure for preparing meds accounts for 3 percent of all medication errors, 11 percent of pharmacy dispensing errors and 5 percent of nurse administration errors, according to the June 2005 issue of Healthcare Purchasing News (article by Susan Cantrell). For these reasons, hospitals focusing on reducing medical errors are good prospects for needleless syringes. Needleless systems cost more, of course, but will more than pay for themselves by averting death and morbidity.

Other needleless systems that will evolve to deliver drugs are nasal sprays. While BD is only “researching” needleless systems at this time, the company currently markets a nasal spray drug delivery system called Accuspray. FluMist, the intranasal flu vaccine, uses this technology now, and soon migraine and ostoeoporosis drugs could be administered nasally. According to Sherry Dean, product manager for BD, “The nasal-delivery market is expected to grow by 20 percent by 2008.”

Both nasal and intradermal delivery methods are cutting edge, and it will take a while for these markets to grow dramatically. Realistically, in five to 10 years, we can probably expect to see as many physicians using needleless injection systems as currently use safety needles.

Distributors don’t report a dramatic increase in safety needle sales from last year. Brad Thompson, director of marketing (lab) for NDC, estimates the conversion rate from traditional non-safety to safety as follows:

• Long-term care: 20 percent to 25 percent

• Primary care: 25 percent to 30 percent

• Acute care: 85 percent to 95 percent

Compliance also varies by geographic location. Many more physicians on the West Coast, especially California, use safety needles than physicians in the Southeast. California has been the most active state in pushing needlestick protection for employees and CalOSHA has a more visible presence than most other state OSHA offices. To boot, California insurance companies often audit doctors’ offices and demand that safety needles be used.

What’s keeping physicians from switching? The data clearly shows that safety products decrease worker injuries that can result in a long, slow death from hepatitis B, hepatitis C and HIV. And, physicians are aware that the law requires safety needles.

The explanation is almost certainly price: Distributors continue to beat their heads against the wall, trying to introduce safety needles to doctors who claim that they “just can’t afford them.”

Safety needles run from about 1.45 to about 2.5 times the cost of conventional needles.

One major distributor, who asked not to be named, says that the GP margin (in dollars) on safety needles runs slightly lower than that for conventional needles, indicating that distributors might be giving customers a break for safety sharps.

Physicians who still refuse to switch might be betting that OSHA will be too busy to focus on them and, if they are inspected, the fines will only be a few thousand dollars – far less than they would have spent on safety needles. One of the flaws in this reasoning is that it only takes one needlestick to kill a co-worker. And, that co-worker’s family will probably sue in criminal court and win.

Although disgruntled healthcare workers are increasingly complaining to OSHA that their employers have not adopted safety sharps, many healthcare organizations have the opposite problem: convincing some workers to adopt new safety devices and procedures.

You’d think it a no-brainer for healthcare workers to use a product that might save them from a lengthy, painful death from AIDS or hepatitis, but that’s not necessarily the case. In 2004, 46 percent of nurses who stuck themselves admitted that a safety device was not in use during the accident. These are usually the same folks who, when a safety product is forced upon them, ignore their own safety and either don’t use the product or bypass the product’s safety features, and get injured.

Switching accounts to passive technology

While you’re at it, consider switching physician offices that do use safety needles to the more safe “passive” systems. A passive system works automatically, which means the safety feature activates after use without the worker having to consciously flip a sheath or perform some other action. Passive safety designs, as opposed to active designs, make it impossible for workers to bypass (intentionally or unintentionally) the safety feature. They don’t need to think about activating the safety feature; it just happens automatically.

Products with passive features more effectively prevent needlesticks for the most part. And, if a procedure can’t be made “needleless,” then the next best bet is passive. Passive devices are the wave of the future and, in most cases, superior to “active,” or non-passive ones.

Another opportunity to switch out suture needles

Suture needles are another product category that poses an uphill battle to convert to a safety alternative. Currently, suture needles cause a whopping 18 percent of needlestick injuries, and this figure has remained steady for the last several years. Most physician offices can’t switch to a safety (blunt) suture needle, because it only functions when suturing an internal organ. For typical physician offices that simply close wounds, OSHA urges foregoing to a sharp-tip suture and substituting a stapling device, adhesive strips or tissue adhesives.

Almost four years after OSHA’s mandate to eliminate occupational needlesticks among healthcare personnel, worker injuries have declined, at least in the acute care setting where compliance is high. In physician offices where the most dangerous procedure for sharps injuries – injections – prevails, employers are hiding under the radar screen and getting away with it.