Naval Medical Center Branch Medical Clinics Portsmouth VA Blood Borne Pathogen Exposures

1. Naval Medical CenterBranch Medical ClinicsPortsmouth VA Blood Borne Pathogen Exposures CDR Moore H. Jan, MC, USN Department Head, Occupational Medicine NMCP and BMCs 17 Feb 2005

2. Introduction Hampton Road Navy Occupational Health Clinics Appx 30,000 visits per year Roughly 150 blood borne pathogen exposures per year (reported) Little over 100 from the medical center alone

3. Introduction OSHA�s Blood Borne Pathogen standard requires a formal program of monitoring, assessment, and training. Both OSHA and BUMED (msg R131551Z Sep 01) emphasize conversion to safe needle devices Hepatitis B infection rate from an accidental exposure can be as high as 30% However, usually significantly less

4. Introduction Most blood pathogen exposures are entirely preventable Each exposure is an unnecessary, avoidable cost Not an acceptable risk of doing business

9. 2004 NMCP Sharps Exposures by Occupational Category, %

10. 2004 NMCP Leading Locations for Sharps Exposures

11. 2004 NMCP Devices Involved in Sharps Exposures

12. Subgroup Analysis-OR

14. 2004 OR Needlesticks by Occupation, %

15. 2004 OR Devices Involved in Sharps Exposures

19. Observations Sharps exposures significantly exceed body fluid exposures BMCs account for relatively few Blood Borne Pathogen (BBP) exposures Medical Center is where most of the exposures occur

20. Observations Medical Center sharps exposure rate (per # occupied beds) exceeds several available civilian benchmarks Military benchmarks do not exist There may be significant differences between civilian and military MTFs (e.g., corpsmen) However, our rate is comparable to other Navy medical centers

21. Observations Overall corpsmen account for nearly 50% of exposures Followed by docs (25%) and nurses (16%) OR accounts for largest proportion (nearly half) of sharps exposures Staff surgeons (31%) and surgical tech students (29%) account for the largest proportions Suture needles involved in 56% of OR exposures (leading device)

22. Observations While ortho does not have the highest rate of exposures (per caseload), it is the only surgical dept where we can say the risk of exposure is probably > 0 for 2004 (? = 0.05)

23. The NMCP Approach Data clearly show that initial efforts to decrease total BBP exposures should be directed at the OR. We conduct periodic inservices for OR staff and provide regular feedback We have notified staff of the local NSHS Surgical Tech School and provide regular feedback We have established contact with surgical depts and provide regular feedback Yet our numbers have not dropped significantly

24. The NMCP Approach We are now looking at more innovative methods of effecting change Failure modes and effect analysis Retrospective analysis of OR exposures for trends (root cause analysis)

25. The NMCP Approach Other strategies Continue to emphasize (proper) use of safe needle devices We conduct periodic worksite visits at both the medical center and branch medical clinics to assess use of safe needle devices We ensure that the annual review of safe devices is conducted by departments as required by OSHA

27. Questions?