News

about healthcare worker safety, needlestick prevention & occupational exposure prevention 

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Center news: 

  • September 2009: Center partners with Dikembe Mutombo Foundation and BD to help support new Occupational Safety Center for Health Workers at Biamba Marie Mutombo Hospital in Kinshasa, Democratic Republic of Congo. More here and here.

  • August 2009: Center conducts EPINet training at WHO-sponsored healthcare worker safety conference in Riyadh, Saudi Arabia. More here.

  • August 2009: EPINet 2007 data reports now available. Click here.
     
  • August 2009: August issue of Health Purchasing News discusses trends in sharps safety products, with comments by IHWSC Associate Director Jane Perry.

  • June 2009: Russian physicians visit Center for one-week Training Program in Occupational Exposure Prevention. More here.

  • April 2009: The United States Court of Appeals (DC Circuit) rendered a decision in Metwest v. U.S. Secretary of Labor, a case for which Center staff member Jane Perry served as an expert witness in 2005 on behalf of the Occupational Safety and Health Administration (OSHA). Metwest, a subsidiary of Quest Diagnostics, a major U.S. lab company, had refused to comply with OSHA's requirement that blood tube holders used during phlebotomy procedures be disposed of after use, with phlebotomy needle attached, to avoid needlestick injury risk. The Court of Appeals ruled in favor of OSHA/DOL and denied Metwest's petition for review. Read decision here.

  • News archives here.

U.S. & international news: 

  • August 2009: U.S. State Department announces public-private partnership to improve safety of blood-drawing practices for healthcare workers and patients in Sub-Saharan Africa. Read more here.

     
  • June 2009: European healthcare employee and employer trade organizations reach agreement on use of safety devices; European Union expected to pass safety needle legislation by end of 2009. Read more here.

  • June 2009: A blog on nursingtimes.net by Susan Elden describes conditions for nurses in Swaziland, where the HIV adult population prevalence is 25%. Click here.

  • May 2009: A new tropical disease risk for healthcare workers: Lujo virus. Read more here.

  • News archives here.

Upcoming conferences:

  • International Congress on Occupational Risk in the Health Care Sector. Madrid, Spain; October 28-30, 2009. Sponsored by European Agency for Safety and Health at Work. More information here.

  • SIGN (Safe Injection Global Network) 2009 Meeting, Nov. 30-Dec. 2, 2009, WHO Headquarters, Geneva. More information will be available soon at the SIGN website, here.

  • The WHO will hold an industry consultative meeting on quality and safety in vaccination on Dec. 3-4, 2009, in Geneva (it will follow directly after the SIGN meeting, above). The meeting will focus, in part, on the safety of devices used for injection. Those interested in attending should contact:
    Dennis Maire (maired@who.int)
    Quality Safety and Standard Unit
    Immunization Vaccine and Biologicals Department
    World Health Organization, Geneva, Switzerland
    Tel: 41 22 791 5882

Publications

Center publications - recent:

  • Perry J. Safety scalpels and sutures have come a long way. Outpatient Surgery Magazine 2009 (May);10(5):48-51. Available at: http://www.outpatientsurgery.net/2009/05/safety_scalpels_and_sutures_have_come_a_long_way.php.
     
  • Boal WL, Leiss JK, Ratcliffe JM, Sousa S, Lyden JT, Li J, Jagger J. The national study to prevent blood exposure in paramedics: rates of exposure to blood. International Archives of Occupational and Environmental Health 2009 May 13. [Epub ahead of print.] Available at: http://www.ncbi.nlm.nih.gov/pubmed/19437031?dopt=Abstract.
    OBJECTIVE: The purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers. METHODS: A survey on blood exposure was mailed in 2002-2003 to a national sample of paramedics. Results for California paramedics were analyzed with the national sample and also separately. RESULTS: The incidence rate for needlestick/lancet injuries was 100/1,000 employee-years [95% confidence interval (CI), 40-159] among the national sample and 26/1,000 employee-years (95% CI, 15-38) for the California sample. The highest exposure rate was for non-intact skin, 230/1,000 employee-years (95% CI, 130-329). The rate for all exposures was 465/1,000 employee-years (95% CI, 293-637). California needlestick/lancet rates, but not national, were substantially lower than rates in earlier studies of paramedics. Rates for all percutaneous injuries among paramedics were similar to the mid to high range of rates reported for most hospital-based healthcare workers. CONCLUSIONS: Paramedics in the United States are experiencing percutaneous injury rates at least as high as, and possibly substantially higher than, most hospital-based healthcare workers, as well as substantially higher rates of exposure to blood on non-intact skin.

  • Shiao JSC, McLaws ML, Lin MS, Jagger J, Chen CJ. Chinese EPINet and recall rates for percutaneous injuries: an epidemic proportion of underreporting in the Taiwan healthcare system. Journal of Occupational Health 2009;51(2):132-6. Available at:
    http://www.jstage.jst.go.jp/article/joh/51/2/51_132/_article.
    OBJECTIVE: As an occupational injury, percutaneous injury (PI) can result in chronic morbidity and death for healthcare workers (HCWs). A pilot surveillance system for PIs using the Chinese version of Exposure Prevention Information Network (EPINet) was introduced in Taiwan in 2003. We compared data from EPINet and recall of PIs using a cross-sectional survey for rates to establish the reliability of the new system. METHODS: HCWs from hospitals that had implemented EPINet for > or =12 months completed a survey for recall of contaminated PIs sustained between October 2004 and September 2005, type of item involved, and reasons for reporting or not reporting the PI. Comparative data from EPINet for the same period were analyzed. RESULTS: The EPINet rate, 36.1/1,000 HCW (95%CI 31.8-41.1) was almost 5 times lower (p<0.0001) than the PI recall rate for 2,464 HCWs of 170/1,000 HCWs (95%CI 155.4-185.5). Approximately 2.5 PIs were recalled for every 1,000 bed-days of care. The recall rate by physicians was 268.3/1,000, 188.5/1,000 for nurses, 88.9/1,000 for medical technologists and 81.3/1,000 for support staff. Hollow-bore needle items most commonly recorded on EPINet includ, disposable needles and syringes were underreported by 81%, vacuum tube holder/needles by 67%, and arterial blood gas needles by 75%. Nearly 63% of the reasons for underreporting were related to the complexity of the reporting process, while 37% were associated with incorrect knowledge about the risks associated with PIs. CONCLUSIONS: EPINet data underestimates a commonplace occupational injury with nearly four in five PIs not reported. Addressing the real barriers to reporting must begin with hospital administrators impressing on HCWs that reporting is essential for designing appropriate safety interventions.

  • De Carli G, Puro V, Jagger J. Needlestick-prevention devices: we should already be there [letter]. Journal of Hospital Infection 2009;71(2):183-4 (Epub 2008 Dec 4).
    Click here to view.
    Occupational exposure data from Italy's Studio Italiano Rischio Occupazionale da HIV (SIROH) group supports the efficacy of needlestick-prevention devices (NPDs) in reducing sharps injury risk to healthcare workers. Data from 16 hospitals (2003-2006) in which NPDs were implemented indicated that injury rates for NPDs were, on average, 80% lower than for conventional devices. During the same period, in hospitals that had not implemented NPDs 12 cases of occupational hepatitis C infection were reported, and one case of occupationally acquired HIV. Eleven of the 13 injuries that resulted in infection involved devices for which safety alternatives were available.

  • Jagger J, Perry J, Gomaa A, Phillips EK. The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: the critical role of safety-engineered devices. Journal of Infection and Public Health 2008 (Dec);1(2):62-71. Available at: http://www.sciencedirect.com/science/journal/18760341.
    In the United States (U.S.), federal legislation requiring the use of safety-engineered sharp devices, along with an array of other protective measures, has played a critical role in reducing healthcare workers' (HCWs) risk of occupational exposure to bloodborne pathogens over the last 20 years. We present the history of U.S. regulatory and legislative actions regarding occupational blood exposures, and review evidence of the impact of these actions. In one large network of U.S. hospitals using the Exposure Prevention Information Network (EPINet) sharps injury surveillance program, overall injury rates for hollow-bore needles declined by 34%, with a 51% decline for nurses. The U.S. experience demonstrates the effectiveness of safety-engineered devices in reducing sharps injuries, and the importance of national-level regulations (accompanied by active enforcement) in ensuring wide-scale availability and implementation of protective devices to decrease healthcare worker risk.
    •

Center publications - in press:

  • Perry J, Gomaa AE, Jagger J. Progress in preventing sharps injuries in the United States. Chapter in: Charney W, ed. Handbook of Modern Hospital Safety (2nd ed). CRC Press, Inc.;2009.
    Traces progress in preventing sharps injuries in the U.S., while also addressing some of the important issues and challenges associated with full implementation of the revised bloodborne pathogens standard.

Other recent articles of interest:

• Exposures to blood and body fluids in Brazilian primary health care.
Authors: Garcia LP, Facchini LA. Published in: Occup Med (Lond) 2009;59(2):107-13.
Summary: Primary health care workers (HCWs) represent a growing occupational group worldwide. They are at risk of infection with blood-borne pathogens because of occupational exposures to blood and body fluids (BBF). AIM: To investigate BBF exposure and its associated factors among primary HCWs. METHODS: Cross-sectional study among workers from municipal primary health care centres in Florianópolis, Southern Brazil. Workers who belonged to occupational categories that involved BBF exposures during the preceding 12 months were interviewed and included in the data analysis. RESULTS: A total of 1077 workers participated. The mean incidence rate of occupational BBF exposures was 11.9 per 100 full-time equivalent worker-years (95% confidence interval: 8.4-15.3). The cumulative prevalence was 7% during the 12 months preceding the interview. University-level education, employment as a nurse assistant, dental assistant or dentist, higher workload score, inadequate working conditions, having sustained a previous occupational accident and current smoking were associated with BBF exposures (P <or= 0.05). CONCLUSIONS: Primary Health Care Centres are working environments in which workers are at risk of BBF exposures. Exposure surveillance systems should be created to monitor their occurrence and to guide the implementation of preventive strategies.  

• Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.
Authors: Nagao M, Iinuma Y, Igawa J, Matsumura Y, Shirano M, Matsushima A, Saito T, Takakura S, Ichiyama S. Published in: Am J Infect Control 2009 (published online 13 April 2009). 
Summary: A retrospective review of all exposure injuries affecting members of the operative care line at a single university hospital between January 2000 and December 2007 was performed. A questionnaire survey on current status of adherence to barrier precautions was also completed by 164 staff members. Of 136 exposure injuries, 87 (64.0%) were in surgeons, and 49 (36.0%) were in scrub nurses. Surgeons were most commonly injured during suturing (49, 56%), followed by "handing over sharps" (7, 8%), whereas scrub nurses were most commonly injured during "counting and sorting of sharps" (15, 41%), followed by "handing over sharps," and "splash." The questionnaire survey revealed that compliance with goggles, face shields, and double gloving was poor, and only 9% of respondents routinely used the hands-free technique. Only 22% of staff who had experienced exposure injuries reported every incident. Because circumstances of exposure injuries in operating rooms differ by profession, appropriate preventive measures should address individual situations. To reduce exposure injuries in the operating room, further efforts are required including education, mentoring, and competency training for operation personnel. 

• Accidental blood and body fluid exposure among doctors.
Authors: Naghavi SH, Sanati KA. Published in: Occup Med (Lond) 2009;59(2):101-6. Summary: Aim - To study the epidemiology and time trends of blood and body fluids (BBF) exposures among hospital doctors. METHODS: A 3-year study was carried out using data from the Exposure Prevention Information Network of four teaching hospitals in the UK. RESULTS: One hundred and seventy-five cases of BBF exposures in doctors were reported over the 3-year study period. Eighty-one (46%) occurred in senior doctors and 94 (54%) in junior doctors. Junior doctors had a higher rate of BBF exposures compared to senior doctors: 13 versus 4 incidents per 100 person-years, respectively (relative risk 3, 95% confidence interval 2-4). The most frequent setting for BBF exposures among senior doctors was the operating theatre/recovery (59%). Among junior doctors, it was the patient room (48%). The commonest original reason for use of sharps by junior doctors was the taking of blood samples (42%). Among senior doctors, it was suturing (41%). CONCLUSION: While ongoing training efforts need to be directed towards both junior and senior doctors, our data suggest that junior doctors are at higher risk of BBF exposures and may need particular attention in prevention strategies. An improvement in the safety culture in teaching hospitals can be expected to reduce the number of BBF exposures.

• Hands-Free Technique in the Operating Room: Reduction in Body Fluid Exposure and the Value of a Training Video.
Authors: Stringer B, Haines T, Goldsmith CH, Blythe J, Berguer R, Andersen J, De Gara CJ. Published in: Public Health Reports 2009;124 (S1):169-79.
Available at: http://www.publichealthreports.org/userfiles/124_4Supp1/169-179.pdf
Summary: This study sought to determine if (1) using a hands-free technique (HFT)-whereby no two surgical team members touch the same sharp item simultaneously-$75% of the time reduced the rate of percutaneous injury, glove tear, and contamination (incidents); and (2) if a video-based intervention increased HFT use to $75%, immediately and over time. METHODS: During three and four periods, in three intervention and three control hospitals, respectively, nurses recorded incidents, percentage of HFT use, and other information in 10,596 surgeries. The video was shown in intervention hospitals between Periods 1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used when $75% passes were done hands-free, was practiced in 35% of all surgeries. We applied logistic regression to (1) estimate the rate reduction for incidents in surgeries when the HFT was used and not used, while adjusting for potential risk factors, and (2) estimate HFT use of about 75% and 100%, in intervention compared with control hospitals, in Period 2 compared with Period 1, and Period 3 compared with Period 2. RESULTS: A total of 202 incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported. Adjusted for differences in surgical type, length, emergency status, blood loss, time of day, and number of personnel present for $75% of the surgery, the HFT-associated reduction in rate was 35%. An increase in use of HFT of $75% was significantly greater in intervention hospitals, during the first post-intervention period, and was sustained five months later. CONCLUSION: The use of HFT and the HFT video were both found to be effective.  

• The incidence and reporting rates of needle-stick injury amongst UK surgeons.
Authors: Thomas WJ, Murray JR. Published in: Ann R Coll Surg Engl 2009;91(1):12-17.
Summary: Needle-stick injuries are common. Such accidents are associated with a small, but significant, risk to our career, health, families and not least our patients. National guidelines steer institution-specific strategies to provide a consistent and safe method of dealing with such incidents. Surgeon-specific guidelines are not currently available. We have observed that hospital sharps policy is often considered cumbersome to the surgeon, resulting in on-the-spot decision making with potential long-term implications. By their essence, these decisions are inconsistent, not reproducible and, thus, we believe them to be unsafe. The under-reporting to occupational health departments is well documented. Current surgical practice has the potential to expose the surgeon to unnecessary risk. The aims of this study were to establish the true incidence of contaminations caused by needle-stick injury in our hospital and to assess how well current protocols are really implemented. SUBJECTS AND METHODS: We identified all surgeons of consultant, non-career staff grade (NCSG) and registrar grade working in a large 687-bed district general hospital serving a population of 550,000, in the UK. We designed a retrospective, anonymous 30-second survey. Surgeons' awareness and opinion of local policy was sought in a free-text section. RESULTS: Of the 98 surgeons in the hospital, 77% responded to the questionnaire and 44% anonymously admitted to having a needle-stick injury. Only 3 of the 33 (9%) who sustained an needle-stick injury said that they followed the agreed local policy. Twenty-three surgeons (70%) performed first aid type procedures such as informing scrub nurse, changing needle and gloves. Seven surgeons (21%) simply ignored the incident and continued. Forty-three surgeons commented on the policy's nature with only 9 who regarded it as 'user friendly'. CONCLUSIONS: Needle-stick injury is still a common problem, particularly in the surgical cohort and remains significantly under-reported. The disparity between hospital sharps policy and actual surgical practice is considered and an explanation for the difference sought. Without this awareness of 'real-life' surgical practice, the occupational health figures for sharps injury will always tell a rosy story under-estimating a real problem. We strongly advocate universal precautions in the operating theatre. However, we acknowledge that sharps injuries will occur. We should remain vigilant and act upon contaminations without surgical bravado but with mater-of-fact professionalism. This includes regular review of policy and, particularly, promotion of surgical awareness.

• Hepatitis B virus, hepatitis C virus and other blood-borne infections in healthcare workers: guidelines for prevention and management in industrialised countries.
Authors: FitzSimons D, François G, De Carli G, Shouval D, Prüss-Ustün A, Puro V, Williams I, Lavanchy D, De Schryver A, Kopka A, Ncube F, Ippolito G, Van Damme P. Published in: Occupational and Environmental Medicine 2008;65(7):446-51.
Summary: The Viral Hepatitis Prevention Board (VHPB) convened a meeting of international experts from the public and private sectors in order to review and evaluate the epidemiology of blood-borne infections in healthcare workers, to evaluate the transmission of hepatitis B and C viruses as an occupational risk, to discuss primary and secondary prevention measures and to review recommendations for infected healthcare workers and (para)medical students. This VHPB meeting outlined a number of recommendations for the prevention and control of viral hepatitis in the following domains: application of standard precautions, panels for counselling infected healthcare workers and patients, hepatitis B vaccination, restrictions on the practice of exposure-prone procedures by infected healthcare workers, ethical and legal issues, assessment of risk and costs, priority setting by individual countries and the role of the VHPB. Participants also identified a number of terms that need harmonization or standardisation in order to facilitate communication between experts.