sharps injury surveillance and prevention in massachusetts angela k. laramie, mph massachusetts...
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Sharps Injury Surveillance and Prevention
in Massachusetts
Angela K. Laramie, MPHMassachusetts Sharps Injury Surveillance SystemOccupational Health Surveillance ProgramMNAJune 2007
Background
• Risk of being exposed to HBV, HCV, and HIV
• Risk of infection for:HBV 6% to 30%
(for those not immune to HBV)
HCV 1.8% (range 0% to 7%)
HIV 0.3%
Costs of sharps injuries
• Direct costs– includes cost of EH personnel, lab tests, HBV
immune globulin, HBV vaccine• ranges from $110 - $1,232
– Includes medical care after seroconversion• ranges from $32,000 - $500,000
• Indirect costs - difficult to quantify
Sharper images: Despite needlestick law, nonsafe sharps practices still go uncheckedBy Ed Frauenheim February 12, 2001 Nurse Week Photo: Courtesy of the White House
Timeline of Regulations
December 1998 Legislation filed by Massachusetts Nurses Association
August 2000 An Act Relative to Needlestick Injury Prevention (Massachusetts)
November 2000 Needlestick Safety and Prevention Act (Federal)
January 2001 OSHA revised Bloodborne pathogen standard
April 2001 MDPH regulations (included in hospital licensure regulations)
States with sharps legislation:
1998 2000 Ohio
California West Virginia Massachusetts
Minnesota New York
1999 Maine
Tennessee Georgia 2001
Maryland Iowa Arkansas
Texas New Hampshire Missouri
New Jersey Alaska Rhode Island
Connecticut Pennsylvania
As of June 2002Oklahoma
MDPH Sharps Injury Prevention Regulations
105 CMR 130.1001 et seq.
Requires hospitals to:
• Incorporate the use of safe needle / sharps devices into engineering and work practice controls
• Maintain a written exposure control plan
– with procedures for selecting safe devices
MDPH Sharps Injury Prevention Regulations
105 CMR 130.1001 et seq.
Requires hospitals to:• Maintain a Sharps Injury Log• Use data for continuous quality improvement• Report to MPDH annually (Annual Summary)
Requires MDPH to:• Establish an Advisory Committee• Develop a list of needleless systems
MDPH Sharps Injury Prevention Advisory Committee
• Mass Nurses Assoc.• Mass Hospital Assoc.• Mass Medical Society• UMass: Sustainable
Hospitals Project• NECOEM• Consumer Advocate
MDPH • Occupational Health
Surveillance• Bureau of Communicable
Disease Control• Division of Health Care
Quality
Objectives of the Sharps Injury Surveillance System
• Document magnitude of the problem and trends in sharps injuries among hospital workers overtime
• Identify departments, occupations, procedures, and hospitals where intervention is needed
• Identify devices associated with sharps injuries
• Facilitate sharing information among hospitals about successful programs and practices
Methods
• Population under surveillance: All health care workers in Massachusetts hospitals (acute and non-acute care) licensed by MDPH
• Reportable exposure incident: BBP exposure that is the result of events that pierce the skin or mucous membranes
• Reporting period: January 1 – December 31
• Coding structure is based on the CDC NaSH system
Annual Summary of Sharps Injuries Hospital: Massachusetts Department of Public Health License Number:Occupational Health Surveillance Program Hospital Contact:
Phone number:Year:
Use of the attached lists is encouraged when completing this form. *Required data elements for reporting to MDPH.
Sharps Injuries among Massachusetts Hospital Workers, 2002 -2004
2002 2003 2004
# of hospitals 101 99 99
% compliance 100% 100% 100%
# of injuries reported 3,413 3,327 3,276
Range of # of injuries reported 0 – 431 0 - 312 1-317
% injuries in acute care hospitals 97% 97% 97%
% injuries in teaching hospitals 40% 58% 59%
Sharps Injuries among Hospital Workers by Occupation, Massachusetts, 2002-2004, N=10,016
Nurse40%
Other / Not answered
3%
Physician32%
Technician19%
Other Medical Staff1%
Support Services
4%
Dental Staff1%
Sharps Injuries among Massachusetts Hospital Workers, 2002-2004
top 4 occupations
05
101520253035404550
Nurse Physician Technician SupportServices
2002N=3,413
2003N=3,327
2004N=3,276
Per
cent
age
of in
jurie
s
Sharps Injuries among Massachusetts Hospital Workers, 2002-2004
top 4 occupations
0
200
400
600
800
1000
1200
1400
Nurse Physician Technician SupportServices
2002N=3,413
2003N=3,327
2004N=3,276
# of
inju
ries
Sharps Injuries among Hospital Workers by Department, Massachusetts, 2002-2004, N=10,016
OR and Procedure
Rooms42%
Inpatient Units23%
ED8%
ICU8%
Laboratories5%
Outpatient Areas4%
Other Areas and Unknown / Not
Answered10%
Sharps Injuries among Massachusetts Hospital Workers, 2002-2004
top 4 departments
05
101520253035404550
OR InpatientUnits
ED ICU
2002N=3,413
2003N=3,327
2004N=3,276
Per
cent
age
of in
jurie
s
Sharps Injuries among Hospital Workers by Procedure or Purpose for which Device was Used, Massachusetts,
2002-2004, N=10,016
Unknown/ Not Answered
7%Other11%
To obtain body fluid or tissue
sample2%
Line Procedures9%
Making the incision
8%
Blood Procedures
19%
Injection23%
Suturing21%
Sharps Injuries among Hospital Workers by Device, Massachusetts, 2002-2004, N=10,016
Unknown/Not Answered
2%
Vacuum tube collection holder
/ needle5%
Hypodermic needle30%
Other hollow-bore needle
12%
Suture Needle21%
Scalpel7%
Glass1%
Other11%
Butterfly10%
Hollow bore needles
57%
Sharps Injuries among Hospital Workers by Conventional Devices, Massachusetts, 2002-2004, N=10,016
Unknown / Not answered
12%
Conventional59%
Safety29%
Sharps Injuries among Massachusetts Hospital Workers, 2002-2004
% safety devices
0102030405060708090
100
Safety Conventional Unknown/Notanswered
2002N=3,413
2003N=3,327
2004N=3,276
Per
cent
age
of in
jurie
s
Sharps Injuries among Hospital Workers by Device Involved in the Injury, Massachusetts, 2002-2004, N=10,016
0
500
1000
1500
2000
2500
3000H
ypo
der
mic
Su
ture
Bu
tterf
ly
Sca
lpel
Va
cuu
m t
ube
Gla
ss
Oth
er
H-B
Oth
er
Un
k /
No
t An
s
Device
Nu
mb
er o
f In
juri
es
Unknown/Not answered
Safety Device
Conventional Device
Sharps Injuries among Hospital Workers by Device - Standard v Safety, Massachusetts, 2002-2004
(excluding unknown)
0102030405060708090
100
Device
Per
cent
Standard Device Safety Device
Hypodermic Vacuum tubeButterfly Scalpel
Sharps Injuries among Hospital Workers by Department where Injury Occurred, Massachusetts, 2002-2004, N=10,016
0500
10001500200025003000350040004500
Inpa
tien
t
OR
ICU
ED
Ou
tpat
ien
t
Lab
ora
tory
Oth
er
Un
kno
wn
Department
Nu
mb
er o
f In
juri
es
Unknown/Not answered
Safety Device
Conventional Device
Sharps Injuries among Hospital Workers with Hypodermic Needles by Procedure - Standard v Safety Device,
Massachusetts, 2002-2004, n=2,984
0
400
800
1200
1600
2000
2400
Inje
ctio
n
Blo
od
pro
ced
ure
s
Lin
e P
roce
du
res
Ob
tain
tis
sue
sa
mp
le
Oth
er
Un
k /
No
t an
s
Procedure
Nu
mb
er o
f In
juri
es
Unknown/Not answered
Safety Device
Conventional Device
Sharps Injuries among Hospital Workers with Hypodermic Needles by Procedure – Conventional v Safety Device,
Massachusetts, 2002-2004, n=942
0
50
100
150200
250
300
350B
loo
d p
roce
du
res
Lin
e P
roce
du
res
Ob
tain
tis
sue
sa
mp
le
Oth
er
Un
k /
No
t an
s
Procedure
Nu
mb
er
of
Inju
rie
s
Unknown/Not answeredSafety DeviceConventional Device
Sharps Injuries among Hospital Workers in the OR by Device, Massachusetts, 2002, n=935
Vacuum tube collection holder
/ needle1%
Hypodermic needle12%
Other hollow-bore needle
9%
Suture Needle48%
Scalpel11%
Other17%
Unknown/Not Answered
1% Butterfly1%
Hollow bore needles
23%
Sharps Injuries among Hospital Workers in the OR by Device: Conventional v. Safety, Massachusetts, 2002, n=935
0
100
200
300
400
500
Hyp
od
erm
ic n
eed
le
sutu
re n
eed
le
sca
lpe
l bla
de
oth
er
hollo
w b
ore
oth
er
/ un
k /
not
ans
Device
Nu
mb
er
of
Inju
rie
s
Unknown/Not answered
Safety device
Conventional device
Strengths of Massachusetts Program
• Census of hospitals
• Not biased by voluntary reporting
• Concordance with federal requirements
• Used by hospitals for continuous quality improvement
• Provides a mechanism for sharing information among hospitals
• Provides a model to be used in other settings
Annual Summary of Sharps Injuries Hospital: Massachusetts Department of Public Health License Number:Occupational Health Surveillance Program Hospital Contact:Use of the attached lists is encouraged when completing this form. Phone number:*Required data elements for reporting to MDPH. Year:
Data Limitations
• Rate of underreporting is unknown and likely varies by hospital/occupation– Underestimates magnitude
– Limits comparison among hospitals
• Limitations of denominator data
• Statewide data on specific devices is difficult to interpret without market share information
# of devices w/ safety features purchased
#
of
sharps
injuries
Response rate for device
evaluations
Timeliness of PEM
Level of under reporting
Conclusions
• Need to look beyond summary data
• Need better information about under-reporting
• Conversions: conventional → safety
→ first generation ↔ second…fourth generation
Conclusions• Patterns are similar to those found in NaSH and
EPINet
• Many standard devices are still in use; e.g. hypodermic needles
• Approximately half of injuries occur after use of the device; e.g. disposal issues and use of safety features
• Rate of participation may be driven by the ability to comply with multiple regulations at one time
Prevention
Elimination
Substitution
· suturing glues
· injection with needles alternative delivery of medications
Engineering controls
· IV systems needleless IV
· conventional needles SESIPs
(retractable, blunting, shielding, plastic)
PreventionAdministrative controls
· neutral zones in OR
· placement of sharps disposal containers
· purchasing policies
· reporting procedures
Personal Protective Equipment
· gloves, mask, gowns, goggles
Progress by Hospitals:
• Written inventory of devices• Increased conversion to safety devices• Review of safety devices• Committee to look at sharps related injuries• Committee to look at new devices• Involvement of staff in decision making• Centralized purchasing process• Improved post exposure management• Use of data in decision making• Reporting of near misses
Acknowledgements:
Phil Adamo, Evie Bain, Helene Bednarsh, Al DeMaria, Karen Daley, Tish Davis, Natalia Firsova, Catherine Galligan, Anuj Goel, Liz O’Connor, Gail Palmeri, Laurie Robert, Margaret Quinn, and Jim Ryan
This presentation is dedicated to Dr. James Ryan, for his passionate work to protect the health and safety of workers, particularly those in the healthcare field.
Massachusetts Department of Public Health
Occupational Health Surveillance Program
Angela Laramie, MPHSharps Injury Surveillance and Prevention
www.mass.gov/dph/ohsp