GENERIC SAFETY SHARP EVALUATION

GENERIC SAFETY SHARP EVALUATION

SAFETY SHARP EVALUATED: ____________________________________

Date:__________ Department:________________________ Occupation:________________________
Product: __________________________________________ Number of times used:_______________

Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.

agree . . . . . . . disagree

1. I can activate the safety feature with one hand.	1	2	3	4	5	NA
2. I can see the tip of the sharp when I need to (even when the safety feature is activated).	1	2	3	4	5	NA
3. It is impossible NOT to use the safety feature.	1	2	3	4	5	NA
4. This product can be used as quickly as I expected.	1	2	3	4	5	NA
5. The product is easy to handle while wearing gloves.	1	2	3	4	5	NA
6. The device offers a good view of any aspirated fluid.	1	2	3	4	5	NA
7. This product will work with all required syringe and needle sizes.	1	2	3	4	5	NA
8. There is a distinct change (audible or visible) when safety feature is activated.	1	2	3	4	5	NA
9. The safety feature operates reliably.	1	2	3	4	5	NA
10. The exposed sharp is permanently blunted or covered after use.	1	2	3	4	5	NA
11. The device is just as easy to process after use than our current product.	1	2	3	4	5	NA
12. This product is easy to learn and understand.	1	2	3	4	5	NA
13. The design of the product suggests proper use.	1	2	3	4	5	NA
14. It is almost impossible to skip a crucial step in proper use of the device.	1	2	3	4	5	NA
15. This device provides a better alternative to our current product.	1	2	3	4	5	NA

Comments/Concerns: ____________________________________________________________________________

____________________________________________________________________________

Adapted from "Training for Development of Innovative Control Technology Project", Trauma Foundation, San Francisco General Hospital, San Francisco, CA.

SAFETY SYRINGE EVALUATION FORM

Date:__________ Department:________________________ Occupation:________________________
Product: __________________________________________ Number of times used:_______________

Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.

		agree . . . . . . . disagree
DURING USE:
1.	The safety feature can be activated using a one-handed technique	1	2	3	4	5	N/A
2.	The safety feature does not obstruct vision of the tip of the sharp	1	2	3	4	5	N/A
3.	Use of this product requires you to use the safety feature	1	2	3	4	5	N/A
4.	This product does not require more time to use than a non-safety device	1	2	3	4	5	N/A
5.	The safety feature works well with a wide variety of hand sizes	1	2	3	4	5	N/A
6.	The device is easy to handle while wearing gloves	1	2	3	4	5	N/A
7.	This device does not interfere with uses that do not require a needle	1	2	3	4	5	N/A
8.	This device offers a good view of any aspirated fluid	1	2	3	4	5	N/A
9.	This device will work with all required syringe and needle sizes	1	2	3	4	5	N/A
10.	This device provides a better alternative to traditional recapping	1	2	3	4	5	N/A

AFTER USE:
11.	There is a clear and unmistakable change (audible or visible) that occurs when the safety feature is activated	1	2	3	4	5	N/A
12.	The safety feature operates reliably	1	2	3	4	5	N/A
13.	The exposed sharp is permanently blunted or covered after use and prior to disposal	1	2	3	4	5	N/A
14.	This device is no more difficult to process after use than non-safety devices	1	2	3	4	5	N/A

TRAINING:
15.	The user does not need extensive training for correct operation	1	2	3	4	5	N/A
16.	The design of the device suggests proper use	1	2	3	4	5	N/A
17.	It is not easy to skip a crucial step in proper use of the device	1	2	3	4	5	N/A

Of the above questions, which three are the most important to your safety when using this product?

Are there other questions which you feel should be asked regarding the safety/utility of this product?

Source: OSHA Compliance Directive CPL 2-2.44D, November 5, 1999

I.V. CONNECTORS EVALUATION FORM

Date:__________ Department:________________________ Occupation:________________________
Product: __________________________________________ Number of times used:_______________

Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.

agree . . . . . disagree

1.	Use of this connector eliminates the need for exposed needles in connections	1	2	3	4	5	N/A
2.	The safety feature does not interfere with normal use of this product	1	2	3	4	5	N/A
3.	Use of this product requires you to use the safety feature	1	2	3	4	5	N/A
4.	This product does not require more time to use than a non-safety device	1	2	3	4	5	N/A
5.	The safety feature works well with a wide variety of hand sizes	1	2	3	4	5	N/A
6.	The safety feature allows you to collect blood directly into a vacuum tube, eliminating the need for needles	1	2	3	4	5	N/A
7.	The connector can be secured (locked) to Y-sites, hep-locks, and central lines	1	2	3	4	5	N/A
8.	A clear and unmistakable change (either audible or visible) occurs when the safety feature is activated	1	2	3	4	5	N/A
9.	The safety feature operates reliably	1	2	3	4	5	N/A
10.	The exposed sharp is blunted or covered after use and prior to disposal	1	2	3	4	5	N/A
11.	The product does not need extensive training to be operated correctly	1	2	3	4	5	N/A

Of the above questions, which three are the most important to your safety when using this product?

Are there other questions which you feel should be asked regarding the safety/utility of this product?

Source: Reprinted with permission of Training for Development of Innovative Control Technology Project. June Fisher, M.D.� June1993, revised August 1998.

I.V. ACCESS DEVICES EVALUATION FORM

Date:__________ Department:________________________ Occupation:________________________
Product: __________________________________________ Number of times used:_______________

Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.

agree . . . . . . . . . . disagree
1.	The safety feature can be activated using a one-handed technique	1	2	3	4	5	N/A
2.	The safety feature does not interfere with normal use of this product	1	2	3	4	5	N/A
3.	Use of this product requires you to use the safety feature	1	2	3	4	5	N/A
4.	This product does not require more time to use than a non-safety device	1	2	3	4	5	N/A
5.	The safety feature works well with a wide variety of hand sizes	1	2	3	4	5	N/A
6.	The device allows for rapid visualization of flashback in the catheter or chamber	1	2	3	4	5	N/A
7.	Use of this product does not increase the number of sticks to the patient	1	2	3	4	5	N/A
8.	The product stops the flow of blood after the needle is removed from the catheter (or after the butterfly is inserted) and just prior to line connections or hep-lock capping	1	2	3	4	5	N/A
9.	A clear and unmistakable change (either audible or visible) occurs when the safety feature is activated	1	2	3	4	5	N/A
10.	The safety feature operates reliably	1	2	3	4	5	N/A
11.	The exposed sharp is blunted or covered after use and prior to disposal	1	2	3	4	5	N/A
12.	The product does not need extensive training to be operated correctly	1	2	3	4	5	N/A

Of the above questions, which three are the most important to your safety when using this product?

Are there other questions which you feel should be asked regarding the safety/utility of this product?

Source: Reprinted with permission of Training for Development of Innovative Control Technology Project. June Fisher, M.D.� June1993, revised August 1998.

SHARPS DISPOSAL CONTAINER EVALUATION (Page 1 of 2)

INSTRUCTIONS: Product evaluators should inspect and operate containers to be evaluated in side-by-side comparisons. Representative sharps (syringes, IV sets, blades, biopsy needles, pipettes, etc.) should be used to test candidate products. Actual use conditions should be simulated, if possible. Prior to inserting test sharps, attempt to reopen sealed containers and attempt to spill or remove contents from unsealed containers if this is a functional requirement. Evaluation facilitators should provide product manufacturer literature and visual instructions and should demonstrate proper operation of each of the containers.

PLEASE CIRCLE YOUR RESPONSE

FUNCTIONALITY	agree . . . . disagree
Container is stable when placed on horizontal surface and when used as described in the product labeling for use in trays, holders, or enclosures		1	2	3	4	5
Container provides for puncture, leak, and impact resistance		1	2	3	4	5
Container, labels, warning devices, and brackets are durable		1	2	3	4	5
Container is autoclavable, if necessary		1	2	3	4	5
Container is available in various sizes and capacities		1	2	3	4	5
Container is available with auxiliary safety features (e.g., restricted access to sharps in the container), if required		1	2	3	4	5
Closure mechanism will not allow needlestick injury		1	2	3	4	5
Closure mechanism provides secure seal		1	2	3	4	5
Design minimizes needle-tip flipback		1	2	3	4	5
Design promotes clinical performance (e.g., will not compromise sterile field or increase injury or infection control hazards)		1	2	3	4	5
Design resists easy reopening after sealing for final disposal or autoclaving		1	2	3	4	5
Inlet design defeats waste removal when open		1	2	3	4	5
Inlet design prevents spillage of contents (physical or liquid) while sharps disposal container is in use in the intended upright position		1	2	3	4	5
Containers designed to be reopenable have removable lids design with tight closure that facilitates ease of removal with grip safety and comfort		1	2	3	4	5
Mounting brackets are rugged and designed for ease of service and decontamination		1	2	3	4	5
ACCESSIBILITY	agree . . . . disagree
Container available in various opening sizes and shapes		1	2	3	4	5
Containers are supplied in sufficient quantity		1	2	3	4	5
Container has an entanglement-free opening/access way		1	2	3	4	5
Container opening/access way and current fill status visible to user prior to placing sharps into container		1	2	3	4	5
Internal design/molding of container does not impede ease of use		1	2	3	4	5
Handles, if present, located above full-fill level		1	2	3	4	5
Handles, if present, facilitate safe vertical transport and are located away from opening/access way and potentially soiled surfaces		1	2	3	4	5
Fixed locations place container within arm's reach of point of waste generation		1	2	3	4	5
Fixed locations allow for installation of the container below horizontal vision level		1	2	3	4	5
In high patient/ visitor traffic areas, container provides for security against tampering		1	2	3	4	5

SHARPS DISPOSAL CONTAINER EVALUATION

VISIBILITY	agree . . . . . disagree
Color or warning label implies danger.		1	2	3	4	5
A warning indicator (i.e., color or warning label) is readily visible to the user prior to user placing sharps into container		1	2	3	4	5
Overfill level provided and current fill status is readily visible to the user prior to use placing sharps into container		1	2	3	4	5
Sharps disposal container complies with OSHA requirements		1	2	3	4	5
Disposal opening/access way is visible prior to user placing sharps into container		1	2	3	4	5
Security, mounting, aesthetic, and safety features do not distort visibility of the opening/access way or fill status indicator		1	2	3	4	5

ACCOMMODATION	agree . . . . . disagree
No sharp edges in construction or materials		1	2	3	4	5
Safety features do not impede free access		1	2	3	4	5
Promotes patient and user satisfaction (i.e., aesthetic to extent possible)		1	2	3	4	5
Is simple to operate		1	2	3	4	5
Any emissions from final disposal comply with pollution regulations		1	2	3	4	5
Easy to assemble, if required		1	2	3	4	5
Components of containers that require assembly are easy to store prior to use		1	2	3	4	5
Use allows one-handed disposal		1	2	3	4	5
Product available in special designs for environments with specific needs (e.g., labs, emergency rooms, emergency medical services, pediatrics, correctional facilities)		1	2	3	4	5
Mounting system durable, secure, safe, cleanable, and, where appropriate, lockable		1	2	3	4	5
Mounting systems allow height adjustments		1	2	3	4	5
Design promotes task confidence		1	2	3	4	5
Cost effectiveness		1	2	3	4	5

OTHER COMMENTS

What design or performance requirements are missing from the product you evaluated that are really needed to safely or more comfortably conduct your job or sharps related task?

Additional Evaluator Concerns and Comments:

Developed by the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health in conjunction with NIOSH Educational Resource Centers; The Johns Hopkins University, Baltimore; the University of Texas, Houston; the University of California, Berkeley; and the Mount Sinai School of Medicine, New York City.

VACUUM TUBE BLOOD COLLECTION SYSTEMS EVALUATION FORM

Date:__________ Department:________________________ Occupation:________________________
Product: __________________________________________ Number of times used:______________

Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.

agree . . . . . disagree

1.	The safety feature can be activated using a one-handed technique	1	2	3	4	5	N/A
2.	The safety feature does not interfere with normal use of this product	1	2	3	4	5	N/A
3.	Use of this product requires you to use the safety feature	1	2	3	4	5	N/A
4.	This product does not require more time to use than a non-safety device	1	2	3	4	5	N/A
5.	The safety feature works well with a wide variety of hand sizes	1	2	3	4	5	N/A
6.	The safety feature works with a butterfly	1	2	3	4	5	N/A
7.	A clear and unmistakable change (either audible or visible) occurs when the safety feature is activated	1	2	3	4	5	N/A
8.	The safety feature operates reliably	1	2	3	4	5	N/A
9.	The exposed sharp is blunted or covered after use and prior to disposal	1	2	3	4	5	N/A
10.	The inner vacuum tube needle (rubber sleeved needle) does not present a danger of exposure	1	2	3	4	5	N/A
11.	The product does not need extensive training to be operated correctly	1	2	3	4	5	N/A

Of the above questions, which three are the most important to your safety when using this product?

Are there other questions which you feel should be asked regarding the safety/utility of this product?

Source: Reprinted with permission of Training for Development of Innovative Control Technology Project. June Fisher, M.D.� June1993, revised August 1998.

SHARPS EVALUATION RESULTS

SAFETY PRODUCT EVALUATED: _________________________________________________________

SHARP PRODUCT CURRENTLY IN USE: ___________________________________________________

EVALUATOR	AVG. SCORE	CONSIDERATIONS	*PUT IN USE?

*If only used under certain circumstances, indicate what these are below.

SAFETY PRODUCT EVALUATED: _________________________________________________________

SHARP PRODUCT CURRENTLY IN USE: ___________________________________________________

EVALUATOR	AVG. SCORE	CONSIDERATIONS	*PUT IN USE?

*If only used under certain circumstances, indicate what these are below.

Comments/Concerns:

_____________________________________ ________________________

OSHA Safety Officer Date