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.

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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2nd Ebola UK military HCW sustains sharps injury

Two military HCW have been repatriated to UK following sharps injuries (SI) while assisting with Ebola patients in West Africa. Both HCW were flown immediately to UK and are under hospital observation. Neither is symptomatic. My heart goes out to the two HCW and their families.

Two injuries in a week in well-trained staff attending high transmission-risk patients is alarming.

Ebola, like 60 other blood-borne pathogens, may be transmitted via the percutaneous route, particularly if unsafe injection practices are used . Likewise, Ebola may be acquired by laboratory workers following accidental sharps injury, the first being reported in 1977.

Rubinson tells of the ensuing emotional roller-coaster following an Ebola sharps injury in Sierra Leone.

How did the injuries occur? Difficult patient/procedure/environment? Lack or incorrect use of safety devices? Many of us would benefit from knowing these details. Hopefully they will be published.

‘Active’ and ‘Passive’ devices is wrong terminology

“Passive vs Active” conjures up “Black and White” – but other colours work well too!

A 7-colour spectrum of terms won’t work but “Active”, “Semiautomatic” and “Automatic” will.

In my recent paper on frequency of use of sharps engineered devices (SED) I deliberated over “passive” and “active” to describe SED mechanisms. Something didn’t gel. The SED in Doris Dicristina’s recent study significantly reduced wingset sharp injuries – but it was neither “passive” nor “active” – because you need push a button.
Then I incredulously learnt of a hospital who were staying with a troublesome active wingset device because “no passive wingsets had been developed” – yet semi-automatic wingset SED proven to reduce SI were available. Then I knew what didn’t gel – our terminology is wrong – it restricts the use of effective technology.

After an hour discussing the issue with a learned colleague we agreed we should be using the three terms proposed by Tosini et al in their large SED study – “Active”, “Semiautomatic” and “Automatic”.

True, they found automatic best, but semiautomatic SED had fourfold less SI than active SED!

We need delete “passive” from our SED vocabulary. More HCW will sustain SI if we keep it.

Your comments are welcome.

Passive vs Active devices is wrong terminology

“Passive vs Active” conjures up “Black and White” – but other colours work well too!

A 7-colour spectrum of terms won’t work but”Active”, “Semiautomatic” and “Automatic” will.

In my recent paper on frequency of use of sharps engineered devices (SED) I deliberated over “passive” and “active” to describe SED mechanisms. Something didn’t gel. The SED in Doris Dicristina’s recent study significantly reduced wingset sharp injuries – but it was neither “passive” nor “active” – because you need push a button.
Then I incredulously learnt of a hospital who were staying with a troublesome active wingset device because “no passive wingsets had been developed” – yet semi-automatic wingset SED proven to reduce SI were available. Then I knew what didn’t gel – our terminology is wrong – it restricts the use of effective technology.

After an hour discussing the issue with a learned colleague we agreed we should be using the three terms proposed by Tosini et al in their large SED study – “Active”, “Semi-automatic” and “Automatic”.

True, they found automatic best, but semiautomatic SED had fourfold less SI than active SED!

We need delete “passive” from our SED vocabulary. More HCW will sustain SI if we keep it.

Your comments are welcome.