Infection Control Today

NOV 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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Page 24 of 36

24 ICT November 2018 Injuries in the operating room (OR) most often involve suture needles, disposable hypodermic needles and syringes, and scalpel blades. According to incident data from the Massachusetts Sharps Injury Surveillance System and the Exposure Prevention Information Network (EPINet), more than 50 percent of these injuries are reported by physicians. Injuries can occur before use with tearing or sharps penetration of a contaminated glove, during use, between steps of a multi-step procedure with a device that may be used many times during one procedure, and after use. The injuries that occur between steps and after use are historically associated with "passing" injuries that happen when a no-hands passing (neutral zone) practice is not in place. Implementation of safer programs for workers is directly related to safer outcomes for patients and should include not only instituting safer technologies and practices, but openness to collaborations, new ideas and innovative technologies that improve outcomes and minimize or eliminate injuries. To focus on decreasing injuries in the OR, the Safe OR Pilot Workgroup was formed. The Workgroup is currently recruiting facilities to pilot a Safe OR "bundled" approach that includes improving uptake of SIPs, activation of SIP mechanisms, alternatives to sutures for skin closure, use of no-hands passing neutral zones, and double gloving. The Safe OR Pilot Workgroup will begin working with a small number of facilities to gather injury data, develop targeted interventions, educational campaigns and evaluation tools, and determine impact over time. It will then identify which program elements and collaborative relationships work best and offer it as a program to a larger number of facilities. Metrics of the Safe OR Pilot may include injuries, usage rates of SIP devices compared to non-SIP devices, compliance with safer practices and personal protective equipment (PPE) use. Metrics can include differences pre- and post-pilot for the use of scalpels and blades with SIP features, blunt sutures and skin closure alternatives, no-hands passing neutral zones, and double gloving. The next face-to-face meeting of the ANA SI Prevention Stakeholder Group will be held at ANA headquarters in Silver Spring, Md. July 25-26, 2019. Safety Concerns Relating to Device and Instrument Reprocessing According to EPINet, approximately 25 percent of all sharps injuries occur to downstream non-users. The Safe OR Pilot Workgroup will attempt to help pilot facilities reduce OR injuries, but SIs also occur during device reprocessing. Professionals who encounter risks based on their work in sterile processing (SP) and central supply (CS) departments of healthcare facilities are often overlooked because they are not responsible for direct patient care. SP/CS employees are responsible for collecting, counting, cleaning, disinfecting, sterilizing and repackaging all reusable medical devices and equipment used by clinical and diagnostic teams. They are often exposed to bloodborne and infectious pathogens as they experience SIs and splashes and splatters, so protecting them is central to any SI prevention program. The Safe OR Pilot workgroup will include elements to ensure continued focus on protecting this critical workforce and the impact they have on safe surgical outcomes for staff and patients alike. According to EPINet incident data, exposures frequently occur when: disassembling and cleaning surgical instruments that are caked with blood and tissue; lifting, transporting, and emptying trays fi lled with instruments; sorting instrument trays when disposable devices have not been discarded safely; and cleaning patient care items (e.g., wheelchairs) when devices have been left in them. Medical devices with SIPs are not in place just to protect the users of those devices, but also those who may come into contact with them downstream. Of utmost importance is the need for direct users to remember that there is no substitution for safe disposal of single use devices. Reprocessing SI Prevention Measures There are several actions that can be taken to prevent injuries among workers in CS and SP. Donning appropriate PPE, including gloves, gowns, and face shields, minimize risk of exposure from splashes. Minimizing risk of a SI can also often be achieved by double gloving. Utilizing baskets to move devices and instruments from one cleaning stage to the next minimizes manual handling of instruments. This can be employed in CS and SP as well as in operating and procedure rooms where devices are used and then placed in a solution for soaking immediately after use. Working with staff in operating and procedure rooms to ensure that instruments are placed in baskets or other containers with the sharp ends facing in the same direction helps those in CS and SP in the event they reach into a basin for a device. Ideally, tools (e.g., forceps) are used to pick up individual instruments, and brushes or sponges with handles are used for initial cleaning of the instruments. Healthcare facilities can greatly reduce their SIs in their sterile processing department by collaborating with the OR staff to eliminate all disposable sharps sent for reprocessing. The OR staff should dispose of sutures, needles, and blades immediately after the surgical procedure, so that the kits and trays sent to SP present lower risk of injury While injuries among staff in CS and SP departments may constitute a small percentage of SIs facility-wide, their impact on the injured worker can be signifi cant. Workers in these departments should be encouraged to report any SIs or splashes immediately to ensure appropriate post-exposure follow-up. This is particularly important as CS and SP staff may not know who the source patient is, thus limiting the ability for learning their serostatus – information which impacts post-exposure care and treatment. SI surveillance and prevention is often focused on direct care staff. Healthcare facilities are encouraged to review processes at each stage in the life cycle of devices and instruments and engage staff in implementing prevention measures appropriate for each stage. Karen A. Daley, PhD, RN, FAAN, is a nationally recognized sharps safety expert and policy advocate and served as president of the American Nurses Association from 2010 to 2014. Amber Hogan Mitchell, DrPH, MPH, CPH is the president and executive director of the International Safety Center. The Center is a 501c3 non-profi t organi- zation that provides the Exposure Prevention Information Network (EPINet®) to healthcare facilities around the world for free. Ò Healthcare facilities are encouraged to review processes at s each stage in the life cycle of devices and instruments and engage staf in implementing prevention measures appropriate for each stage.

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