Preventing Sharps Injury

1. Ralph Lee Occupational Hygienist Infection Control Branch Centre for Health Protection 5 February 2005 Preventing Sharps Injury

2. Itinerary Legislations Occupational Exposures and Risks Risk Control Strategies Engineering Control Sharps Injury Log Overview of Sharps Injury Surveillance in US Current Status of DH and her needs

3. Legislations Local Legislations: Occupational Safety and Health Ordinance (Cap. 509) Employee Compensation Ordinance (Cap. 282) Occupational Safety and Health Administration (OSHA): 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens

4. Occupational Safety and Health Ordinance (Cap. 509) to ensure the safety and health of employees when they are at work; to prescribe measures that will contribute to making the workplaces of employees safer and healthier for them; to improve the safety and health standards applicable to certain hazardous processes, plant and substances used or kept in workplaces; generally to improve the safety and health aspects of working environments of employees.

5. General Duties of Employers ensure the safety and health at work provide or maintain plant and systems of work that are safe and without risks to health; make arrangements for ensuring safety and absence of risks to health in connection with the use, handling, storage or transport of plant or substances; provide information, instruction, training and supervision maintain the workplace in a condition that is safe and without risks to health; provide or maintain means of access to and egress from the workplace that are safe and without any such risks; provide or maintain a working environment for the employer's employees that is safe and without risks to health.

6. General Duties of Employees take care for the safety and health of persons (including the employee) who are at the employee's workplace and who may be affected by the employee's acts or omissions at work; as regards any requirement imposed in the interests of safety or health on the employee's employer or any other person by this or any other Ordinance, must, so far as reasonably practicable, co-operate with the employer or other person so far as may be necessary to enable the requirement to be complied with.

7. Notifiable Occupational Diseases Under section 15 of OSHO (Cap. 509) If, on examining an employee or a former employee or the body of a person who was immediately before the death an employee or former employee, a medical practitioner- finds or suspects that the employee or former employee is or was suffering from an occupational disease specified in Schedule 2; and believes that the disease was or may have been attributable to an occupation specified in column 3 of that Schedule, the practitioner must notify the finding or suspicion to the Commissioner.

8. Employee Compensation Ordinance (Cap. 282) Sch. 2 � Occupational Diseases B7 Parenterally contracted viral hepatitis Any occupation involving contact with-(a) human blood or human blood products; or(b) a source of viral hepatitis.

9. OSHA�s Bloodborne Pathogens Standard

10. Bloodborne Pathogens Standard 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens Published December 1991 Effective March 1992 Scope ALL occupational exposure to blood and other potentially infectious material (OPIM) OPIM: Semen, vaginal secretion, CSF, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, and any body fluid visibly contaminated with blood. Unfixed tissue / organ HIV containing cell or tissue cultures and organ culture uOPIM: Semen, vaginal secretion, CSF, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, and any body fluid visibly contaminated with blood. Unfixed tissue / organ HIV containing cell or tissue cultures and organ culture u

11. Bloodborne Pathogens Standard Major Provisions by Paragraph (b) Definitions (c) Exposure Control Plan (ECP) (d) Engineering and Work Practice Controls - Personal Protective Equipment (PPE) (e) HIV and HBV Research Labs (f) Vaccination, Post-Exposure Follow-up (g) Labeling and Training (h) Recordkeeping Labeling and training: biohazard label on container and waste. Record keeping includes medical record, training record, availability, transfer of records. And sharp injury log.Labeling and training: biohazard label on container and waste. Record keeping includes medical record, training record, availability, transfer of records. And sharp injury log.

12. Occupational Exposure and Risks

13. Blood and Body Fluid Exposure Percutaneous injury (e.g., needlesticks or cut with sharps, human bites) Contact of mucous membrane or non intact skin with blood or body fluid.

14. Risks of Needlestick & Sharps Injuries Source status Risks of infection HBsAg+ HBeAg + 30% HCV+ 3-10% HIV+ 0.3%

15. Risk of occupational HIV Transmission Route Percutaneous Mucous membrane Cutaneous

16. Common causes of percutaneous injuries Disposal-related causes Collision with health care worker or sharp Clean up Handling/passing device during or after use

17. Other Potentially Infectious Material (OPIM) Body fluids visibly contaminated with blood: Semen, vaginal secretions Cerebrospinal fluid (CSF) Synovial fluid Pleural and pericardial fluid Peritoneal fluid Pericardial fluid Amniotic fluid Unfixed tissue/organ HIV containing cell or tissue cultures or organ cultures

18. Methods of Compliance (OSHA BBP Standard) Universal Precautions Engineering and Work Practice Controls Personal protective equipment Housekeeping

19. Risk Control Strategies Engineering control Administrative control Record Keeping and Surveillance Work practice control Employee vaccination programme Treatment immediately after the accident Post-exposure prophylaxis

20. Engineering Control

21. Additional Definitions1910.1030(b) Engineering Controls - includes additional definitions and examples: Sharps with Engineered Sharps Injury Protections Needleless Systems

22. Engineering ControlsNew Definition �� means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.�

23. Remember� Engineering Controls reduce exposure to blood and OPIM Suction Canisters No-slip Flooring Sharps Containers As well as� Engineered Sharps

24. Needleless SystemsNew Definition Device that does not use a needle for: Collection of bodily fluids Administration of medication/fluids Any other procedure with potential percutaneous exposure to a contaminated sharp

25. Engineered SharpsNew Definition Non-needle sharp or a needle with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

26. Hypodermic syringes with �Self-Sheathing� safety feature

27. Hypodermic syringes with �Retractable Technology� safety feature

28. Phlebotomy needle with �Self-Blunting� safety feature

29. �Add-on� safety feature

30. Retracting lancets with safety features

31. Disposable scalpels with safety features

32. Engineering and Work Practice Controls Selection of engineering and work practice controls is dependent on the employer�s exposure determination.

33. Exposure Determination The employer must: Identify worker exposures to blood or OPIM Sticks and� SPLASHES AND SPLATTERS Review all processes and procedures with exposure potential Re-evaluate when new processes or procedures are used

34. Engineering and Work Practice Controls (con�t) The employer must: Evaluate available engineering controls (safer medical devices) Train employees on safe use and disposal Implement appropriate engineering controls/devices

35. Recordkeeping: OSHA 1910.1030(h)

36. Sharps Injury Log At a minimum, the log must contain, for each incident: Type and brand of device involved Department or area of incident Description of incident

37. Surveillance

38. Why Sharps Injury Surveillance? Benefits of aggregated data Confidential Identify devices that continue to result in injuries Serve as early warning for device or design-related injuries Identify job class, procedures, work activities, that continue to be at risk for sharps injuries.

39. Overview of Sharps Injury Surveillance Program in US California the first state in the U.S. to develop a voluntary sharps injury registry Collects data from acute care hospitals, home health agencies, and skilled nursing facilities. Collected 1940 reports from 442 facilities (Jan. 1998 - Jan. 2000). 2-year sharps surveillance Compile a list of safety device Aim at educating public with sharps / bloodborne pathogens Compile a list of available device 2-year sharps surveillance Compile a list of safety device Aim at educating public with sharps / bloodborne pathogens Compile a list of available device

40. Research Methods Developed injury log form for reporting Sent survey letter to 2550 California acute care hospitals, skilled nursing facilities and home health care agencies requesting data Sent follow up post card; second mailing Data coding, entry, cleaning and analyses

41. Inclusion Criteria Only includes injuries from sharp objects (not splashes, bites, or exposure to mucous membranes) Only injuries from contaminated sharps Injuries to employees (not patients or visitors)

42. Sharps Injury Log Form Description of the Exposure Incident Job Classification Department or work area Procedure Use of safety device (types & brands) How the incident occurred Body part injured Use of protective mechanism Opinion on safety device

43. Results of Surveillance Reported Injuries by Facility Type Recording Format Gender and Age of Injured Person Shift Worked Job Class Location Procedure

44. Results of Surveillance (Con�t) Facility Type vs. Injury Circumstances Job Class. vs. Injury Circumstances Job Class. vs. Procedure Injury Circumstances vs. Procedure Injury Circumstances vs. Type of Device Department Location vs. Procedure

45. Conclusion from the Surveillance Majority of reports were not in standardized format Nurses contribute to the majority number of injuries Substantial number of injuries in Patient Room High risk procedures: injection, venous blood taking Most frequent injury circumstances: during use of sharp Devices associated with injuries: disposable needle/syringe

46. Where are we now?

47. Our status: Sharps injury is classified as IOD Only reported and documented on IOD form Not designed explicitly for sharps injury Does not serve the purpose for risk assessment and surveillance either Rooms to improve by�

48. Future Plans/Recommendations for Department of Health Survey of Healthcare Professional in DH on Occupational Exposure to Blood and Body Fluids Establish and encourage the use of standardized reporting mechanism Set up a platform for central reporting and surveillance Collect sharps injury logs Change voluntary nature of reporting Develop recommendations based on injury circumstance and device type