A semi-structured interview study on the use of re-engineered sharp safety devices in 6 Canadian hospitals

Introduction
The use of sharp safety devices (SDs) is recommended to decrease the risk of percutaneous injury in health care workers, although their use is not uniform. After completing an audit of 699 sharps containers in six acute care hospitals, it was decided to conduct interviews in which participants could provide their perceptions on why SDs were and were not being used, and why the safety features of these devices were and were not being activated after use.

Methods
Posters and targeted emails were used to recruit nurses, physicians and phlebotomists working on the same wards from which sharps containers were selected for audit. After receiving signed consent, 45 face to face, in-depth semi-structured interviews, lasting approximately 25 minutes, were conducted.

Results
Several reasons for the ongoing use of non SDs were identified: unavailability of smaller gauge SDs, SDs stocked side by side with non SDs, purchased kits included non SDs even though SDs were available, unavailability of a SD on one ward although it was being used on other wards in the facility.Clinical personnel had minimal input into selecting all SDs and while most evaluated at least one device, how the results of their evaluations were used was unclear. Almost none of the physicians were trained to use SDs, although that was not so for nurses and phlebotomists. Overall, they received both verbal and hands on training to use all of them. Safety features were not activated because: recommended methods seemed risky, it was felt not to be necessary if non-activated sharps could be directly disposed of in a sharps container, patients complained of pain, and due to habit.

Discussion
Our study results point to several potential interventions for implementation that should increase the overall use of SDs and their activation levels.