Infection Control Today

JUN 2019

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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21 June 2019 ICT • Build out post-exposure follow-up and treatment for pathogen exposures, including sharps injuries and mucocutaneous exposure incidents and guidance for "after hours" exposures including accessing local emergency department for HIV, HCV source and employee testing. • Given extraordinarily high co -infection among patient populations of HIV and HCV or HBV, recommend spending more time on needlesticks, sharps injuries, and mucocu- taneous exposures especially since exposure incidents have been rising year over year since 2013. Additionally, more focus on eye protection since nearly 50 percent of all reported mucocutaneous exposures occur to the eye with only 3 percent of employees indicating they are wearing eye protection at the time of the incident. https://internationalsafetycenter.org/ wp-content/uploads/2018/10/Offi cial-2017-BBFSummary.pdf • Also bolster the importance of not just using engineering controls (devices with sharps injury prevention features), but the criticality of frontline employee feedback on identifi cation, evaluation, selection of devices to improve safety feature activation and safe disposal to prevent not only injuries to users, but those downstream (EVS, laundry). • Given so many recently published studies on self-contami- nation upon PPE doffi ng — hand hygiene recommendations must be built out to include, including appropriate glove donning and doffi ng procedures and timing. • Consider adding more information about the increased prevalence of co-infection in patient populations, resulting in potential occupational exposure to not just BBP, but several including MDROs (especially in body fl uid in eye exposures). Potential references include: https://www.cdc.gov/hepatitis/ hiv-hepatitis-coinfection.htm and https://www.ncbi.nlm.nih. gov/pmc/articles/PMC4484961/ and https://www.cdc.gov/ mmwr/volumes/67/wr/mm6722a2.htm • Consider adding more information about whistleblower and employee rights statements. "Additional review from the OSHA Directorate of Enforcement Programs will make this document more accurate and ultimately more protective for healthcare personnel and the patients and communities they care for, as well as review by an industrial hygienist and/or safety engineer at the NIOSH National Personal Protective Technology Laboratory (NPPTL) and a review by the NIOSH Offi ce of the Director prior to publication," Mitchell adds. Several organizations have provided commentar y on the proposed updated guideline; let's examine the specifi cs from the key agencies. APHA In public comments, signed by Mary Miller, MN, RN, and Celeste Monforton, DrPH, MPH, co-chairs of the Policy Committee of the Occupational Health and Safety Section of the American Public Health Association (APHA), emphasized that "Protecting healthcare workers from occupational injuries and illnesses is critically important to a sustainable and effective healthcare system." The organization recommended that the draft guidance document be reviewed by the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Health and Safety Administration (OSHA) to ensure that the terminology used is consistent with OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030), Access to Medical Records (29 CFR 1910.1020) and other OSHA standards, as well as terminology used by occupational health and safety professionals. The Association of Occupational Health Professionals in Healthcare (AOHP) recently released report of the EXPO-S.T.O.P. (EXPOsure Survey of Trends in Occupational Practice) 2016 and 2017 surveys in the AOHP Journal (Vol. 39, No. 1). AOHP's EXPO-S.T.O.P. is an electronic survey designed to ascertain the incidence of sharps injuries and mucocutaneous blood exposures among healthcare workers (HCWs) in U.S. healthcare facilities. EXPO-S.T.O.P., the largest annual survey of its kind conducted in the United States, was initiated in 2011 to establish a nationally repre- sentative overview of blood and body fl uid exposure. The 2016 survey, with facilities from 37 different states participating, is geographically the most extensive to date, and with 224 hospitals participating, EXPO-S.T.O.P. 2017 is the largest survey to date. AOHP publishes the survey results to provide healthcare facilities with up-to-date data on national exposure rates and trends to enable benchmarking and evidence-based decisions for their exposure-reduction strategies. In addition, the survey identifi es the top 10 participating facilities with the lowest rates and, via these, has enabled other research to be published on successful exposure-reduction strategies. "All blood exposures are potentially infectious and pose a serious occupational risk to HCW," explains Linda Good, PhD, RN, COHN-S, survey co-author and Manager, Employee Occupational Health Services, Scripps Health, San Diego. "Trends documented by EXPO-S.T.O.P. show that a renewed vigor must be attained to protect HCWs." The 2016 and 2017 overall results for all hospitals, as with the 2015 survey, document a signifi cant increase in blood exposure incidence over the 2011 results. "It is alarming that data from the last three surveys have shown a year-by-year signifi cant increase in sharps injuries (SI), and that the 2017 rate is almost back to the 2001 rate," describes survey co-author Terry Grimmond of Grimmond & Associates Microbiology Consultants in New Zealand, "These increasing rates validate that the signifi cant decrease in sharps injuries in the years immediately following the Occupational Safety and Health Administration's (OSHA's) Needlestick Safety and Prevention Act of 2001 has not been sustained." "The OSHA law is clear," says Good. "Employers and employees must strive to reduce exposures with the use of safety-engineered devices (SED) and staff training and must review their exposure control plan annually in pursuit of exposure reductions." Conclusions documented in the EXPO-S.T.O.P. 2016 and 2017 Report include: ♦ The signifi cant rise in SI incidence with the 2016 and 2017 surveys indicates that current strategies have not been successful in reducing national SI rates. ♦ There is an urgent need to adopt more aggressive exposure reduction strategies. ♦ Large exposure databases, detailed databases of SI mechanisms, and research on SI mechanisms, SED effectiveness, and effective training are required, as well as continued publication of strategies proven to reduce exposure incidence. "The recent rise in SI incidence is of urgent concern and should draw the attention of every healthcare institution," Grimmond adds. "An aggressive and relentless approach is now needed to achieve signifi cant reductions in bloodborne pathogen exposure. A zero rate is diffi cult to achieve, but zero must always be our aim." AOHP Releases 2016 and 2017 Report of Its National Survey on Blood Exposures Among U.S. Healthcare Workers

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