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Introducing safety syringes in a dental school

 

Clinical bottom line

The introduction of safety syringes in a dental school reduced avoidable needlestick injuries from 12 to 0 per million hours worked.


Reference

JM Zakrzewska et al. Introducing safety syringes into a UK dental school - a controlled study. British Dental Journal 2001 190: 88-92.

Study

This study examined the effects on needlestick injuries of introducing a safety syringe in a dental school. Three years before introduction was used a temporal control, compared with two years after introduction. A dental surgery unit without any change in syringes was used as an additional control.

There introduction of non-disposable syringes to disposable safety syringes was achieved when an opportunity arose to do so. The change was carefully managed with nine key elements:

  1. Collecting evidence for the need for change, and setting outcome measures. This involved an assessment of percutaneous injuries and the reasons for them. The majority of needlestick injuries was caused by resheathing and dismantling of syringes.
  2. Testing the product. Two dentists examined a range of products and evaluated them.
  3. Choosing when to make the introduction. This was when major changes in sterilising instruments was being considered.
  4. Convincing key players of the need for change. Information was given to key clinicians in the department, as well as service managers, nursing staff and clinical directors.
  5. Ensuring adequate supplies and means of disposal.
  6. Setting a clear protocol for changeover. This involved ensuring high attendance at training sessions, and publicising the date for the changeover.
  7. Training staff. Multiple training sessions were organised, with all grades of staff and dental students and trainee nurses.
  8. Ensuring smooth changeover after training . problems were picked up on and additional advice and training given. New staff are introduced to the system during induction.
  9. Follow up. Monitoring after change for problems, and contact with manufacturers. This involved re-design of the system for easier use.

Results

The frequency of avoidable needlestick injuries fell from an average of 12 per million hours worked in the three years before introduction, to 0 per million hours worked in the second year of introduction (Figure 1). In a control surgical unit no significant change occurred over the same five years.

Figure 1: Needlesticks per million hours worked. The arrow shows when the safety system was introduced.


 

Comment

This paper shows not just what to do and what the results of change, but also the way to manage change. It has all they key elements involving informing staff, and good follow up, as well as monitoring and feedback, which in this case also involved a re-design of the product. It is a necessary read for any nother institute wanting to make a change.

One interesting element of this paper is that it gives some estimates of costs involved in needlestick injuries in the UK (Table 1). The costs in table 1 are based on an E grade nurse and where the source patient is HIV negative or HIV negative. The costs include administrative and staff costs, 30 minute consultations, and drug costs.

Table 1: Costs involved in needlestick injuries

Intervention
Cost (£)
No drugs, no starter pack
136
Starter pack, no further drug course
297
Full drugs course, no sickness absence
2,152
Full drugs course, sickness absence
3,845
Extra one hour counselling session
96