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Sharps Injury Surveillance and Prevention in Massachusetts

Sharps Injury Surveillance and Prevention in Massachusetts . Angela K. Laramie, MPH Massachusetts Sharps Injury Surveillance System Occupational Health Surveillance Program MNA June 2007. Background. Risk of being exposed to HBV, HCV, and HIV Risk of infection for: HBV 6% to 30%

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Sharps Injury Surveillance and Prevention in Massachusetts

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  1. Sharps Injury Surveillance and Preventionin Massachusetts Angela K. Laramie, MPH Massachusetts Sharps Injury Surveillance System Occupational Health Surveillance Program MNA June 2007

  2. Background • Risk of being exposed to HBV, HCV, and HIV • Risk of infection for: HBV 6% to 30% (for those not immune to HBV) HCV 1.8% (range 0% to 7%) HIV 0.3%

  3. Costs of sharps injuries • Direct costs • includes cost of EH personnel, lab tests, HBV immune globulin, HBV vaccine • ranges from $110 - $1,232 • Includes medical care after seroconversion • ranges from $32,000 - $500,000 • Indirect costs - difficult to quantify

  4. Sharper images: Despite needlestick law, nonsafe sharps practices still go uncheckedBy Ed Frauenheim February 12, 2001 Nurse Week Photo: Courtesy of the White House

  5. Timeline of Regulations

  6. States with sharps legislation:

  7. MDPH Sharps Injury Prevention Regulations105 CMR 130.1001 et seq. Requires hospitals to: • Incorporate the use of safe needle / sharps devices into engineering and work practice controls • Maintain a written exposure control plan • with procedures for selecting safe devices

  8. MDPH Sharps Injury Prevention Regulations105 CMR 130.1001 et seq. Requires hospitals to: • Maintain a Sharps Injury Log • Use data for continuous quality improvement • Report to MPDH annually (Annual Summary) Requires MDPH to: • Establish an Advisory Committee • Develop a list of needleless systems

  9. MDPH Sharps Injury Prevention Advisory Committee MDPH • Occupational Health Surveillance • Bureau of Communicable Disease Control • Division of Health Care Quality • Mass Nurses Assoc. • Mass Hospital Assoc. • Mass Medical Society • UMass: Sustainable Hospitals Project • NECOEM • Consumer Advocate

  10. Objectives of the Sharps Injury Surveillance System • Document magnitude of the problem and trends in sharps injuries among hospital workers overtime • Identify departments, occupations, procedures, and hospitals where intervention is needed • Identify devices associated with sharps injuries • Facilitate sharing information among hospitals about successful programs and practices

  11. Methods • Population under surveillance: All health care workers in Massachusetts hospitals (acute and non-acute care) licensed by MDPH • Reportable exposure incident: BBP exposure that is the result of events that pierce the skin or mucous membranes • Reporting period: January 1 – December 31 • Coding structure is based on the CDC NaSH system

  12. Sharps Injuries among Massachusetts Hospital Workers, 2002 -2004

  13. Sharps Injuries among Hospital Workers by Occupation, Massachusetts, 2002-2004, N=10,016

  14. Sharps Injuries among Massachusetts Hospital Workers, 2002-2004 top 4 occupations Percentage of injuries

  15. Sharps Injuries among Massachusetts Hospital Workers, 2002-2004 top 4 occupations # of injuries

  16. Sharps Injuries among Hospital Workers by Department, Massachusetts, 2002-2004, N=10,016

  17. Sharps Injuries among Massachusetts Hospital Workers, 2002-2004 top 4 departments Percentage of injuries

  18. Sharps Injuries among Hospital Workers by Procedure or Purpose for which Device was Used, Massachusetts, 2002-2004, N=10,016

  19. Sharps Injuries among Hospital Workers by Device, Massachusetts, 2002-2004, N=10,016 Hollow bore needles 57%

  20. Sharps Injuries among Hospital Workers by Conventional Devices, Massachusetts, 2002-2004, N=10,016

  21. Sharps Injuries among Massachusetts Hospital Workers, 2002-2004 % safety devices Percentage of injuries

  22. Sharps Injuries among Hospital Workers by Device Involved in the Injury, Massachusetts, 2002-2004, N=10,016

  23. Sharps Injuries among Hospital Workers by Device - Standard v Safety, Massachusetts, 2002-2004(excluding unknown) Hypodermic Butterfly Vacuum tube Scalpel

  24. Sharps Injuries among Hospital Workers by Department where Injury Occurred, Massachusetts, 2002-2004, N=10,016

  25. Sharps Injuries among Hospital Workers with Hypodermic Needles by Procedure - Standard v Safety Device, Massachusetts, 2002-2004, n=2,984

  26. Sharps Injuries among Hospital Workers with Hypodermic Needles by Procedure – Conventional v Safety Device, Massachusetts, 2002-2004, n=942

  27. Sharps Injuries among Hospital Workers in the OR by Device, Massachusetts, 2002, n=935 Hollow bore needles 23%

  28. Sharps Injuries among Hospital Workers in the OR by Device: Conventional v. Safety, Massachusetts, 2002, n=935

  29. Strengths of Massachusetts Program • Census of hospitals • Not biased by voluntary reporting • Concordance with federal requirements • Used by hospitals for continuous quality improvement • Provides a mechanism for sharing information among hospitals • Provides a model to be used in other settings

  30. Data Limitations • Rate of underreporting is unknown and likely varies by hospital/occupation • Underestimates magnitude • Limits comparison among hospitals • Limitations of denominator data • Statewide data on specific devices is difficult to interpret without market share information

  31. Conclusions • Need to look beyond summary data • Need better information about under-reporting • Conversions: conventional → safety → first generation ↔ second…fourth generation

  32. Conclusions • Patterns are similar to those found in NaSH and EPINet • Many standard devices are still in use; e.g. hypodermic needles • Approximately half of injuries occur after use of the device; e.g. disposal issues and use of safety features • Rate of participation may be driven by the ability to comply with multiple regulations at one time

  33. Prevention Elimination Substitution · suturing  glues · injection with needles  alternative delivery of medications Engineering controls · IV systems  needleless IV · conventional needles  SESIPs (retractable, blunting, shielding, plastic)

  34. Prevention Administrative controls · neutral zones in OR · placement of sharps disposal containers · purchasing policies · reporting procedures Personal Protective Equipment · gloves, mask, gowns, goggles

  35. Progress by Hospitals: • Written inventory of devices • Increased conversion to safety devices • Review of safety devices • Committee to look at sharps related injuries • Committee to look at new devices • Involvement of staff in decision making • Centralized purchasing process • Improved post exposure management • Use of data in decision making • Reporting of near misses

  36. Acknowledgements: Phil Adamo, Evie Bain, Helene Bednarsh, Al DeMaria, Karen Daley, Tish Davis, Natalia Firsova, Catherine Galligan, Anuj Goel, Liz O’Connor, Gail Palmeri, Laurie Robert, Margaret Quinn, and Jim Ryan This presentation is dedicated to Dr. James Ryan, for his passionate work to protect the health and safety of workers, particularly those in the healthcare field.

  37. Massachusetts Department of Public HealthOccupational Health Surveillance Program Angela Laramie, MPH Sharps Injury Surveillance and Prevention Sharps.Injury@state.ma.us www.mass.gov/dph/ohsp

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