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The introduction and enforcement of legislation within countries mandating the use of safety syringes and other safety-engineered medical
devices was intended to protect healthcare workers from the risk of needlestick injury.
However data indicates that current safety syringe technologies are not providing optimal protection to healthcare workers from the risk of
acquiring a bloodborne pathogen. Annually reported data from the Massachusetts Sharps Injury Surveillance System suggests that since
OSHA began to actively enforce the Bloodborne Pathogens Standard in 2002, the number of reported syringe-related needlestick injuries
has remained stable, with products incorporating some type of safety feature now causing the majority of all reported needlestick injuries.
One reason for the continued risk to healthcare workers is that many types of currently available safety syringes require healthcare
workers to undertake a secondary action to manually engage the safety mechanism. OSHA categorizes safety-engineered medical devices
with needles by the method of activation and its level of integration within the product.
Passive or Active Activation:
Passive safety features remain in effect before, during and after use, while active devices require the operator to activate the safety
mechanism - often once the needle has been removed from the body of the patient.
Integrated or Accessory Safety:
Products with safety features that are built in as an integral part of the device and cannot be removed are usually preferred over
those which are external to the device and are dependent on employee compliance.
Devices with passive, integrated safety features are often preferred or encouraged for use, but are rarely available. For example, some
types of retractable syringe can also require operators to apply additional pressure on the plunger after the full delivery of the dose to
activate the safety mechanism, which retracts the needle into a barrel at a rapid, uncontrolled rate. Such devices have been associated
with removal of the non-sterile needle from the body prior to activation, which can create a risk of infection via needlestick injuries and
aerosol (splatter).
According to the Emergency Care Research Institute (ECRI), the most preferred type of safety syringe are those which offer a preremoval
activation feature that allows healthcare workers to activate the safety mechanism before it is removed from the patient. For some types
of retractable syringe which are preferred for use by ECRI, it is noted that many healthcare workers do not initiate preremoval activation
but instead first remove the needle from the body. ECRI Activating the safety mechanism after the needle is removed from the patient not
only negates the preremoval activation advantage, but can also lead to blood or medication splatter.
Reported Needlestick Injuries in Massachusetts Healthcare Facilities
Safety vs Standard (Non-Safety) Syringes
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Hospitals that have adopted safety
devices in all situationsand still
experience needlestick injuries often see
the injuries occur as a result of non-
activation of the device. So compliance
with activation is still an issue
influencing many hospitals to select
devices with a passive activation feature
where the needle is covered
automatically as part of the use of the
device, such as retractable needles.
Gina Pugliese, Vice President
Premier Safety Institute
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