Early safety focus pays off for South Carolina hospitals

PHT still monitors sharps safety

To many health care workers, a needlestick was hardly worth worrying about. It was just a prick. It happened fairly often. And the risk of a seroconversion seemed distant and minimal.

South Carolina hospitals that belonged to Palmetto Hospital Trust, a workers' compensation self-insurance pool, were among the first to change that mindset and take sharps safety seriously. The impetus: hepatitis C.

Even today, hepatitis C remains a more problematic risk from sharps injuries than even HIV. There is no rapid test for identifying source patients with HCV. There is no accepted post-exposure prophylaxis. And lifetime treatment for one occupationally acquired case of hepatitis C could run $200,000 to $1 million, if the health care worker needs a liver transplant.

After a couple of HCV seroconversions led to "permanent and total" disability claims, the PHT board of trustees, comprised of hospital CEOS, made its position clear. In 1999, the Sharp Object Injury Prevention Program became an underwriting requirement to receive workers' compensation coverage from the trust.

"When we delved into it from a risk management standpoint, we understood that the hospitals weren't taking advantage of some of the safety devices that were out there," says Larry Gray, AIC, senior vice president, property and casualty, PHT Services (PHTS), the risk management services firm that administers Palmetto Hospital Trust.

But within a year, South Carolina hospitals had made significant progress toward converting to safety. "We determined that our members were in compliance about a year before [President] Clinton signed the [Needlestick Safety and Prevention Act]."

The South Carolina experience highlights the benefits of sharps safety. At one time, PHT, which has more than 30 member hospitals, had 15 open claims for possible or confirmed cases of occupationally acquired HCV. Today, there are two.

Needlesticks actually rose initially, due to greater awareness and better reporting. But from 2002 to 2004, PHT hospitals reported a 38% decrease in sharps injuries.

PHT wasn't satisfied with that improvement and realized that injuries were continuing unabated in the operating room. In 2003, PHT implemented an additional requirement for hospitals to develop prevention programs in the OR.

To put weight behind that, PHTS executives visited the hospitals, spoke to surgeons, and even observed in the OR. They brought in Mark Davis, MD, FACOG, a sharps safety expert and former surgeon, to talk to physicians.

"We had to tailor [the program] to the hospital so the implementation would occur smoothly and be accepted by the staff and physicians," explains Edward B. Hall, Jr., MS, CSP, vice president, risk management at PHTS.

Some hospitals have a physician-dominated culture. Sharps safety efforts may be stalled if physicians refuse to use a device they are unaccustomed to or that proved unacceptable in an earlier version, says Gray. Other hospitals have a more staff-driven culture, in which OR staff are able to demand some changes, such as a neutral zone or hands-free passing.

PHT allows hospitals to move at their own pace. The trust provides data to help the hospitals make the sharps safety case to surgeons. For example, to encourage double gloving, PHT educated surgeons about a study that showed that 30% of single gloves fail, while only 5% of double gloves fail.

PHT facilities also participate in EPINet, a bloodborne pathogen exposure database of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville. Hospitals receive quarterly data reports and can see whether their prevention efforts are effective, says Hall. "It arms them with great data, and that's what physicians want to hear."

So what's left to do once you've made a big push for sharps safety?

PHT hospitals have been among the first to face that challenge. They have developed a system for maintaining their progress. "We're constantly monitoring to make sure we don't backtrack," says Hall.

All PHT facilities received an on-site audit immediately after the initial implementation of the Sharp Object Injury Prevention Program. Now, some hospitals receive an annual data audit, although about two-thirds still receive an on-site audit.

A spike in bloodborne pathogen exposures at a member hospital is likely to result in an on-site audit, says Hall. The audits also include hospital-affiliated physician offices and clinics, he says.

PHTS also covers sharps safety in one of its in-house electronic newsletters, or e-zines, and continues to provide educational programs related to sharps safety.

PHT also lauds improvements in safety device design. All hospitals are required to review their device selections and consider new technologies. That is particularly important in the OR, says Hall.

"As the devices continue to improve, you'll see better compliance," he predicts.