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.

The top 10 Questions people ask Google

Just reading Becker’s Hospital Review.

It is fascinating to learn the questions we ask Google.

There are a myriad of categories including medical symptoms, dogs, movies, fashion,  diets and even celebrity pregnancies!

Here are a few “Top 10” that caught my eye…

Symptoms Questions Dog Questions Fashion Questions
1.     Flu 1.      Why do dogs wag their tail? 1.       How to walk in heels?
2.     Gallbladder Infection 2.      How to crate train your puppy? 2.      What to wear on the first day of school?
3.     Measles 3.      How to register a dog as a service animal? 3.      How to fray jeans?
4.     Listeria 4.      How to register a dog with the AKC? 4.      How to tie a shirt?
5.     Sinus Infection 5.      How to keep puppy from eating poop? 5.      What should a bride wear to the rehearsal dinner?
6.     Gastritis 6.      When do puppies get shots? 6.      What to wear booties with?
7.     Anxiety Attack 7.      Why do dogs chew their paws? 7.      What are mules shoes?
8.     H. Pylori Infection 8.      What breed is the ‘Target’ dog? 8.      What to wear to a wedding in the woods?
9.     Heat stroke 9.      How to paper train a puppy? 9.      How to dress up like Miranda Sings?
10. Lactose Intolerance 10.  How to stop dogs from biting? 10.   What color shoes goes with a black and blue dress?

 

For the 42 other categories see https://www.google.com/trends/topcharts#vm=cat&geo=US&date=2015&cid.

EXPO-STOP 2012 – US largest blood exposure study published

EXPO-STOP:2012 Survey of US blood exposures is published in JAOHP

Linda Good and I, and the US Association of Occupational Health Professionals in Healthcare (AOHP) are pleased to announce the publication of our 2012 EXPO-STOP Survey in the recent edition of JAOHP.

The survey, the largest in US, examined the 9,494 blood exposures reported from 157 hospitals in 32 states, and calculated annual incidences using 4 denominators.

The 7,119 sharps injuries (SI) and 2,375 mucocutaneous exposures (MC) resulted in incidence rates of:
• 28.2 SI / 100 occupied beds; 2.2 / 100 staff; 3.3 / 100 nurses; and 0.43 / 100 Adjusted Patient Days.
• 10.1 MC / 100 occupied beds; 0.8 / 100 staff; and 0.15 / 100 Adjusted Patient Days.
• Of Total reported SI, 42% were among nurses and 36% among doctors.
• 44% of reported SI occurred during surgical procedures

The 2012 exposure incidences were significantly higher than those reported in the most recently published surveys by EPINet and Massachusetts Dept Public Health, and, disturbingly, higher than the EPINet incidence published in 2001 following the enactment of the OSHA needlestick Safety and Prevention Act (NSPA).

The study concludes that compliance with the NSPA is, in itself, insufficient to achieve the national reduction in exposures needed

The top 5 lowest-incidence hospitals had incidences 60% lower than their counterpart same-size hospitals. Their successful strategies were reported in the study and included education, repeated competency training, rapid investigation, unflagging diligence, and searching for safer safety devices.

A pre-publication Author Copy of the study is available for personal use and the definitive article is purchasable from AOHP

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Pistols and Poise: Day 24 in Sierra Leone

Temperature gun - Mamadu Fever (>38C) is an early sign of Ebola so temperatures are taken several times a day at entry to Bldgs, and police roadblocks. Still “no touch” law, so taken with infrared pistol aimed at temple. Ocass misreads and need recheck – happen to me yesterday. 2nd was normal!Ocass 34C – so I check pulse for life signs.
 7 baskets on head lowres  Food on head lowres  I soon understood why many Sierra Leone women have great poise – it takes a straight back to walk with these loads atop their heads – and a very strong neck!PS. In 2nd Pic “Nor Pis Ya” is “No urinating here” in local Krio (creole)

Tried local dish FuFu this week – local colleague said “are you sure” and I bravely stated I like to try local cooked food. The fermented “roll” is from cassava flour and is consistency of playdough (it had pleasant sweet taste) – you dip it into soup – my soup was beef and fish and dark green vegetable and had a rancid taste. My colleague said it was dish only made on Saturdays – I tried as much as I could politely sustain. Very glad today’s Sunday!

At office this week, a colleague became very pale – she barely made it to the garden. I sourced water and cup and her colour returned eventually. A timely warning of “If you can’t peel it, don’t eat it”. I had tummy episode Thur but worked out it was the quantity of chilli in the goat-pepper soup – goodness the Sierra Leone’s love their chilli! I’m still checking if my lips are still there.

This week I was a millionaire! – at 5,000 Leones to 1US$, $200 makes you a millionaire. Jokes aside, I do not know how the SL people survive as prices are high compared to wages – of those that have work. A nurse manager earns about $12 a day.

This Fri, 2 of 3 Provinces are in 3 day “Lock Down”. No shopping, no traffic, no-one outdoors – everyone has to stay home. This is only 2nd in 6 months and is to enable 7,000 health workers to visit every home and advise on Ebola safety and hand out brochures – in an effort to eradicate the disease.

Sunday here – our day off – only 1 work mtg scheduled – 8 of us went to beach for lunch – an earned break.

Warm regards to you all, Terry

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WHO launches Injection Safety campaign

I am fortunate to have spent two days at the Geneva WHO SIGN meeting where Dr Chan, WHO D-G launched the new Injection Safety campaign.

I am very excited because HCW sharps safety is an integral part of the campaign.

Even with safety engineered devices (SED), many countries are finding if difficult to further reduce their sharps injury incidence and this is the shot in the arm (forgive the pun) that they need.

As with WHO’s Hand Hygiene campaign, WHO will ask their 194 member countries to sign up to the campaign. Hopefully this will lead to the increased resources needed for more SED uptake and greater attention to competency-based SED training.

The campaign will require all signatories to exclusively use SED that meet WHO Prequal Standards (or their equivalent) by 2020.

I’m about to board a plane to Sierra Leone to assist for 2 months a CDC and WHO program to establish an Infection Control infrastructure throughout the 14 provinces. I’ll keep you updated via this website.

2nd Ebola UK military HCW sustains sharps injury

Two military HCW have been repatriated to UK following sharps injuries (SI) while assisting with Ebola patients in West Africa. Both HCW were flown immediately to UK and are under hospital observation. Neither is symptomatic. My heart goes out to the two HCW and their families.

Two injuries in a week in well-trained staff attending high transmission-risk patients is alarming.

Ebola, like 60 other blood-borne pathogens, may be transmitted via the percutaneous route, particularly if unsafe injection practices are used . Likewise, Ebola may be acquired by laboratory workers following accidental sharps injury, the first being reported in 1977.

Rubinson tells of the ensuing emotional roller-coaster following an Ebola sharps injury in Sierra Leone.

How did the injuries occur? Difficult patient/procedure/environment? Lack or incorrect use of safety devices? Many of us would benefit from knowing these details. Hopefully they will be published.

Lab tests from a blood-drop – no more phlebotomy sharps injuries?

At 19 Elizabeth Holmes started her high-tech lab-test company Theranos, – it’s now worth $9bill.

Fortune lauded her amazing technology but I see her work leading to the end of phlebotomy sharps injuries.

Theranos specializes in low-cost, rapid-turnaround lab tests – from a drop of blood!.
With more than 200 patents and another 200 in the wind, this not just a PKU, she and her team have developed over 200 lab tests achievable from a simple finger-prick – and hope to have 1,000 tests soon.

If this is phlebotomy of the future then sharps injuries from hollow-bore needles will become a thing of the past – you just need a finger-lancet – a safety finger lancet.

My recent audits of sharps container contents showed that safety engineered devices are not as commonly used as we thought – but another observation I made (unpublished) was that that (i) every lancet was a safety lancet, and (ii) every single safety lancet was activated correctly!

Thanks to Theranos, the future for phlebotomists looks very safe indeed.

Sharps safety devices – why is Australian use lower than USA?

Australian hospitals use less sharps safety devices than USA

Sharps injuries (SI) among Australian healthcare professionals (HCP) are three times that of USA.

The best way to reduce SI is to use safety engineered devices (SED). All Australian hospitals use SED – but to what extent?

To ascertain SED extent, you need to “dumpster dive” – you need look at sharps container contents. If Australian HCP are using less SED  it could be a contributing factor in the higher SI rate.

In my survey published online last week in Healthcare infection I examined the contents of 102 sharps containers from 27 hospitals in 5 Australian capital cities and found 30% of the 10,000 hollow-bore needles were SED.  A similar but smaller sampling in the U.S. revealed that 46% were SED.

The paper concludes a high proportion of Australian HCP are unnecessarily at risk of SI while handling sharps. Recommendations include more widespread SED evaluation and adoption (automatic and semi-automatic SED where feasible), repetitive competency training and safety-ownership. Legislation may be indicated.

Click here for access to Abstract and Author copy for this study

Buttering Bread is an Infection Control Strategy!

Buttering bread stopped a plague.

In the 16th century, Copernicus (yes, the physician and astronomer) commanded the Allenstein castle in Prussia which was besieged by Teutonic Knights. A “plague” in the castle rendered many soldiers ill, including Copernicus. He divided the people into various diets and noted that the contagion was related to bread intake.

Soldiers atop the castle worked 12 hour shifts and took lunch while on duty (no workers’ rights there!). Copernicus determined that the bread-loaf was contaminated when accidentally dropped on the floor whilst being carried up the narrow steep stairs to the turrets by untrained staff pressed into waitering. The staff put the dropped bread back on the tray but as it was black in colour, the contamination with dirt and pathogens was not noticed.

A friend suggested coating the loaf with a light-coloured spread so they would detect if it had been dropped. They used churned cream and when eaters elected to clean or reject visibly dirtied bread, the epidemic halted. The practice was publicised by Copernicus’ colleague, BUTTENADT, secretary to the Apothecaries and Physicians Guild. The practice of BUTTENADTING later became popular with the people and the shortened form of the word became BUTTERING.

PS (TG). The epidemic would not have been THE plague (Yersinia pestis – spread by flea bites) but likely to have been any one of several diseases transmitted from rat faeces. Must be coincidence that the word “butter” is derived from the Greek Bouturon (“cow-cheese”). And for those whose bread always falls butter-side down – that’s fundamental physics and the height of your table!