Archive for: Needlesticks & Sharps Injuries

Safety Month showcase: Steps for when a worker is exposed to bloodborne pathogens

By: June 11th, 2018 Email This Post Print This Post

The National Safety Council has designated June as its annual National Safety Month as a way to focus on “reducing leading causes of injury and death at work, on the road, and in our homes and communities.” In accordance with that, HCPro’s safety team will highlight a different healthcare-oriented safety topic each week in the month of June by sharing an excerpt from one of our many books, all available on HCMarketplace.com.

The focus this week is on infection control. The excerpt is from The Infection Control Manual for Outpatient Settings, authored by Gwen M. Rogers, DBA, RN, CIC.

Her book explains the steps that physicians and staff at outpatient facilities should take to protect patients, employees, and the environment and to prevent the spread of infectious diseases, though safety pros who work at hospitals may also find this excerpt useful. It looks at the OSHA Bloodborne Pathogen Standard and what should be done when one of your employees is exposed to blood or other potentially infectious material (OPIM).

Are your employees familiar with the Bloodborne Pathogen Standard from OSHA? They should be; it is one of the key documents for healthcare best practices in preventing the spread of and bloodborne pathogens (BBP). It is important for you to maintain a safe work environment for yourself and your employees, and to provide documentation that you have done so, especially because agencies such as OSHA and The Joint Commission are narrowing their scrutiny of the physician’s office environment. Representatives from these and other groups want to see whether physician practices have a plan in place to educate and train employees in enacting an infection control plan.

The goal of OSHA’s Bloodborne Pathogens Standard, published in 1991 in the Federal Register, is to guide you in minimizing exposure. A good way to introduce employees to the concept of the standard is simply to tell them that they must assume that any needle and any specimen (i.e., anything relating to blood or bodily fluids) should be considered infectious. The standard applies to all employees who have occupational exposure to blood or other potentially infectious material. Occupational exposure is defined as “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of the employee’s duties.”

As employers, physician practices are required by OSHA to take precautions to protect staff members likely to be exposed to blood or OPIM while on the job. Separate but dependent sets of rights and responsibilities were established for both employees and employers within the OSHA standards. Employees are obligated to follow office rules, wear personal protective equipment (PPE), and report hazardous conditions. Meanwhile, employers are required to become familiar with all OSHA standards, communicate them to employees, and enforce them in the workplace.

So, what steps must be taken when an employee is exposed to BBP?

Employees should follow a certain protocol after bona fide BBP exposure has occurred. Protocols for evaluation and management of an employee or patient exposure to the blood (or other potentially infectious material) of a patient need to be outlined in the exposure control plan. Any response should begin with providing immediate first aid.

What information must the employer provide to the healthcare professional following an exposure incident? The healthcare professional must be provided with a copy of the standard, as well as the following information:

  • A description of the employee’s duties as they relate to the exposure incident
  • Documentation of the route(s) and circumstances of the exposure
  • The results of the source individual’s blood testing, if available
  • All medical records relevant to the appropriate treatment of the employee, including vaccination status (which are the employer’s responsibility to maintain)

What serological testing must be done on the source individual?

The employer must identify and document the source individual if known, unless the employer can establish that identification is not feasible or is prohibited by state or local law. The source individual’s blood must be tested as soon as is feasible, after consent is obtained, to determine HIV and HBV infectivity. The information on the source individual’s HIV, HBV, and Hepatitis C testing must be provided to the evaluating healthcare professional. Also, the results of the testing must be provided to the exposed employee. The exposed employee must be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.

What if consent cannot be obtained from the source individual?

If consent cannot be obtained and is required by state law, the employer must document in writing that consent cannot be obtained. When law does not require the source individual’s consent, the source individual’s blood, if available, shall be tested and the results documented.

When is the exposed employee’s blood tested?

After consent is obtained, the exposed employee’s blood is collected and tested as soon as is feasible for HIV and HBV serological status. If the employee consents to the follow-up evaluation after an exposure incident but does not give consent for HIV serological testing, the blood sample must be preserved for 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested for HIV, testing must be done as soon as is feasible.

What information does the healthcare professional provide to the employer following an exposure incident?

The employer must obtain and provide to the employee a copy of the evaluating healthcare professional’s written opinion within 15 days of completion of the evaluation. The healthcare professional’s written opinion for hepatitis B is limited to whether hepatitis B vaccination is indicated and whether the employee received the vaccination. The written opinion for post-exposure evaluation must include information that the employee has been informed of the evaluation results and has been told of any medical conditions resulting from exposure that may require further evaluation and treatment. All other findings or diagnoses must be kept confidential and must not be included in the written report.

What type of counseling is required following an exposure incident?

The standard requires that post-exposure counseling be given to employees following an exposure incident. Counseling should include U.S. Public Health Service recommendations for transmission and prevention of HIV. These recommendations include refraining from blood, semen, or organ donation; abstaining from sexual intercourse or using measures to prevent HIV transmission during sexual intercourse; and refraining from breastfeeding infants during the follow-up period. In addition, counseling must be made available regardless of the employee’s decision to accept serological testing.

What should be done with an employee’s confidential medical records?

Records of all employees with occupational exposure must be maintained for 30 years after the employee terminates employment. These records should be stored separately from patient records, and access to the records requires the employee’s written permission. The medical records include a copy of the employee’s vaccination status and copies of the results of all medical examinations and tests. Post-exposure records must include the employee’s name, Social Security number, hepatitis B vaccination status, results of follow-up procedures to exposure incidents, and a copy of the evaluator’s written opinion.

To purchase The Infection Control Manual for Outpatient Settings, please click here. And check back next Monday for a free HCPro book excerpt focusing on a different healthcare safety topic.

CDC study: Excessive noise can contribute to high blood pressure and cholesterol

By: April 3rd, 2018 Email This Post Print This Post

Door alarms, heart monitors, surgical equipment, and Ted Nugent? Yes, Ted Nugent.

As I wrote in this month’s Medical Environment Update newsletter, excessive noise is an issue in the OR, where the eardrums of surgical team members are often bombarded by a bunch of different sources. Believe it or not, that sometimes includes classic rockers like the aforementioned Mr. Nugent, a popular playlist pick among surgeons.

Excessive noise in the OR can affect auditory processing among surgical team members, leading to miscommunication in critical moments and, subsequently, medical mistakes that affect patients plus needlestick injuries and slip-ups with a surgical knife.

I also focused on how it can expose surgical team members to hearing damage, too.

“[The surgical team is] like a construction crew,” Matthew Bush, MD, of the University of Kentucky, told me in a phone conversation. “Perhaps there are some people who have to use jackhammers and there’s other people who are using paintbrushes.” But in any case, that noise can add up, and “we need to be very conscious of that.”

Another thing to be wary of, according to a recent CDC study published in the American Journal of Industrial Medicine, is high blood pressure and high cholesterol.

“A significant percentage of the workers we studied have hearing difficulty, high blood pressure, and high cholesterol that could be attributed to noise at work,” Liz Masterson, MD, one of the study’s authors, said in a CDC press release. “This study provides further evidence of an association of occupational noise exposure with high blood pressure and high cholesterol, and the potential to prevent these conditions if noise is reduced.”

While the healthcare was not mentioned in that press release as an industry “with the highest prevalence of occupational noise exposure,” OR staff members often must work through loud bursts of noise that occur throughout many surgeries.

This is a concern that Lisa Spruce of the Association of periOperative Registered Nurses brought up during our recent chat about excessive noise, saying it “has been linked to impaired sleep, increased stress, physical discomfort, increase in blood pressure, heart rate, and breathing. And that all just has an effect on a person’s well-being.”

Spruce says some healthcare facilities have noise-related policies. And if yours doesn’t, she recommends forming an interdisciplinary team to evaluate noise in facilities and by individual types of surgery, and then determining what actions you can take to decrease noise levels, including exploring quieter alternatives for surgical equipment.

“I think we’re bringing more attention to [noise] as a problem where we haven’t in the past,” she said. “So, I think we are going to see more and more hospitals having policies and looking at it from a patient safety, and also a staff safety standpoint.”

Our expert answers a couple of reader questions related to waste disposal

By: February 19th, 2018 Email This Post Print This Post

When you’ve got healthcare safety or standards questions, we’ve got answers. More specifically, we’ve got a stable of industry experts who are only an email away and are willing and able to give you the guidance you are seeking.

This time, we turned to Dan Scungio, MT(ASCP), SLS, the laboratory safety officer for Sentara Healthcare in Virginia, to answer a pair of waste disposal questions recently posed by our readers. Scungio, aka “Dan, the Lab Safety Man,” writes a monthly column for our monthly Medical Environment Update newsletter.

Question No. 1, from a blog commenter named Sarah Winters: “I am the nursing supervisor for a school district. At the end of every year, the nurses at the schools close and seal their full sharps boxes and transport them in their vehicles to [our] central office, where I then take them to EMS for disposal. A safety/health inspector has told us this is unsafe and violates the OSHA standard. I cannot find how that violates any OSHA regulation. Suggestions? Resources? Thanks.”

Answer from Dan, the Lab Safety Man: “OSHA does not directly regulate the transport of hazardous waste, but the U.S. Department of Transportation does. The DOT states that if you are not in the business of transporting hazardous materials, the process of sharps transport for the schools falls under the DOT’s Materials of Trade exemption. That means it is acceptable to transport used sharps in your private vehicle provided they are packaged in containers constructed of a rigid material that is resistant to punctures and securely closed to prevent leaks. That said, individual state regulations may supersede federal DOT rules, so it is important to know what the transport laws are in your specific state.”

Question No. 2, submitted anonymously via email: “Can we dispose of irrigation fluid from the anterior chamber of the eye in the regular garbage if not visibly contaminated with blood and is self-contained in a sealed bag?”

Answer from Dan, the Lab Safety Man: “Eye irrigation fluid may not be considered an infectious waste if it does not contain blood, but it is probably not a good idea to place it into the regular (non-hazardous) waste stream. It is important to consider those who handle the trash after it leaves your site. If there is breakage of a sealed container or bag that creates an exposure, that would create a scenario that will raise questions for the person exposed and a situation that should be avoided.”

Got a question you’d like answered? Shoot us a note at mvensel@hcpro.com.

A noisy OR puts more than patients at risk

By: January 8th, 2018 Email This Post Print This Post

Excessive noise can be distracting in any work environment. You might expect that to be an issue on a construction site or at an airport, but not in the OR.

A recent story published online by OR Today serves as a reminder that it can get loud in the OR, too, adding another degree of difficult to already-challenging tasks.

“Noise is a distraction that interrupts patient care and potentially increases the risk for error,” Mary J. Ogg, MSN, RN, CNOR, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN), told OR Today. “It may minimize the ability of OR team members to communicate effectively, making it difficult to understand content and contributing to miscommunication.”

And that not only puts patients in peril, but potentially your employees, too.

A lack of focus in the OR could result in accidental injuries to surgeons or one of their assistants via needlestick injuries or knife cuts, for example.

Plus, as Ogg told OR Today, excess noise in the OR can negatively impact employees because it “is associated with job dissatisfaction, irritability, tachycardia, anxiety, fatigue, illnesses, stress, emotional exhaustion, burnout and injury.”

The article cited one study that found that the average noise level during OR trauma procedures was 85 decibels, nearly double the EPA-recommended limit of 45.

In addition to medical equipment such as powered surgical instruments and clinical and alert alarms, Ogg said common sources of noise in the OR include HVAC systems, phones and audio players, and non-case-relevant chitchat.

OR Today offered suggestions for reducing noise and distractions in the OR. The list included turning off cell phones and personal music devices (or leaving them outside the OR), limiting the amount of foot traffic in and out of the OR, and evaluating the noise level of medical equipment while deciding which devices to purchase.

Fact sheet unveiled to protect lab workers from Zika virus

By: October 3rd, 2017 Email This Post Print This Post

A new OSHA Fact Sheet has been published to help employers protect biomedical laboratory workers from the Zika virus, which has been blamed for infants being born with Microcephaly and other brain and eye abnormalities.

For lab workers, the most likely sources of exposure to Zika include needlesticks and similar cuts or puncture wounds, as well as areas of compromised skin that come into contact with contaminated materials, according to the four-page fact sheet. Workers also face risks of exposure through the eyes, nose, and mouth; mosquito bites; and coming into contact with blood or other body fluids.

“Employers and workers in laboratories should follow required and recommended infection prevention and biosafety practices to minimize the risk of infection,” the document states, noting that employers must comply with relevant regulations and standards, such as OSHA’s Bloodborne Pathogens standard.

“In all cases, employers should assess and control their workers’ Zika virus exposure risk, consider relevant advisory documents, and review new information as it becomes available, including from the Centers for Disease Control and Prevention (CDC),” the document states.

For more, download the fact sheet from OSHA’s website.

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Guest Column: Be Personally Protected

By: July 8th, 2014 Email This Post Print This Post

The following is an occasional series of guest blogs by experts in the medical clinic safety field. If you would like to be featured in this blog as a guest columnist, please email Managing Editor of Safety John Palmer at jpalmer@hcpro.com.

In some laboratories, the use of Personal Protective Equipment (PPE) may be confusing to staff. However, a look at OSHA’s Bloodborne Pathogens and Chemical Hygiene Standards should make clear the requirements for proper PPE selection and use.

Both standards speak clearly to the necessity of PPE when working in the laboratory. Different PPE is needed for different tasks. Lab coats are always necessary in the lab for protection against blood and body fluid splashes or chemical splashes. Plastic aprons may also be used as extra protection in areas where gross tissue work is performed. Lab coats should be buttoned, the sleeves should not be rolled up, and they should be knee-length.

Gloves are needed when handling blood, body fluids, or chemicals, but different gloves may be used for different tasks. Many labs are turning away from using latex gloves because of allergic reactions by staff. Nitrile gloves have become the norm in recent years. However, make sure you have the correct gloves for the duties being performed. Some manufacturers make nitrile gloves that act as a barrier against blood and body fluids, but they do not provide protection against chemicals.  While these will be fine while running a CBC in hematology, they won’t provide enough protection when changing the stainer. Be sure to use chemical-resistant gloves for this and other tasks (gram stains, handling chemistry reagents, pouring acids, etc.). Check the package if you are not sure about the proper use of gloves.

Goggles or face protection is important PPE that is widely under-utilized. Do you carry open specimens in the lab? What about carrying a rack of specimen tubes to or from an analyzer? That is a task that creates a risk for exposure, and face protection should be used. Are you pouring a chemical? Protection is necessary. Help your staff avoid all exposures to the eyes or mucous membranes.

The OSHA standards mentioned above also require that PPE is removed before leaving the laboratory. Do not wear lab coats or gloves to another location outside the laboratory. Does a procedure need to be performed in another area that requires PPE? If so, bring fresh PPE with you for use in the treatment area and dispose of it before returning to the lab.

In a laboratory, all areas should be considered hazardous, bio-hazardous, or contaminated. Do you have a desk area in the lab where only paperwork is done? I have always said that if there is an area in the lab where there are no patient specimens or chemicals, then one could consider the area “clean.” However, that does not mean that food or drink can be consumed there or that no PPE is needed. Remember, you are still in the walls of a laboratory, and accidents may occur. It is acceptable to label the area as “clean” so that gloves are not needed for the computer or phone, but a lab coat would still be required.

Remember, if an OSHA inspector arrives, he will be looking to see that all aspects of safety regulations are being followed. Keep your employees safe and keep your facility from unnecessary fines by using PPE where and whenever needed.

Dan Scungio, MT (ASCP), SLS, also known as “Dan the Lab Safety Man,” is a Laboratory Safety Officer for Sentara Healthcare, a multi-hospital system in the Tidewater region of Virginia.

Ask the expert: Recapping fill needles

By: September 17th, 2012 Email This Post Print This Post

Q: What guidance does OSHA give on recapping fill needles?

A: OSHA is pretty blunt about recapping needles – they don’t recommend it!

Let me address the recapping of needles into categories:

A)     Contaminated needles

The Bloodborne Pathogens standard section (d)(2)(vii): “Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed…”  The violation of the OSHA standard could not only injure staff members but also cost it as much as $7,000 as a serious fine, as classified by OSHA.  If an employer continues this practice, it could become a willful fine, which ups the ante to $70,000.

B)     Non-contaminated Needles

The standard strictly prohibits bending, recapping, or removal of contaminated sharps unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure. [29 CFR 1910.1030(d)(2)(vii)(A)] The standard does not focus on the recapping of non-contaminated needles.  However, the health and safety of both the clinician and the patient are important. It would be important not to recap the needle and risk the health care worker being contaminated with the medication that is in the fill syringe. It is equally as important not to contaminate the needle with the healthcare worker’s skin, because this would provide risk to the patient.

The standard requires each employer to establish an exposure control plan “designed to eliminate or minimize employee exposure.” If the medical practices require recapping or removal of sharps or if no alternative, such as immediate discarding into an approved sharps container, is feasible, the exposure control plan must include a provision for the use of mechanical devices in these circumstances. Although OSHA cannot, of course, approve or endorse particular products, there are a number of acceptable mechanical recapping devices.

Editor’s note: This Q&A was answered by Ron Stoker, executive director of the International Sharps Injury Prevention Society (ISIPS), Harriman, UT. www.isips.org

Feds encourage blunt-tip suture needle use

By: June 5th, 2012 Email This Post Print This Post

To put it bluntly, the FDA, CDC, NIOSH, and OSHA want to see more use of blunt-tip suture needles in operating rooms.

The four federal agencies posted a joint announcement on May 30 reminding “health care professionals to use blunt-tip suture needles as an alternative to standard suture needles when suturing fascia and muscle to decrease the risk of needlestick injury.”

Read the rest of this entry »

Reducing phlebotomy needlesticks

By: May 29th, 2012 Email This Post Print This Post

More than 10 years after the passage of the Needlestick Prevention and Safety Act phlebotomy procedures still pose significant needlestick risks for healthcare workers. A free webinar for nursing staff will discuss “the most recent needlestick injury data and nurses’ rights under current laws/regulations, as well as provide a review of available safety-engineered technologies and the benefits and limitations of each class of devices.”

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Study assesses dental students on bloodborne exposures

By: April 16th, 2012 Email This Post Print This Post

Fewer than half of dental school students showed “adequate knowledge of transmission and management” of occupational exposure to bloodborne pathogens according to a study appearing in the April issue of the Journal of Dental Education.

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Needlestick prevention group takes to the road

By: April 2nd, 2012 Email This Post Print This Post

Safe in Common, a non-profit organization established to raise awareness about needlestrick hazards for U.S. healthcare personnel, has launched The Needlestick Safety Awareness Tour.

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Call to Action issued to protect healthcare workers from bloodborne disease exposures

By: March 9th, 2012 Email This Post Print This Post

Progress has been made since the passage of the federal Needlestick Safety and Protection Act ten years ago, yet significant challenges remain in reducing the risk of healthcare worker exposure to bloodborne pathogens, according to a March 8 joint news release by the International Healthcare Worker Safety Center at the University of Virginia and the American Nurses Association.

The two organizations, along with 17 other nursing and healthcare organizations have endorsed a Consensus Statement and Call to Action for future efforts on needlestick prevention.

“We view this as a roadmap for future progress in preventing needlesticks, one of the most serious occupational risks healthcare workers face,” according to Center director and UVa Professor Janine Jagger, MPH, PhD. The eight-page statement provides “a snapshot of where we are now and where further work is needed in order to continue to protect healthcare workers from this risk they face every day in the line of duty,” Jagger says.

The Call to Action focuses on five pivotal areas in need of attention:

  1. Improve sharps safety in surgical settings
  2. Understand and reduce exposure risks in non-hospital settings (which include physicians’ offices, clinics, home healthcare, and an array of other settings)
  3. Involve frontline workers in the selection of safety devices
  4. Address gaps in available safety devices, and encourage innovative designs and technology
  5. Enhance worker education and training

A recommendation included in third item on exposure risks in non-hospital settings calls for OSHA  to “promote regional emphasis programs that focus on enforcement of the BPS [Bloodborne Pathogens Standard] in non-hospital settings; further, that other relevant groups, such as accrediting and licensing bodies and healthcare and workers’ compensation insurers enhance compliance incentives for non-hospital employers.”

Jordan Barab, Deputy Assistant Secretary of the OSHA, expressed the agency’s support, according to the news release, and noted, “The goal of this consensus statement, which is to continue the progress in reducing the risk of sharps injuries to healthcare workers, is one that is in line with OSHA’s mission.”

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