The Integration of Safety Engineered Needles in Acute Care Hospitals: Opportunities and Challenges of Regulated Change

Needlestick injuries have been identified as an important modifiable risk factor associated with the transmission of bloodborne pathogens between patients and healthcare workers. A number of jurisdictions, including the province of Ontario, turned to regulation to accelerate the adoption of safety-engineered needles (SENs) for the prevention of needlestick injuries. Available surveillance data demonstrates that needlestick injuries captured in work-related emergency department records and workers’ compensation claims have not declined substantially in Ontario. Drawing on organizational change and implementation science theory, a qualitative instrumental case study design was used to examine the implementation of SENs in three acute care hospitals in Ontario. Program documents were reviewed and interviews were carried out with staff across the three hospitals. While all three hospitals responded to the regulatory requirements with integrity, there was evidence of inconsistent processes and outcomes, which may have been due to variation in the types of SENs that had been integrated, the organization’s readiness for change, and the implementation practices that were adopted. During the initial implementation phase some front-line workers developed strategies to avoid using the SENs. There was a conflict between the values healthcare workers placed on performance and patient care and the learning curve associated with the initial transition to SENs. Explanations as to why needlestick injuries continue to occur were organized under two themes: the importance of staff compliance and "being more careful" and the inevitability of injury as a consequence of the work environment. While further progress will be challenged by competing health and safety priorities, a renewed interested in this injury issue among front-line workers and health and safety professionals may produce better outcomes as there appear to be a number of opportunities to advance prevention efforts to further reduce ongoing needlestick injuries.Ph