‘Active’ and ‘Passive’ devices is wrong terminology

“Passive vs Active” conjures up “Black and White” – but other colours work well too!

A 7-colour spectrum of terms won’t work but “Active”, “Semiautomatic” and “Automatic” will.

In my recent paper on frequency of use of sharps engineered devices (SED) I deliberated over “passive” and “active” to describe SED mechanisms. Something didn’t gel. The SED in Doris Dicristina’s recent study significantly reduced wingset sharp injuries – but it was neither “passive” nor “active” – because you need push a button.
Then I incredulously learnt of a hospital who were staying with a troublesome active wingset device because “no passive wingsets had been developed” – yet semi-automatic wingset SED proven to reduce SI were available. Then I knew what didn’t gel – our terminology is wrong – it restricts the use of effective technology.

After an hour discussing the issue with a learned colleague we agreed we should be using the three terms proposed by Tosini et al in their large SED study – “Active”, “Semiautomatic” and “Automatic”.

True, they found automatic best, but semiautomatic SED had fourfold less SI than active SED!

We need delete “passive” from our SED vocabulary. More HCW will sustain SI if we keep it.

Your comments are welcome.

Passive vs Active devices is wrong terminology

“Passive vs Active” conjures up “Black and White” – but other colours work well too!

A 7-colour spectrum of terms won’t work but”Active”, “Semiautomatic” and “Automatic” will.

In my recent paper on frequency of use of sharps engineered devices (SED) I deliberated over “passive” and “active” to describe SED mechanisms. Something didn’t gel. The SED in Doris Dicristina’s recent study significantly reduced wingset sharp injuries – but it was neither “passive” nor “active” – because you need push a button.
Then I incredulously learnt of a hospital who were staying with a troublesome active wingset device because “no passive wingsets had been developed” – yet semi-automatic wingset SED proven to reduce SI were available. Then I knew what didn’t gel – our terminology is wrong – it restricts the use of effective technology.

After an hour discussing the issue with a learned colleague we agreed we should be using the three terms proposed by Tosini et al in their large SED study – “Active”, “Semi-automatic” and “Automatic”.

True, they found automatic best, but semiautomatic SED had fourfold less SI than active SED!

We need delete “passive” from our SED vocabulary. More HCW will sustain SI if we keep it.

Your comments are welcome.

Too many sharps injuries from punctured containers – why?

“Finer needles, higher temps, and thinner walls, all make container penetration easier.”

500 healthcare professionals in USA and 200 in UK sustain sharps injuries (SI) from needles puncturing containers each year. Not high numbers but they CAN be markedly reduced with tougher sharps containers (and tougher Standards)?

In my recent paper, I researched this question by examining 3 parameters affecting needle penetration – needle gauge, temperature, and container wall thickness.

Under controlled standard conditions I conducted 288 tests comparing 6 needle gauges (21G – 30G), 3 temperatures (130C, 230C, 430C) and 3 wall thicknesses (1.9mm, 2.4mm, 2.8mm).

Would 30G penetrate more easily than 21G? Many say 21G …but the answer is 30G – by far. A 30G needle penetrates a wall at 1/3rd the force needed for 21G! At 430C it is 1/7th.

So… finer needles, higher temps, and thinner walls are why sharps injuries from container-penetration are occurring – ‘container abuse’ is rare.

46% of U.S. needles are finer than 21G (31% in UK) so it is surprising Standards still use 21G to test containers. And USA Standard F2132 still uses a low 12.5N as the Pass for “force necessary to penetrate”. However, Canada’s healthcare workers lobbied successfully to raise their Standard’s requirement for wall toughness to 20N – 60% higher than older Standards. Go Canada!

True, tougher containers cost more. So too do needle safety devices. If we pay more for safety devices, then we need pay more for safer, tougher containers. There’s always a cost for safety.

In our quest for zero Sharps Injuries, needles penetrating through sharps containers is one cause of injury we can readily eliminate.

Survey reveals USA sharps injury prevention is not meeting goals

This is my first blog so please forgive any ineptness – I felt I should quickly get the word out to as many as I could. My recent national survey with my colleague Linda Good estimated that 322,000 US healthcare personnel (HCP) sustain sharps Injuries (SI) each year – but that disturbing news is compounded by the fact that our results show there has been no significant decrease in this figure since 2001. And this is in a developed country that has enacted sharps injury specific laws (NSPA 2001) – think of the plight of HCP in developing countries with scarce resources for safety devices.

Sharps injuries (penetrating injuries of the skin by a cutting/pointy item) among HCP can transmit over 60 different diseases (AJIC 2006) the three most published being HIV/AIDS, Hepatitis B and Hepatitis C. With Hepatitis B, the risk of getting disease from a positive patient is a worrying 1 in 30. This worrying is an important but often neglected facet. HCP often have to wait months for confirmation of “All clear” and have to modify their sexual and maternal practices while waiting, and this takes a huge emotional toll on injured HCP. I know of 4 marriages that have broken under this stress.

Along with many colleagues I am striving to bring this situation to the notice of politicians, healthcare administrators and managers, and the public. We need put zero back on the radar. We need find a new vigor to protect these workers – it may be more intense, repetitive, competency-based education, HCP ownership of their safety, or technology less dependent on human behavior, but a change must occur.