safe injection practices. 2 speaker sue dill calloway rn, esq. cphrm ad, ba, bsn, msn, jd ...

Safe Injection Practices

2

Speaker

Sue Dill Calloway RN, Esq. CPHRM

AD, BA, BSN, MSN, JD

President

Patient Safety and Healthcare Consulting

5447 Fawnbrook Lane

Dublin, Ohio 43017

[email protected]

614 791-1468

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Identify Risks for Transmitting Infections

Hospital and ASC in Colorado where surgery tech with Hepatitis C infection steals Fentanyl and replaces it with used syringes of saline infecting 17 patients as of December 11, 2009 and 5,970 patients tested (total 36 for 3 facilities)

Kristen Diane Parker in 2010 gets 30 years for drug theft and needle swap scheme

Worked at Denver’s Rose Medical Center and Colorado Springs’ Audubon Surgery Center

1 www.krdo.com/Global/link.asp?L=399119

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Infection Control

The CDC says there are 1.7 million healthcare infection (HAI) in America every year There are 99,000 deaths in American hospitals every

year

Leadership need to make sure there is adequate staffing and resources to prevent and manage infections

Healthcare-Associated Infections (HAIs) are one of the top ten leading causes of death in the US1

1 www.cdc.gov/ncidod/dhqp/hai.html

Infection Control

There have been more than 35 outbreaks of viral hepatitis in the past 10 years because of unsafe injection practices

This has resulted in the exposure of over 100,000 individuals to HBV and 500 patients to HCV

This includes inappropriate care of maintenance of finger stick devices and glucometers

Includes syringe reuse, contaminations of vials or IV bags and failure of safe injection practices Source: APIC position paper: Safe injection, infusion, and

medication vial practices in health care

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Infection Control Back to Basics It is important to get back to basics in infection

control1

Education and training is imperative to learn each person’s role in preventing infections

What practices and constant reminders do you use to remind staff during patient care encounters?

New needle and syringe for every injection

Single dose saline syringes 1 http://www.jcrinc.com/infection-prevention-back-to-basics/

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What is Injection Safety or Safe Injection Practices?

The CDC says it is a set of measures taken to perform injections in an optimally safe manner for patients, healthcare personnel, and others

A safe injection does not harm the recipient, does not expose the provider to any avoidable risks and does not result in waste that is dangerous for the community

Injection safety includes practices intended to prevent transmission of infectious diseases between one patient and another, or between a patient and healthcare provider, and also to prevent harms such as needle stick injuries

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CDC Injection Safety Website

The CDC has an injection safety website

Contains information for providers

Injection Safety FAQs

Safe Injection Practices to Prevent Transmissions of Infections to Patients

Section from Guidelines for the Isolation Precautions to Prevent Transmission and more

www.cdc.gov/ncidod/dhqp/injectionsafety.html

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CDC Guidelines CDC has a publication called 2007 Guideline for

Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

Has a section on Safe Injection Practices (III.A.1.b. and starts on page 68)

Discusses four large outbreaks of HBV and HCV among patients in ambulatory facilities

Identified a need to define and reinforce safe injection practices

www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

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Lumbar Puncture Procedures

CDC investigated 8 cases of post-myleography meningitis

Streptococcus species from oropharngeal flora

None of the physicians wore a mask

Droplets of oral flora indicated

Lead to CDC recommendations of 2007

Later related to not wearing a mask when anesthesiologists put in epidural lines for pain relief on women in labor

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CDC Guidelines Recently, five cases where anesthesiologist inserts

epidural line in OB patients without wearing a mask January 29, 2010 CDC MMWR at

www.cdc.gov/mmwr/preview/mmwrhtml/mm5903a1.htm

CDC made recommendation in June 2007 after several reports of meningitis after myelograms

Bacterial meningitis in postpartum women and Ohio woman dies May 2009

Streptococcus salivarius meningitis (bacteria that is part of normal mouth flora)

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Wear Mask When Inserting Epidural/Spinal

Hospital in NY

–Enhanced hand hygiene

–Maintenance of sterile fields

–Full gown, gloves, and mask

–No visitors when epidural put in

CDC has only identified 179 cases of post spinal (including lumbar punctures) world wide from 1952 to 2005

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CDC Guidelines

CDC identified four outbreaks in

Pain clinic

Endoscopy clinic

Hematology/oncology clinic

Will discuss major findings later

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CDC GuidelinesPrimary breaches

Reinsertion of used needles into multidose vials

Used 500cc bag of saline to irrigate IVs of multiple patients

Use of single needle or syringe to administer IV medications to multiple patients

Preparing medications in same work space where syringes are dismantled

Remember OSHA Bloodborne Pathogen standard (sharps containers at the bedside)

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What to Do?

Use only single dose vials and not multidose vials when available

This includes the use of saline single dose flushes

Single use of a disposal needle and syringe for each injection

Prevent contamination of injection equipment and medication

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What to Do?

Wear masks when inserting epidural or spinals

Discard used syringe intact in appropriate sharps container

Make sure sharps container in each patient room

Do not administer medications from single dose vials to multiple patients or combine left over contents for later use

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What to Do?

If multiple-dose vials are used, restrict them to a centralized medication area or for single patient use

Never re-enter a vial with a needle or syringe used on one patient if that vial will be used to withdraw medication for another patient

Store vials in accordance with manufacturer’s recommendations and discard if sterility is compromised

Mark date on multi-dose vial

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What to Do?

Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients

Follow the CDC 10 recommendations

Maintaining clean, uncluttered, and functionally separate areas for product preparation to minimize the possibility of contamination

CMS Hospital CoP requirement, tag 501

TJC 2010 MM.05.01.07

Clean top with Bleach wipe after each use

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A Scary Study The CDC says a survey of US Healthcare found

that 1% to 3% reused the same syringe and/or the same needle on multiple patients

This is what lead to the Nevada patients being exposed to HIV, HCV, and HCB

40,000 patients were notified who has anesthesia injections from March 2004 to January 11, 2008 and 115 patients infected with HCV

Clinic reused syringes in colonoscopies and other gastrointestinal procedures

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Please Ask Me

The Ask Me Program and the Nevada Medical Association posts information on their website

The Nevada State Health Division has encouraged patients to ask several questions prior to a surgical procedure http://health.nv.gov/docs/030308PressRelease.pdf

Can you assure me that I am safe in your facility from the transmission of communicable diseases?

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Please Ask Me Program How does the staff at this facility conduct

sterilization of diagnostic equipment after each patient use?

Are single or multiple dose vials used at the facility? Are label instructions followed specifically?

Are syringes and needles disposed of after each use?

Has your facility ever received a complaint of the spread of an infectious disease to another patient as a result of staff practices?

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CDC Injections Safety for Providers

The CDC also issues Injection Safety for Providers Issued March 2008 at http://www.cdc.gov/ncidod/dhqp/ps_providerInfo.html

Notes several investigations leading to transmission of Hepatitis C to patients

Thousands of patients notified to be test for HVB, HCV, and HIV

Referral of providers to the licensing boards for disciplinary actions

Malpractice suits filed by patients

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CDC 10 Recommendations

The CDC has a page on Injection Safety that contains the excerps from the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

Summarizes their 10 recommendations

Available at http://www.cdc.gov/ncidod/dhqp/injectionSafetyPractices.html

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CDC Safe Injection Recommendations

Use aseptic technique to avoid contamination of sterile injection equipment. Category 1A

Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed.

Needles,cannula and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient.1A

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Use fluid infusion and administration sets (i.e., intravenous bags, tubing and connectors) for one patient only and dispose appropriately after use

Consider a syringe, needle, or cannula contaminated once it has been used to enter or connect to a patient's intravenous infusion bag or administration set 1B

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Use single-dose vials for parenteral medications whenever possible 1A

Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use 1A

If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile 1A

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Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations;

Discard if sterility is compromised or questionable 1A

Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients 1B

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Wear a mask when placing a catheter or injecting material into the spinal canal or subdural space

Example, during myelograms, lumbar puncture and spinal or epidural anesthesia. 1B

Worker safety; Adhere to federal (OSHA) and state requirements for protection of healthcare personnel from exposure to blood borne pathogens 1B

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CDC has Injection Safety FAQs for Providers

CDC has another resources with frequently asked questions

What is injection safety?

Incorrect practices identified in IV medications for chemotherapy, cosmetic procedures, and alternative medicine therapies

Available at http://www.cdc.gov/ncidod/dhqp/injectionSafetyFAQs.html

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Also puts patients at risk for bacterial and fungal infections beside HIV and Hepatitis

Single dose vials do not contain a preservative to prevent bacterial growth so safe practices necessary to prevent bacterial and viral contamination

Proper hand hygiene before handling medications

Make sure contaminated things are not placed near medication preparation area

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Single use parenteral medication should be administered to one patient only

Pre-filled medication syringes should never be used on more than one patient

A needed or other device should never be left inserted into a medication vial septum for multiple uses

This provides a direct route for microorganisms to enter the vial and contaminate the fluid

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Multi-dose Vials

The safest thing to do is restrict each medication vial to a single patient, even if it's a multi-dose vial

Proper aseptic technique should always be followed

If multi-dose medication vials must be used for more than one patient, the vial should only be accessed with a new sterile syringe and needle

It is also preferred that these medications not be prepared in the immediate patient care area

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To help ensure that staff understand and adhere to safe injection practices, we recommend the following:

Designate someone to provide ongoing oversight for infection control issues

Develop written infection control policies

Provide training

Conduct performance improvement assessments

USP 797

USP published a revision to the USP general Chapter of 797

These standards apply to pharmacy compounded sterile preparation

This includes injections, nasal inhalations, suspensions for wound irrigations, eye drops etc.

Applies to the pharmacy setting as well as to all persons who prepare medications that are administered

And it applies to all healthcare centers58

USP 797 This chapter includes standards for preparing,

labeling, and discarding prepared medications

Pharmacies compound sterile preparations under laminar flow hoods with stringent air quality and ventilation to maintain the sterility of the drug (ISO class 5 setting)

If prepare outside the pharmacy then environment has particulates and microorganisms increasing the potential for contaminating the vial, IV solution or syringes Need to wash hands before preparing medication outside the

pharmacy59

USP 797

Want to prepare IVs and piggybacks in the pharmacy when at all possible

Breathing over the sterile needle and vial stopper can create the potential for microbial contamination

USP exempts preparation outside the pharmacy for immediate use

1 hour limit from completing preparation and this includes spiking an IV bag

Cost of medication disposal can be daunting if case not started within one hour which is why should consider pharmacy preparing under ISO class 5 environment

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USP 797 This way the drugs used for surgery are prepared

by properly trained, cleansed, and garbed personnel to prolong the usability of the immediate use compounded sterile drugs (CSD)

These can be stored for 48 hours

Another option is to located a manufacturers injectable product (prepackaged syringe) that is discarded according to manufacturer expiration date

APIC supports preparing parenteral medication as close as possible to the time of administration

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USP 797 APIC Recommendations Make sure only trained staff are preparing medications

Need to prepared in a clean dry workspace that is free of clutter and obvious contamination sources like water, sinks

Medications should be stored in a manner to limit the risk of tampering

Should verify the competency of those preparing medications and monitor compliance with aseptic technique

28 day discard date on multidose vials even though CDC says manufacturers recommendations

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APIC Recommendations

APIC issues recommendations and key talking points for hospitals and healthcare facilities

http://apic.informz.net/apic/archives/archive_272235.html

The infection preventionist at our facility has designed a coordinated infection control program

This is protect everyone coming in to our facility

Our program implements evidenced based practices from leading authorities including the CDC

APIC Recommendations Cleanse the access diaphragm of vials using

friction and a sterile 70% isopropyl alcohol, ethyl alcohol, iodophor, or other approved antiseptic swab

Allow the diaphragm to dry before inserting any device into the vial

Never store or transport vials in clothing or pockets.

Discard single-dose vials after use

Never use them again for another patient

Use multi-dose medication vials for a single patient whenever possible

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APIC Recommendations

Never leave a needle, cannula, or spike device inserted into a medication vial rubber stopper because it leaves the vial vulnerable to contamination

even if it has a 1-way valve

Use a new syringe and a new needle for each entry into a vial or IV bag

Utilize sharps safety devices whenever possible

Dispose of used needles/syringes at the point of use in an approved sharps container

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Blood Glucose Monitoring Devices APIC

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APIC Key Talking Points

This program includes

Rigorous hand hygiene practices

Monitoring the cleaning disinfection, and sterilization of equipment and instruments

An Exposure Control Plan that serves to minimize bloodborne pathogens such as HIV, Hepatitis B and C by patients and staff

As part of this program there are measures to prevent the re-use of items designed to be used only once such as needles and syringes

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A Patient Safety Threat-Syringe Reuse

CDC published a fact sheet called “A Patient Safety Threat- Syringe Reuse”

It was published for patients who had received a letter stating they could be at risk due to syringe reuse

Discusses the dangers of the reuse of syringes

Discusses that multidose vial be assigned to a single patient to reduce the risk of disease transmission

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Anesthesia DeliveryNevada clinics started with Lidocaine 1 cc and Propofol 9ccs in one syringe

Clean needle and syringe initially

If patient needed more used clean needle but used old syringe

If medication left in the single dose Propofol vial used to sedate the next patient

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Anesthesia Delivery

Propofol is single dose medication and preservative free

Bought 20-50cc vials but only used 10-15cc per patient

Clinic had not had full inspection by state surveyors in 7 years

Identified a number of infection control problems with ASC

CMS has new freestanding ASC CMC CfCs May 18, 2009 and revised December 30, 2009

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Never Event: Unsafe Injection Practices

The CDC has a website entitled “ A Never Event: Unsafe Practices”

Has a power point presentation and an audio presentation

Available at www.cdc.gov/ncidod/dhqp/COCA_Unsafe_Injection_Practices.html

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Hematology Oncology Clinic

Has an outbreak of HCV among outpatients 3-00 to 7-01

Reported to Nebraska Health Department

99 patients with clinic acquired HCV after having chemotherapy

All were genotype 3 a which is uncommon in the US

Related to catheter flushing

Source: Macedo de Oliveira et al., Annals of Internal Medicine, 2005, 142:898-902

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Hematology Oncology Clinic

Nurse drew blood from the IV catheter

Then she reused the same syringe to flush the catheter with saline

She did use a new syringe for each patient

However, she used solution from same 500cc bag for multiple patients

Oncologist and RN license revoked

Never use an IV solution bag to flush the solution for more than patient

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Other Cases Patient in US gets malaria from saline flush

Emerging Infectious Diseases, Vol 11, No. 7, July 2005

Oklahoma Pain Clinic where anesthesiologist filled syringe with sedation medication to treat up to 24 patients and injected via hep lock

71 patients with HCV and 31 with HBV

25 million dollar settlement

Source: Comstock et al. ICHE, 2004, 25:576-583

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Other Cases

19 patients get HCV in New York in 2001 from contamination of multi-dose anesthesia vials

CDC MMWR September 26, 2003, Vol 52, No 38

NY City private physician office with 38 patients with HBV

Associated with injections of vitamins and steroids

Gave 2 or 3 in one syringe Source: Samandari et al. ICHE 2005 26 (9);745-50

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Bacterial Outbreak Due to Unsafe Needle

7 patients get serratia marcescens from spinal injections in a pain clinic

Source: Cohen Al et al. Clin J Pain 2008; 24(5):374-380

Several other studies where patients got infection from joint and soft tissue injections

Got staph aureus

In 2003 and 2009

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Dialysis Facilities

CDC issues MMWR report April 2008

Dialysis units must follow CDC guidelines to receive Medicare payments for outpatient services

Recent outbreaks of HCV and other bacterial infections

From reentry into single dose medication vials to more than one patient

CDC recommends to use single dose vials

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Dialysis Facilities

If multi-dose then should be assigned to one person

Should be prepared in a clean area separate from potentially contaminated surfaces

Medications should be prepared in clean area removed from the patient treatment area because surfaces are subjected to frequent blood contamination

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Injections Safety and Recent Outbreaks

The CDC website has a slide presentation called “Injection Safety & Recent Outbreaks”

From APIC North Carolina October 5, 2009

Has 48 slides

Available at http://www.cdc.gov/ncidod/dhqp/injectionsafety.html

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WHO Injection Safety

The World Health Organization also has resources on injection safety

Recently had 10th annual meeting of the Safe Injection Global Network (SIGN)

Has revised injection safety assessment tool

73 pages document

http://www.who.int/injection_safety/en/

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WHO Safe Injection Tool

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WHO

Also has a 51 pages document

Covers the 2008 conference that was held in Moscow

Additional information about the Safe Injection Global Network (SIGN)

Includes a report of the SIGN

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One and Only Campaign

Educational awareness to improve safe practices in healthcare

One needle, one syringe, and only one time for each patient

To empower patients and re-educate healthcare providers

Has free posters

Coalition partners include APIC, AANA, CDC. AAAHC, Nebraska Medical Association, Nevada State Department of Health etc.

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http://oneandonlycampaign.org/

Advancing ASC Quality

ASC Quality Collaboration has ASC tool kit for infection prevention

Includes one on hand hygiene and safe injection practices

Includes a basic and expanded version of the toolkit

These are available at http://www.ascquality.org/advancing_asc_quality.cfm

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The End Questions



President

Patient Safety and Healthcare Consulting

5447 Fawnbrook Lane

Dublin, Ohio 43017

614 791-1468

[email protected]

Avoiding Needlestick Follows114114

Avoiding Needle Stick Injuries

116

Speaker



President

Patient Safety and Education

5447 Fawnbrook Lane

Dublin, Ohio 43017

614 579-1481

[email protected]

116116

OSHA

Ten years after the Needlestick Safety and Prevention Act was signed into law

Which is part of the OSHA Bloodborne Pathogen Standard (29 CFR 1910.1030)

OSHA announces a regulatory review of the law

Has this standard had a impact on healthcare worker safety?

Recent article says sharps in non-surgical setting has declined by about 32% 1

1 Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings versus non-surgical settings after passage of national needlestick legislation. J Amer Col Surg 2010; 210:496-502

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OSHA

Safely engineered devises have resulted in 74% decrease in injuries in phlebotomy

However, this is not true in the surgery operating room where adoption of blunt suture needles and other sharps safety measures have lagged

Sharps injury has increased from 1993 to 2006 by 6.5%

This regulation remains the most frequent cited standard in OSHA inspections of hospitals

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OSHA Inspectors were most likely to cite for failing to have

an adequate exposure control plan or failing to update the plan to reflect changes in technology

The standard requires employers to review their exposure control plans annually

Hospitals also were cited for failing to provide safety-engineered devices

Or failing to document that employees had been offered the hepatitis B vaccine

The same types of violations are being seen by ASCs

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www.osha.gov/SLTC/bloodbornepathogens/index.html

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Needlestick Safety and Prevention Act The Occupational Exposure to Bloodborne Pathogen

Standard was first published in 1991

Passed because of concerns to healthcare workers of things such as HIV, hepatitis B and C who were exposed to blood or other potentially infectious materials

saliva, blood, semen, cerebrospinal fluid, amniotic, synovial, pleural, pericardial, peritoneal etc

Employer needed an exposure control plan on details on employee protection measures

Engineering controls included safer medical devices, such as needleless devices, shielded needle devices and plastic capillary tubes

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Needlestick Safety and Prevention Act

Despite these advances with non-needle devises needlestick and sharps injuries continued

OSHA said there were nearly 600,000 percutaneous injuries involving sharps so Congress passed the Needlestick Safety and Prevention Act which became effective April 18, 2001 (passed November 6, 2000)

Still requires employers to adopt engineering and work practice controls that would eliminate or minimize employee exposure from hazards associated with bloodborne pathogens

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Need to pull out your exposure control plan every year

Need to do an annual review

Need to update to reflect changes in technology that help to eliminate or reduce exposure to bloodborne pathogens

Take into consideration new safer devices designed to reduce needlestick injuries

Document consideration and use of appropriate safer devices

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Sample Model Plans from OSHAwww.osha.gov/Publications/osha3186.html

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List employees involved and describe how input was requested or present minutes of meetings

Employers need to get input from employees responsible for direct patient care (non management such as nurses) on evaluation, identification and selection of effective and safer devices

Employees selected should include those exposure in different areas like peds, geriatrics, nuclear medicine etc.

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Engineering controls include things that isolate or remove a hazard from the workplace

Such as sharp disposal containers and self-sheathing needles

Sharps with engineered sharps injury protection (SESIP) includes nonneedle sharps or needle devices with safety features including Syringes with a sliding sheath that shields the attached needle after use

Needles that retract into a syringe after use

Shielded or retracting catheters

IV delivery systems that use a catheter port with a needle housed in a protective covering

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Needless systems include IV medication using a port with non needle connections or jet injection system that deliver liquid medicine under the skin or through a muscle

Employers must keep a Sharps Injury Log for the recording of percutaneous injuries from contaminated sharps

Remember that sharps containers must be easily accessible to employees and located as close as feasible to the immediate area where sharps are used

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www.cdc.gov/niosh/sharps1.html

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www.osha.gov/SLTC/bloodbornepathogens/index.html

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Sharps Safety

Have a policy and procedure on sharps safety

Include safety measures to prevent injury during perioperative care

Use double gloving, blunt suture needles for fascial closing and neutral zones, when appropriate, to avoid hand to hand passage of sharps

Include references position statements in P&P and where these are located1

1 www.cspsteam.org/sharpssafety/sharpssafety.html

Blunt Tip Suture Needles

Surgical personnel are at risk of bloodborne injuries from sharp surgical instruments

OSHA has document on the “Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel: Safety and Health Information Bulletin” 1

Sharp tip suture needles are the leading source of percutaneous injuries to surgical personnel causing 51 to 77% of these incidents

1 http://www.cdc.gov/niosh/docs/2008-101/

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Sharp-tip Suture Needles

Suture needle injuries can occur when surgical personnel;

Load or reposition the needle into the needle holder

Pass the needle hand-to-hand between team members

Sew toward the surgeon or assistant while the surgeon or assistant holds back other tissue

Tie the tissue with the needle still attached

Leave the needle on the operative field

Place needles in an over-filled sharps container or

Place needles in a poorly located sharps container139

National Associations Blunt Tip Suture

American College of Surgeons ACS) recommends in 2005 the universal adoption of blunt-tip suture needles for suturing fascia

Also encourages further investigation of their appropriate use in other surgical applications

AORN endorsed this ASC statement in support of blunt-tip suture needles where effective and clinically appropriate

Other organizations endorse such as ASA, ASPAN, AANA, American Association of Surgical PAs, and the Association of Surgical Technologists

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Blunt Tip Suture Needles

Blunt tip suture needles can be used to suture less dense tissue such as muscle and fascia

59% of the suture needle injuries occur when suturing muscle and fascia

Multiple studies have reported the effectiveness of blunt tip suture needles in decreasing percutaneous injuries

OSHA and NIOSH strongly encourage their use when feasible and appropriate

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AORN 2010 Page 697 Perioperative Standards and Recommended Practices

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ACS www.facs.org/fellows_info/statements/st-52.html

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www.cdc.gov/sharpssafety/

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Free Workbook from the CDC

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International Sharps Injury Prevention Society www.isips.org/

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www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_22.htm

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http://www.tdict.org/

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www.healthsystem.virginia.edu/internet/epinet//

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http://nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/occupationalhealth/SafeNeedles.aspx

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www.cdc.gov/niosh/topics/bbp/ndl-law.html

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www.facs.org/about/committees/cpc/preventingsharpsinjuries.pdf

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Resources

Jagger J, Bentley M, Tereskerz P. A study of patterns and prevention of blood exposure in OR personnel. AORN J. 1998; 67(5):979-81, 983-4, 986-7

Berguer R, Heller PJ. Preventing sharps injuries in the operating room. J Am Coll Surg. 2004; 199(3):462-7

Makary MA, Al-Attar A, Holzmueller CG, Sexton JB, Syin D, Gilson MM, Sulkowski MS, Pronovost PJ. Needlestick injuries among surgeons in training. N Engl J Med. 2007 Jun 28; 356(26):2693-9

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Resources

Davis MS. Advanced Precautions for Today's OR: The Operating Room Professional's Handbook for the Prevention of Sharps Injuries and Bloodborne Exposures, 1st ed. Atlanta; Sweinbinder; 1999.

American College of Surgeons (ACS). Statement on blunt suture needles. Bull Am Coll Surg. 2005 Nov; 90(11):24. Available from http://www.facs.org/fellows_info/statements/st-52.html

172

Resources

Association of Perioperative Registered Nurses (AORN). AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting. In: 2005 Standards, Recommended Practices, and Guidelines. 2005; 199-204.

Available from www.aorn.org/about/positions/pdf/SECTI-2esharpssafety.pdf

Centers for Disease Control and Prevention (CDC). Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures-New York City, March 1993-June 1994. MMWR Morb Mortal Wkly Rep. 1997; 46(2):25-9.

http://www.cdc.gov/ mmwr/preview/mmwrhtml/00045660.htm 173

Resources

CFR (Code of Federal regulations). Title 29 Part 1910, OSHA. Washington, DC: U.S. Government Printing Office, Office of the Federal Register

Dauleh MI, Irving AD, Townell NH. Needle prick injury to the surgeon-do we need sharp needles? J R Coll Surg Edinb. 1994; 39(5):310-1.

Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings versus non-surgical settings after passage of national needlestick legislation. J Amer Col Surg 2010; 210:496-502

174

Resources

Davis MS. Advanced Precautions for Today’s O.R. In: The Operating Room Professional’s Handbook for the Prevention of Sharps Injuries and Bloodborne Pathogen Exposures. Atlanta, GA: Sweinbinder Publications LLC; 2001.

Aarnio P, Laine T. Glove perforation rate in vascular surgery—A comparison between single and double gloving. Vasa. 2001;30(2):122-124.

Berguer R, Heller PJ. Strategies for preventing sharps injuries in the operating room. Surg Clin North Am. 2005;85(6):1288-305, xiii.

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Resources

Caillot JL, Cote C, Abidi H, Fabry J. Electronic evaluation of the value of double gloving. Br J Surg. 1999;86(11):1387-1390.

Dauleh MI, Irving AD, Townell NH. Needle prick injury to the surgeon—Do we need sharp needles? J R Coll Surg Edinb. 1994;39(5):310-311.

Eggleston MK Jr, Wax JR, Philput C, et al. Use of surgical pass trays to reduce intraoperative glove perforations. J Matern Fetal Med. 1997;6(4):245-247.

176

Resources

Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures—New York City, March 1993–June 1994. MMWR Morb Mortal Wkly Rep. 1997;46(2):25-29.

Gerberding JL, Littell C, Tarkington A, et al. Risk of exposure of surgical personnel to patients’ blood during surgery at San Francisco General Hospital. N Engl J Med. 1990;322(25):1788-1793.

177

Resources

Hartley JE, Ahmed S, Milkins R, et al. Randomized trial of blunt-tipped versus cutting needles to reduce glove puncture during mass closure of the abdomen. Br J Surg. 1996;83(8):1156-1157

Hollaus PH, Lax F, Janakiev D, et al. Glove perforation rate in open lung surgery. Eur J Cardiothorac Surg. 1999;15(4):461-464.

Jagger J, Bentley M, Tereskerz P. A study of patterns and prevention of blood exposures in OR personnel. AORN J. 1998;67(5):979-981, 983-974, 986-977.

178

Resources

Jensen SL. Double gloving—Electrical resistance and surgeons’ resistance. Lancet. 2000;355(9203):514-515.

Laine T, Aarnio P. How often does glove perforation occur in surgery? Comparison between single gloves and a double-gloving system. Am J Surg. 2001;181(6):564-566.

Mingoli A, Sapienza P, Sgarzini G, et al. Influence of blunt needles on surgical glove perforation and safety for the surgeon. Am J Surg. 1996;172(5):512-516; 516-517.

179

Resources

Montz FJ, Fowler JM, Farias-Eisner R, Nash TJ. Blunt needles in fascial closure. Surg Gynecol Obstet. 1991;173(2):147-148.

Naver LP, Gottrup F. Incidence of glove perforations in gastrointestinal surgery and the protective effect of double gloves: A prospective, randomised controlled study. Eur J Surg. 2000;166(4):293-295.

Quebbeman EJ, Telford GL, Hubbard S, et al. Risk of blood contamination and injury to operating room personnel. Ann Surg. 1991;214(5):614-620.

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Resources

Rice JJ, McCabe JP, McManus F. Needle stick injury. Reducing the risk. Int Orthop. 1996;20(3):132-133.

Stringer B, Infante-Rivard C, Hanley JA. Effectiveness of the hands-free technique in reducing operating theatre injuries. Occup Environ Med. 2002;59(10):703-707.

Tokars JI, Bell DM, Culver DH, et al. Percutaneous injuries during surgical procedures. JAMA. 1992;267(21):2899-2904.

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Resources

A recent CDC presentation on Unsafe Injection Practices, along with audio and a transcript of the presentation are available at: www.cdc.gov/ncidod/dhqp/COCA_Unsafe_Injection_Practices.html

Re: infection control and injection practices www.cdc.gov/ncidod/dhqp/ps_providerInfo.html

183

Resources

Re: protecting patients from bloodborne pathogens in healthcare settings www.cdc.gov/ncidod/dhqp/bp_patient.html

Re: prevention of surgical site infections www.cdc.gov/ncidod/dhqp/gl_surgicalsite.html

Re: hand hygiene in healthcare facilities www.cdc.gov/handhygiene/

184

Resources

Re: healthcare facility physical environment and infection control

www.cdc.gov/ncidod/dhqp/gl_environinfection.html

CDC’s home page for infection control provides links to additional information:

www.cdc.gov/ncidod/dhqp/index.html

185

Resources

Mast ST, Woolwine JD, Gerberding JL. Efficacy of gloves in reducing blood volumes transferred during simulated needlestick injury. J Infect Dis 1993;168(6):1589-92.

Henry K, Campbell S, Collier P, Williams CO. Compliance with universal precautions and needle handling and disposal practices among emergency department staff at two community hospitals. Am J Infect Control 1994;22(3):129-37.

186

Resources

Vaughn TE, McCoy KD, Beekmann SE, Woolson RE, Torner JC, Doebbeling BN. Factors promoting consistent adherence to safe needle precautions among hospital workers. Infect Control Hosp Epidemiol 2004;25(7):548-55.

Clarke SP, Rockett JL, Sloane DM, Aiken LH. Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses. Am J Infect Control 2002;30(4):207-16.

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Resources CDC Training on Hepatitis

www.cdc.gov/hepatitis/Resources/Professionals/TrainingResources.htm

188

Resources

Danzig LE, Short LJ, Collins K, et al. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAMA 1995;273(23):1862-4.

189

Resources

Patel PR, Larson AK, Castel AD, et al. Hepatitis C virus infections from a contaminated radiopharmaceutical used in myocardial perfusion studies. JAMA 2006;296:2005--11.

CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47(No. RR-19).

Williams IT, Perz JF, Bell BP. Viral hepatitis transmission in ambulatory health care settings. Clin Infect Dis 2004;38:1592--8.

190

Resources

Comstock RD, Mallonee S, Fox JL, et al. A large nosocomial outbreak of hepatitis C and hepatitis B among patients receiving pain remediation treatments. Infect Control Hosp Epidemiol 2004;25:576--83.

Krause G, Trepka MJ, Whisenhunt RS, et al. Noscomial transmission of hepatitis C virus associated with the use of multidose saline vials. Infect Control Hosp Epidemiol 2003;24:122--7.

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