Healthcare Worker Safety;Healthcare Worker Safety;More than replacing devicesMore than replacing devices

April 1April 1stst, 2008, 2008

Sharps and Needlestick Injury FactsSharps and Needlestick Injury Facts

• 70,000 - 107,000 incidents each year in Canada70,000 - 107,000 incidents each year in Canada

• 10% of incidents are high risk10% of incidents are high risk

• Incident rate rising – e.g. 136% increase in lost-Incident rate rising – e.g. 136% increase in lost-time injuries in Ontario from 1998 to 2001time injuries in Ontario from 1998 to 2001

• 58% of sharps injuries are unreported=58% of sharps injuries are unreported=

Sharps Injuries have a Serious Sharps Injuries have a Serious Personal ImpactPersonal Impact

• 6 – 12 months waiting to know test results – serious 6 – 12 months waiting to know test results – serious impact on individuals and familiesimpact on individuals and families

• Treatment is debilitatingTreatment is debilitating

• Job impactsJob impacts

• HCV is a serious health riskHCV is a serious health risk

• Chronic infection in 75% - 85% of patientsChronic infection in 75% - 85% of patients

• Active liver disease in 70% of these patientsActive liver disease in 70% of these patients

Who has these injuries?Who has these injuries?

PositionsPositions CCDR StatsCCDR Stats

Nurses RN/Assistant/StudentNurses RN/Assistant/Student 58%58%

PhysicianPhysician 15%15%

PhlebotomistPhlebotomist 5%5%

Housekeeping/LaundryHousekeeping/Laundry 4%4%

TechnologistTechnologist 3%3%

Clinical Lab WorkerClinical Lab Worker 4%4%

Surgery AttendantSurgery Attendant 5%5%

OtherOther 6%6%

SOURCE: Health Canada: Surveillance of Healthcare Workers exposed to Blood/Body Fluids

and Bloodborne Pathogens:. Canadian Needle Stick Surveillance Network

1 April, 2000 to 31 March, 2001

When do these injuries occur?When do these injuries occur?WHEN INJURY OCCURREDWHEN INJURY OCCURRED EPINET %EPINET %

During Use of ItemDuring Use of Item 30.1%30.1%

Between steps of multi-step procedureBetween steps of multi-step procedure 13.7%13.7%

Disassembling deviceDisassembling device 4.2%4.2%

Preparing instrument for re-usePreparing instrument for re-use 1.9%1.9%

Recapping device withdrawing from resistant Recapping device withdrawing from resistant materialmaterial

3.6%3.6%

Other after use, before disposalOther after use, before disposal 16.8%16.8%

Item left on disposal containerItem left on disposal container 0.6%0.6%

After disposal, item protruding from disposal After disposal, item protruding from disposal containercontainer

2.8%2.8%

Restraining patientRestraining patient 0.5%0.5%

Pierced side of disposal containerPierced side of disposal container 0.3%0.3%

Significant Injury Reduction Significant Injury Reduction is Possibleis Possible

Reduction in Injuries:Reduction in Injuries:

• CDC: CDC:

• 75% reduction in injuries75% reduction in injuries

• U of Virginia - EPINET: U of Virginia - EPINET:

• 85% reduction from engineering 85% reduction from engineering controlscontrols

• 95% reduction from comprehensive approach95% reduction from comprehensive approach

• Toronto East General: Toronto East General:

• 80% reduction in total injuries 80% reduction in total injuries

• 100% reduction in blood collection injuries100% reduction in blood collection injuries

National Survey - ManitobaNational Survey - Manitoba

• First to legislate First to legislate mandatedmandated environment – environment – announced in Sept 04announced in Sept 04

• Bill 23 – The Workplace Safety and Health Bill 23 – The Workplace Safety and Health Amendment Act (Needles in Medical Workplaces)Amendment Act (Needles in Medical Workplaces)

• Passed into law effective January 2006Passed into law effective January 2006• Change process is currently underway – 3 year plan Change process is currently underway – 3 year plan

lead by WRHAlead by WRHA

National Survey - SaskatchewanNational Survey - Saskatchewan

• Minister of Labour announced mandated Minister of Labour announced mandated environment at SFL Congress Sept 04environment at SFL Congress Sept 04

• Regulations passed fall 2005 – requirement Regulations passed fall 2005 – requirement in 2006in 2006

• MandatesMandates use of SEMD in all workplaces use of SEMD in all workplaces where there is the risk of a sharps injurywhere there is the risk of a sharps injury

National Survey – Nova ScotiaNational Survey – Nova Scotia

• New regulations passed Summer ’06New regulations passed Summer ’06– Safe Needles in Healthcare Workplaces ActSafe Needles in Healthcare Workplaces Act

• MandatesMandates use of SEMD use of SEMD• Applies to all health care workplacesApplies to all health care workplaces• Fines up to $250kFines up to $250k

National Survey - OntarioNational Survey - Ontario

• Ministry of Labour conducted audits fall 2004 – generated Ministry of Labour conducted audits fall 2004 – generated inconsistent activityinconsistent activity

• April 05 Martell tables private member’s bill mandating April 05 Martell tables private member’s bill mandating SEMDSEMD

• April 05 Min of Health announces $11.6 million one-time April 05 Min of Health announces $11.6 million one-time funding – funds allocated for every acute care facilityfunding – funds allocated for every acute care facility

• August ’07 announcement of regulation (474/07) to mandate August ’07 announcement of regulation (474/07) to mandate use of SEMD – hospitals in ’08, all other workplaces in ‘09use of SEMD – hospitals in ’08, all other workplaces in ‘09

Quebec, New Brunswick, Newfoundland Quebec, New Brunswick, Newfoundland and PEIand PEI

• Quebec – approach still to be definedQuebec – approach still to be defined

• New Brunswick – NBNU, NBGEU, CUPE New Brunswick – NBNU, NBGEU, CUPE have campaign underwayhave campaign underway

• Newfoundland – stakeholder report into MoL Newfoundland – stakeholder report into MoL + MoH+ MoH

• PEI – 100% converted to SEMDPEI – 100% converted to SEMD

National Survey – B.C. Leads the WayNational Survey – B.C. Leads the Way

• Updated regulations in 1998. Hierarchy of risk Updated regulations in 1998. Hierarchy of risk reduction beginning with engineering controls - reduction beginning with engineering controls - required the use of SEMD but did not specify thisrequired the use of SEMD but did not specify this

• Fines to VIHA prompted province-wide conversionFines to VIHA prompted province-wide conversion• Updated regulations Jan 1, 2008 Updated regulations Jan 1, 2008 mandatesmandates SEMD SEMD

– device that provides the “highest level of safety”– device that provides the “highest level of safety”

National Survey – B.C. Leads the WayNational Survey – B.C. Leads the Way

• New regulations – “highest level of safety” and New regulations – “highest level of safety” and broad definition of biohazards including pandemic broad definition of biohazards including pandemic influenzainfluenza

• Unique roles and dialogue between stakeholders – Unique roles and dialogue between stakeholders – BCNU, WorkSafe BC, Health Regions and OHSAHBCNU, WorkSafe BC, Health Regions and OHSAH

• Broad implementation of sharps devicesBroad implementation of sharps devices– Concurrent implementation at FHAConcurrent implementation at FHA

• WHITE system + VIHA Exposure Control PlanWHITE system + VIHA Exposure Control Plan

National Survey – B.C. National Survey – B.C.

• If more than one type of safety-engineered hollow If more than one type of safety-engineered hollow bore needle or safety-engineered medical sharp is bore needle or safety-engineered medical sharp is available in commercial markets, the needle or available in commercial markets, the needle or sharp that provides the highest level of protection sharp that provides the highest level of protection from accidental parenteral contact must be used.from accidental parenteral contact must be used.

• Based upon information from manufacturers, Based upon information from manufacturers, independent testing agencies, objective product independent testing agencies, objective product evaluation, or other reliable sources.evaluation, or other reliable sources.

• Vendors must provide training.Vendors must provide training.

BCNU Focus Group FindingsBCNU Focus Group Findings

1.1. Time available to do training and education Time available to do training and education is compromising change efforts.is compromising change efforts.

2.2. Management must provide active support Management must provide active support for the change process.for the change process.

3.3. Successful implementation of sharps safety Successful implementation of sharps safety technology can improve the overall culture technology can improve the overall culture of safety.of safety.

Culture of Safety: Still Much To DoCulture of Safety: Still Much To Do

VIHA Survey Statistics:VIHA Survey Statistics:

Have you reviewed the VIHA BBF Exposure Control Plan? Have you reviewed the VIHA BBF Exposure Control Plan? 20%20%

Have you reviewed the VIHA BBF Exposure Control Plan with your Have you reviewed the VIHA BBF Exposure Control Plan with your staff? staff? 9%9%

For what percentage of your employees that may be occupationally For what percentage of your employees that may be occupationally exposed to blood and other body fluids, do you have documentation exposed to blood and other body fluids, do you have documentation indicating that each employee has received specific BBF indicating that each employee has received specific BBF Education/Training? Education/Training? 25%25%

From adoption to complianceFrom adoption to compliance

• Compliance still inconsistent within certain Compliance still inconsistent within certain provinces: e.g. Alberta, British Columbiaprovinces: e.g. Alberta, British Columbia

• Challenges within certain areas:Challenges within certain areas:– PharmacyPharmacy– AnaesthesiaAnaesthesia– Nuc. Med., ENTNuc. Med., ENT

Key Success FactorsKey Success Factors

• Executive level leadership/sponsorship is essentialExecutive level leadership/sponsorship is essential• Proactive Clinical Leadership (Risk Management and/or OHSS)Proactive Clinical Leadership (Risk Management and/or OHSS)• Robust Business PlanRobust Business Plan• Implementation plan that considers broader change Implementation plan that considers broader change

management challenges. Framed within context of creating a management challenges. Framed within context of creating a culture of safetyculture of safety

• Strong Education and Training (safety and clinical)Strong Education and Training (safety and clinical)• Sharing best practices – creation of reference sitesSharing best practices – creation of reference sites

Comprehensive ApproachComprehensive Approach

• U. of Virginia: 83% reduction from engineering controls. U. of Virginia: 83% reduction from engineering controls. 94% 94% reduction from comprehensive approachreduction from comprehensive approach

• Elements of Comprehensive ApproachElements of Comprehensive Approach

• Exposure Control PlanExposure Control Plan

• Use of Safety-engineered medical devicesUse of Safety-engineered medical devices

• Training & Education about risks and preventionTraining & Education about risks and prevention

• Sharps Injury LogSharps Injury Log

• Post Exposure Control PlanPost Exposure Control Plan

• Creation of a culture of safety – organizational capacityCreation of a culture of safety – organizational capacity

Healthcare Worker Safety;Healthcare Worker Safety;More than replacing devicesMore than replacing devices

April 1April 1stst, 2008, 2008