Understanding sharps injuries in home healthcare: The Safe Home Care qualitative methods study to identify pathways for injury prevention

Abstract

BackgroundHome healthcare is one of the fastest growing sectors in the United States. Percutaneous injuries from sharp medical devices (sharps) are a source of bloodborne pathogen infections among home healthcare workers and community members. Sharps use and disposal practices in the home are highly variable and there is no comprehensive analysis of the system of sharps procurement, use and disposal in home healthcare. This gap is a barrier to effective public health interventions. The objectives of this study were to i) identify the full range of pathways by which sharps enter and exit the home, stakeholders involved, and barriers for using sharps with injury prevention features; and ii) assess the leverage points for preventive interventions.MethodsThis study employed qualitative research methods to develop two systems maps of the use of sharps and prevention of sharps injuries in home healthcare. Twenty-six in-depth interview sessions were conducted including home healthcare agency clinicians, public health practitioners, sharps device manufacturers, injury prevention advocates, pharmacists and others. Interview transcripts were audio-recorded and analyzed thematically using NVIVO qualitative research analysis software. Analysis of supporting archival material also was conducted. All findings guided development of the two maps.ResultsSharps enter the home via multiple complex pathways involving home healthcare providers and home users. The providers reported using sharps with injury prevention features. However, home users’ sharps seldom had injury prevention features and sharps were commonly re-used for convenience and cost-savings. Improperly discarded sharps present hazards to caregivers, waste handlers, and community members. The most effective intervention potential exists at the beginning of the sharps systems maps where interventions can eliminate or minimize sharps injuries, in particular with needleless treatment methods and sharps with injury prevention features. Manufacturers and insurance providers can improve safety with more affordable and accessible sharps with injury prevention features for home users. Sharps disposal campaigns, free-of-charge disposal containers, and convenient disposal options remain essential.ConclusionsSharps injuries are preventable through public health actions that promote needleless treatment methods, sharps with injury prevention features, and safe disposal practices. Communication about hazards regarding sharps is needed for all home healthcare stakeholders.

Practices related to sharps disposal among diabetic patients in Sri Lanka

“…We found that many of the interviewed patients handled household sharps poorly and disposed sharps either loosely or into the household common garbage bin, household garbage pit or a common garbage dump in the area. The findings are similar to other studies done in this regard [9–15]. Such unsafe practices pose a major threat to others through the possibility of needle stick injuries [12, 14].…”

Prevenção e controle das infecções no domicílio: desafios e implicações para enfermagem

“…It includes exploring standard precautions that should be applied to health care provided to all patients, in the presence of any risk of contact with blood, body fluids, secretions and excretions, skin with injury and mucosae. (14) Besides knowing the procedures in home care, it is necessary to master the theoretical bases that support the practice for possible adaptations to eliminate or minimize as much as possible the risk of microbial transmission. (15) The most important prevention factor is the attitude each individual adopts, which is often the result of cultural aspects and/or education/ training processes.…”

Home care caregivers knowledge about infections related to health care

“…This include to explore the standard precautions that must be applied on the attendance to all the patients, in the presence of a contact risk with blood; body flawed; secretions and excretions; skin with continuity solution; and mucous [16].…”