Preventing Needlesticks and Other Sharps Injuries…Everything You ...
Transcript of Preventing Needlesticks and Other Sharps Injuries…Everything You ...
Part I:Background
Preventing Needlesticks and Other Sharps
Injuries…Everything You Need to Know
• Part I: Background• Part II: Safer Sharps Devices• Part III: Safe Work Practices
The Problem
• CDC estimates ~385,000 sharps injuries annually among hospital-based healthcare personnel (>1,000 injuries/day)– Many more in other healthcare settings (e.g., emergency
services, home care, nursing homes)
• Increased risk for bloodborne virus transmission
• Costly to personnel and healthcare system
Risks of Seroconversion due to Sharps Injury from a known positive source
Virus
HBVHCVHIV
Risk (Range)
6-30%*~ 2%
0.3%
(*Risk for HBV applies if not HB vaccinated)
What is the Risk for HIV Alone?
• Percutaneous 0.3%
• Mucous membrane 0.1%
• Non-intact skin <0.1%
Occupational HIV Transmission among U.S. Healthcare Personnel, 1985-2004
• 57 documented cases – i.e., HIV negative at time of exposure and
became HIV positive during follow-up period
• 137 other cases – i.e., No documented exposure and no
known risk factor for HIV infection
Occupational HIV TransmissionDocumented Cases (n=57)
• 50 (88%) involved percutaneous exposures
45 caused by hollow-bore needles, half of which were used in a vein or artery
• 5 mucocutaneous exposures
• 2 exposure route unknown
Costs of Sharps Injuries
• Baseline and follow-up laboratory testing• Treatment of exposed personnel
– $71-~$5,000 depending on treatment provided• Lost productivity• Time to complete paperwork• Loss of income / loss of career• Emotional costs• Societal costs
O’Malley, et. al. Costs of Management of Occupational Exposure to Blood and Body Fluids. ICHE, July 2007, v 28, No. 7.
Preventing Sharps Injuries
is Our Goal!
How Do Sharps Injuries Happen?
• Who gets injured?
• Where do they happen?
• When do injuries occur?
• What devices are involved?
• How can they be prevented?
Data Sources
• National Surveillance System for Healthcare Workers (NaSH)
• Exposure Prevention Information Network (EPINet™)
Who Gets Injured?
Nurse43%
Technician15%
Student4%
Dental1%
Housekeeping/Maintenance
3%
Clerical / Admin
1%
Other5%
Physician28%
Occupational Groups of Healthcare
Personnel Exposed to Blood/Body Fluids,NaSH June 1995—
December 2003 (n=23,197)
Where Do Sharps Injuries Occur?
• Patient Room 39%(Inpatient: Medical – ICUs )
• Operating Room 27%• Outpatient 8%• ER 8%• Laboratory 5%• Other 13%
Source: NaSH, June 1995—December 2003
When Do Sharps Injuries Occur?
• During use 41%
• After use/before disposal 40%
• During and after disposal 15%
• Other 4%
Source: NaSH, June 1995—December 2003
What Devices are Involved in Sharps Injuries?
Six Devices Account for 78% of All Injuries• Disposable Syringes 30%
• Suture Needles 20%
• Winged-Steel Needles 12%
• Intravenous Catheter Stylets 5%
• Phlebotomy Needles 3%
• Scalpels 8%
Source: NaSH, June 1995—December 2003
0
5
10
15
20
25
30
35
40
DisposableSyringe
CartridgeSyringe
Butterfly IV Stylet PhlebotomyNeedle
IV TubingNeedle
Percentage of injuries Rate/100K devices purchased
Jagger, et al. Rates of needle-stick injury caused by various devices in a university hospital. NEJM. 1988;319.
Devices that Require Manipulation after Use are Associated with an Increased Rate of Injury
How Do Injuries Occur With Hollow-Bore Needles?
During Sharps Disposal
13%
During Clean Up9%
In Transit to Disposal
4%
Handle/Pass Equipment
6%
Improper Disposal
9%
Access IV Line5%
Transfer/Process Specimens
5%
Recap Needle6%
Collision W/Worker or
Sharp10%
Manipulate Needle in Patient
28%
Other5%
Circumstances Associated with Hollow-Bore Needle Injuries NaSH June 1995—December 2003 (n=10,239)
Disposal Related:
35%
Sharps Injuries Are Preventable
Preventable64%Nonpreventabl
e18%
Undetermined18%
Preventability of Needlesticks in 78 NaSH Hospitals, June 1995--December 2004 (n=11,625)
Preventing Sharps Injuries is a National Priority!
• Federal and state laws increase enforcement of sharps injury prevention– Needlestick Safety and Prevention Act, 2000– OSHA enforcement of needlestick prevention increasing– 21 states with laws/regulations
• CDC: targets needlesticks for elimination
Sharps Injuries at ______Hospital (period of time)
• Last year _____ sharps injuries were reported by our employees/staff
• The occupations most affected were _____
• The devices most commonly involved were _____
• The most common ways sharps injuries occurred were _____
What are Strategies to Eliminate Sharps Injuries?
• Eliminate or reduce the use of needles and other sharps
• Use devices with safety features to isolate sharps
• Use safer practices to minimize risk for remaining hazards
• Part II: Safer Sharps Devices
• Part III: Safe Work Practices