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									Workbook for Designing,
     Implementing and
    Evaluating a Sharps
      Injury Prevention
               Program
   The Problem of Sharps Injuries


• CDC estimates ~385,000 sharps injuries
  annually among hospital-based healthcare
  personnel*
• Sharps injuries are a hazard
  – Increased risk for bloodborne virus transmission
  – Cost to workers and healthcare system

  *Panlilio AL, et al. Infect Control Hosp Epidemiol, 2004
Sharps Injuries Are Preventable

    Preventability of Needlestick Injuries involving
     Hollow-bore Needles in 78 NaSH Hospitals,
        June 1995 to December 2004 (n=11,625)
   Bloodborne Virus Transmission


                                Risk from
          Virus            Percutaneous Injury

 Hepatitis B virus (HBV)         6%-30%*
 Hepatitis C virus (HCV)        Approx. 2%
Human immunodeficiency            0.3%
         virus (HIV)
                           *Risk applies to
                           unvaccinated workers only
    The Costs of Sharps Injuries


• Medical costs
  – $71 to ~$5,000 per exposure*

• Lost time from work
• Emotional cost
• Long-term costs
    *   O’Malley EM, et al. Infect Control Hosp Epidemiol, 2007
Needlestick Safety and Prevention Act (2000)



  • Federal OSHA standard requires:
    – Use of engineering and work practice controls
    – Recordkeeping on a Sharps Injury Log
    – Written Exposure Control Plan
           Exposure Control Plan


• Must reflect changes in technology use for
  prevention
• Document annual consideration, evaluation of
  safer sharps devices
  – Employers are required to solicit input from direct
    patient care personnel regarding the identification and
    selection of engineering and work practice controls.
               Recent OSHA Citations


• July 2003: Fined nursing home $92,500 for
  “serious” and “willful” violations
   – Levied maximum fine for willful violations: failure to utilize
     sharps safety devices

• September 2003: Hospital fined $9,000
   – Complaint filed by staff that safety-engineered devices were
     not available

Source: Advances in Exposure Prevention
          Purpose of Workbook


• Assist healthcare facilities to organize a sharps
  injury prevention program
• All-in-one tool that helps:
   – Develop and maintain a program
   – Enhance or augment existing programs
      The Workbook will help…


• Assess a facility’s sharps injury
  prevention program
• Document a prevention plan and
  implementation of activities
• Evaluate the impact of prevention
  measures
       Contents of the Workbook


• Overview of sharps injury epidemiology and
  prevention strategies
• Organization-wide method of developing
  prevention program
  – Based on model of Continuous Quality Improvement (CQI)

• Program model of operational processes
• Program resources
           Organizational Steps


1. Develop organizational capacity
  –   Form a multidisciplinary leadership team

2. Assess the operational processes of the
   prevention program
3. Prepare a baseline profile of sharps injuries
   and current prevention activities
   Organizational Steps (cont’d.)


4. Determine prevention priorities
5. Develop and implement Action Plan
  – Action plan focuses on reducing injuries and
    improving program activities

6. Monitor performance improvement
Operational Processes




Essential activities of any
sharps injury prevention
         program
           Operational Processes


• The 5 processes:
  – Develop an institution-wide culture of safety in the
    work environment
  – Promote reporting of sharps injuries and injury
    hazards
  – Analyze sharps injury data for prevention planning
  – Select/evaluate sharps injury prevention devices
  – Educate and train healthcare personnel
              Operational Processes:

Culture of Safety
  Culture of safety: the shared commitment of management and
  employees to ensure the safety of patients and personnel

• Measures of safety culture are linked to:
   – Reductions in sharps injuries
   – Personnel compliance with safe work practices
   – Availability of devices with engineered safety features

• Workbook contains:
   – Strategies for creating a culture of safety
   – Survey form for measuring the safety “climate” among personnel
            Operational Processes:


Injury Reporting

 • Under-reporting of sharps injuries continues to be
   an issue at healthcare facilities
     – Varies by occupation, department and facility
     – Is influenced by the safety culture and safety climate
 • CDC NaSH data from 38 hospitals, 1996-2003
     – only 45% of total injuries are reported
          Operational Processes:


Injury Reporting (cont’d.)

     • Workbook tools:
        – Reporting survey
        – Blood and body fluid
          exposure report form
        – Sharps injury hazard
          observation and report forms
        – Root cause analysis form
         Operational Processes:


Analysis of Data

 • Analysis of sharps injury data drives
   prevention planning
 • Workbook features:
    – Instructions for compiling and analyzing data
    – Directions for calculating sharps injury rates
            Operational Processes:


Selection/Evaluation of Devices

 • A Systematic approach for selecting devices ensures:
    – comprehensive review of devices
    – thorough selection process

 • Key elements of this approach:
    – Team input
    – Review current device use, prioritize devices for consideration
    – In-use evaluation of new devices
           Operational Processes:


Selection/Evaluation of Devices (cont’d.)

  • Workbook tools:

     – Survey of device use (by department or unit)
     – Device pre-selection worksheet
     – Device evaluation form
         Operational Processes:


Education and Training of Personnel


    • Workbook features:
       – General guidance on sharps injury
         prevention education and training
       – List of websites of other educational
         resources
                  Other Resources


• Sections on safe work practices and problem-
  specific strategies for preventing sharps injuries
• Cost analysis
   – Sample form for estimating cost of needlesticks
   – Sample form for estimating device-specific injury costs
   – Sample form for estimating device implementation costs
                      Summary


• Sharps injuries are an important concern
  – Increased risk of disease transmission
  – High costs to personnel and healthcare system

• Most sharps injuries are preventable
• Needlestick Safety and Prevention Act
  requires prevention efforts be undertaken
           Summary (cont’d.)


• Workbook is a comprehensive collection of
  valuable resources
• Valuable in development of sharps injury
  prevention program
• Potential to enhance current prevention
  activities
          Summary (cont’d.)


• Useful Workbook tools may benefit
  other organizational processes by:
  – Enhancing teamwork
  – Improving perceptions of safety culture
  – Reducing costs due to more effective,
    focused prevention efforts
Optional Extra Slides
Sharps Injuries at [insert your hospital name]
       by Distribution of Safety Device
          Sharps Injuries at
[insert your hospital name] by Device
              Sharps Injuries at
[insert your hospital name] by Work Location
Sharps Injuries at [insert your hospital name]
           by Occupational Group

								
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