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Story Teller - Rhea Martin

No Needle Stick Injury ……. Story Teller - Rhea Martin Story Assistants - O’Leary D, Heland M, Wake F, Naidoo H, Schleiger C, Tait T & Grayson ML. Once upon a time…. 33 yo resident NSI from IV cannula Hepatitis C seroconversion 3 weeks later Severe acute hepatitis requiring hospitalisation

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Story Teller - Rhea Martin

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  1. No Needle Stick Injury ……. Story Teller - Rhea Martin Story Assistants - O’Leary D, Heland M, Wake F, Naidoo H, Schleiger C, Tait T & Grayson ML.

  2. Once upon a time….. • 33 yo resident • NSI from IV cannula • Hepatitis C seroconversion 3 weeks later • Severe acute hepatitis requiring hospitalisation • Interferon and Ribavirin • Re admitted with depression • Off work 1 year

  3. The facts...Current Rates of HCV Exposures in HCWs in Melboune

  4. A bad luck story…..Hepatitis C Risk Assessment • transmission rate 3% to 10% • mortality rate for HCV infection of 5% to 7%1 • greatest risk = hollow-bore, blood-filled needles eg. peripheral I.V. catheters and blood drawing devices2 1Gerberding JL. Management of occupational exposures to blood-borne viruses. N Engl J Med 1995; 332:444-451. 2Lemon S, Brown E. Hepatitis C Virus. Principles and Practice of Infectious Disease. Ed. Mandell GM, Bennett JE, Dolin R 1995: 1474-86

  5. Risk In Victoria it is estimated that between 3 – 5 health care workers will get Hepatitis C from a needle stick injury per annum

  6. More facts….Consequences for HCW • Personal Health • Their work • The safety of their patients

  7. ….Consequences for Patient For a HCV +ve surgeon, the risk to patients is • 1 in 1,750 - 16, 000 per operation1 • 2.3% risk NSI, 27% recontact, 2.2% seroconversion • 6.8% risk of transmitting it per year (500 operations pa) • 50.3% risk over 10 years 1Rosset al. Arch Int Med 2000; 160: 2313

  8. Another true story... • I sustained a needlestick while starting an intravenous line . I was 23 years old, a registered nurse working in the Intensive Care Unit. I had received in-depth training and inservicing on safety and technique from my hospital. I was complying with all recommended precautions at the time of my needlestick, but it was not enough to prevent the injury. While removing the needle from the patient’s vein, he suddenly moved his arm and knocked mine. The motion forced the bloody exposed needle directly into my left palm. It punctured my latex gloves (Arnold, 1996).

  9. The plot thickens… a visit by worksafe • ·December 2000 Cannula Related Injury • ·June 2001 VWA Improvement Notice • ØReduce risk associated with cannulas so far as is practicable • ØIntroduce safety cannulas in all applications unless contraindicated by hospital Policy • ØBefore 28/02/02

  10. Great, we’ve got a PIN (what’s that?) • Cannot have a paper system • Hierarchy of Control • - elimination • - substitution • - engineering • - administration • - personal protection • Safe System of Work

  11. And so ….if you don’t • ·       Contravention • Ø    $600,000 corporation • Ø    $120,000 individual • Ø    Daily contravention • ·       Premium Impact of Needlestick • Ø    $344,000 one year • Ø    VWA now using solicitors from legal panel to assign estimates to all claims with common law liability • Ø    Each needlestick workcover claim = $300K 

  12. The good news….Minimise infectious risks:prevent adverse events • Unsafe acts are like mosquitoes. You can try to swat them one at a time, but there will always be others to take their place. The only effective remedy is to drain the swamps in which they breed. In the case of errors, the "swamps" are equipment designs that promote operator error, bad communications, high workloads, budgetary pressures, …

  13. ARMCNo-Needle-Stick Program • Components: • Corporate commitment • Integrated education and accreditation program • Needleless IV system • Specified IV insertion trolleys • Safety cannullae

  14. Optiva Safety Cannula - Choice Terumo B&D Autoguard J&J Acuvance J&J Protective Plus

  15. Results from Acuvance Trial

  16. Action Plan • Executive approval for NSI Program • including introduction of J&J Acuvance cannulae • Expedite necessary steps to comply with Workcover PIN

  17. Action Plan • Executive approval for NSI Program • including introduction of J&J Acuvance cannulae • Expedite necessary steps to comply with Worksafe PIN • Program implementation: • Establishment of education program for: • Current RMOs and interns • High user groups - ICU, Anaesthetics, ER & Radiology • Purchase of safety cannullae - 1 week • Purchase of IV trolleys - 2-3 weeks • Complete formal NSI policy - 2 weeks • Publicise ARMC NSI Program

  18. Action Plan • Executive approval for NSI Program • including introduction of J&J Acuvance cannulae • Expedite necessary steps to comply with Workcover PIN • Program implementation: • Establishment of education program for: • Current RMOs and interns • High user groups - ICU, Anaesthetics, ER & Radiology • Purchase of safety cannullae - 1 week • Purchase of IV trolleys - 2-3 weeks • Complete formal NSI policy - 2 weeks • Publicise ARMC NSI Program • Media release

  19. A Fairy Tale Ending Worksafe Award "Best Risk Solution"

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