EXPO-STOP 2015 -a small decrease in US Sharps Injuries

Our EXPO-STOP 2015 results, published online in July AJIC, show a small reduction in sharps injuries since 2001

181 hospitals from 34 states contributed data to EXPO-STOP 2015, making it the largest of our 6 EXPO-STOP annual surveys .

Of the 9,343 exposure reported, 71% were sharps injuries (SI) and 29% were mucocutaneous exposures. Of total sharps injuries reported, 38% were during surgical procedures.

The SI rate was 25.2 per 100 occupied beds (OB) however we concluded that “Occupied Beds” is no longer a valid denominator  as it does not include the rising number of patients seen as day cases.

We believe “FTE” is the gold standard as it includes ALL staff no matter how patients are seen – and the 2015 rate was 2.1/100 FTE – significantly less than the 2.7/100 FTE EPINet found in 2001.

But the reduction is not enough. We estimate over 300, 000 US HCW sustain SI annually – that’s 800 every day of the year!

Click here for an ‘Author Copy’ of our paper (if you are an APIC member click here for the AJIC published article ).

And our publication “5 Proven Strategies to Reduce Sharps Injuries” has now been made freely available by AOHP- click here for copy.

 

AOHP offers “Sharps injury reduction strategies” free to all

The Association for Occupational Health Professionals (AOHP) have offered a valuable high-interest article free of charge .

JAOHP recently published its member-survey which ascertained their strategies to reduce sharps injuries and mucocutaneous blood exposures.

In the EXPO-STOP 2015 survey the “top” low incidence hospitals had SI incident rates 70% below the U.S. national average. The paper outlines their effective strategies.

Click here for the announcement and then click  within to get the free PDF article.

A 7min video on Sharps Injuries in USA

How many sharps injuries occurred to US Healthcare workers in 2015 and how do we prevent them?

At the Association for the Healthcare Environment annual conference in Pittsburg last year, I was asked if I would do a brief video on sharps injuries.

I jumped at the offer (of course)  and spoke on the EXPO-STOP survey that Dr Linda Good and I conduct annually for the Association of Occupational Health Professionals (AOHP).

The 2015 data showed that:

  • Approximately 1,000 HCW sustan a sharps injury DAILY
  • 40% of reported sharps injuries  were from nurses, 35% doctors; and 2-4% were environmental services staff
  • Of EVS staff, the two main causes were (I) handling sharps containers (ii) improper disposal of sharps (left on floor, bed, table, etc)
  • Four prevention strategies were:
    • Helping your institution become more sharps aware
    • Using safety engineered devices more frequently and more correctly
    • Training staff until they are competent in the use of that device/procedure
    • Investigating EVERY sharps injury
  • Thanks to AHE, if you would like to use the video in your training sessions click here.

Sharps Injuries among Australian Healthcare Workers

Sharps Injuries are far too frequent among Australian healthcare workers (HWC)

Accidental sharps injuries (SI) via needles, sutures, etc, all carry a small but real risk of transmitting bloodborne diseases like HepB, HIV, etc., to the injured HCW.

In fact, Tarantola et al state there are 60 infectious diseases that can be transmitted by these injuries.

At the Australasian College of Infection Prevention and Control (ACIPC) 2016 conference, myself, Nicole Vaust and Jane Parker presented the results of a national survey we conducted among ACIPC members (with ACIPC and Ethics approval)

We asked members 9 questions on their institution’s 2014 occurrence of SI and mucocutaneous exposures (blood splashes to face, etc) – 307 hospitals from 6 states participated, making the survey one of largest in Australia – and we were surprised at the results.

Three out of every hundred HCW reported a sharps injury in 2014 (higher than USA rate); 51% of reported SI were nurses and 37% doctors; and 47% of all SI occurred during surgical procedures.

Extrapolating to Australia nationally, this means over 30,000 HCW sustain an SI annually – 80 per day!

Could it be that Australian HCW are not using safety engineered devices often enough? Or correctly?

What is clear is that this issue needs greater attention at state, perhaps federal legislative level – as it has in most developed countries.

click here for our poster

We will shortly submit our manuscript to the ACIPC Journal of Infection, Disease and Health – so watch this space.

EXPO-STOP 2015 Blood-exposure Survey – Sneak Preview

AOHP EXPO-STOP blood-exposure survey is too large for one post – but here’s a sneak preview

The 2015 EXPO-STOP blood exposure survey of the Association of Occupational Health Professionals in Healthcare (AOHP) will take several publications to convey all the data to readers – so Linda Good and I wanted to share the presentation we delivered at the Sept 2016 AOHP Conference in Myrtle Beach SC, USA.

In this 5th annual EXPO-STOP survey, 182 hospitals from 38 states participated  – making it USA’s largest.

The PowerPoint covers: the 2015 EXPO-STOP national blood exposure incidence; proven strategies to reduce sharps injury (SI) incidence; and url’s of many resources

Take Home Messages

  • USA SI incidence is 2.1 per 100 FTE hospital staff – a significant decrease from 2.7 in 2001
  • Nurses at 3.2 SI/100 FTE represent 46% of all reported SI (Drs 32%)
  • Surgical SI = 38% of all SI reported
  • But… this incidence means 320,000 HCW sustain SI annually – almost 1,000/day.
  • Renewed focus on prevention strategies is needed
  • Best practices include more effective Safety Devices, Competency training, Communication to all, Investigation, Engagement – particularly in OR.

Click here for download of PPT presentation

Watch this Space! – the top proven SI prevention strategies will be published in JAOHP Winter Issue in March 2017

AOHP’s latest 2013 & 2014 Blood Exposure Study

The USA Association of Occupational Health Professionals in Healthcare (AOHP) has issued a press release on the publication of their 2013-14 survey of Blood exposure incidence among US healthcare workers (HCW).

The survey, AOHP’s third in their annual series, and in which 84 hospitals in 28 states participated in supplying their 2013 and 2014 data, shows a significant rise in exposure incidents among US HCW.

Using “per 100 occupied beds” as the denominator, the 2014 sharps injury (SI) rate of 33.3, is significantly higher than the 24.0 in AOHP’s 2011 survey, and significantly higher than the EPINet rate of 22.2 in 2001, the year safety engineered devices (SED) became mandatory.
Exposure incidents include the HCW being stuck with a blood-contaminated needle or having a patient’s blood or blood-contaminated fluids splashed onto them. Each such incident carries a small but definite risk of transmitting one or more of 60 diseases, the three most well-known being HIV, Hepatitis C and Hepatitis B.

The denominator showing the highest rise was “Occupied beds” and this may reflect  the inability of this denominator to reflect the increases in day-patients and outpatients. However, “Total FTE”, a mirror of total patient workload, also showed a rising trend.

The paper, authored by Carol Brown, Miranda Dally, myself and Linda Good, propose the rise may be due to:

  • increasing HCW workloads;
  • decreasing resources;
  • increasing day-patient and outpatient numbers, and
  • incorrect use of SED

Several hospitals stood out for their low exposure rates. Examples of their successful reduction-strategies were: Competency-based education at orientation and annually (and repeated with all injured HCW); Investigation of every sharps injury; Making SI rates transparent and known to all staff; Requiring a waiver to be requested for non-SED use; Holding HCW and Management responsible for their safety.

The published copyright paper may be purchased by emailing AOHP at [email protected]  A complimentary, pre-publication Author Copy , for personal use only, is available here.

AOHP’s fifth annual survey (2015 calendar year) is in progress with publication aim late 2016.

The top 10 Questions people ask Google

Just reading Becker’s Hospital Review.

It is fascinating to learn the questions we ask Google.

There are a myriad of categories including medical symptoms, dogs, movies, fashion,  diets and even celebrity pregnancies!

Here are a few “Top 10” that caught my eye…

Symptoms Questions Dog Questions Fashion Questions
1.     Flu 1.      Why do dogs wag their tail? 1.       How to walk in heels?
2.     Gallbladder Infection 2.      How to crate train your puppy? 2.      What to wear on the first day of school?
3.     Measles 3.      How to register a dog as a service animal? 3.      How to fray jeans?
4.     Listeria 4.      How to register a dog with the AKC? 4.      How to tie a shirt?
5.     Sinus Infection 5.      How to keep puppy from eating poop? 5.      What should a bride wear to the rehearsal dinner?
6.     Gastritis 6.      When do puppies get shots? 6.      What to wear booties with?
7.     Anxiety Attack 7.      Why do dogs chew their paws? 7.      What are mules shoes?
8.     H. Pylori Infection 8.      What breed is the ‘Target’ dog? 8.      What to wear to a wedding in the woods?
9.     Heat stroke 9.      How to paper train a puppy? 9.      How to dress up like Miranda Sings?
10. Lactose Intolerance 10.  How to stop dogs from biting? 10.   What color shoes goes with a black and blue dress?

 

For the 42 other categories see https://www.google.com/trends/topcharts#vm=cat&geo=US&date=2015&cid.

EXPO-STOP 2012 – US largest blood exposure study published

EXPO-STOP:2012 Survey of US blood exposures is published in JAOHP

Linda Good and I, and the US Association of Occupational Health Professionals in Healthcare (AOHP) are pleased to announce the publication of our 2012 EXPO-STOP Survey in the recent edition of JAOHP.

The survey, the largest in US, examined the 9,494 blood exposures reported from 157 hospitals in 32 states, and calculated annual incidences using 4 denominators.

The 7,119 sharps injuries (SI) and 2,375 mucocutaneous exposures (MC) resulted in incidence rates of:
• 28.2 SI / 100 occupied beds; 2.2 / 100 staff; 3.3 / 100 nurses; and 0.43 / 100 Adjusted Patient Days.
• 10.1 MC / 100 occupied beds; 0.8 / 100 staff; and 0.15 / 100 Adjusted Patient Days.
• Of Total reported SI, 42% were among nurses and 36% among doctors.
• 44% of reported SI occurred during surgical procedures

The 2012 exposure incidences were significantly higher than those reported in the most recently published surveys by EPINet and Massachusetts Dept Public Health, and, disturbingly, higher than the EPINet incidence published in 2001 following the enactment of the OSHA needlestick Safety and Prevention Act (NSPA).

The study concludes that compliance with the NSPA is, in itself, insufficient to achieve the national reduction in exposures needed

The top 5 lowest-incidence hospitals had incidences 60% lower than their counterpart same-size hospitals. Their successful strategies were reported in the study and included education, repeated competency training, rapid investigation, unflagging diligence, and searching for safer safety devices.

A pre-publication Author Copy of the study is available for personal use and the definitive article is purchasable from AOHP

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Pistols and Poise: Day 24 in Sierra Leone

Temperature gun - Mamadu Fever (>38C) is an early sign of Ebola so temperatures are taken several times a day at entry to Bldgs, and police roadblocks. Still “no touch” law, so taken with infrared pistol aimed at temple. Ocass misreads and need recheck – happen to me yesterday. 2nd was normal!Ocass 34C – so I check pulse for life signs.
 7 baskets on head lowres  Food on head lowres  I soon understood why many Sierra Leone women have great poise – it takes a straight back to walk with these loads atop their heads – and a very strong neck!PS. In 2nd Pic “Nor Pis Ya” is “No urinating here” in local Krio (creole)

Tried local dish FuFu this week – local colleague said “are you sure” and I bravely stated I like to try local cooked food. The fermented “roll” is from cassava flour and is consistency of playdough (it had pleasant sweet taste) – you dip it into soup – my soup was beef and fish and dark green vegetable and had a rancid taste. My colleague said it was dish only made on Saturdays – I tried as much as I could politely sustain. Very glad today’s Sunday!

At office this week, a colleague became very pale – she barely made it to the garden. I sourced water and cup and her colour returned eventually. A timely warning of “If you can’t peel it, don’t eat it”. I had tummy episode Thur but worked out it was the quantity of chilli in the goat-pepper soup – goodness the Sierra Leone’s love their chilli! I’m still checking if my lips are still there.

This week I was a millionaire! – at 5,000 Leones to 1US$, $200 makes you a millionaire. Jokes aside, I do not know how the SL people survive as prices are high compared to wages – of those that have work. A nurse manager earns about $12 a day.

This Fri, 2 of 3 Provinces are in 3 day “Lock Down”. No shopping, no traffic, no-one outdoors – everyone has to stay home. This is only 2nd in 6 months and is to enable 7,000 health workers to visit every home and advise on Ebola safety and hand out brochures – in an effort to eradicate the disease.

Sunday here – our day off – only 1 work mtg scheduled – 8 of us went to beach for lunch – an earned break.

Warm regards to you all, Terry

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WHO launches Injection Safety campaign

I am fortunate to have spent two days at the Geneva WHO SIGN meeting where Dr Chan, WHO D-G launched the new Injection Safety campaign.

I am very excited because HCW sharps safety is an integral part of the campaign.

Even with safety engineered devices (SED), many countries are finding if difficult to further reduce their sharps injury incidence and this is the shot in the arm (forgive the pun) that they need.

As with WHO’s Hand Hygiene campaign, WHO will ask their 194 member countries to sign up to the campaign. Hopefully this will lead to the increased resources needed for more SED uptake and greater attention to competency-based SED training.

The campaign will require all signatories to exclusively use SED that meet WHO Prequal Standards (or their equivalent) by 2020.

I’m about to board a plane to Sierra Leone to assist for 2 months a CDC and WHO program to establish an Infection Control infrastructure throughout the 14 provinces. I’ll keep you updated via this website.