CMS survey targets employee health

The pilot testing version of the CMS survey includes the following elements on hospital employee health:

• Healthcare personnel receive job-specific training on hospital infection control practices, policies, and procedures upon hire and at regular intervals. The hospital infection control system trains healthcare personnel that are in contact with bloodborne pathogens on the bloodborne pathogen standards upon hire and when problems are identified.

• The hospital infection control system addresses needle sticks, sharps injuries, and other employee exposure events. Following an exposure event, post-exposure evaluation and follow-up, including prophylaxis as appropriate, is available.

• The hospital infection control system ensures healthcare personnel with TB test conversions are provided with appropriate follow-up.

• The hospital infection control system ensures the facility has a respiratory protection program that details required worksite-specific procedures and elements for required respirator use. Respiratory fit testing is provided at least annually to appropriate healthcare personnel.

• Hospital has well-defined policies concerning contact of personnel with patients when personnel have potentially transmissible conditions. These policies should include work-exclusion policies that encourage reporting of illnesses and do not penalize with loss of wages, benefits, or job status.

• Aggregated rates of TB-test conversion are periodically reviewed to determine the need for corrective action plans.

• Healthcare personnel competency and compliance with job-specific infection prevention policies and procedures are ensured through routine training and when problems are identified.

• The hospital infection control system provides Hepatitis B vaccine and vaccination series to all employees who have occupational exposure and conducts post-vaccination screening after the third vaccine dose is administered.

• The hospital infection control system ensures that all healthcare personnel (paid and unpaid) who have potential for exposure to TB are screened for TB upon hire and, if negative, based upon facility risk classification thereafter.

• The hospital infection control system ensures that all healthcare personnel are offered annual influenza vaccination

 

Why are there still so many sharps injuries?

MA data sheds some light

About 3,000 sharps injuries occur each year in Massachusetts hospitals. That's about the same number that occurred in 2002, although the rate dropped by 31% — which means that the goal of eliminating needlesticks is still far from accomplished.1

In fact, the Centers for Disease Control and Prevention estimates that 385,000 sharps injuries occur in the nation's hospitals every year,2 even though sharps safety is now an accepted part of life in U.S. hospitals.

Why are needlesticks so difficult to prevent? The Massachusetts data, which comes from all 97 hospitals licensed by the state, sheds light on persistent problems. Angela Laramie, MPH, epidemiologist with the Massachusetts Department of Public Health Occupational Health Surveillance Program, offers these observations from her analysis of the data:

Too many sharps devices still lack sharps injury prevention features. In 2010, more than half of sharps injuries (57%) occurred with devices that lacked safety features, including about a quarter (24%) of hypodermic needles/syringes.3 One major contributor: Conventional needles continue to be placed in pre-packaged kits, such as a central line kit, says Laramie.

Between 2006 and 2010, 55% of the 3,057 injuries that occurred from devices in pre-packaged kits involved devices that lacked sharp injury prevention features. In fact, those conventional devices in pre-packaged kits accounted for one in every 10 sharps injuries reported by Massachusetts hospitals.

Laramie acknowledges that the problem of pre-packaged kits isn't simple to solve. Health care workers are supposed to have input into the selection of sharps safety technology and they need training if the device differs from the ones they normally use. She recommends that hospitals work with kit packers to obtain kits with safety-engineered devices.

The bottom line: Hospitals need to seek ways to reduce injuries that occur with safety-engineered devices, she says. "We require the hospitals to use their data as a part of continuous quality improvement. Hospitals are doing what they can to continue to look at devices. They often have committees that are reevaluating devices," she says.

Injuries are still occurring because there wasn't safe disposal. About 12% of injuries occurred because of improper disposal or during disposal, Laramie notes. For example, an unprotected sharp may have been left on a table or tray, or someone was injured while disposing of a device. She advises reviewing the placement of sharps containers. "You want to make sure that they're as close [as possible] to the point of use and placed at a height that's easy for people to reach," she says. Of course, activation of safety devices also decreases the risk of sharps injury after use and before disposal.

Medical trainees are at greater risk of sharps injury. Laramie analyzed 8,268 sharps injuries that occurred among physicians from 2002 to 2009 and found that more than half (4,972 or 60%) were among medical trainees. They were more likely to be injured during the first quarter of the academic year, and they were most often injured by suture needles or hypodermic needles without safety features.

In fact, the problem of sharps injuries among medical trainees is likely much worse than that because of underreporting, Laramie says. Attending physicians should model good work practices and use of safety devices, she says.

"Make sure that trainees are aware of the sharps reporting procedure and that reporting of these injuries is part of the safety culture," she says. You can make that easier by setting up a system of phone triage if an injury occurs in the operating room. Trainees should be given time to report injuries and receive post-exposure follow up.

Of course, it's also important to provide adequate training in the use of sharps devices. For example, 14% of injection-related sharps injuries among medical trainees involved recapping of needles — which is expressly forbidden by the Bloodborne Pathogen Standard.

By analyzing injuries, reevaluating devices and improving training, hospitals can reduce their sharps injuries, Laramie says. Each injury represents a health care worker who is at risk of acquiring HIV, hepatitis B or C or another of the 20 or so bloodborne infections.

"My goal is to work myself out of a job," she says. "There would be no need to count needlesticks if they don't happen.

"I always say to people, we collect data and they turn into numbers," she adds. "But we have to remember that there are people behind these numbers. And that's why we do this."

References

1. Massachusetts Department of Public Health Occupational Health Surveillance Program. Sharps injuries among hospital workers in Massachusetts, 2002-2009. Available at www.mass.gov/eohhs/docs/dph/occupational-health/sharps-injuries-hospital-workers.pdf. Accessed on May 16, 2012.

2. Panlilio AL, Orelien JG, Srivastava PU, et al. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infect Control Hosp Epidemiol 2004; 25:556-562.

3. Massachusetts Department of Public Health Occupational Health Surveillance Program. Sharps Injuries among Hospital Workers in Massachusetts, 2010: Findings from the Massachusetts Sharps Injury Surveillance System. Available at www.mass.gov/eohhs/docs/dph/occupational-health/injuries-hospital-2010.pdf. Accessed on May 16, 2012.