The federal Occupational Health Safety Network (OHSN) is expanding exponentially, with the number of hospitals submitting healthcare worker injury and exposure data expected to climb to 300 in 2018. With the recent addition of two new reporting categories for needlesticks and blood exposures, a national reporting system that touts local interventions is on the horizon.
“People who believe as we do see occupational injuries as preventable — they should be at zero,” says Ahmed Gomaa, MD, ScD, MSPH, a medical officer at OHSN. “There is a reason for every injury that happens. This is a continuous process as people retire and the next generation of physicians and nurses come in — they need to be educated and trained. We are trying to help them determine where things are happening and how, so they can fix it. We can help them in terms of tools to do that and to measure the impact.”
The OHSN was created by the National Institute for Occupational Safety and Health (NIOSH), a branch of the CDC that is openly urging more hospitals to join the expanding network to bolster the power of its cumulative data.
“This is voluntary, so the more people we have, the more injuries we can prevent,” he says. “[Occupational health] is complementary to patient safety. Worker safety is part of hospital safety; we cannot do one without the other. A protected worker is a magnet for patient safety. It improves the reputation of the hospital because they take care of their workers and their patients.”
Think Global, Act Local
While the big-picture view of aggregate occupational health data is a clear benefit of the system, OHSN officials say the real solutions occur at the local level.
“They can see an aggregate rate of the whole system,” Gomaa says. “We don’t do any statistical analysis or comparisons of hospital to hospital. That is not our goal. Our goal is to give an [individual] hospital data in a way that it is actionable. We offer them our prevention tools. If you have a problem with violence, there is training on how to prevent that. Basically, these are courses and tips you can present and then see if you can maintain the effect of, for example, needleless IV systems or other safety devices. It depends on your own data.”
The OHSN was launched in 2013 and officials have been testing the concept, the methodology, and the direct interaction with the hospitals, he notes.
“They told us they really don’t have a system to give them feedback on a hospital level,” he says. “You can get national reports that show general U.S. trends, but few details on the root causes at [individual] hospitals. So, there is nothing [to guide] specific actions. We came up with a system which is basically designed [to protect] the front-line healthcare workers in hospitals. We feed this [data] back to the people who are responsible for preventing hospital injuries.”
The OHSN has modules for injuries related to patient handling, slips, trips, and falls, workplace violence, and, most recently, sharps injuries and blood and body fluid exposures.
“Originally, we launched three modules — injury from patient handling; injuries from slips, trips and falls; and injury from violent acts against healthcare workers — whether it is physical or verbal,” Gomaa says. “In March of this year, we launched two new modules. One is on needlesticks and sharps injuries, and the second one is blood and body fluid exposures. This has been received very well because those are the most feared exposures among healthcare workers. It is gaining a lot of traction and people want to join and participate in these new modules.”
The U.S. is one of the few industrialized countries lacking a nationally standardized sharps injury and blood and body fluids surveillance system, he says. Given its continuing expansion, the OHSN system could complement, or even eventually partner with, the existing needlestick tracking systems. These include the EPINet program at the International Safety Center, which was involved in developing the new OHSN needlestick and exposure modules.
“[We] were thrilled to work with NIOSH on the development of OHSN’s new modules,” says Amber Hogan Mitchell, DrPH, MPH, director of the International Safety Center. “Since OHSN’s newest modules are modeled after EPINet, current and future EPINet users can simply upload their existing data to OHSN if they so wish. We applaud NIOSH for joining us in capturing bloodborne and infectious disease incident data so that we can work together to create an accurate national picture of ongoing risk. With HIV and HCV infection more prevalent than ever, it is critical that we measure exposures being sustained by healthcare personnel so that we can build programs, controls, and systems to prevent them.”
The other major needlestick surveillance system is the annual EXPO-S.T.O.P. survey conducted by the Association of Occupational Health Professionals in Healthcare (AOHP). (For more information on the survey, see the July 2017 issue of Hospital Employee Health.)
“Our goal is improved safety for all healthcare workers,” the AOHP told HEH in an email statement. “If NIOSH or other surveys such as EPINet can ramp up and represent data for the entire U.S., have ‘benchmarking’ details available to all, and present prevention strategies, then AOHP would consider partnering with one of those other studies.”
Report Data on Hand
In addition to using standard definitions, the OHSN system compiles injury data employee health professionals already are collecting for OSHA standards and requirements.
“That’s one of the benefits of our system,” Gomaa says. “We are not really asking them to collect any new data. OSHA requires hospitals to collect [much of] this data. Some hospitals keep this data as hard [print] copy, but it can be computerized with our system.”
The data can be broken down by unit and the healthcare activity that was underway at the time of the injury, or by the reportable incident. The OHSN data are uploaded by the healthcare facility monthly or quarterly. After that, the feedback is timely, with reports coming back to the hospital within a week to 10 days, Gomaa says. In addition, an archive of prior data is available to assess problems and progress over time. Hospitals can select a denominator for rate calculation, using a measure of monthly admission, facility bed size, or the number of full-time employees, he explains.
“If you want to see injuries among nurses in ICUs, you can click on the menu and decide how to display it — month by month, or year by year,” he says. “You can look at [the data] by department or by risk factors — say, a patient is being moved from a stretcher to a bed, or you were doing a procedure, or a patient gets violent. All this data comes to us in a standard format and we give it back to them electronically on a secure website. It is basically an interaction between us and them. Everybody sees their own data and they cannot see anyone else’s. They can sit at their desk, look at their data, and cut it and slice it any way they want. It gives them local knowledge about what is going on, and we help them come up with solutions.”
That is the key difference between the OHSN and existing surveillance systems for occupational injuries, as the network reports the data back to the individual reporting hospitals in a manner that highlights areas of concern and the need for intervention.
“The first thing we do is connect the health outcome with actionable prevention [approaches],” he says. “If this injury was due to patient handling, that is the first step — you connect the two. If you are moving a patient from point A to point B and get injured, you should know what to do to prevent it. When you moved the patient from a bed to a stretcher, did you use safe lifting equipment or a lift team?”
The OHSN program will help hospitals pinpoint such problems, and try to provide insight in terms of root causes and interventions, he says.
“For example, right now we are seeing a lot of patient handling injuries in radiology,” Gomaa says. “That did not use to happen, but if a radiology tech is injured you may need some lifting equipment there. They may not expect that to happen [in that unit] — it is not in the ICU. It is not on the floor. So, they can look at our guide and analyze the data. If they come up with a solution, they can objectively measure when the rates went down. It’s an ongoing process. You have to look at the data and the distribution of [the injuries], do something about it accordingly, and then measure the impact. It is not just data or a piece of equipment — it is a safety culture issue.”