safe injection practices. 2 speaker sue dill calloway rn, esq. cphrm ad, ba, bsn, msn, jd ...
TRANSCRIPT
Safe Injection Practices
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Speaker
Sue Dill Calloway RN, Esq. CPHRM
AD, BA, BSN, MSN, JD
President
Patient Safety and Healthcare Consulting
5447 Fawnbrook Lane
Dublin, Ohio 43017
614 791-1468
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Identify Risks for Transmitting Infections
Hospital and ASC in Colorado where surgery tech with Hepatitis C infection steals Fentanyl and replaces it with used syringes of saline infecting 17 patients as of December 11, 2009 and 5,970 patients tested (total 36 for 3 facilities)
Kristen Diane Parker in 2010 gets 30 years for drug theft and needle swap scheme
Worked at Denver’s Rose Medical Center and Colorado Springs’ Audubon Surgery Center
1 www.krdo.com/Global/link.asp?L=399119
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Infection Control
The CDC says there are 1.7 million healthcare infection (HAI) in America every year There are 99,000 deaths in American hospitals every
year
Leadership need to make sure there is adequate staffing and resources to prevent and manage infections
Healthcare-Associated Infections (HAIs) are one of the top ten leading causes of death in the US1
1 www.cdc.gov/ncidod/dhqp/hai.html
Infection Control
There have been more than 35 outbreaks of viral hepatitis in the past 10 years because of unsafe injection practices
This has resulted in the exposure of over 100,000 individuals to HBV and 500 patients to HCV
This includes inappropriate care of maintenance of finger stick devices and glucometers
Includes syringe reuse, contaminations of vials or IV bags and failure of safe injection practices Source: APIC position paper: Safe injection, infusion, and
medication vial practices in health care
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Infection Control Back to Basics It is important to get back to basics in infection
control1
Education and training is imperative to learn each person’s role in preventing infections
What practices and constant reminders do you use to remind staff during patient care encounters?
New needle and syringe for every injection
Single dose saline syringes 1 http://www.jcrinc.com/infection-prevention-back-to-basics/
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What is Injection Safety or Safe Injection Practices?
The CDC says it is a set of measures taken to perform injections in an optimally safe manner for patients, healthcare personnel, and others
A safe injection does not harm the recipient, does not expose the provider to any avoidable risks and does not result in waste that is dangerous for the community
Injection safety includes practices intended to prevent transmission of infectious diseases between one patient and another, or between a patient and healthcare provider, and also to prevent harms such as needle stick injuries
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CDC Injection Safety Website
The CDC has an injection safety website
Contains information for providers
Injection Safety FAQs
Safe Injection Practices to Prevent Transmissions of Infections to Patients
Section from Guidelines for the Isolation Precautions to Prevent Transmission and more
www.cdc.gov/ncidod/dhqp/injectionsafety.html
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CDC Guidelines CDC has a publication called 2007 Guideline for
Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
Has a section on Safe Injection Practices (III.A.1.b. and starts on page 68)
Discusses four large outbreaks of HBV and HCV among patients in ambulatory facilities
Identified a need to define and reinforce safe injection practices
www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf
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Lumbar Puncture Procedures
CDC investigated 8 cases of post-myleography meningitis
Streptococcus species from oropharngeal flora
None of the physicians wore a mask
Droplets of oral flora indicated
Lead to CDC recommendations of 2007
Later related to not wearing a mask when anesthesiologists put in epidural lines for pain relief on women in labor
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CDC Guidelines Recently, five cases where anesthesiologist inserts
epidural line in OB patients without wearing a mask January 29, 2010 CDC MMWR at
www.cdc.gov/mmwr/preview/mmwrhtml/mm5903a1.htm
CDC made recommendation in June 2007 after several reports of meningitis after myelograms
Bacterial meningitis in postpartum women and Ohio woman dies May 2009
Streptococcus salivarius meningitis (bacteria that is part of normal mouth flora)
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Wear Mask When Inserting Epidural/Spinal
Hospital in NY
–Enhanced hand hygiene
–Maintenance of sterile fields
–Full gown, gloves, and mask
–No visitors when epidural put in
CDC has only identified 179 cases of post spinal (including lumbar punctures) world wide from 1952 to 2005
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CDC Guidelines
CDC identified four outbreaks in
Pain clinic
Endoscopy clinic
Hematology/oncology clinic
Will discuss major findings later
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CDC GuidelinesPrimary breaches
Reinsertion of used needles into multidose vials
Used 500cc bag of saline to irrigate IVs of multiple patients
Use of single needle or syringe to administer IV medications to multiple patients
Preparing medications in same work space where syringes are dismantled
Remember OSHA Bloodborne Pathogen standard (sharps containers at the bedside)
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What to Do?
Use only single dose vials and not multidose vials when available
This includes the use of saline single dose flushes
Single use of a disposal needle and syringe for each injection
Prevent contamination of injection equipment and medication
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What to Do?
Wear masks when inserting epidural or spinals
Discard used syringe intact in appropriate sharps container
Make sure sharps container in each patient room
Do not administer medications from single dose vials to multiple patients or combine left over contents for later use
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What to Do?
If multiple-dose vials are used, restrict them to a centralized medication area or for single patient use
Never re-enter a vial with a needle or syringe used on one patient if that vial will be used to withdraw medication for another patient
Store vials in accordance with manufacturer’s recommendations and discard if sterility is compromised
Mark date on multi-dose vial
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What to Do?
Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients
Follow the CDC 10 recommendations
Maintaining clean, uncluttered, and functionally separate areas for product preparation to minimize the possibility of contamination
CMS Hospital CoP requirement, tag 501
TJC 2010 MM.05.01.07
Clean top with Bleach wipe after each use
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A Scary Study The CDC says a survey of US Healthcare found
that 1% to 3% reused the same syringe and/or the same needle on multiple patients
This is what lead to the Nevada patients being exposed to HIV, HCV, and HCB
40,000 patients were notified who has anesthesia injections from March 2004 to January 11, 2008 and 115 patients infected with HCV
Clinic reused syringes in colonoscopies and other gastrointestinal procedures
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Please Ask Me
The Ask Me Program and the Nevada Medical Association posts information on their website
The Nevada State Health Division has encouraged patients to ask several questions prior to a surgical procedure http://health.nv.gov/docs/030308PressRelease.pdf
Can you assure me that I am safe in your facility from the transmission of communicable diseases?
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Please Ask Me Program How does the staff at this facility conduct
sterilization of diagnostic equipment after each patient use?
Are single or multiple dose vials used at the facility? Are label instructions followed specifically?
Are syringes and needles disposed of after each use?
Has your facility ever received a complaint of the spread of an infectious disease to another patient as a result of staff practices?
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CDC Injections Safety for Providers
The CDC also issues Injection Safety for Providers Issued March 2008 at http://www.cdc.gov/ncidod/dhqp/ps_providerInfo.html
Notes several investigations leading to transmission of Hepatitis C to patients
Thousands of patients notified to be test for HVB, HCV, and HIV
Referral of providers to the licensing boards for disciplinary actions
Malpractice suits filed by patients
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CDC 10 Recommendations
The CDC has a page on Injection Safety that contains the excerps from the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
Summarizes their 10 recommendations
Available at http://www.cdc.gov/ncidod/dhqp/injectionSafetyPractices.html
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CDC Safe Injection Recommendations
Use aseptic technique to avoid contamination of sterile injection equipment. Category 1A
Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed.
Needles,cannula and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient.1A
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CDC Safe Injection Recommendations
Use fluid infusion and administration sets (i.e., intravenous bags, tubing and connectors) for one patient only and dispose appropriately after use
Consider a syringe, needle, or cannula contaminated once it has been used to enter or connect to a patient's intravenous infusion bag or administration set 1B
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CDC Safe Injection Recommendations
Use single-dose vials for parenteral medications whenever possible 1A
Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use 1A
If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile 1A
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CDC Safe Injection Recommendations
Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations;
Discard if sterility is compromised or questionable 1A
Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients 1B
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CDC Safe Injection Recommendations
Wear a mask when placing a catheter or injecting material into the spinal canal or subdural space
Example, during myelograms, lumbar puncture and spinal or epidural anesthesia. 1B
Worker safety; Adhere to federal (OSHA) and state requirements for protection of healthcare personnel from exposure to blood borne pathogens 1B
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CDC has Injection Safety FAQs for Providers
CDC has another resources with frequently asked questions
What is injection safety?
Incorrect practices identified in IV medications for chemotherapy, cosmetic procedures, and alternative medicine therapies
Available at http://www.cdc.gov/ncidod/dhqp/injectionSafetyFAQs.html
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CDC has Injection Safety FAQs for Providers
Also puts patients at risk for bacterial and fungal infections beside HIV and Hepatitis
Single dose vials do not contain a preservative to prevent bacterial growth so safe practices necessary to prevent bacterial and viral contamination
Proper hand hygiene before handling medications
Make sure contaminated things are not placed near medication preparation area
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CDC has Injection Safety FAQs for Providers
Single use parenteral medication should be administered to one patient only
Pre-filled medication syringes should never be used on more than one patient
A needed or other device should never be left inserted into a medication vial septum for multiple uses
This provides a direct route for microorganisms to enter the vial and contaminate the fluid
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CDC has Injection Safety FAQs for Providers
Multi-dose Vials
The safest thing to do is restrict each medication vial to a single patient, even if it's a multi-dose vial
Proper aseptic technique should always be followed
If multi-dose medication vials must be used for more than one patient, the vial should only be accessed with a new sterile syringe and needle
It is also preferred that these medications not be prepared in the immediate patient care area
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CDC has Injection Safety FAQs for Providers
To help ensure that staff understand and adhere to safe injection practices, we recommend the following:
Designate someone to provide ongoing oversight for infection control issues
Develop written infection control policies
Provide training
Conduct performance improvement assessments
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USP 797
USP published a revision to the USP general Chapter of 797
These standards apply to pharmacy compounded sterile preparation
This includes injections, nasal inhalations, suspensions for wound irrigations, eye drops etc.
Applies to the pharmacy setting as well as to all persons who prepare medications that are administered
And it applies to all healthcare centers58
USP 797 This chapter includes standards for preparing,
labeling, and discarding prepared medications
Pharmacies compound sterile preparations under laminar flow hoods with stringent air quality and ventilation to maintain the sterility of the drug (ISO class 5 setting)
If prepare outside the pharmacy then environment has particulates and microorganisms increasing the potential for contaminating the vial, IV solution or syringes Need to wash hands before preparing medication outside the
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USP 797
Want to prepare IVs and piggybacks in the pharmacy when at all possible
Breathing over the sterile needle and vial stopper can create the potential for microbial contamination
USP exempts preparation outside the pharmacy for immediate use
1 hour limit from completing preparation and this includes spiking an IV bag
Cost of medication disposal can be daunting if case not started within one hour which is why should consider pharmacy preparing under ISO class 5 environment
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USP 797 This way the drugs used for surgery are prepared
by properly trained, cleansed, and garbed personnel to prolong the usability of the immediate use compounded sterile drugs (CSD)
These can be stored for 48 hours
Another option is to located a manufacturers injectable product (prepackaged syringe) that is discarded according to manufacturer expiration date
APIC supports preparing parenteral medication as close as possible to the time of administration
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USP 797 APIC Recommendations Make sure only trained staff are preparing medications
Need to prepared in a clean dry workspace that is free of clutter and obvious contamination sources like water, sinks
Medications should be stored in a manner to limit the risk of tampering
Should verify the competency of those preparing medications and monitor compliance with aseptic technique
28 day discard date on multidose vials even though CDC says manufacturers recommendations
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APIC Recommendations
APIC issues recommendations and key talking points for hospitals and healthcare facilities
http://apic.informz.net/apic/archives/archive_272235.html
The infection preventionist at our facility has designed a coordinated infection control program
This is protect everyone coming in to our facility
Our program implements evidenced based practices from leading authorities including the CDC
APIC Recommendations Cleanse the access diaphragm of vials using
friction and a sterile 70% isopropyl alcohol, ethyl alcohol, iodophor, or other approved antiseptic swab
Allow the diaphragm to dry before inserting any device into the vial
Never store or transport vials in clothing or pockets.
Discard single-dose vials after use
Never use them again for another patient
Use multi-dose medication vials for a single patient whenever possible
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APIC Recommendations
Never leave a needle, cannula, or spike device inserted into a medication vial rubber stopper because it leaves the vial vulnerable to contamination
even if it has a 1-way valve
Use a new syringe and a new needle for each entry into a vial or IV bag
Utilize sharps safety devices whenever possible
Dispose of used needles/syringes at the point of use in an approved sharps container
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Blood Glucose Monitoring Devices APIC
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APIC Key Talking Points
This program includes
Rigorous hand hygiene practices
Monitoring the cleaning disinfection, and sterilization of equipment and instruments
An Exposure Control Plan that serves to minimize bloodborne pathogens such as HIV, Hepatitis B and C by patients and staff
As part of this program there are measures to prevent the re-use of items designed to be used only once such as needles and syringes
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A Patient Safety Threat-Syringe Reuse
CDC published a fact sheet called “A Patient Safety Threat- Syringe Reuse”
It was published for patients who had received a letter stating they could be at risk due to syringe reuse
Discusses the dangers of the reuse of syringes
Discusses that multidose vial be assigned to a single patient to reduce the risk of disease transmission
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Anesthesia DeliveryNevada clinics started with Lidocaine 1 cc and Propofol 9ccs in one syringe
Clean needle and syringe initially
If patient needed more used clean needle but used old syringe
If medication left in the single dose Propofol vial used to sedate the next patient
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Anesthesia Delivery
Propofol is single dose medication and preservative free
Bought 20-50cc vials but only used 10-15cc per patient
Clinic had not had full inspection by state surveyors in 7 years
Identified a number of infection control problems with ASC
CMS has new freestanding ASC CMC CfCs May 18, 2009 and revised December 30, 2009
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Never Event: Unsafe Injection Practices
The CDC has a website entitled “ A Never Event: Unsafe Practices”
Has a power point presentation and an audio presentation
Available at www.cdc.gov/ncidod/dhqp/COCA_Unsafe_Injection_Practices.html
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Hematology Oncology Clinic
Has an outbreak of HCV among outpatients 3-00 to 7-01
Reported to Nebraska Health Department
99 patients with clinic acquired HCV after having chemotherapy
All were genotype 3 a which is uncommon in the US
Related to catheter flushing
Source: Macedo de Oliveira et al., Annals of Internal Medicine, 2005, 142:898-902
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Hematology Oncology Clinic
Nurse drew blood from the IV catheter
Then she reused the same syringe to flush the catheter with saline
She did use a new syringe for each patient
However, she used solution from same 500cc bag for multiple patients
Oncologist and RN license revoked
Never use an IV solution bag to flush the solution for more than patient
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Other Cases Patient in US gets malaria from saline flush
Emerging Infectious Diseases, Vol 11, No. 7, July 2005
Oklahoma Pain Clinic where anesthesiologist filled syringe with sedation medication to treat up to 24 patients and injected via hep lock
71 patients with HCV and 31 with HBV
25 million dollar settlement
Source: Comstock et al. ICHE, 2004, 25:576-583
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Other Cases
19 patients get HCV in New York in 2001 from contamination of multi-dose anesthesia vials
CDC MMWR September 26, 2003, Vol 52, No 38
NY City private physician office with 38 patients with HBV
Associated with injections of vitamins and steroids
Gave 2 or 3 in one syringe Source: Samandari et al. ICHE 2005 26 (9);745-50
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Bacterial Outbreak Due to Unsafe Needle
7 patients get serratia marcescens from spinal injections in a pain clinic
Source: Cohen Al et al. Clin J Pain 2008; 24(5):374-380
Several other studies where patients got infection from joint and soft tissue injections
Got staph aureus
In 2003 and 2009
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Dialysis Facilities
CDC issues MMWR report April 2008
Dialysis units must follow CDC guidelines to receive Medicare payments for outpatient services
Recent outbreaks of HCV and other bacterial infections
From reentry into single dose medication vials to more than one patient
CDC recommends to use single dose vials
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Dialysis Facilities
If multi-dose then should be assigned to one person
Should be prepared in a clean area separate from potentially contaminated surfaces
Medications should be prepared in clean area removed from the patient treatment area because surfaces are subjected to frequent blood contamination
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Injections Safety and Recent Outbreaks
The CDC website has a slide presentation called “Injection Safety & Recent Outbreaks”
From APIC North Carolina October 5, 2009
Has 48 slides
Available at http://www.cdc.gov/ncidod/dhqp/injectionsafety.html
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WHO Injection Safety
The World Health Organization also has resources on injection safety
Recently had 10th annual meeting of the Safe Injection Global Network (SIGN)
Has revised injection safety assessment tool
73 pages document
http://www.who.int/injection_safety/en/
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WHO Safe Injection Tool
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WHO
Also has a 51 pages document
Covers the 2008 conference that was held in Moscow
Additional information about the Safe Injection Global Network (SIGN)
Includes a report of the SIGN
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One and Only Campaign
Educational awareness to improve safe practices in healthcare
One needle, one syringe, and only one time for each patient
To empower patients and re-educate healthcare providers
Has free posters
Coalition partners include APIC, AANA, CDC. AAAHC, Nebraska Medical Association, Nevada State Department of Health etc.
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http://oneandonlycampaign.org/
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Advancing ASC Quality
ASC Quality Collaboration has ASC tool kit for infection prevention
Includes one on hand hygiene and safe injection practices
Includes a basic and expanded version of the toolkit
These are available at http://www.ascquality.org/advancing_asc_quality.cfm
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The End Questions
Sue Dill Calloway RN, Esq. CPHRM
AD, BA, BSN, MSN, JD
President
Patient Safety and Healthcare Consulting
5447 Fawnbrook Lane
Dublin, Ohio 43017
614 791-1468
Avoiding Needlestick Follows114114
Avoiding Needle Stick Injuries
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Speaker
Sue Dill Calloway RN, Esq. CPHRM
AD, BA, BSN, MSN, JD
President
Patient Safety and Education
5447 Fawnbrook Lane
Dublin, Ohio 43017
614 579-1481
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OSHA
Ten years after the Needlestick Safety and Prevention Act was signed into law
Which is part of the OSHA Bloodborne Pathogen Standard (29 CFR 1910.1030)
OSHA announces a regulatory review of the law
Has this standard had a impact on healthcare worker safety?
Recent article says sharps in non-surgical setting has declined by about 32% 1
1 Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings versus non-surgical settings after passage of national needlestick legislation. J Amer Col Surg 2010; 210:496-502
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OSHA
Safely engineered devises have resulted in 74% decrease in injuries in phlebotomy
However, this is not true in the surgery operating room where adoption of blunt suture needles and other sharps safety measures have lagged
Sharps injury has increased from 1993 to 2006 by 6.5%
This regulation remains the most frequent cited standard in OSHA inspections of hospitals
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OSHA Inspectors were most likely to cite for failing to have
an adequate exposure control plan or failing to update the plan to reflect changes in technology
The standard requires employers to review their exposure control plans annually
Hospitals also were cited for failing to provide safety-engineered devices
Or failing to document that employees had been offered the hepatitis B vaccine
The same types of violations are being seen by ASCs
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www.osha.gov/SLTC/bloodbornepathogens/index.html
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Needlestick Safety and Prevention Act The Occupational Exposure to Bloodborne Pathogen
Standard was first published in 1991
Passed because of concerns to healthcare workers of things such as HIV, hepatitis B and C who were exposed to blood or other potentially infectious materials
saliva, blood, semen, cerebrospinal fluid, amniotic, synovial, pleural, pericardial, peritoneal etc
Employer needed an exposure control plan on details on employee protection measures
Engineering controls included safer medical devices, such as needleless devices, shielded needle devices and plastic capillary tubes
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Needlestick Safety and Prevention Act
Despite these advances with non-needle devises needlestick and sharps injuries continued
OSHA said there were nearly 600,000 percutaneous injuries involving sharps so Congress passed the Needlestick Safety and Prevention Act which became effective April 18, 2001 (passed November 6, 2000)
Still requires employers to adopt engineering and work practice controls that would eliminate or minimize employee exposure from hazards associated with bloodborne pathogens
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Needlestick Safety and Prevention Act
Need to pull out your exposure control plan every year
Need to do an annual review
Need to update to reflect changes in technology that help to eliminate or reduce exposure to bloodborne pathogens
Take into consideration new safer devices designed to reduce needlestick injuries
Document consideration and use of appropriate safer devices
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Sample Model Plans from OSHAwww.osha.gov/Publications/osha3186.html
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Needlestick Safety and Prevention Act
List employees involved and describe how input was requested or present minutes of meetings
Employers need to get input from employees responsible for direct patient care (non management such as nurses) on evaluation, identification and selection of effective and safer devices
Employees selected should include those exposure in different areas like peds, geriatrics, nuclear medicine etc.
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Needlestick Safety and Prevention Act
Engineering controls include things that isolate or remove a hazard from the workplace
Such as sharp disposal containers and self-sheathing needles
Sharps with engineered sharps injury protection (SESIP) includes nonneedle sharps or needle devices with safety features including Syringes with a sliding sheath that shields the attached needle after use
Needles that retract into a syringe after use
Shielded or retracting catheters
IV delivery systems that use a catheter port with a needle housed in a protective covering
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Needlestick Safety and Prevention Act
Needless systems include IV medication using a port with non needle connections or jet injection system that deliver liquid medicine under the skin or through a muscle
Employers must keep a Sharps Injury Log for the recording of percutaneous injuries from contaminated sharps
Remember that sharps containers must be easily accessible to employees and located as close as feasible to the immediate area where sharps are used
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www.cdc.gov/niosh/sharps1.html
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www.osha.gov/SLTC/bloodbornepathogens/index.html
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Sharps Safety
Have a policy and procedure on sharps safety
Include safety measures to prevent injury during perioperative care
Use double gloving, blunt suture needles for fascial closing and neutral zones, when appropriate, to avoid hand to hand passage of sharps
Include references position statements in P&P and where these are located1
1 www.cspsteam.org/sharpssafety/sharpssafety.html
Blunt Tip Suture Needles
Surgical personnel are at risk of bloodborne injuries from sharp surgical instruments
OSHA has document on the “Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel: Safety and Health Information Bulletin” 1
Sharp tip suture needles are the leading source of percutaneous injuries to surgical personnel causing 51 to 77% of these incidents
1 http://www.cdc.gov/niosh/docs/2008-101/
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Sharp-tip Suture Needles
Suture needle injuries can occur when surgical personnel;
Load or reposition the needle into the needle holder
Pass the needle hand-to-hand between team members
Sew toward the surgeon or assistant while the surgeon or assistant holds back other tissue
Tie the tissue with the needle still attached
Leave the needle on the operative field
Place needles in an over-filled sharps container or
Place needles in a poorly located sharps container139
National Associations Blunt Tip Suture
American College of Surgeons ACS) recommends in 2005 the universal adoption of blunt-tip suture needles for suturing fascia
Also encourages further investigation of their appropriate use in other surgical applications
AORN endorsed this ASC statement in support of blunt-tip suture needles where effective and clinically appropriate
Other organizations endorse such as ASA, ASPAN, AANA, American Association of Surgical PAs, and the Association of Surgical Technologists
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Blunt Tip Suture Needles
Blunt tip suture needles can be used to suture less dense tissue such as muscle and fascia
59% of the suture needle injuries occur when suturing muscle and fascia
Multiple studies have reported the effectiveness of blunt tip suture needles in decreasing percutaneous injuries
OSHA and NIOSH strongly encourage their use when feasible and appropriate
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AORN 2010 Page 697 Perioperative Standards and Recommended Practices
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ACS www.facs.org/fellows_info/statements/st-52.html
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www.cdc.gov/sharpssafety/
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Free Workbook from the CDC
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International Sharps Injury Prevention Society www.isips.org/
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www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_22.htm
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http://www.tdict.org/
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www.healthsystem.virginia.edu/internet/epinet//
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http://nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/occupationalhealth/SafeNeedles.aspx
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www.cdc.gov/niosh/topics/bbp/ndl-law.html
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www.facs.org/about/committees/cpc/preventingsharpsinjuries.pdf
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Resources
Jagger J, Bentley M, Tereskerz P. A study of patterns and prevention of blood exposure in OR personnel. AORN J. 1998; 67(5):979-81, 983-4, 986-7
Berguer R, Heller PJ. Preventing sharps injuries in the operating room. J Am Coll Surg. 2004; 199(3):462-7
Makary MA, Al-Attar A, Holzmueller CG, Sexton JB, Syin D, Gilson MM, Sulkowski MS, Pronovost PJ. Needlestick injuries among surgeons in training. N Engl J Med. 2007 Jun 28; 356(26):2693-9
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Resources
Davis MS. Advanced Precautions for Today's OR: The Operating Room Professional's Handbook for the Prevention of Sharps Injuries and Bloodborne Exposures, 1st ed. Atlanta; Sweinbinder; 1999.
American College of Surgeons (ACS). Statement on blunt suture needles. Bull Am Coll Surg. 2005 Nov; 90(11):24. Available from http://www.facs.org/fellows_info/statements/st-52.html
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Resources
Association of Perioperative Registered Nurses (AORN). AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting. In: 2005 Standards, Recommended Practices, and Guidelines. 2005; 199-204.
Available from www.aorn.org/about/positions/pdf/SECTI-2esharpssafety.pdf
Centers for Disease Control and Prevention (CDC). Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures-New York City, March 1993-June 1994. MMWR Morb Mortal Wkly Rep. 1997; 46(2):25-9.
http://www.cdc.gov/ mmwr/preview/mmwrhtml/00045660.htm 173
Resources
CFR (Code of Federal regulations). Title 29 Part 1910, OSHA. Washington, DC: U.S. Government Printing Office, Office of the Federal Register
Dauleh MI, Irving AD, Townell NH. Needle prick injury to the surgeon-do we need sharp needles? J R Coll Surg Edinb. 1994; 39(5):310-1.
Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings versus non-surgical settings after passage of national needlestick legislation. J Amer Col Surg 2010; 210:496-502
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Resources
Davis MS. Advanced Precautions for Today’s O.R. In: The Operating Room Professional’s Handbook for the Prevention of Sharps Injuries and Bloodborne Pathogen Exposures. Atlanta, GA: Sweinbinder Publications LLC; 2001.
Aarnio P, Laine T. Glove perforation rate in vascular surgery—A comparison between single and double gloving. Vasa. 2001;30(2):122-124.
Berguer R, Heller PJ. Strategies for preventing sharps injuries in the operating room. Surg Clin North Am. 2005;85(6):1288-305, xiii.
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Resources
Caillot JL, Cote C, Abidi H, Fabry J. Electronic evaluation of the value of double gloving. Br J Surg. 1999;86(11):1387-1390.
Dauleh MI, Irving AD, Townell NH. Needle prick injury to the surgeon—Do we need sharp needles? J R Coll Surg Edinb. 1994;39(5):310-311.
Eggleston MK Jr, Wax JR, Philput C, et al. Use of surgical pass trays to reduce intraoperative glove perforations. J Matern Fetal Med. 1997;6(4):245-247.
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Resources
Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures—New York City, March 1993–June 1994. MMWR Morb Mortal Wkly Rep. 1997;46(2):25-29.
Gerberding JL, Littell C, Tarkington A, et al. Risk of exposure of surgical personnel to patients’ blood during surgery at San Francisco General Hospital. N Engl J Med. 1990;322(25):1788-1793.
177
Resources
Hartley JE, Ahmed S, Milkins R, et al. Randomized trial of blunt-tipped versus cutting needles to reduce glove puncture during mass closure of the abdomen. Br J Surg. 1996;83(8):1156-1157
Hollaus PH, Lax F, Janakiev D, et al. Glove perforation rate in open lung surgery. Eur J Cardiothorac Surg. 1999;15(4):461-464.
Jagger J, Bentley M, Tereskerz P. A study of patterns and prevention of blood exposures in OR personnel. AORN J. 1998;67(5):979-981, 983-974, 986-977.
178
Resources
Jensen SL. Double gloving—Electrical resistance and surgeons’ resistance. Lancet. 2000;355(9203):514-515.
Laine T, Aarnio P. How often does glove perforation occur in surgery? Comparison between single gloves and a double-gloving system. Am J Surg. 2001;181(6):564-566.
Mingoli A, Sapienza P, Sgarzini G, et al. Influence of blunt needles on surgical glove perforation and safety for the surgeon. Am J Surg. 1996;172(5):512-516; 516-517.
179
Resources
Montz FJ, Fowler JM, Farias-Eisner R, Nash TJ. Blunt needles in fascial closure. Surg Gynecol Obstet. 1991;173(2):147-148.
Naver LP, Gottrup F. Incidence of glove perforations in gastrointestinal surgery and the protective effect of double gloves: A prospective, randomised controlled study. Eur J Surg. 2000;166(4):293-295.
Quebbeman EJ, Telford GL, Hubbard S, et al. Risk of blood contamination and injury to operating room personnel. Ann Surg. 1991;214(5):614-620.
180
Resources
Rice JJ, McCabe JP, McManus F. Needle stick injury. Reducing the risk. Int Orthop. 1996;20(3):132-133.
Stringer B, Infante-Rivard C, Hanley JA. Effectiveness of the hands-free technique in reducing operating theatre injuries. Occup Environ Med. 2002;59(10):703-707.
Tokars JI, Bell DM, Culver DH, et al. Percutaneous injuries during surgical procedures. JAMA. 1992;267(21):2899-2904.
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182
Resources
A recent CDC presentation on Unsafe Injection Practices, along with audio and a transcript of the presentation are available at: www.cdc.gov/ncidod/dhqp/COCA_Unsafe_Injection_Practices.html
Re: infection control and injection practices www.cdc.gov/ncidod/dhqp/ps_providerInfo.html
183
Resources
Re: protecting patients from bloodborne pathogens in healthcare settings www.cdc.gov/ncidod/dhqp/bp_patient.html
Re: prevention of surgical site infections www.cdc.gov/ncidod/dhqp/gl_surgicalsite.html
Re: hand hygiene in healthcare facilities www.cdc.gov/handhygiene/
184
Resources
Re: healthcare facility physical environment and infection control
www.cdc.gov/ncidod/dhqp/gl_environinfection.html
CDC’s home page for infection control provides links to additional information:
www.cdc.gov/ncidod/dhqp/index.html
185
Resources
Mast ST, Woolwine JD, Gerberding JL. Efficacy of gloves in reducing blood volumes transferred during simulated needlestick injury. J Infect Dis 1993;168(6):1589-92.
Henry K, Campbell S, Collier P, Williams CO. Compliance with universal precautions and needle handling and disposal practices among emergency department staff at two community hospitals. Am J Infect Control 1994;22(3):129-37.
186
Resources
Vaughn TE, McCoy KD, Beekmann SE, Woolson RE, Torner JC, Doebbeling BN. Factors promoting consistent adherence to safe needle precautions among hospital workers. Infect Control Hosp Epidemiol 2004;25(7):548-55.
Clarke SP, Rockett JL, Sloane DM, Aiken LH. Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses. Am J Infect Control 2002;30(4):207-16.
187
Resources CDC Training on Hepatitis
www.cdc.gov/hepatitis/Resources/Professionals/TrainingResources.htm
188
Resources
Danzig LE, Short LJ, Collins K, et al. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAMA 1995;273(23):1862-4.
189
Resources
Patel PR, Larson AK, Castel AD, et al. Hepatitis C virus infections from a contaminated radiopharmaceutical used in myocardial perfusion studies. JAMA 2006;296:2005--11.
CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47(No. RR-19).
Williams IT, Perz JF, Bell BP. Viral hepatitis transmission in ambulatory health care settings. Clin Infect Dis 2004;38:1592--8.
190
Resources
Comstock RD, Mallonee S, Fox JL, et al. A large nosocomial outbreak of hepatitis C and hepatitis B among patients receiving pain remediation treatments. Infect Control Hosp Epidemiol 2004;25:576--83.
Krause G, Trepka MJ, Whisenhunt RS, et al. Noscomial transmission of hepatitis C virus associated with the use of multidose saline vials. Infect Control Hosp Epidemiol 2003;24:122--7.
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The End Questions
Sue Dill Calloway RN, Esq. CPHRM
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