Sharps Injuries in the Operating Room

Amanda M. Gust, MPHAmanda M. Gust, MPH

Raymond C. Sinclair, PhDRaymond C. Sinclair, PhD

Pat Hickey, RN, BSN, MS, CNORPat Hickey, RN, BSN, MS, CNOR

Alice Weiss, RNAlice Weiss, RN

Carmen Garcia, RNCarmen Garcia, RN

National Institute for Occupational Safety and HealthNational Institute for Occupational Safety and Health

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

August 1, 2002August 1, 2002

Introduction / Objectives

Sharps injury prevention activitiesSharps injury prevention activities Information & education campaignInformation & education campaign

Stop Sticks CampaignStop Sticks Campaign• Operating Room Safety BlitzOperating Room Safety Blitz

Campaign ProcessCampaign Process Communications campaign are sustainedCommunications campaign are sustained

““Can campaign methods be used to effectively Can campaign methods be used to effectively prevent occupational sharps injuries?” prevent occupational sharps injuries?”

Stop Sticks Campaign

Columbia, SC—5-year pilot projectColumbia, SC—5-year pilot project Goal: Goal:

Raise awareness among health care workers regarding Raise awareness among health care workers regarding exposure to BBPs from sharps injuriesexposure to BBPs from sharps injuries

Increase exposure prevention behaviorsIncrease exposure prevention behaviors Target Audience:Target Audience:

Clinical HCWsClinical HCWs Non-clinical HCWsNon-clinical HCWs Health care administratorsHealth care administrators

Six (6) primary facilitiesSix (6) primary facilities

Stop Sticks Campaign

Aims to deliver information and educationAims to deliver information and education BBPs, exposure prevention methods, device BBPs, exposure prevention methods, device

evaluation, & PEPevaluation, & PEPMultiple messagesMultiple messagesMultiple channelsMultiple channelsMultiple timesMultiple times

InterventionsInterventions Posters, newsletter articles, workshops, in-service Posters, newsletter articles, workshops, in-service

trainings, website, trainings, website, PSAs, direct mail, exhibits, PSAs, direct mail, exhibits, safety fairs, mini-campaignssafety fairs, mini-campaigns

OR Safety Blitz

February 2002February 2002 1 month long1 month long

Largest community hospitalLargest community hospital 24 operating rooms24 operating rooms ~150 OR staff~150 OR staff

OR has highest rate of sharps injuryOR has highest rate of sharps injury Reduce injuries by going “back to the basics”Reduce injuries by going “back to the basics”

Campaign Process

AudienceAudience

AudienceAnalysis

MessageDevelopment

MessageDelivery Evaluation

1 2 3 4

Campaign Process

Audience AnalysisAudience Analysis The more you know the betterThe more you know the better

Demographic characteristicsDemographic characteristics Attitudes & knowledgeAttitudes & knowledge Existing circumstancesExisting circumstances

Information gathering methodsInformation gathering methods Surveys, employee records, small groups, Surveys, employee records, small groups,

one-on-one, staff meetingsone-on-one, staff meetings Tailor campaign & messages accordinglyTailor campaign & messages accordingly

OR Safety Blitz

Audience AnalysisAudience Analysis Occupation – Occupation – Techs, Nurses, SurgeonsTechs, Nurses, Surgeons

EducationEducation – – 2-15 years of additional schooling 2-15 years of additional schooling

Attitudes about safety – Attitudes about safety – various stages (Ex: Neutral Zone)various stages (Ex: Neutral Zone)

Environment – Environment – Fit campaign into current working conditionsFit campaign into current working conditions

Messages kept fairly non-technical with a few exceptionsMessages kept fairly non-technical with a few exceptions

Ex: surgical grand roundsEx: surgical grand rounds

Campaign Process

Message DevelopmentMessage Development Relative risk, prevention strategies, & treatment optionsRelative risk, prevention strategies, & treatment options Content should lead to increased knowledgeContent should lead to increased knowledge Clear / simple messages with frequent repetitionClear / simple messages with frequent repetition Develop messages simultaneouslyDevelop messages simultaneously

Avoid contradictionAvoid contradiction Creative & appealing Creative & appealing Pilot draft messages before usePilot draft messages before use

Campaign Process

AudienceAudience

MessageDevelopment

MessageDelivery Evaluation

1 2 3 4

Audience Analysis

OR Safety Blitz

Message DevelopmentMessage DevelopmentOne message per weekOne message per week

1.1. Risk of experiencing a sharps injuryRisk of experiencing a sharps injury

2.2. Passing and loading cause the most sharps injuriesPassing and loading cause the most sharps injuries

3.3. Establish a neutral zoneEstablish a neutral zone

4.4. Use safer sharps devicesUse safer sharps devices

Balance between “reviewing old” information and Balance between “reviewing old” information and “providing new” information to capture attention“providing new” information to capture attention

Campaign Process

Message DeliveryMessage Delivery Set a strategic schedule for disseminationSet a strategic schedule for dissemination

Coordinate message releaseCoordinate message release• Ex: risk of sharps injuries Ex: risk of sharps injuries info. about safer info. about safer

sharps devicessharps devices device evaluation device evaluation Method of delivery & number of repetitionsMethod of delivery & number of repetitions

Use several channelsUse several channels• Numerous choicesNumerous choices• Strengths & weaknesses varyStrengths & weaknesses vary

RepetitionRepetition

OR Safety Blitz

Message DeliveryMessage Delivery Use pre-existing channels if appropriate Use pre-existing channels if appropriate (we had several)(we had several)

Six (6) channels of communicationSix (6) channels of communication Posters (over the scrub sinks)Posters (over the scrub sinks) Newsletter articlesNewsletter articles Mandatory bi-monthly staff meetings Mandatory bi-monthly staff meetings Paycheck stufferPaycheck stuffer Device fair exhibitDevice fair exhibit Promotional itemsPromotional items

OR Safety Blitz

PostersPosters Newsletter Newsletter ArticlesArticles

Paycheck Paycheck StufferStuffer

Staff Staff MeetingsMeetings

Promotional Promotional ItemsItems

ExhibitExhibit

Week 1Week 1 XX XX XX XX

Week 2Week 2 XX XX XX

Week 3Week 3 XX XX XX XX

Week 4Week 4 XX XX XX XX

Campaign Process

EvaluationEvaluation Coherent & systematic planCoherent & systematic plan Determine indicatorsDetermine indicators

Exposure to message / campaign is often Exposure to message / campaign is often overlooked, but important overlooked, but important

• If campaign exposure is determined, look for If campaign exposure is determined, look for changeschanges

– Awareness, knowledge, attitudes, Awareness, knowledge, attitudes, motivations, behaviorsmotivations, behaviors

– Campaign feedback – likes / dislikesCampaign feedback – likes / dislikes

Campaign Process

EvaluationEvaluation Injury reduction difficult to measureInjury reduction difficult to measure

Awareness, infrequent occurrences, campaign length Awareness, infrequent occurrences, campaign length Set up comparisonSet up comparison

Pre-test / post-testPre-test / post-test Methods of data collectionMethods of data collection

Focus groups, surveys, interviews, beh. obs.Focus groups, surveys, interviews, beh. obs. Choosing methodsChoosing methods

• Available resources, what questions you want Available resources, what questions you want answered, existing opportunitiesanswered, existing opportunities

OR Safety Blitz

EvaluationEvaluation Pre-test given during week 1 – (n = 90 / 150)Pre-test given during week 1 – (n = 90 / 150) Post-test 1 month after completion of blitz – (n = 37 / 150)Post-test 1 month after completion of blitz – (n = 37 / 150) General make-up between pre / post-test comparableGeneral make-up between pre / post-test comparable Q = During my time of employment in the OR, I have experienced a Q = During my time of employment in the OR, I have experienced a

sharps injury:sharps injury: Never = 35%Never = 35% 1-3 times = 49%1-3 times = 49% More than 3 times = 9%More than 3 times = 9% No answer = 7%No answer = 7%

Respondents valued all 4 methods of reducing sharps injuriesRespondents valued all 4 methods of reducing sharps injuries Safer techniques, neutral zone, improved communications, Safer techniques, neutral zone, improved communications,

increased trainingincreased training

OR Safety Blitz

EvaluationEvaluation Campaign feedbackCampaign feedback

All were aware of OR campaignAll were aware of OR campaign71% felt the campaign had an effect on the 71% felt the campaign had an effect on the

way they do their workway they do their workMost preferred: posters, safety fair, & Most preferred: posters, safety fair, &

neutral zone demonstrationneutral zone demonstration

OR Safety Blitz

EvaluationEvaluation Suggested actions / improvements:Suggested actions / improvements:

More physician involvement – More physician involvement – esp. anesthesiaesp. anesthesia

• Include residents and studentsInclude residents and students Implement what we have learnedImplement what we have learned

Increased campaign impact?Increased campaign impact? Speaker with a negative outcomeSpeaker with a negative outcome More staff inputMore staff input

Next steps:Next steps: Follow-up & continued emphasis of safety practicesFollow-up & continued emphasis of safety practices Implementation of safety techniques & deviceImplementation of safety techniques & device

OR Safety Blitz

Lessons LearnedLessons Learned Importance of close communicationImportance of close communication

Posters and newsletter articlesPosters and newsletter articles Paycheck stufferPaycheck stuffer EvaluationEvaluation

• Pre / post-test coordinationPre / post-test coordination• Behavioral observationsBehavioral observations

Campaigns may work in OSH Campaigns may work in OSH Only positive feedback – Only positive feedback – “we want more”“we want more”

Content added to residency orientationContent added to residency orientation Blitz approach used for JCAHO activitiesBlitz approach used for JCAHO activities

Conclusion

OR Safety Blitz vs Stop Sticks CampaignOR Safety Blitz vs Stop Sticks Campaign Department, Facility, or Community levelDepartment, Facility, or Community level

Still contains all four (4) processesStill contains all four (4) processes• Study your audience – Study your audience – check back at each stagecheck back at each stage

• Use multiple messages – Use multiple messages – stay consistentstay consistent

• Use multiple channels – Use multiple channels – repetitionrepetition

• Evaluate your effortsEvaluate your efforts Systematic approach when doing communicationsSystematic approach when doing communications

Contact Information

National Institute for Occupational Safety & HealthNational Institute for Occupational Safety & Health (800) 35 - NIOSH(800) 35 - NIOSH

www.cdc.gov/nioshwww.cdc.gov/niosh

Ray Sinclair Ray Sinclair

(513) 533-8172(513) 533-8172

Rsinclair@cdc.govRsinclair@cdc.gov