OSHA-AORN Sharps Injury Prevention Program May 2009

8/9/2019 OSHA-AORN Sharps Injury Prevention Program May 2009

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Sharps Safety In the

Operating Room

Creating an Injury Prevention Program


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Objectives

Discuss the regulations that impact an OR

Sharps Safety program

Describe the issues that effect sharps

safety in the OR

Discuss a process for creating an OR

sharps safety program

Identify barriers to the implementation of a

sharps safety program


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Bloodborne pathogens are

viruses or infectious

agents carried by human

blood and body fluids.

They can enter our bodies

and cause disease and

immune deficiencies, whichcan sometimes lead to death.

HIV, HBV, HCV

Epidemiology of Bloodborne Diseases:

HCV

H I V
http://www.disasterrelief.org/Disasters/011221drigresistance/Images/virus.jpghttp://www.niddk.nih.gov/health/digest/ddnews/win00/images/1hepc_virus.jpg


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Transmission of Bloodborne Pathogens

Blood & Body Fluids-from accidents, illnesses, medical procedures,

research samples and handling medical waste

Disease Transmission

-through cuts, punctures, contact with broken skin,contact with mucous membranes

Bloodborne Pathogen Prevalence*

Hepatitis B 1 in 20

Hepatitis C 1 in 50

HIV 1 in 250

Prevalence in an average population, prevalence is higher for

at risk populations


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HIV Hep B Hep CHIV &

Hep C Any

26% 4% 35% 17% 38%

Prevalence of HIV, Hepatitis B and Hepatitis C

Among Surgery Patients

* Weiss, Makary, Wang, Syin, Pronovost, Chang & Cornwell

Annals of Surgery, Volume 241, Number 5, May 2005

Prevalence of Bloodborne Pathogens in an Urban,

University-Based General Surgical Practice*


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Percentage of Patients with HIV &

Hepatitis C for 4 common operations

0

10

20

30

40

50

60

70

lymph nodebiopsy

drainage ofsoft tissue

abscess

open ventralhernia repair

small bowelresection

* Weiss, Makary, Wang, Syin, Pronovost, Chang & Cornwell

Annals of Surgery, Volume 241, Number 5, May 2005

HIV +

Hep C +


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The Bloodborne Pathogens Standard

Promulgated by OSHA in 1991

Purpose: to protect all workers who may comeinto contact with human blood or body fluids as a

routine part of their job Revised in 2001

New definitions

Additional requirements regarding safety devices

Sharps Injury Log

29 CFR 1910.1030 Full text & additional information can be

found on the OSHA website at:www.osha.gov/pls/oshaweb/owadisp.show_document?

_p_table+STANDARDS&p_id=10051

29
http://www.aegenviro.com/Code%20of%20Federal%20Regulations.JPGhttp://www.aegenviro.com/Code%20of%20Federal%20Regulations.JPG


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t t


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o nt omm ss on tan ar sSharps Safety

Human Resources Standards

HR.01.04.01 (2) The hospital orients its staff tothe key safety content before staff providescare, treatment, and services. Completion ofthis orientation is documented.

HR.01.04.01 (4) The hospital orients staff ontheir specific job duties, including those relatedto infection prevention and control.

HR.01.05.03 Staff participate in ongoingeducation and training. Human Resources. In Comprehensive Accreditation Manual: CAMH for

Hospitals. The Official Handbook. Oakbrook Terrace, IL: JointCommission;2009: HR.01.04.01 (2) (4); HR.01.05.03.


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Healthcare Workers Exposed to

Blood/Body Fluids

Physician

30%

Nurse44%

Technician

13%

Other4%

Clerical

1%

Dental

1%

Students

3%

Housekeeping

3%

Research

1%

NaSH data, 23 hospitals, 1995-1999


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Hollow-bore needles and other devices associated with

percutaneous injuries in NaSH hospitals, by % total percutaneous

injuries (n=4,951), June 1995July 1999. (Source: CDC [1999].)

Needlestick Risk


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Causes of percutaneous injuries with hollow-bore needles in NaSH

hospitals, by % total percutaneous injuries (n=3,057), June 1995July

1999. (Source: CDC [1999].)

Needlestick Risk


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Creating a Sharps Safety Program

in the OR

Engineering Controls Tools, instruments, sharps shelters

Work Practices Safe zone, double gloving, one-hand re-capping only when

unavoidable

Making Changes Assembling committee, evaluating product and selecting safety

sharps, participating in education & in safety conversion


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Implementation Suggestions

Use scalpel blades with safety blades

Reusable Disposable


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Use mechanical /instrument tissue

retraction


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Use blunt retractors


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Alternative cutting methods

Cautery

Harmonic scalpel

Cautery

Harmonic Scalpel
http://www.ophthalmic.hyperguides.com/tutorials/oculoplastics/congenital/slide3.asphttp://www.ophthalmic.hyperguides.com/tutorials/oculoplastics/congenital/slide3.asp


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Adopt a hands-free technique of passing suture

needles and sharps between perioperative team

members


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Use a one handed or instrument assistedsuturing technique to avoid finger contact

with needles

Use control-release or pop-off needles


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Double glove during all surgical

procedures


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Sharps disposal

Closable orange or red, leakproof

puncture resistant containers

Located close to the point of use

maintained upright

Replaced routinely and not allowed to

overfill

Wall mounted

Floor mounted


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Sharps disposal: new containers

Safety sharps containers

Goal: to Prevent Needlesticks

Counter-balanced drop in

prevents childrens fingers from

getting in

Automatically closes at full

prevents overfilling

Reusable sharps containers

Goal: to reduce landfill waste

Outside contractor removes

contaminated sharps, cleans container

and returns it


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Worker Responsibilities

Observe regulations

Comply with methods available to protect

yourself

Practice using safety devices

Use safety devices

Actively participate in evaluation and safety

conversion process


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Worker Responsibilities

Reporting Exposures Employers required by OSHA to document all staff

exposures to blood / body fluids anonymously

OSHA 300 Log

Sharps Injury Log

Location, job title, description of incident, type

& brand of sharps involved

Source testing, risk analysis & post-exposure

prophylaxis if indicated


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Employer Responsibilities

Comply with regulations

Create a safety-oriented culture

Encourage reporting Analyze data

Provide training

Evaluate devices Establish safe staffing patterns


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Implementation Statistics

In a nationwide survey 71% of respondents indicated they had not evaluated

use of blunt tip suture needles in the OR

2% had fully implemented blunt tip suture needles

14% of respondents had implemented safety scalpelsinto the OR

AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting


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BARRIERS TO

IMPLEMENTATION

Psychosocial and organizational factors

Attitude/Resistance to Change

Shortcomings associated with safety devices

Perceived cost associated with engineered

devices

Inadequate training

Time limitations


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Overcoming Obstacles to

Compliance

Frequent and multiple training methods

Multidisciplinary sharps injury prevention plan

Educate new employees and incoming residents and

medical students

Multidisciplinary sharps safety committee

Network with other facilities

Involve front-line workers in evaluation and selection of

safety devices


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Overcoming Obstacles to

Compliance

Collaborate with personnel who use the device

and facilitate change

Discuss current research

Work with resistant team members Remove old technology when new is trialed and

available

Create a Culture of Safety


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Whats new

Collaboration with NIOSH Memorandum ofUnderstanding

Alliance with OSHA

ACS statement on the use of blunt suture Needles

Letter to ACS CDC National Sharps Injury Prevention Meeting

9/12/2005

ACS Statement on Blunt Suture Needles 6/05

OSHA Safety and Health Information Bulletin: Use ofBlunt-Tip Suture Needles to Decrease PercutaneousInjuries to Surgical Personnel 3/07


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Further resources

www.aorn.org http://www.osha.gov/OshDoc/data_BloodborneFacts/bbf

act01.pdf http://www.osha.gov/SLTC/bloodbornepathogens/index.

html http://www.cdc.gov/sharpssafety/ http://www.cdc.gov/niosh/topics/bbp/

http://www.jointcommission.org/ http://www.isips.org/

http://www.nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/occupationalhealth/SafeNeedles/NeedlestickPrevention.aspx

www.premiersafetyinstitute.org
http://www.aorn.org/http://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdfhttp://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdfhttp://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.cdc.gov/sharpssafety/http://www.jointcommission.org/http://www.jointcommission.org/http://www.jointcommission.org/http://www.isips.org/http://www.premiersafetyinstitute.org/http://www.premiersafetyinstitute.org/http://www.isips.org/http://www.jointcommission.org/http://www.jointcommission.org/http://www.cdc.gov/sharpssafety/http://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdfhttp://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdfhttp://www.aorn.org/


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Developed by

Deborah G. SprattRN, MPA, CNAA, CNOR

Edited by

Mary J. Ogg

RN,MSN, CNOR

Documents

OSHA-AORN Sharps Injury Prevention Program May 2009