Splash and splatter risk often underestimated

Splashes and splatters can transmit disease effectively, but many institutions don't adequately protect against this risk, says Susan Y. Parnell, RN, MSN, MPH, CIC, director of employee health clinical services at the University of Texas Health Science Center in Houston.

"These exposures are grossly underreported," she says. "The risk of HIV and hepatitis B transmission through this route is lower than with a needlestick, but it is still a very significant risk."

Parnell advises managers to review their work practice control policies to determine if they adequately address splash and splatter risk by requiring protective equipment and protective measures when contact with blood and bodily fluids is "reasonably anticipated," as required by the Occupational Safety and Health Administration (OSHA). The work practice control policy should define those circumstances for your facility, so that the frontline worker is not left to guess about each situation, Parnell says. The definitions will vary for each institution, based on variables such as the type of patients treated, procedures performed, and patient volume.

"The next step is a product review. We're all pretty focused on sharps containers and related items, but we need to review the containers for body fluids also to make sure they have tight-fitting lids to prevent spills and splash exposures," Parnell says. "Then you need to review your personal protective equipment. That is where you can gain the most ground in preventing exposures through splash and splatter."

The manager should ensure that all units have an adequate supply of the gear that can prevent bodily fluid exposure: protective glasses and goggles, face shields, hair covers, sleeve covers, long gowns, and gloves, Parnell says. And remember, it's not enough to just have a supply of those items. They have to fit the user, and that might mean keeping a variety of sizes.

"Many, many splashes occur because small nurses are wearing gloves that are too big for them, so they don't have a good grip. They lose control of a container or tubing, and someone gets splashed," Parnell explains.

The work control policy also should specify what equipment is appropriate for different procedures and situations. Parnell says a manager, working closely with the person responsible for employee health, can have great influence in improving policies and procedures to prevent splash and splatter exposure. Become involved with the acquisition of protective equipment also, she suggests. Bring in the frontline employees, and let them review the products you're considering in a "product review fair." This fair can show employees that you aren't simply buying the lowest-bid products and that you want them to have the most effective supplies.

"A lot of what they say won't be new to you, but somebody's going to say something novel, point out a problem that you hadn't realized, or why one product is better than another for your facility. You really need to hear from those frontline nurses," Parnell says. "We can't always buy the most expensive option, but if what they're saying ties directly to the injuries we're seeing in our data, the added cost can be justified, because injuries cost money."

Involving the staff also can reveal other issues that need to be addressed by the manager. For example, Parnell says you might ask nurses to review protective equipment options, and one mentions that "my manager says we use too many of those, so she won't keep them on the unit." That's a managerial problem that must be addressed. [More on Splashes and Spatters can be found in the Feb. 26, 2010, issue of the Same-Day Surgery Weekly Alert.For a free subscription to the ezine, click here.