A conversation with a safety expert on staff protection

Pugliese: We're fortunate in fire United States because of the responsiveness of the CDC in developing educational resources on many of these new disease challenges--with review and input from clinicians. Armed with these resources being loaded up on the CDC website almost daily, we've been able to get ahead of the curve and implement intense educational efforts with healthcare workers on the need for early identification mid appropriate isolation. Early identification is the key. This ensures that all the necessary precautions are taken ahead of time, when a diagnosis is suspected and not after the disease is confirmed.

We know from past experiences that it is more likely flint a successful transmission of the disease takes place from an unidentified case. If healthcare workers have a high level of awareness and identify who is potentially infected as quickly as possible, an effective active surveillance and isolation program can be implemented. Our experiences with both smallpox immunization and identification and isolation of SARS cases have helped all of us prepare for tire monkeypox outbreak and likely will help us adapt to new diseases that may be just over the horizon.

HPN: Do you think the manufacturers have adequately addressed sharps safety in terms of product innovation, or do they still have a long way to go?

Pugliese: We're already into the second and third generation of sharps safety devices and so, I believe that we've made a lot of progress. There's been a rapid proliferation of new safety syringe devices over the past 10 years, and in just the past several years, we've seen a lot of new phlebotomy safety device designs, including winged steel [butterfly] needles. We are also very pleased to see that in the past year there are a number of safety Huber needles on the market--needles that are used with implanted ports for chemotherapy. Safety enhancements are still needed in a number of product categories, including spinal needles and pre-filled medications. The challenge with pre-filled medications is that they allow a caregiver to add a needle or drop it into a safety syringe that's specially made for the vial. In some cases, a caregiver may administer the medication without a safety device, or use it with a standard, not safety, syringe. The key is to get sharps safety devices into the hands of healthcare workers, and that includes involving those workers at the frontline in evaluating and selecting devices. The revised bloodborne pathogen rules require frontline worker input into sharps safety selection, but I think it's needed in selection of all areas of personal protective equipment. Why? Compliance with the use of personal protective equipment (sharps safety devices, gowns, masks) depends on the worker's preferences. If healthcare staff thinks the gowns are too hot, a safety shield fogs up or slips, or a sharps safety device is too cumbersome to activate, they won't use them properly.

Another big area of concern right now relates to appropriate removal of barrier protection with suspected SARS patients. Epidemiologists believe that SARS is transmitted primarily by large droplets that can infect those in close contact with an infected person, as well as through direct contact with contaminated environmental surfaces. Until the airborne route is ruled out, precautions to protect the eyes and respiratory tract are required. The issue is not how long the virus that causes SARS can live outside its host, but how it is transmitted. There is current research being conducted to determine the most appropriate method, and in what order, barriers (gown, gloves, masks) should be removed to avoid contamination of the worker. The order of removal is an issue with SARS because of the potential multiple routes of transmission.

HPN: In general, are the current CDC guide lines outlining the efficacy of alcohol-based hand robs, their low incidence of dermatitis and their key role in improving hand-washing compliance being met enthusiastically by hospitals?