Thursday, May 30, 2013

NIOSH's Stop Sticks Program: Sharps Injuries

Sharps Injuries

hand of health care worker handling syringe The Centers for Disease Control and Prevention (CDC) estimates that about 385,000 sharps-related injuries occur annually among health care workers in hospitals. More recent data from the Exposure Prevention Information Network (EPINet) suggest these injuries can be reduced, as sharps-related injuries in nonsurgical hospital settings decreased 31.6% during 2001–2006 (following the Needlestick Safety and Prevention Act of 2000). However, injuries in surgical settings increased 6.5% in the same period, where adoption of safety devices was limited compared to nonsurgical settings. It has been estimated about half or more of sharps injuries go unreported. Most reported sharps injuries involve nursing staff, but laboratory staff, physicians, housekeepers, and other health care workers are also injured.

Sharps injuries overview

A sharps injury is a penetrating stab wound from a needle, scalpel, or other sharp object that may result in exposure to blood or other body fluids. Sharps injuries are typically the result of using dangerous equipment in a fast-paced, stressful, and understaffed environment. These strenuous demands often produce feelings of fatigue, frustration, and occasionally anger. In the operating room, for example, health care personnel do not have the luxury of "taking a break," but must continue with their duties until the procedure is completed. These conditions can increase the risk of injury and infection for health care workers.
Health care workers may also incur injuries from improper procedures, such as passing sharps hand-to-hand between team members, placing sharps in a disposal container, or failing to use a safer sharps device. A report from the Exposure Prevention Information Network (EPINet) found that nearly half of all sharps injuries occurred during use of the sharp, and of the nearly 40% of needle injuries which involved a safety designed needle, the majority occurred before activating the safety device. Moreover, the report also showed that many sharps injuries occurred in patient rooms among nurses and operating rooms among surgical team members.1
The cost of a sharps injury can be a compelling reason to use safer sharps practices. One sharps injury can cause a number of direct and indirect costs for the health care facility, including:
  • Loss of employee time
  • Cost of tying up staff to investigate the injury
  • Expense of laboratory testing
  • Cost of treatment for infected staff
  • Cost of replacing staff
In addition to costs incurred by the health care facility, the stress on the affected worker and the worker’s family can be enormous. In addition to the initial concern, testing for bloodborne pathogens can last for months, producing feelings of anxiety and distress for an extended period of time.

How do sharps injuries occur?

In addition to the use of sharps devices, injuries are also closely associated with certain work practices that can pose an increased risk of bloodborne pathogen exposure. These work practices include:
  • Disposal-related activities (11%)
  • Activities after use and prior to disposal, such as item disassembly (30%)
  • Recapping a used needle (3%)

Pie chart showing how sharps injuries occur Figure 1: Activities associated with percutaneous injuries in EPINet hospitals, by % total percutaneous injuries (n= 951), 2007 (Source: EPINet [2009]External Web Site Icon).

What devices are involved with sharps injuries?

Injuries are also closely associated with certain devices that can pose an increased risk of bloodborne pathogen exposure. These devices include:
  • Disposable Syringe (31%)
  • Suture Needle (24%)
  • Winged Steel Needle (5%)

Pie chart showing devices involved with sharps injuries Figure 2: Devices associated with percutaneous injuries in EPINet hospitals, by % total percutaneous injuries (n= 951), 2007 (Source: EPINet [2009]External Web Site Icon).

1 The EPINet report surveyed 29 health care facilities across the United States, 2007.

Tuesday, May 21, 2013

NIOSH's Stop Sticks Program

Campaign User's Guide and Resources

Why focus on sharps injuries?

Sharps injuries are a significant injury and health hazard for health care workers and also result in a number of direct and indirect organizational costs. The Centers for Disease Control and Prevention (CDC) estimates that about 385,000 sharps-related injuries occur annually among health care workers in hospitals. More recent data from the Exposure Prevention Information Network (EPINet™) suggest these injuries can be reduced, as sharps-related injuries in nonsurgical hospital settings decreased 31.6% during 2001–2006 (following the Needlestick Safety and Prevention Act of 2000). However, injuries in surgical settings increased 6.5% in the same period, where adoption of safety devices was limited compared to nonsurgical settings. It has been estimated about half or more of sharps injuries go unreported. Most reported sharps injuries involve nursing staff, but laboratory staff, physicians, housekeepers, and other health care workers are also injured.

Campaign goal and target audience

Reducing sharps injuries first requires that health care workers have a full understanding of the magnitude of the problem. The STOP STICKS campaign focuses on raising awareness which, in turn, prepares and motivates health care workers to make the changes needed to reduce sharps injuries. Change itself requires a shift in the organization's safety culture and use of safer sharps devices and practices, and management support is a critical component of any change initiative.
The STOP STICKS campaign is a community-based information and education program. Its goal is to raise awareness about the risk of exposure to bloodborne pathogens such as HIV, hepatitis B, and hepatitis C from needlesticks and other sharps-related injuries in the workplace. While the campaign materials were developed mainly with operating room and emergency department audiences, the target audience includes clinical and nonclinical health care workers and health care administrators in hospitals, doctor's offices, nursing homes, and home health care agencies.

How the STOP STICKS campaign was developed

The National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), developed the materials available through this website by conducting a multiyear pilot project in Columbia, South Carolina. Other partners involved with NIOSH in pilot testing this campaign and developing the tools necessary to conduct your own awareness campaign include Palmetto Health Alliance, Dorn VA Hospital, CM Tucker Nursing Care Center, the South Carolina Department of Health and Environmental Control, PHT Services, the Association of Professionals in Infection Control, the University of South Carolina School of Public Health, the South Carolina Nurses Association, and other local Columbia, SC health care employers.
The tools available for conducting your own STOP STICKS campaign are highly customizable so that you can decide which components best fit the needs of your facility. You may choose to conduct a complete campaign, or only use certain components, depending on the needs and resources available at your facility. The STOP STICKS campaign may be presented as a stand-alone initiative, or it may be tied with other initiatives, such as introduction of a new safety device or an annual refresher to remind staff of the hazards associated with sharps injuries.

What is a "safety campaign" and a "communication blitz"?

A safety campaign is a series of strategic communication initiatives designed to convey a consistent key message targeting a safety need. In this sharps injuries campaign, the key message is "STOP STICKS."
The communication blitz is a component of the safety campaign and refers to brief, targeted communication interventions that bring attention to the safety campaign goals. Specifically, the blitzes for the STOP STICKS campaign focus on bloodborne pathogens, exposure prevention methods, equipment evaluation, and proper post-exposure prophylaxis protocols. The blitzes feature posters, newsletters, health and safety fairs, exhibits, and videos, among other communication methods and channels to communicate the campaign message.

STOP STICKS campaign guide and resources

This website includes guidance on how to prepare blitzes, use templates and other media resources in preparing the blitz materials, implement the blitzes, and evaluate the campaign outcomes. See the full list of campaign resources on the menu at left.

Tuesday, May 14, 2013

Antiseptic hand cleansers as an acceptable handwashing practice?

March 31, 2003

Dear Ms. Z***:

Thank you for your January 3, 2003 inquiry to the Occupational Safety and Health Administration (OSHA) regarding OSHA requirements for handwashing under the bloodborne pathogens standard [29 CFR 1910.1030]. Your question has been outlined below followed by OSHA's response.

The new Centers for Disease Control and Prevention (CDC) "Guideline for Hand Hygiene in Health-Care Settings" (Morbidity and Mortality Weekly Report, October25, 2002) supports the use of alcohol-based hand rubs as an effective means for decontaminating hands in healthcare settings. Is this consistent with the requirements for handwashing established in OSHA's bloodborne pathogens standard?
Many of CDC's hand hygiene guidelines are for infection control and patient safety, which OSHA standards do not specifically address. However, we feel that these guidelines which do address occupational exposures to blood or other potentially infectious materials (OPIM) are consistent with OSHA's bloodborne pathogens standard. In paragraph (d)(2) of OSHA's standard, the section that most appropriately addresses "handwashing" in the scenario that you describe, the following is stated:
(v) Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment. (vi) Employers shall ensure that employees wash hands and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials.
OSHA interprets this to mean that when an employee is removing gloves and has had contact, meaning occupational exposure to blood or blood or other potentially infectious materials (OPIM), hands must be washed with an appropriate soap and running water. If a sink is not readily accessible (e.g., in the field) for instances where there has been occupational exposure, hands may be decontaminated with a hand cleanser or towelette, but must be washed with soap and running water as soon as feasible. If there has been no occupational exposure to blood or OPIM, antiseptic hand cleansers may be used as an appropriate "handwashing" practice.

Again, if there has been no occupational exposure to or contact with blood or OPIM (as defined in [29 CFR 1910.1030(b)]), the use of alcohol-based hand cleansers described in the CDC's October 2002 guidelines would be appropriate. The application of the standard and its specific elements must be put into place where there has been actual or reasonably anticipated exposure to blood or OPIM and does not apply if no occupational exposure exists.

OSHA has consistently relied on the findings and recommendations of the CDC in developing good work practices for those employees with occupational exposure to blood or OPIM and feels that the existing standard does not compromise or contradict the recommendations included in the CDC's most recent guidelines.

Tuesday, May 7, 2013

"Freehand" Ear Piercing Clarification

December 8, 2005

Mr. David Vidra, CPLN, MA
President
Mr. Kris Lachance-Peters
Vice President
Health Educators, Inc.
515 E. Grand River Avenue, Suite F
East Lansing, MI 48823

Dear Mr. Vidra & Mr. Lachance-Peters:

Thank you for your letter to the Occupational Safety and Health Administration's (OSHA's) Directorate of Enforcement Programs regarding the applicability of OSHA's bloodborne pathogens standard (29 CFR 1910.1030) to the "freehand" body piercing technique. Your question is restated below, followed by OSHA's response. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence.

Scenario: A "freehand" piercing technique is one where the practitioner uses his or her hands as the piercing instrument instead of piercing forceps. In this procedure, the practitioner's fingers are placed in close proximity to the cutting edge of the needle as it exits the piercing site.

Question: Does OSHA view the practice of "freehand" piercing without the use of forceps and a receiving tool (cork or tube) as safe for the practitioner performing the procedure?

Reply: The practice of "freehand" piercing without the use of forceps or other available engineering and work practice controls to prevent contact with the used end of the piercing needle violates 29 CFR 1910.1030(d)(2)(i), an important provision of the bloodborne pathogens standard which requires that engineering and work practice controls shall be used to eliminate or minimize employee exposure.

In a previously published letter of interpretation, OSHA wrote:

"When an employee has exposure to a contaminated sharp and engineering controls (e.g., sharps with engineered safety features) are not available, hazard control is primarily gained through the implementation of work practices. In order to best protect an employee from an injury with a contaminated needle, minimal manipulation of the needle serves as means of control." [
Vidra, 8/19/03]