Globally, millions of injections are administered each year, making them the most common procedure performed in healthcare. Administering safe injection requires the application of underlying safe practices in the use of needle and syringes among Registered Nurses (RNs). Typically, a safe injection is one that does not expose healthcare workers to avoidable risks, does not harm patients, and avoids waste that may endanger society. Anesthetists play a crucial role in preventing the transmission of diseases by adhering to safe injection practices. Despite numerous standards outlining the best practices in needle and syringe safety among anesthetists, violations and mistakes still occur. Such mistakes cost the healthcare sector heavily in terms of reputation, financial burden, physical pain, and emotional trauma among patients. This paper uses the Situation-Background-Assessment-Recommendation (SBAR) Model to design a quality improvement plan on safe practices for needle and syringe use that can be adopted by RN anesthetists.
According to the standards issued by the American Association of Nurse Anesthetists (AANA), Standard IX requires Certified Registered Nurse Anesthetists to take necessary precautions to minimize the risk of infecting the CRNA, the patient, and other healthcare providers as well. Similarly, anesthetists are required to uphold and adhere to all ethical standards contained in the AANA’s code of ethics for the professionals (Thompson et al., 2009). All these standards are aimed at eliminating or reducing, to the minimum, hazards that emanate from unsafe clinical procedures. Numerous efforts have been undertaken to educate healthcare providers regarding the different public health hazards associated with needle and syringe use, as well as other unsafe injection procedures, in hospitals. Regardless, the transmission of pathogens still remains a major problem in healthcare.
Quality Improvement Plan and Implementation using the SBAR Model
Numerous methods underline how disease causing pathogens can be transmitted between patients. One of the ways of transmission is through the re-use of syringes and needles between patients. Such a practice allows for direct transferal of contaminated body fluids and infected blood from one patient to another. Multiple uses of single-dose vials and flush solutions have been identified as another mechanism of transmitting pathogens between patients (Kelli, 2013). Similarly, the wrong use of multi-dose vials can also lead to the transmission of diseases. Infection occurs when a used syringe or needle or both are placed into a multi-dose vial with the aim of obtaining additional medication.
From 1998-2008, there were 38 serious outbreaks that involved the transmission of Hepatitis C or B viruses as a result of unsafe injection practices (Thompson et al., 2009). Over 60,000 patients were placed at risk of being infected with blood-borne infections. In 2008 and 2009, multiple incidents related to unsafe injection procedures were recorded in the United States. In one of the incidents that occurred in a medical Centre in Colorado, thousands of patients were notified of possible exposure to Hepatitis C virus (HCV) during a surgical procedure. The event followed the actions by a surgical technician who re-used contaminated syringes. At least 26 patients were infected with HCV (Adams et al., 2019). Similarly, multiple anesthesiologists were named in several lawsuits following the incident.
All these unsafe clinical practices, which emanate primarily from the lack of compliance to infection control guidelines that underline basic safe use of needles and procedures is evidenced by outbreaks of infections that still occur to-date. While different oversight authorities such as the AANA have strived to develop standard operating procedures aimed at enhancing safety in needle and syringe use, the ideal situation in is yet to be achieved. Primarily, compliance to these standards stands out as the first major overhaul that should be thought of. However, it would be unfair to assume all mistakes emanate from disregard to these standards. Multi-approached solution to other factors such as inadequate healthcare workers and improved training needs to be emphasized.
In order to protect patients, anesthetists, other healthcare workers, and society at large, there is a need to adhere to various recommendations on safe procedures when handling needles and syringes during anesthetics. First, healthcare facilities need to create Needle and Syringe Programs (NSP) and ensure they conform with government and other stakeholders’ guidelines. Secondly, all staff must be trained, well-informed, and well prepared on how to handle needles and syringes. Additionally, programs that focus on how to use (or not to use) equipment related to needles and syringes should be put in place across all levels of care (Leicht, 2014). Thirdly, healthcare organizations must create quality control departments that monitor and report on anesthetists’ strict adherence to the set guidelines by both the organizations and other regulatory bodies regarding the safe use of syringes and needles. Those found in breach of the set standards must be held responsible and stern measures taken against them.
Implementation and Steps Forward
The first step towards implementing the above recommendations as a way of fostering safe usage of needles and syringes is to create a knowledgeable and dedicated team mandated with the responsibility of developing the NSP. In order to ensure that the team creates and adopts an effective plan, all necessary stakeholders must be involved at this point. Some of the important stakeholders that must be involved include the AANA and anesthetists. Typically, creating such a team should be done within a week. The second step is to review the NSP with the stakeholders once it has been drafted, all necessary recommendations are incorporated, and the program is ready to be rolled out. The next step is to train all members of staff and ensure that all are familiar with the standards, procedures, and guidelines contained in the NSP. Typically, training can take place within two weeks. After the training, the program should be rolled over, with monitoring and review being conducted regularly, typically after every week. The results from the monitoring process should be reviewed and n corrective and /or improvement measures implemented.
Mistakes emanating from unsafe syringe and needle practices cost the healthcare sector heavily in terms of reputation, financial burden, physical pain, and emotional trauma among patients. The failure to conform to infection control guidelines that underline basic safety in needles and syringes use is major cause of hazards in healthcare facilities. As a quality improvement measure in hospitals, facilities need to create Needle and Syringe Programs (NSP), initiate vigorous training to anesthetists, and create quality control departments that monitor and report on anesthetists’ strict adherence to the set guidelines.
Adams, J. L., Rust, D. B., Anderson, L. R., & McShane, F. J. (2019). Safe injection practices among anesthesia providers: A scoping review protocol. JBI Database of Systematic Reviews and Implementation Reports, 17(8), 1573-1581.
Kelli Ford CRNA, M. S. H. S. (2013). Survey of syringe and needle safety among student registered nurse anesthetists: Are we making any progress? AANA Journal, 81(1), 37.
Leicht, A. (2014). Improving the quality of needle and syringe programmes: An overlooked strategy for preventing hepatitis C among people who inject drugs. BMC Infectious Diseases, 14(S6), S8.
Thompson, N. D., Perz, J. F., Moorman, A. C., & Holmberg, S. D. (2009). Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998–2008. Annals of Internal Medicine, 150(1), 33-39.