Compliance with safety sharps continues to decrease, leaving facilities open to safety citations.
By John Palmer
It appears that healthcare workers aren’t getting the message about the dangers of needlesticks on the job, and how to keep them from happening, despite years of repeated efforts to raise awareness.
That’s the consensus of a workplace safety watchdog group that provides healthcare facilities with a standardized system for tracking the occupational exposures that put healthcare staff at risk.
In July 2017, the Houston-based group International Safety Center (ISC) released surveillance data from hospitals in 2015 that showed a marked increase in injuries from sharps and needlesticks to training physicians (residents and interns) compared to 2014, and an overall increase in injuries sustained in the operating room, along with an unexpected decrease in the use of safety-engineered medical devices.
The data came from ISC’s EPINet® (the Exposure Prevention Information Network), which provides healthcare facilities with a standardized system for tracking occupational exposures that put healthcare staff at risk, which includes employee incident reports on needlesticks and sharps injuries, as well as blood and body fluid exposures.
According to a report released from ISC about the study, the 2015 data show that a greater proportion of blood and body fluid splashes and splatters are occurring in patient and exam rooms than in years past and almost two-thirds of those exposures involved workers’ eyes. Fewer than 7% of the workers involved with those exposures reported that they were wearing eye protection, according to the report.
“While the 2015 EPINet® data suggest that pathogen exposure risks to healthcare workers are on the rise, they also indicate that workers are increasingly aware that these exposures are preventable,” said Ginger Parker, ISC’s chief information officer and deputy director.
In 2014, the report continued, only about 30% of injured or exposed healthcare workers said that they felt the injury could have been prevented by engineering controls or other technologies, or by changes in administrative work practices. In contrast, in 2015 almost half (48.7%) of workers reporting sharps injuries and more than two-thirds (68.6%) exposed to blood and body fluid splashes indicated that they thought the exprosures were preventable.
“These EPINet® results should be a wake-up call to the many healthcare institutions concerned about worker and patient safety. The data show rising exposures to sharps and body fluids that can transmit pathogens to healthcare workers, potentially endangering them, their patients and their families,” said Dr. Amber Mitchell, ISC president and executive director, in a written statement. “The growing prevalence of fluid-borne infectious organisms affecting the general public, such as hepatitis C and emerging infectious diseases like Zika, highlights the importance of protecting workers from the unanticipated exposures they encounter while providing routine care.”
Since its introduction in 1992, EPINet® has been distributed to over 1,500 U.S. hospitals and to hospitals in 95 countries. Sharps injury and blood and body fluid exposure data from participating healthcare facilities is collected on an annual basis, merged into an aggregate database and analyzed using EPINet® software. Participating hospitals vary in size, geographic location and teaching status. Access to the EPINet® system is offered to healthcare facilities around the world free of charge. For more information, visit internationalsafetycenter.org/use-EPINet®.
The ISC findings are alarming considering the amount of attention given to the dangers of needlesticks in the healthcare workplace in recent years. According to OSHA, up to 5.6 million workers in the U.S. are at risk of exposure to bloodborne pathogens such as HIV and hepatitis, because they use needles and other sharps such as scalpels as part of their everyday job. In fact, every year about a million workers in hospital and clinic settings suffer a needle stick or other sharps-related injury. What’s worse, it’s estimated that as much as half of the actual number of needlestick injuries go unreported.
In addition to providing data from hospitals, ISC also provides a consensus statement, which attempts to advise what hospitals can do to help fight the problem of exposures.
The ISC Consensus Statement indicated that from 2010-2014, about 70% of all reported occupational splash or splatter exposures involving body fluids were contaminated with blood. Yet more than 40% of the affected workers indicated that they were wearing everyday clothes or non-protective scrubs or uniforms during the exposure, and only 17% were wearing a protective gown. ISC says the problem oftentimes stems not only from a worker’s refusal to wear proper protection, but also from the employer not providing the proper training or consequences for non-compliance.
“When a hazard cannot be eliminated or engineered out, it is then that we rely on safe work practices, administrative controls, and the use of PPE,” the statement said. “These controls are highly dependent on personal and professional behavior, training, education, availability and access, adequate staffing, and the overall anticipation of hazard being likely to occur. We have already indicated that PPE use and compliance is low during an exposure with blood and body fluids, often times because that exposure is not anticipated and a worker cannot adequately prepare for it. This in part is because all factors may not be in place to create the safest environment. In short, it is difficult to create reliable systems of protection if there are too many opportunities for that system to fail – exposures are not anticipated, PPE use is low even when they are anticipated, and PPE when worn during anticipated exposures is unreliable.”
It can be an extremely costly injury for healthcare facilities. The CDC estimates that testing and follow-up treatment for a needle stick can cost up to $5,000 per worker depending on treatment received.
A suburban Boston hospital was faced with a surprise OSHA inspection in 2014 for suspected bloodborne pathogens and sharps safety violations. Melrose-Wakefield Hospital in Melrose, Massachusetts, part of the Hallmark Health System, was penalized $28,000 (eventually reduced to $22,000) for several violations of the Bloodborne Pathogens standard, as well as a safe sharps violation.
The fines stemmed from complaints received about the conditions at the hospital—presumably from a confidential employee complaint—which triggered an OSHA inspection of the facility in April 2014.
According to documents quoted in the reports from WBZ-TV, OSHA inspectors found several violations, including potential sharps injuries ‘when contaminated disposable blades are included with reusable surgical instruments to be cleaned and sterilized.”
In addition, the documents reported that “surgical employees did not always disassemble and wipe down used surgical instruments,” and also that “surgical employees placed open or loosely covered basins containing hazardous medical waste (excess blood, tissue, bone, feces, fat, etc.) and contaminated instruments into utility carts that leaked these contaminated fluids …”
After the unannounced OSHA inspection took place, William Doherty, MD, chief medical officer of the hospital, said the hospital underwent several days of on-site visits in which the inspector interviewed staff members, watched them work, and went through policies and procedures. The result, he says, was a series of violations that fell into three categories:
- The hospital did not update its bloodborne pathogens exposure plan every year. Specifically, sharps devices weren’t up to date with safety devices, and there wasn’t enough input from staff members about what sharps were being used.
- The hospital failed to use engineering or work practices that would eliminate exposure to bloodborne pathogens. In this case, Doherty says the hospital’s surgical staff had an ongoing process in which used instruments and medical waste were placed in open or loosely covered containers. He says he didn’t know OSHA requires the containers to have lockable covers for transport to avoid spillage of potentially contaminated fluids.
- The hospital’s annual training program did not allow for staff question and answer opportunities. The hospital’s mandatory computerized annual bloodborne pathogens training for workers “had specific verbiage” that employees could contact a supervisor if they had any questions. The problem here, Doherty says, was that the supervisor on duty on the night shift may not have known the answers.
Trying to raise awareness
ISC is one of several watchdog groups in recent years to try to raise awareness about the need for sharps safety to reduce needlesticks in the healthcare workplace.
Safe in Common (SIC), a non-profit organization based in York, Pennsylvania, issued a list of guidelines in 2013 that serves as a “wish list” of attributes for sharps safety. Established in 2010, SIC is an organization of healthcare professionals and advocates that work to raise awareness and save lives of healthcare workers at risk of needle stick injuries.
The guidelines, titled “The Top Ten Golden Rules of Safety,” were released at the Association for Professionals in Infection Control and Epidemiology [APIC] Convention in Ft. Lauderdale, Florida. Specifically, the guidelines seek to make needlestick injuries a “never event,” an incident so rare that it almost never happens, by lobbying for sharps that are easy to use in even the most distracting environments. In addition, safety devices should be activated automatically so that it’s safe and easy to use with one hand. Sharps should also be “rendered safe prior to removal or exposure to the environment,” they should not cause additional harm or discomfort to the patient, and should not add weight to already high cost of medical waste.
Sharps have been a presence in healthcare as long as healthcare has been in existence. While needlestick safety is considered paramount, distracted and busy healthcare workers still get stuck with needles. In 1991, OSHA introduced the Bloodborne Pathogens Standard [BBP], which mandated that employers take steps, including universal standards designed to reduce worker exposure to blood and potentially infectious diseases.
Included in that law was ensuring the use of commercially-available “safer” medical devices, but a lack of safer devices on the market led to the use of sharps containers, but not necessarily safer needles. Workers were still being stuck with needles that were bulky and cumbersome, and in many cases required two hands and several motions to cap the needles in the field.
“It’s like the difference between a seat belt and an airbag, says Mary Foley, PhD, RN, Safe in Common chairperson. “The air bag is passive and drivers were not securing their seat belts. Humans are humans, and it’s the same principle in health care. This is a higher standard, and one we should be advocating.”
In 2000, President Clinton signed the Needlestick Safety and Prevention Act, which instructed OSHA to revise the BBP standard, with a new emphasis on preventing needlesticks. The new law encouraged the use of newer safety devices designed to cap themselves with safety sheaths or with retractable needles, and healthcare supply manufacturers answered by offering new safety devices. The law also requires healthcare facilities to evaluate new sharp safety devices annually.
John Palmer is a contributing writer to PSQH.