RESEARCH ARTICLES

Safety-engineered sharp devices versus accidents with exposure to biological material

Nathalia Pey Tournillon Sper^I; Maria Yvone Chaves Mauro^II; Isabel Cristina de Morais Gomes^III

^I Nurse. Occupational Nursing Intern of Rio de Janeiro State University. Brazil. E-mail: nathy.sper@globo.com
^II PhD in Nursing. Retired Professor of the Department of Public Health Nursing at the Nursing Faculty of the State University of Rio de Janeiro. Brazil. E-mail: mycmauro@uol.com.br
^III Master in Public Health. Occupational Nurse of the Safety and Health Department of Rio de Janeiro State University. Brazil. E-mail: icmgomes.66@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2016.11518

ABSTRACT

Objective: to characterize police complaint reports and establish the dimensions profile the forensic medical examination of victims of sexual violence. Method: this retrospective study analyzed occurrences of sexual violence against women 18 or more old, recorded at a Special Police Service for Women. Data were collected using a tool adapted to Microsoft Excel®, and analyzed using descriptive statistics. Results: time between assault and complaint ranged from hours to fourteen months. Most victims who underwent foren­sic examination were young, white and had attended middle school. Most offenders were unknown, older men with less schooling than their victims. Women abused by men they knew withdrew the complaint. Conclusion: for effective care that offers a solution, it is not enough to implement interdisciplinary actions; services must accept and support women on the basis of humanized care.

Keywords: Sexual assault; woman's health; gender; intersectorality.

INTRODUCTION

Accidents through contact with blood and other body fluids correspond to exposures more commonly reported in the scientific literature and generally happen due to injuries with needles and other sharp instruments¹.

Actions to protect health workers have been discussed through public policy with preventive proposals, such as the National Policy on Safety and Occupational Health. This policy aims to promote worker's health and quality of life, and the prevention of occupational accidents and health damages resulting from labor by eliminating or reducing risks in the workplace². The National Policy for Occupational Health also aims, in Article 8, item II, to adopt protective parameters for human health in the occupational environment and processes³.

So, strategies for anticipation, recognition, evaluation and control of the occurrence of risk factors are considered, as envisaged in the Regulatory Norm 9 (NR 9), which deals with the design and implementation of the Environmental Risk Prevention Program⁴, and the Regulatory Norm 7 (NR7), which regulates the development and implementation of the Occupational Health Control Program⁵.

Measures to protect the safety and health of workers from health services are set forth in the Regulatory Norm 32 (NR 32), which calls for the development and implementation of a Plan for Preventing Risks of Accident with Sharps Materials, according to the guidelines set forth in Annex III. From this norm, the use of sharp instruments with safety-engineered device must be provided by employers and the training on its correct use both by employers and by manufacturers⁶.

In recent years, the safety-engineered devices in sharp instruments, such as the retractable needle systems and the needle guards, have been adopted by evidencing positive impact on reducing the number of needlestick injuries⁷.

Due to the importance of controlling risk factors at work through the application of preventive measures, the object of this study is the use of safety-engineered devices in sharp instruments in health work, addressed in scientific journals, to answer the following guiding question: how the incorporation of safety-engineered devices in sharp instruments relates to the occurrence of occupational accidents involving exposure to biological material in health professionals?

Authors assumed that the incorporation of safety-engineered devices in sharp instruments provides the reduction of accidents related to exposure to biological material in health care workers.

The objective was to analyze the relationship between the incorporation of safety-engineered devices in sharp instruments and the occurrence of occupational accidents involving the use of these instruments by health professionals, from the literature.

This work is justified by the importance of this topic due to the range of published studies reporting accidents with exposure to biological material when using sharp instruments. Another factor that indicates its importance is the lack of publications on accidents with sharp instruments with safety-engineered devices.

The relevance of this study is related to research, education and care.

In the research field, the aim of this study is to contribute to the discussions on the theme and encourage the creation of new devices and improvement of the existing ones.

In the field of education, this study aims to encourage the creation of disciplines and laboratories related to the use of safety technologies appropriate to the health work, aimed at reducing the exposure of workers to occupational hazards.

In the field of assistance, it aims to foster the reduction of accidents involving health workers, through the use of sharp instruments with safety-engineered devices during care for clients.

METHODOLOGY

This is a bibliographical, descriptive research with qualitative approach, of integrative review type, as it narrates the facts in a reality⁸ and allows the synthesis of knowledge and inclusion of conclusions of scientifically recognized studies due to methodological rigor and relevant findings, supporting the improvement of practice⁹. For its preparation, six phases are covered, which are described below¹⁰.

In the first phase, authors defined the theme and research question: how the incorporation of safety-engineered devices in sharp instruments relates to the occurrence of occupational accidents involving exposure to biological material in health professionals?

The selected descriptors were: equipment safety, risk management, accident prevention, exposure to biological agents, and health workers, drawn from Descriptors in Health Sciences (DeCS), and employed associatedly, using and between them.

In the second phase, the criteria for inclusion were: electronic publications in Portuguese, English and Spanish languages, enrolled between January 2005 and December 2014, in the databases Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL); and for exclusion: studies not available online in full, and articles reproduced in different bases. Studies were selected in one of the bases in order to avoid repetition.

In the third phase, the authors proceeded to the data collection, and the articles were summarized in a synoptic table containing the relevant information.

In the fourth phase, it was conducted a thematic content analysis, based on the criteria of inclusion and exclusion, on the relevance and importance of articles for this study.

Then, in the fifth phase, the results were interpreted and discussed using descriptive analysis of the columns contained in that synoptic table.

Finally, in the sixth phase, researchers presented the results obtained throughout the study, based on articles included in two predefined categories: safety-engineered devices in sharp instruments; and accidents using sharp instruments with and without safety-engineered devices in face of exposure to biological material.

RESULTS

The search found 707 articles, and 14 were relevant to this review, which were published from 2006 to 2014. The summaries of these publications are described below.

Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel. Evaluates different safety-engineered devices in sharp instruments, being the estimated accident rate by about 1-5 accidents per 1000 people/year. The considerable risk of research bias may explain the lack of evidence of a beneficial effect of the implementation of such safety devices, requiring experimental studies¹¹.

Cost-benefit evaluation of a preventive intervention on the biological risk in health: the accidental puncture during the administration of insulin in the University Hospital Federico II of Naples , Estimates that percutaneous exposures can be prevented by adopting safety measures in sharp instruments. It compared the profitability of adopting these methods in insulin therapy, as the cost of accidents that can occur with traditional methods, concluding that it is advantageous with regard to preventive effectiveness and cost of the accident¹².

Percutaneous injuries with biological hazards, caused by safety devices in the Community of Madrid . Noted that there was an increase of percutaneous injuries related to the use of safety devices, however, only 2.6% could be attributed to device failure. External factors for the occurrence of such accidents include high rate of pressure of time / work (46.5%) and carrying out the process at inconvenient positions (31.5%). It concludes that it is necessary to identify the factors that are related to accidents to develop individualized actions that minimize risks¹³.

Safety-engineered needle devices: evaluation prior to introduction is essential . Reports on the adoption of Directive 2010/32 / EC in 2010 in the European Union, whose demand was to introduce safety devices in sharp instruments, in order to prevent injuries and infections in health care workers. The results of this study show the need to assess safety, satisfaction and acceptance of the professional and patient comfort resulting from this implementation¹⁴.

Safety syringes and anti-needlestick devices in orthopaedic surgery . Tested several different sharps material with safety-engineered devices. During the tests there were no percutaneous accidents, but it was found that some models were more effective than others, depending on the procedure¹⁵.

Needlestick injury rates according to different types of safety-engineered devices: results of a French multicenter study . Evaluated the incidence of needlestick injuries among different device models designed for safety (automatic, semi-automatic, and manual activation) in healthcare environments. Automatic devices have been associated with lower incidence of accidents and semi-automatic were more effective than the manual ¹⁶.

Integration of new safety technologies for needle aspiration of breast cysts. Mentions the norms of national and international regulatory agencies for improvements aimed at patient safety and health professionals. It concluded that new technologies for sharp instruments may be evaluated and introduced to improve patient and professionals' safety, since the lesions decrease between 60 and 70% of cases¹⁷.

Occupational exposure to potentially contaminated materials among support staff. Surveyed the frequency of occupational accidents involving biological material that affected the cleaning and laundry staff. It concluded that three main pillars of care should be strengthened: the information system to support the institutional policy, the continuing education of professionals who generate sharp waste in the process and the acquisition instruments with safety devices¹⁸.

T he impact of U.S. policies to protect healthcare workers from bloodborne pathogens: the critical role of safety-engineered devices . Mentions reducing the risk of occupational exposure of healthcare workers from the United States to pathogens, due to the requirement imposed by their law on the introduction of safety devices in sharp instruments, as well as a number of other protective measures. It demonstrated the importance of regulations to ensure the availability and implementation of large-scale protection devices¹⁹.

Needle protective devices; where are we now? . Mentions the existence of the Safety and Prevention Law (which imposes health facilities to buy and provide sharp instruments with safety device) in the United States since 2001 and the lack of prescriptive legislation on the subject in the UK, where 100,000 needlestick injuries were estimated per year. We conclude that although the cost of some safety devices in sharp instruments may be greater than the standard devices, this should be balanced against the risks and costs associated with accidents and potential costs attributable to treatments²⁰.

Prevalence and prevention of needlestick injuries among health care workers in a German university hospital . Investigated the frequency and causes of accidents with needles at a German university hospital. The results showed that on average 34% of all needlestick injuries could have been prevented with the use of safety devices on sharp instruments and concluded that the implementation of safety devices would lead to improved health and safety of staff²¹.

Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers. Evaluated the incidence of needlestick injuries before and after the introduction of the safety device. The incidence of percutaneous injuries from intravenous catheter with safety device has significantly decreased, whereas the incidence of injuries resulting from unprotected suture needle has increased accordingly, concluding that such devices reduce the risk of exposure to pathogens, by reducing accidents²².

Potential for reported needlestick injury prevention among healthcare workers through safety device usage and improvement of guideline adherence: expert panel assessment. Estimated the proportion of occupational accidents with needles that could have been avoided, either by introducing safety devices in sharp instruments, either by better guidance, continuing education, or a combination of all. The results were: 56% of all injuries and 80% of lesions by venipuncture / injection administration could probably be avoided by the use of sharp instruments with safety device²³.

Impact of safety needle devices on occupationally acquired needlestick injuries: a four-year prospective study . Evaluated the effect of the introduction of a variety of safety devices for hypodermic needles in relation to the reported number of needlestick injuries. There was a significant reduction in the number of needlestick injuries and user satisfaction and acceptance of safety needles was also very favorable²⁴.

DISCUSSION

The results are discussed based on two categories of interpretation, which are addressed below.

Safety device in sharp instruments

The results show the existence of various types of safety devices for different sharp instruments.

Most of the articles mention safety articles devices in lumen needles, as used intravenously, either for drug administration and blood sampling, for example¹¹. Other authors, in two publications, are more specific, and study the introduction of safety devices in sharp instruments used in orthopedic procedures (injections and aspirations)¹⁵, and in obstetrical and gynecological procedures (breast cyst aspiration)¹⁷.

In other studies, the authors compared the lumen needles that have a safety device and suture needles with no protection^22,23.

There is also mention of safety systems in sharp instruments used subcutaneously, as in the case of insulin, and also through hypodermic via ^12,13,24.

There are still studies that report the mode of operation of such safety devices, divided into passive, where there is no need of the user to activate the safety feature, and active, that requires the user to trigger the safety feature. Furthermore, they can also be classified as an automatic, semi-automatic, and manual activation^14-16.

Finally, there is a study that does not focus on specific safety devices, but raises the importance of acquiring instruments with such technology ¹⁸. However, the number of manufacturers of sharp instruments with safety device is still relatively small in Brazil²⁵, and there is still low awareness of workers about the importance of the availability of safety devices as a preventive measure for exposure to biological material ²⁶.

Accidents: use of an instrument with and without safety devices

Among the 13 international papers and one national article included in this review, 12 (85%) ensure that the adoption of safety devices in sharp instruments is effective in reducing occupational exposure to biological risk; one article mentions that there was an increase of percutaneous injuries even with the use of safety devices¹³; and another was impartial, citing a lack of evidence of a beneficial effect of these devices, for possible bias in the research, mentioned by the author¹¹.

The article demonstrating increased percutaneous injuries related to the use of sharp instruments with safety devices is not necessarily unfavorable to the use of them, as the authors state that only 2.6% of accidents could actually be attributed to failure of the safety mechanisms¹³.

Most health institutions in Brazil have no prospects of deploying safety devices in sharp instruments in the short term, due to its high cost²⁷. However, authors favorable to this innovation state that the adoption of this feature is advantageous not only with regard to preventive effectiveness, but also in economic terms, when considering the costs of accidents that can occur with the use of traditional procedures and the potential costs attributable to the treatment^12,20,28.

Some experts also ensure that such technologies improve not only the safety of workers, as well as of the patient, and can reduce injuries between 60 and 70% of cases¹⁷.

The importance of sharp instruments with safety devices is reaffirmed in articles addressing the legal requirement of these resources in certain countries in order to prevent injuries and infections to healthcare workers through the active application of regulations, such as Directive 2010 / 32 / EC in the European Union, the Safety and Prevention Law, Needlestick Safety and Prevention Act, of the USA, and the UK Health Law. This strategy has ensured the availability and implementation of protective devices on sharp instruments on a large scale^14,19,20. In Brazil, the legislation on this theme is classified as initial – the Regulatory Norm 32, it is the first on Safety and Health at Work in Health Facilities, and requires additions^29,30 and effective control of its application and results.

Despite the benefits of the safety devices in terms of reducing accidents, certain studies emphatically mention the importance of training workers for their use and the continuing education of professionals in waste treatment, present on sharp instruments, generated in the process work^31-33. These requirements stem from the fact that there are different models of safety devices d (automatic, semi-automatic and manual activation) ^16,18,23,24.

CONCLUSION

There are different types of safety devices available in the variety of sharp instruments, which leads to at least two distinct classifications.

Most authors stated that the use of sharp instruments with safety device ensures the reduction of accidents involving exposure to biological material. Only one publication mentioned that there was an increase in accidents, because there were failures in safety mechanism, inexperience and lack of knowledge by workers in the use of this technology, which suggests the need for training of professionals.

The cost of the implementation of sharp instruments with safety devices is higher than instruments without such devices, however, the burden of occupational accidents of health professionals and related consequences outweigh the costs of implementation of these features.

Considering the present review, we conclude, therefore, that the incorporation of safety devices in sharp instruments provides the reduction of accidents in health care professionals; economically decreases, in the long term, the expenses of the institution; promotes the safety and health of workers; and hence improves the quality of health care provided to clients.

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