PRESENTED BY APRIL 18, The University of Texas MD Anderson Cancer Center Houston, Texas

Transcription

1 PRESENTED BY APRIL 18, 2018 The University of Texas MD Anderson Cancer Center Houston, Texas

2 CURRENT TRENDS IN BLOOD AND BODY FLUID EXPOSURES: SHARPS INJURIES & MUCOCUTANEOUS EXPOSURES Amber H Mitchell, DrPH, MPH, CPH

3 OCCUPATIONAL HEALTH SIGNIFICANCE & CHANGING RISKS OF BLOODBORNE AND INFECTIOUS DISEASE EXPOSURES CURRENT TRENDS, EPINET SUMMARY DATA NEEDLESTICK AND SHARP OBJECT INJURY BLOOD AND BODY FLUID EXPOSURES BUILDING PREVENTION STRATEGIES FOR HIGHEST RISK EXPOSURES CAMPAIGN STRATEGIES OBJECTIVES

4 DISCLOSURE International Safety Center is funded through charitable contributions from medical device and PPE manufacturers so that EPINet can be offered to healthcare facilities around the world for free.

5 OCCUPATIONAL HEALTH SIGNIFICANCE Changing Risk of Bloodborne Pathogens

6 APHA POLICY STATEMENT (2015/16) The cases of Ebola virus disease (EVD) in the United States remind us that infectious disease threats continue to challenge our public health s, health system s and communities capacities to adequately protect the population from exposure to microorganisms (bacteria, viruses, and spores) that may cause illness or infection and generate stigma and fear.

7 APHA RECOMMENDATION development of innovative new technologies and to the certification of personal protective equipment (PPE) and other protective apparel used to eliminate or minimize exposures to microorganisms that cause illness and infection.

8 HEPATITIS B VIRUS With increasing access to US healthcare systems, global risk of unvaccinated disease to healthcare personnel grows: 2 BILLION People 3 MILLION Refugees Thanks for Slides from Elise Handelman & Elayne Phillips. BD & McKesson

9 HEPATITIS C VIRUS CDC Warns on Rising Cases of Hepatitis C Hepatitis C killed almost 20,000 Americans in More of us died from hepatitis C than from 60 other infectious diseases combined, including HIV and TB, with baby boomers at greatest risk. Summary source: Preidt, R. Hepatitis C Now Leading Infectious Disease Killer in U.S. HealthDay; 2016 May 4 Available from:

10 HIV Today, 1.1 Million people in the US are living with HIV. 1 in 7 don t know they are infected and can pass the virus to others. CDC 2015

11 RISK OF CO-INFECTION People with HIV infection are often affected by chronic viral hepatitis (10-25%) Chronic HIV, HBV, HCV, and co-infection with a multidrug resistant organism like MRSA Increased access to healthcare factsheets/hiv-viral-hepatitis.pdf 11

12 Emerging Infectious Disease Exposures

13 OSHA RECORDKEEPING REQUIREMENTS What s New! 13

14 NEW REQUIREMENT FOR ELECTRONIC SUBMISSION Beginning in 2017 REF: 14

15 FINAL RULE TO IMPROVE TRACKING OF WORKPLACE INJURIES AND ILLNESSES public disclosure of the data will nudge employers to reduce work-related injuries and illnesses in order to demonstrate. safe and healthy work environments for their employees. 15

16 UNIQUE REQUIREMENTS FOR SHARP INJURY, EXPOSURE TESTING & SEROCONVERSION OSHA Recordkeeping 300, 300A Instructions Available: new-osha300form pdf Privacy Information: Access to Employee Exposure and Medical Records Standard wadisp.show_document?p_table=stan DARDS&p_id=

17 UNIQUE RECORDKEEPING REQUIREMENT OF THE OSHA BLOODBORNE PATHOGENS STANDARD (2001 REVISION) Why might this not be enough to be actionable? What might you add? Edit? 17

18 EXPOSURE INCIDENT SUMMARY DATA SHARP OBJECT & NEEDLESTICK INJURIES

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20 SUMMARY SHARP OBJECT INJURIES (SOI) Injury Incident Reports / 100 Average Daily Census (ADC) 39.5 / 100 ADC; Teaching Facilities / 100 ADC; Non-Teaching Facilities Injury Incident Reports / 100 Average Daily Census (ADC) 38.5 / 100 ADC; Teaching Facilities 19.9 / 100 ADC; Non-Teaching Facilities Injury Incident Reports / 100 Average Daily Census (ADC) 27.2 / 100 ADC; Teaching Facilities 20.4 / 100 ADC; Non-Teaching Facilities

21 SHARP OBJECT INJURY & NEEDLESTICK INCIDENT SUMMARY DATA, N=30 US HEALTH SYSTEMS; 2016 C.N.A./HHA 1% Other 7% Clin Lab 1% EVS 2% EMT/First 0% Other Attend 3% MD Attending 17% Phleb/Veni 2% MD Int/Res 18% Tech (non lab) 4% Surg Tech/Attend 11% Nurse 33% Med Student 1%

22 Sharp Object injury & Needlestick Incident Summary Data 2016, N=30 US Health Systems Pre-Filled Cartridge Other Needle Lancets 1% Scissors Razors Glass All Others DEVICE CAUSING INJURY FOR ALL Disposable Syringe 26.5% Vacuum Tube w Needle IV Stylet Winged Steel Needle Scalpel 5.7% Suture 24.6% 22

23 2016 EPINET SUMMARY DATA: SHARPS INJURIES Need to Improve Safety Device Use AND Safety Feature Activation to Prevent Injuries

24 More than 1/4 of all injuries occurring downstream, outside of the control of the user. Injuries to EVS/housekeeping/hygiene, waste haulers, laboratorians, team members.

25 2016 EPINET SUMMARY DATA: SHARPS INJURIES

26 Why do you think that people feel injuries may be unpreventable?

27 HIGHEST PREVALENCE BY PROCEDURE TYPE, Mitchell et al. Journal of Hospital Infection, 2017

28 SHARP OBJECT INJURY SAFETY COMPARED TO NON-SAFETY, Mitchell et al. Journal of Hospital Infection, 2017

29 BLOOD & BODY FLUID EXPOSURE (BBFE) INCIDENTS Non-Sharps

30 BLOOD & BODY FLUID EXPOSURE RATE / RATIOS incidents reported per 100 Average Daily Census 13.6 / 100 ADC Teaching Facilities 7.6 / 100 ADC Non-Teaching Facilities incidents reported per 100 Average Daily Census 9.4 / 100 ADC Teaching Facilities 8.1 / 100 ADC Non-Teaching Facilities

31 BLOOD & BODY FLUID EXPOSURE INCIDENT SUMMARY DATA, EPINET 2016, N=30 FACILITIES OTHER SKIN MOUTH EYES 64.9% NOSE

32 BLOOD & BODY FLUID EXPOSURE INCIDENT SUMMARY DATA, EPINET 2016, N=30 HEALTH SYSTEMS

33 BLOOD & BODY FLUID EXPOSURE INCIDENT SUMMARY DATA, EPINET 2016, N=30 HEALTH SYSTEMS ICU/CCU L&D Clinic/OP OR Other Patient Room Emerg Dept

34 Even if the fluid wasn t blood, nearly 60% of all fluids were contaminated with blood meaning that these are potentially OSHA recordable, especially given almost 70% are occurring to the EYES.

35 TOTAL PPE & BARRIER GARMENT WORN Which barrier garments were worn at the time of exposure? % of Total Records Single pair of gloves 45.3% Double pair of gloves 3.3% Protective Eyewear / Goggles 2.0% Eyeglasses (not protective) 1.5% Eyeglasses with sideshields 1.5% Faceshield 2.4% Surgical mask 9.9% Surgical gown 10.4% Plastic apron 0.2% Labcoat / Scrub Jacket, cloth, (not protective) 0.7% Respirator 0.0% Other 2.9% 5.9% Wearing appropriate eye protection 47% Indicated only wearing uniform/scrubs during an incident 35

36 EXPOSED PART DURING THE BBFE EXPOSURE Did the blood or body fluid? % of Total Records Touch unprotected skin 41.3% Touch skin between gap in protective garment 5.3% Soaked through protective garment 0.4% Soaked through clothing 1.3% 36

37 IMPROVING FRONTLINE EMPLOYEE FEEDBACK ON SAFETY DEVICE USE AND PPE CAN IMPROVE OUTCOMES AND REDUCE EXPOSURES

38 250 Blood & Body Fluid Exposures Compared to Eye ONLY, Eye Protection Use Total Incidents # to Eyes # Wearing Eye-Appropriate PPE

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40 Percent of Nurses, Eye Protection Use, and Location, EPINet

41 Percent Key Incident Descriptions for Eye Exposures, EPINet

42 The Eye Capillaries Semi-Transparent Skin Covering: First Line of Defense Source: 42

43 UNAWARE & UNKNOWN EVENTS Staff unaware of splash in 40% of instances leading to eyewear contamination during vascular procedures Surgeon performing lesion surgery unaware of splash 86% of the time i.e., almost always Thanks to Victor Lange

44 PUBLISHED REPORTS Environment ICU ER/Isolation Patient Room Lab/Research Lab/Diagnostic Lab Ortho Surgery Dental Security/Police Veterinary Relief Workers Infection Influenza, HIV SARS HBV Herpes B Virus HIV, HCV Plague Hepatitis, HIV HIV HCV Rabies Ebola Exposures and Subsequent Eye Infections, Illnesses, and Seroconversions are Occurring 44

45 BUILDING PREVENTION STRATEGIES FOR HIGHEST RISK EXPOSURES CAMPAIGN STRATEGIES

46 PREVENTING INJURIES Ditch the Pinch Bilateral exposure injuries during subcutaneous injection Selecting Correct Size and Gauge Needle Am J Infect Control Employee Evaluation & Feedback, Safer Devices Improving Safety Device Activation Eliminating Downstream Injuries Safety Device Activation Improving Disposal Practices Eliminating Needle Transfer from Syringe to Blood Tube No Recapping!

47 DISPOSABLE NEEDLE SIZE Evaluate Needle Usage, Gauge Appropriateness of Size Selection

48 PREVENTING INJURIES FROM BLOOD TRANSFER

49 PREVENTING DOWNSTREAM INJURIES: ADAPTING COMMUNITY MODELS

50 PREVENTING BBFE INCIDENTS Improving Eye Protection Use, Compliance Universal Eye Protection or 100% OR? OHS & Infection Prevention Partnership Balance between Worker & Patient Safety Employee Evaluation & Feedback PPE Placement & Accessibility Infection Control Caddies Overcoming Poor PPE Compliance Considering New Technologies, Innovations

51 IMPROVING ACCESSIBILITY & VISUAL CUES Not an Endorsement

52 INNOVATIONS IN TEXTILES, ADDRESSING POOR PPE COMPLIANCE Not an Endorsement

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54 THANK YOU! InternationalSafetyCenter.org