As a consequence of bloodborne pathogen exposure, there are more than 385,000 healthcare workers injured in the United States. Most of the exposure injuries occur from contaminated needlesticks, sharps, or splash exposures. While the greatest risk is amongst nursing staff, the laboratory staff, physicians, dental team and housekeepers are also at risk.
The nearly 1000 daily injuries begs the question – what is driving these injuries? According to BD’s Exposure Prevention Information Network, heath care worker injuries are most commonly occurring as the result of improper procedures (e.g. recapping, disposal related activities, passing sharps hand-to-hand between team members) or failure to use a safer sharp device. These are costly injuries. In addition to the indirect cost of anxiety and distress for the exposed employee and their family, there is the direct cost of treatment for the injury, laboratory testing, and staffing replacement.
To address this known risk, California Department of Industrial Relations signed into law California Code of Regulations, Title 8, Section 5193 requiring each employer to establish, implement and maintain and effective Exposure Control Plan designed to eliminate or minimize employee exposures. Elements of the plan include:
- Exposure determinations
- The schedule and method of implementation for:
- Methods of compliance
- Hepatitis B vaccination and post-exposure evaluation and follow-up,
- Communication of hazard to the employees
- Provisions for the initial reporting of exposure incidents
- Hepatitis B vaccination series for unvaccinated employees
- Effective procures for:
- Evaluating the circumstances surrounding exposure incidents
- Work practice controls
- Gathering Sharp Injury Log information
- Marking periodic determinations of the frequency of use and the types and the brands of sharps involved in exposure incidents
- Identifying and selecting appropriate and currently available engineering control devices
- Engineering controls
- Actively involving employees in the review and update of the exposure control plan for the procedures they perform.
Here are some suggestions for minimizing the risk and preventing the occurrence of bloodborne pathogens exposure.
Require the clinical team to demonstrate competency with all new devices. Include exposure training upon hiring. Provide mandatory initial and ongoing education.
Provide trending metrics and share findings through appropriate committees to reach decision makers. Further communicate by: encouraging reporting, developing an awareness campaign, and discussing ways to communicate with patients that are high-risk for employee exposures. Consider creating an alert system outside patient rooms to alert co-workers that a high-risk procedure is in progress to avoid an inadvertent startle and possible injury.
Conduct a thorough root cause analysis to determine the injury cause and actively use the injured employee and manager in the investigation to help gather valuable information.
Involve frontline staff in partnership with Employee Health and Administration ion injury reduction initiatives.
There remains much work to be done around needle stick prevention. Summarized well by Mary Foley, Associate Director of the Center for Nursing Research and Innovation at the University of California San Francisco, people are not bad for not taking the extra step, they are human. Healthcare workers are focused on the well-being of others and are very likely to put their own needs secondary, and that could cause serious harm. Because this is true, revisit the Exposure Control Plan; know the risks, identify currently available engineering control devices to help eliminate the risk, communicate and engage!
AHC Media. (2016, August 1). To Stop Needlesticks,Educate, Communicate, and Investigate. Retrieved July 19, 2016, from AHC Media: http://www.ahcmedia.com/articles/138250-to-stop-needlesticks-educate-communicate-and-investigate
Prevention, C. f. (2013, June 26). Stop Sticks Campaign. Retrieved July 18, 2016, from The National Institute for Occupational Safety and Health (NIOSH): http://www.cdc.gov/niosh/stopsticks/sharpsinjuries.html
Pyrek, K. M. (2010, November 2). Needlestick Safety and Prevention Act 10-Year Anniversary. Retrieved July 28, 2016, from Infection Control Today: http://www.infectioncontroltoday.com/articles/2010/11/needlestick-safety-and-prevention-act-10-year-anniversary.aspx
Relations, D. o. (2016, July 19). Exposure Control Plan for Bloodborne Pathogens Exposure. Retrieved 19 2016, 2016, from Department of Industrial Relations: http://www.dir.ca.gov/title8/5193.html
If you have questions about bloodborne pathogen exposures, or other safety issues, please contact Phil Westphal, Loss Prevention Manager at firstname.lastname@example.org