Sharps Injury Prevention Program

					Sharps Safety In the Operating Room

   Creating an Injury Prevention Program
Through the OSHA and AORN Alliance, AORN developed this
presentation for informational purposes only. It does not
necessarily reflect the official views of OSHA or the U.S. Department
of Labor. 05/2009
               Objectives
• Discuss the regulations that impact an OR
  Sharps Safety program
• Describe the issues that effect sharps
  safety in the OR
• Discuss a process for creating an OR
  sharps safety program
• Identify barriers to the implementation of a
  sharps safety program
             Background
• Workplace Safety Task Force
• Position statement on Workplace Safety
• Web page
• Position statement on Safe work/Oncall
  practices
• Guidance document on Sharps safety
• Ergonomics
 Epidemiology of Bloodborne Diseases:

                                         HCV


• Bloodborne pathogens are
  viruses or infectious
  agents carried by human
  blood and body fluids.
  – They can enter our bodies
    and cause disease and
    immune deficiencies, which
    can sometimes lead to death.

• HIV, HBV, HCV

                                   HIV
Transmission of Bloodborne Pathogens
  • Blood & Body Fluids
          -from accidents, illnesses, medical procedures,
      research samples and handling medical waste
  •    Disease Transmission
          -through cuts, punctures, contact with broken skin,
      contact with mucous membranes

      Bloodborne Pathogen                       Prevalence*
      Hepatitis B                                  1 in 20
      Hepatitis C                                  1 in 50
      HIV                                          1 in 250
      •Prevalence in an average population, prevalence is higher for
      at risk populations
Prevalence of Bloodborne Pathogens in an Urban,
  University-Based General Surgical Practice*

      Prevalence of HIV, Hepatitis B and Hepatitis C
                 Among Surgery Patients
                              HIV &
         HIV      Hep B Hep C Hep C Any


          26%       4%       35%      17%      38%

  * Weiss, Makary, Wang, Syin, Pronovost, Chang & Cornwell
  Annals of Surgery, Volume 241, Number 5, May 2005
  Percentage of Patients with HIV &
     Hepatitis C for 4 Common
            Operations
       70
       60                                                HIV +
       50
                                                         Hep C +
       40
       30
       20
       10
        0
            lymph node drainage of open ventral small bowel
              biopsy    soft tissue hernia repair resection
                         abscess

* Weiss, Makary, Wang, Syin, Pronovost, Chang & Cornwell
Annals of Surgery, Volume 241, Number 5, May 2005
   The Bloodborne Pathogens Standard

• Promulgated by OSHA in 1991
  – Purpose: to protect all workers who may come
    into contact with human blood or body fluids as a
    routine part of their job
• Revised in 2001
   New definitions                                      29
   Additional requirements regarding safety devices
   Sharps Injury Log
• 29 CFR 1910.1030
  – Full text & additional information can be
    found on the OSHA website at:
    www.osha.gov/pls/oshaweb/owadisp.show_document?
    _p_table+STANDARDS&p_id=10051
    Joint Commission/Joint
Commission Resources Standards
        & Sharps Safety
• Infection Control Standards:
  – IC.1.10 The risk of development of a
    healthcare associated infection is minimized
    through an organization-wide infection control
    program
  – IC.4.10 Once the organization has prioritized
    its goals, strategies must be implemented to
    achieve these goals
 Joint Commission/Joint Commission
 Resources Standards & Sharps Safety
• Environment of Care Standards
  – EC.1.10 The organization manages safety
    risks
  – EC.3.10 The organization manages its
    hazardous waste risks (including infectious
    and regulated medical waste, including
    sharps)
  – EC.9.10(1) The organization establishes &
    implements processes for reporting and
    investigating occupational illnesses and
    injuries to staff
  – EC.9.30(1) Appropriate staff participates in
    implementing recommendations
  Joint Commission/Joint Commission
  Resources Standards & Sharps Safety
• Human Resources Standards
  – HR.2.10(3) Each staff member, licensed independent
    practitioner, student, & volunteer is oriented to: specific
    job duties & responsibilities & service, setting, or
    program-specific job duties & responsibilities related to
    safety & infection control
  – HR.2.10 Employee orientation provides initial job
    training & information
  – HR.2.20 Staff members, licensed independent
    practitioners, students, & volunteers, as appropriate,
    can describe or demonstrate their roles &
    responsibilities, based on specific job duties or
    responsibilities, relative to safety
  – HR.2.30 Ongoing education, including in-services,
    training, and other activities, maintains and improves
    competence
  Ambulatory Accrediting Bodies
• AAAHC
 – OSHA standards
• AAAASF
 – OSHA standards
      Healthcare Workers Exposed to
            Blood/Body Fluids

               Dental   Research
Housekeeping               1%      Clerical
                1%
    3%                               1%       Other
                                               4%
    Students
       3%
  Technician
     13%
                                                      Nurse
                                                       44%

                  Physician
                    30%
                               NaSH data, 23 hospitals, 1995-1999
                   Needlestick Risk




 Hollow-bore needles and other devices associated with
percutaneous injuries in NaSH hospitals, by % total percutaneous
injuries (n=4,951), June 1995—July 1999. (Source: CDC [1999].)
                   Needlestick Risk




Causes of percutaneous injuries with hollow-bore needles in NaSH
hospitals, by % total percutaneous injuries (n=3,057), June 1995—July
1999. (Source: CDC [1999].)
Creating a Sharps Safety Program
            in the OR
• Engineering Controls
  – Tools, instruments, sharps shelters

• Work Practices
  – Safe zone, double gloving, one-hand re-capping only when
    unavoidable

• Making Changes
  – Assembling committee, evaluating product and selecting safety
    sharps, participating in education & in safety conversion
  Implementation Suggestions
• Use scalpel blades with safety blades




             Reusable        Disposable
  Implementation Suggestions
• Use mechanical /instrument tissue
  retraction
  Implementation Suggestions
• Use blunt retractors
  Implementation Suggestions
• Alternative cutting methods
• Cautery
• Harmonic scalpel




            Cautery
                            Harmonic Scalpel
  Implementation Suggestions
• Use blunt suture needles, stapling devices
  or steristrips


          Blunt suture needle
                                    Steristrips




          Stapler
      Implementation Suggestions
• Keep used needles on the sterile field in a
  disposable puncture resistant needle container
  Implementation Suggestions
• Adopt a hands-free technique of passing suture
  needles and sharps between perioperative team
  members
   Implementation Suggestions
• Use a one handed or instrument assisted
  suturing technique to avoid finger contact
  with needles
• Use ―control-release‖ or ―pop-off‖ needles
  Implementation Suggestions
• Double glove during all surgical
  procedures
    Implementation Suggestions
       DO NOT bend, break or recap contaminated needles




If re-capping is absolutely required, use
one-handed scoop technique: (1) Place needle cap on table
                                 (2) Holding the syringe only,
                                     guide needle into cap
                                 (3) Lift up syringe so cap is
                                     sitting on needle hub
                                 (4) Secure needle cap into place
            Sharps Disposal

• Closable orange or red, leak-proof
  puncture resistant containers
• Located close to the point of use
  maintained upright
• Replaced routinely and not allowed to
  overfill
• Wall mounted
• Floor mounted
 Sharps Disposal: New Containers
                                 Safety sharps containers
                                 Goal: to Prevent Needlesticks
                                 • Counter-balanced drop in
                                 prevents children’s fingers from
                                 getting in
                                 • Automatically closes at ¾ full –
                                 prevents overfilling



Reusable sharps containers
Goal: to reduce landfill waste
• Outside contractor removes
contaminated sharps, cleans container
and returns it
      Employer Responsibilities
•   Comply with regulations
•   Create a safety-oriented culture
•   Encourage reporting
•   Analyze data
•   Provide training
•   Evaluate devices
•   Establish safe staffing patterns
       Worker Responsibilities
• Observe regulations
• Comply with methods available to protect
  yourself
• Practice using safety devices
• Use safety devices
• Actively participate in evaluation and safety
  conversion process
      Worker Responsibilities
• Use appropriate personal protective equipment
• Use appropriate sharps containers
• Participate in education and follow
  recommendations
• Support others to follow the recommendations
• Follow your exposure control policy
      Worker Responsibilities
• Report Exposures
 – Employers required by OSHA to document all staff
   exposures to blood / body fluids anonymously
    • OSHA 300 Log
    • Sharps Injury Log
       – Location, job title, description of incident, type
         & brand of sharps involved
 – Source testing, risk analysis & post-exposure
   prophylaxis if indicated
        Implementation Statistics
• In a nationwide survey…
    – 71% of respondents indicated they had not evaluated
      use of blunt tip suture needles in the OR
    – 2% had fully implemented blunt tip suture needles
    – 14% of respondents had implemented safety scalpels
      into the OR




AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting
            BARRIERS TO
          IMPLEMENTATION
• Psychosocial and organizational factors
• Attitude/Resistance to Change
• Shortcomings associated with safety devices
• Perceived cost associated with engineered
  devices
• Inadequate training
• Time limitations
         Overcoming Obstacles to
               Compliance
• Frequent and multiple training methods
• Multidisciplinary sharps injury prevention plan
• Educate new employees and incoming residents and
  medical students
• Multidisciplinary sharps safety committee
• Network with other facilities
• Involve front-line workers in evaluation and selection of
  safety devices
       Overcoming Obstacles to
             Compliance
• Collaborate with personnel who use the device
  and facilitate change
• Discuss current research
• Work with resistant team members
• Remove old technology when new is trialed and
  available
• Create a Culture of Safety
                 What’s New
• Collaboration with NIOSH – Memorandum of
  Understanding
• ACS statement on the use of blunt suture Needles
• Letter to ACS
• CDC National Sharps Injury Prevention Meeting
  9/12/2005
• ACS Statement on Blunt Suture Needles 6/05
• OSHA Safety and Health Information Bulletin: Use of
  Blunt-Tip Suture Needles to Decrease Percutaneous
  Injuries to Surgical Personnel 3/07
              Further resources
•   http://www.isips.org/
•   http://www.isips.org/prevention.html
•   http://www.nursingworld.org/needlestick/needleguide.pdf
•   http://www.osha.gov/OshDoc/data_BloodborneFacts/bbf
    act01.pdf
•   www.osha-
    slc.gov/SLTC/needlestick/saferneedledevices/saferneedl
    edevices.html
•   www.cdc.gov.sharpssafety/
•   www.premiersafetyinstitute.org
•   www.cdc.niosh/topics/bbp/safer/
•   www.JCAHO.org
•   www.aorn.org
Yesterday –Today
Through the OSHA and AORN Alliance, AORN developed this
presentation for informational purposes only. It does not
necessarily reflect the official views of OSHA or the U.S. Department
of Labor. 05/2009