1/2 Day seminar – Preventing Sharps Injuries

I’ve exciting news!

A major player has agreed to sponsor a 6-city Sharps Injury Seminar in US and Canada.

SI have not decreased as expected. The impact of safety engineered devices (SED) has plateaued and HCW are asking what more can they do?

Myself and two other passionate experts are determined to put SI back on the radar with 3 educational outcomes covering:

  1. Incidence and trends
  2. Impact on HCW
  3. Successful prevention strategies

The seminar is CEU accredited and will be held in Philadelphia, Chicago, Orlando, Montreal, Vancouver and Toronto.

Sponsorship has enabled a very low fee. Click here for your city and more details

Shall we do the sick (and non-sick) no Harm!

Survey Finds 4 in 10 Healthcare Professionals Work While Sick

A new study published in Nov 2017 Amer J Infect Control and highlighted by Infection Control Today found 41% of HCW continue to work while experiencing influenza-like symptoms.  

Pharmacists and Physicians had highest % (see below), and Long-term care workers had lowest (29%).

With higher numbers of older patients and immunocompromised patients (and risk to colleagues), the authors ask that healthcare facilities encourage staff to stay home while ill .

Reasons for continuing to work were:

  • Could still perform job
  • Not really “sick enough” to stay home
  • Not really contagious
  • Professional obligation to assist co-workers
  • Difficulty finding replacement

EXPO-STOP 2015 -a small decrease in US Sharps Injuries

Our EXPO-STOP 2015 results, published online in July AJIC, show a small reduction in sharps injuries since 2001

181 hospitals from 34 states contributed data to EXPO-STOP 2015, making it the largest of our 6 EXPO-STOP annual surveys .

Of the 9,343 exposure reported, 71% were sharps injuries (SI) and 29% were mucocutaneous exposures. Of total sharps injuries reported, 38% were during surgical procedures.

The SI rate was 25.2 per 100 occupied beds (OB) however we concluded that “Occupied Beds” is no longer a valid denominator  as it does not include the rising number of patients seen as day cases.

We believe “FTE” is the gold standard as it includes ALL staff no matter how patients are seen – and the 2015 rate was 2.1/100 FTE – significantly less than the 2.7/100 FTE EPINet found in 2001.

But the reduction is not enough. We estimate over 300, 000 US HCW sustain SI annually – that’s 800 every day of the year!

Click here for an ‘Author Copy’ of our paper (if you are an APIC member click here for the AJIC published article ).

And our publication “5 Proven Strategies to Reduce Sharps Injuries” has now been made freely available by AOHP- click here for copy.


AOHP offers “Sharps injury reduction strategies” free to all

The Association for Occupational Health Professionals (AOHP) have offered a valuable high-interest article free of charge .

JAOHP recently published its member-survey which ascertained their strategies to reduce sharps injuries and mucocutaneous blood exposures.

In the EXPO-STOP 2015 survey the “top” low incidence hospitals had SI incident rates 70% below the U.S. national average. The paper outlines their effective strategies.

Click here for the announcement and then click  within to get the free PDF article.

A 7min video on Sharps Injuries in USA

How many sharps injuries occurred to US Healthcare workers in 2015 and how do we prevent them?

At the Association for the Healthcare Environment annual conference in Pittsburg last year, I was asked if I would do a brief video on sharps injuries.

I jumped at the offer (of course)  and spoke on the EXPO-STOP survey that Dr Linda Good and I conduct annually for the Association of Occupational Health Professionals (AOHP).

The 2015 data showed that:

  • Approximately 1,000 HCW sustan a sharps injury DAILY
  • 40% of reported sharps injuries  were from nurses, 35% doctors; and 2-4% were environmental services staff
  • Of EVS staff, the two main causes were (I) handling sharps containers (ii) improper disposal of sharps (left on floor, bed, table, etc)
  • Four prevention strategies were:
    • Helping your institution become more sharps aware
    • Using safety engineered devices more frequently and more correctly
    • Training staff until they are competent in the use of that device/procedure
    • Investigating EVERY sharps injury
  • Thanks to AHE, if you would like to use the video in your training sessions click here.

Sharps Injuries among Australian Healthcare Workers

Sharps Injuries are far too frequent among Australian healthcare workers (HWC)

Accidental sharps injuries (SI) via needles, sutures, etc, all carry a small but real risk of transmitting bloodborne diseases like HepB, HIV, etc., to the injured HCW.

In fact, Tarantola et al state there are 60 infectious diseases that can be transmitted by these injuries.

At the Australasian College of Infection Prevention and Control (ACIPC) 2016 conference, myself, Nicole Vaust and Jane Parker presented the results of a national survey we conducted among ACIPC members (with ACIPC and Ethics approval)

We asked members 9 questions on their institution’s 2014 occurrence of SI and mucocutaneous exposures (blood splashes to face, etc) – 307 hospitals from 6 states participated, making the survey one of largest in Australia – and we were surprised at the results.

Three out of every hundred HCW reported a sharps injury in 2014 (higher than USA rate); 51% of reported SI were nurses and 37% doctors; and 47% of all SI occurred during surgical procedures.

Extrapolating to Australia nationally, this means over 30,000 HCW sustain an SI annually – 80 per day!

Could it be that Australian HCW are not using safety engineered devices often enough? Or correctly?

What is clear is that this issue needs greater attention at state, perhaps federal legislative level – as it has in most developed countries.

click here for our poster

We will shortly submit our manuscript to the ACIPC Journal of Infection, Disease and Health – so watch this space.

A sleuth story Patricia Cornwall would appreciate

Microbes, a Pharmacy Clean Room, Waste Bins, ATP, and a keen-eyed pharmacist

Recently I was part of a trio who presented an intriguing case-study of a microbiological contamination issue in a pharmacy clean room – it took months to solve, and ATP proved an excellent tool.

Tyler Weaver, Josh Guinter (Children’s Hospital of Philadelphia) and I delivered our paper entitled “Resolving microbial contamination of reusable waste bins in a pharmacy clean-room” at the Sept Association for the Healthcare Environment (AHE) conference in Pittsburg PA.

We are soon to publish – in meantime click here to view our PowerPoint presentation.

The story in a nutshell…

  Within a hospital, a Pharmacy Clean Room (PCR) is where sterile medications are prepared for patients – it is an “inner sanctum” with restricted access and is regularly tested for microbes to ensure all surfaces are scrupulously decontaminated to an ISO Standard – at a level higher than operating rooms.

A recent failure in a PCR resulted in 753 patients being infected with 64 deaths across 20 USA states.

The problem

  • PCR work-surfaces are required to be regularly tested for microbes. Two tests in PCR exceeded allowable level – triggering immediate action
  • Surfaces and ducts were scrupulously cleaned – but tests failed a second time. Several weeks of investigations proceeded
  • Then a keen-eyed pharmacist noticed a gown-tie moving as it hung from a waste bin in the PCR
  • Tie-movement meant air-flow; airflow meant bugs could waft in air – perhaps bin was source?
  • The reusable bins were tested, found to have very high microbial counts, and bin-vendor A was asked to remedy

The remedy

  • Microbe tests are expensive, so bins were ATP-tested as surrogate (ATP detects microbes and other living cells)
  • Bin-vendor A could not reduce ATP count to target-level  of <250 Relative Light Units (RLU) – aver of highest counts was 14,844 RLU
  • Second vendor (Vendor B) supplied bins for testing – all passed – aver of highest counts was 103 RLU – hospital changed to Vendor B for PCR.
  • No further PCR work-surface tests failed.

The explanation

  • Vendor A supplied bins “nested”. Entrapped moisture in bottom bin enabled microbial growth
  • When pushed into bin, discarded gowns created “piston effect” liberating microbial aerosol which wafted onto PCR work-surface
  • Vendor B wash process had higher level of bin decontamination. Bins supplied individually, not nested.
  • In 4 years: bins have exceeded ATP threshold of 250 RLU occasionally, and none since Aug 2015; no failures in PCR work-surface microbe tests have occurred.

Take Home Messages

  • Vendors of reusable bins have differing wash, drying  and delivery processes. Ask for details of processes and ATP-test (particularly if for PCR use).
  • ATP testing using a threshold of 250 RLU is a useful adjunct for checking QA of external waste bins used in PCR

EXPO-STOP 2015 Blood-exposure Survey – Sneak Preview

AOHP EXPO-STOP blood-exposure survey is too large for one post – but here’s a sneak preview

The 2015 EXPO-STOP blood exposure survey of the Association of Occupational Health Professionals in Healthcare (AOHP) will take several publications to convey all the data to readers – so Linda Good and I wanted to share the presentation we delivered at the Sept 2016 AOHP Conference in Myrtle Beach SC, USA.

In this 5th annual EXPO-STOP survey, 182 hospitals from 38 states participated  – making it USA’s largest.

The PowerPoint covers: the 2015 EXPO-STOP national blood exposure incidence; proven strategies to reduce sharps injury (SI) incidence; and url’s of many resources

Take Home Messages

  • USA SI incidence is 2.1 per 100 FTE hospital staff – a significant decrease from 2.7 in 2001
  • Nurses at 3.2 SI/100 FTE represent 46% of all reported SI (Drs 32%)
  • Surgical SI = 38% of all SI reported
  • But… this incidence means 320,000 HCW sustain SI annually – almost 1,000/day.
  • Renewed focus on prevention strategies is needed
  • Best practices include more effective Safety Devices, Competency training, Communication to all, Investigation, Engagement – particularly in OR.

Click here for download of PPT presentation

Watch this Space! – the top proven SI prevention strategies will be published in JAOHP Winter Issue in March 2017

AOHP’s latest 2013 & 2014 Blood Exposure Study

The USA Association of Occupational Health Professionals in Healthcare (AOHP) has issued a press release on the publication of their 2013-14 survey of Blood exposure incidence among US healthcare workers (HCW).

The survey, AOHP’s third in their annual series, and in which 84 hospitals in 28 states participated in supplying their 2013 and 2014 data, shows a significant rise in exposure incidents among US HCW.

Using “per 100 occupied beds” as the denominator, the 2014 sharps injury (SI) rate of 33.3, is significantly higher than the 24.0 in AOHP’s 2011 survey, and significantly higher than the EPINet rate of 22.2 in 2001, the year safety engineered devices (SED) became mandatory.
Exposure incidents include the HCW being stuck with a blood-contaminated needle or having a patient’s blood or blood-contaminated fluids splashed onto them. Each such incident carries a small but definite risk of transmitting one or more of 60 diseases, the three most well-known being HIV, Hepatitis C and Hepatitis B.

The denominator showing the highest rise was “Occupied beds” and this may reflect  the inability of this denominator to reflect the increases in day-patients and outpatients. However, “Total FTE”, a mirror of total patient workload, also showed a rising trend.

The paper, authored by Carol Brown, Miranda Dally, myself and Linda Good, propose the rise may be due to:

  • increasing HCW workloads;
  • decreasing resources;
  • increasing day-patient and outpatient numbers, and
  • incorrect use of SED

Several hospitals stood out for their low exposure rates. Examples of their successful reduction-strategies were: Competency-based education at orientation and annually (and repeated with all injured HCW); Investigation of every sharps injury; Making SI rates transparent and known to all staff; Requiring a waiver to be requested for non-SED use; Holding HCW and Management responsible for their safety.

The published copyright paper may be purchased by emailing AOHP at [email protected]  A complimentary, pre-publication Author Copy , for personal use only, is available here.

AOHP’s fifth annual survey (2015 calendar year) is in progress with publication aim late 2016.

Zika: update on geography, precautions and sexual transmission

Last Friday I stated Zika was in theory capable of sexual spread, and on Tues Feb 2nd, the Texas Dept State Health Services confirmed a sexually transmitted case.

Prior to the Texas announcement only one sexually transmitted case had been confirmed – Foy et al in 2011 published a case in the wife of a Zika researcher returning to Colorado in 2008. Subsequently, Musso et al in 2013 found Zika in the semen of an infected Tahitian male.

Notwithstanding the above, CDC confirm transmission is primarily via mosquitoes (Aedes – they also transmit dengue, but not malaria), and rarely, to the foetus from infected mothers.

Zika is a mild disease, predominantly with no symptoms, but with 4,800 cases of microcephaly in Brazilian babies in the last 18 months, this aspect, and the rapidity of spread of the disease (up to 1.4 million cases in Brazil in 2015) caused WHO on Monday to classify ZIKA as a Public Health Emergency of International Concern (PHEIC).

By classifying Zika as a PHEIC, WHO mobilizes internationally the resources for research and action into the disease, its sequelae, and its prevention.

WHO state there should not be travel or trade restrictions with any Zika-active country and CDC state prevention is via classic anti-mosquito measures and have issued cautionary travel advice for pregnant females

The US has the relevant Zika Aedes species in the lower states and as yet mosquito-transmission has not been documented but, with returning travelers, there is the possibility of local Zika transmission

But if Zika was first discovered in Uganda monkeys in 1947 (first human case in 1952), then appeared in the Pacific in 2007 with the first major epidemic being in French Polynesia in 2013, how did it suddenly explode in Brazil? It was not the Brazil World Cup as originally thought. Musso examined the “fingerprint” of Zika isolates in infected countries and determined that during 2013-14:

  • The origin of introduction to French Polynesia is unknown
  • New Caledonia was infected from infected travelers returning from French Polynesia
  • French Polynesians brought the virus to Easter Island when attending the island’s Tapati Festival in early 2014
  • Other nearby Pacific countries were infected because inter-travel is common
  • In Aug 2014, teams from several of the above Pacific countries attended the World Canoe Championships in Rio de Janeiro. Musso suggests this introduced Zika to Brazil.

Now, in just 18 months, 28 countries have active Zika transmission.

Fortunately for New Zealand (where I live) the Ministry of Health state the subspecies of Aedes has not been found. But returning travelers with symptoms might need heed the Texas news. And spread via an accidental needlestick to an attending healthcare worker, although as yet undocumented, must also be a concern.