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DR NOORHAIDA UJANG MEDICAL OFFICER(RESEARCH) QUALITY HEALTHCARE DIVISION

A QUALITY IMPROVEMENT EFFORT A STUDY ON ASSESSMENT OF SHARPS INJURIES AND ITS MANAGEMENT AMONG HEALTH CARE WORKERS WITHIN THE MINISTRY OF HEALTH MALAYSIA. DR NOORHAIDA UJANG MEDICAL OFFICER(RESEARCH) QUALITY HEALTHCARE DIVISION INSTITUTE FOR HEALTH SYSTEM RESEARCH 18 APRIL 2010. Background.

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DR NOORHAIDA UJANG MEDICAL OFFICER(RESEARCH) QUALITY HEALTHCARE DIVISION

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  1. A QUALITY IMPROVEMENT EFFORTA STUDY ON ASSESSMENT OF SHARPS INJURIES AND ITSMANAGEMENT AMONG HEALTH CARE WORKERS WITHIN THE MINISTRY OF HEALTH MALAYSIA DR NOORHAIDA UJANG MEDICAL OFFICER(RESEARCH) QUALITY HEALTHCARE DIVISION INSTITUTE FOR HEALTH SYSTEM RESEARCH 18 APRIL 2010

  2. Background • 3,168 cases of needle stick injuries among HCW reported from 2002 to 2006 (Occupational Health Unit, Ministry of Health) • The indicator for NIA is the Incidence of NSI among HCW and the standard is 0 • Highest SIQ for NIA indicators were reported from Perak, Johor, Selangor and Sarawak • Currently follow up information of NSI cases unknown

  3. OBJECTIVES General objective To assess the management of sharps injuries among healthcare workers. Specific objectives 1. To determine the existing sharps injuries management protocol in hospitals. 2. To identify the proportion of sharps injury cases which have been reported with incomplete follow up. 3. To identify the reason/s for incomplete follow up of sharps injuries.

  4. Methodology • Phase 1 • Cross sectional survey of sharps injuries in all hospitals in the four identified states (Perak, Selangor, Sarawak and Johor) • Postal survey sent to 55 hospital directors • Data collected on hospital protocol and numbers of sharps injuries • Phase 2 • Two states (Johor and Perak) with highest incidence of the sharps injuries. • Self-administered questionnaire on Post Exposure experience and follow-up assessment to all the HCWs who had sustained sharps injuries in the year 2006

  5. FINDINGS – Phase 1 Results from 41 hospitals

  6. 41 hospitals (76.36%) responded

  7. Incidence Rate of Needle stick Injury among HCW in the MOH (per 1000 HCW)-2006 Malaysia : 3.7/1000 HCW 5.2/1000HCW

  8. Office hours After office hours • Infection control unit (73.8%) • Emergency unit (21.4%) • Emergency unit (54.8%) • Respective departments(35.7%) To determine the existing sharps injuries management protocol in hospital.1) All 41 hospitals studied have a protocol on NSI management. 2) Units responsible for managing sharp injuries

  9. Currently there is no standardized protocol as indicated by the following findings • Storage of drugs: 57.1% of Post Exposure Prophylactic (PEP) drugs for immediate use were kept in the Pharmacy. • 88.1% records of all the sharps injuries were kept in the Infection Control Unit. • The infection control nurse/sister were responsible for compilation and analysis of data (88.1%).

  10. Injury Rate Within Type of Hospitals Sharps Injury Rate = No. of HCW with sharps injury/ Total no of HCW

  11. To identify the proportion of sharps injury cases which have been reported with incomplete follow up.

  12. Regularity of presentation of analysed data to the hospital management

  13. PRESENTATIONof Sharp Injuries ANALYSED Data TO THE HOSPITAL MANAGEMENT by Type of Hospitals

  14. Summary of Phase 1 findings : • There are protocols in all hospitals however not standardized • Different units managing sharps injuries • Different areas of storage of PEP drugs • Different areas of storage of sharps injuries records • Different person responsible for compilation and analysis of data • Poor follow up rates • No standardization in regularity of presentation of analyzed data to hospital management

  15. Findings – Phase 2 Self-administered questionnaire to HCWs

  16. Sharps injuries in year 2006 16

  17. Frequency of sharps injury by occupation

  18. Frequency of Immediate Care Received By Location

  19. Post-exposure experience • 21.3%(13) felt they were not given sufficient information to make a decision about post exposure treatment • 46.1%(6) – doctors • 23.1%(3) – nurses • 15.4%(2) – attendants

  20. Follow up assessment • Of the 41 who were asked to come for follow up, 11(26.8%) did not complete their follow up

  21. Reasons for not completing follow up

  22. Interpretation of findings • The study has identified the following weaknesses in the protocols: • No standardization in management of cases • No specific department identified to handle sharps injuries cases • Inadequate follow up rates • Irregularity in presentation of data to hospital management • Insufficient post exposure information given to the injured personnel • Injured staff not giving adequate importance to follow up

  23. Recommendations

  24. Recommendations • Sharps injuries management protocol has been developed by the Occupational Health Unit which should be used by all MOH hospitals • Dedicated staff to handle sharps injury cases have been outlined out in the protocol • Specific department indentified for managing cases has been identified in the protocol • Documented Reminder System to improve follow-up compliance to be developed

  25. Sharps Injury Surveillance Manual

  26. Guidelines On Occupational Exposures to HIV, HBV and HCV, And Recommendations For Post Exposure Prophylaxis

  27. Guidelines On Management of HCW Infected with HIV,HBV and HCV

  28. Recommendations • Regular presentation of data on sharps injuries to hospital management to ensure proper and effective management • Reporting of analyzed data to the State Infection Control Committee as per the protocol • More commitment from top level management • Ministry : Evaluation • State : Monitoring • Institution : Adhering to protocol

  29. Recommendations • Review of Quality Assurance Indicator ‘Incidence of Needle Stick Injury Among Health Care Workers In Ministry of Health’ to include all sharps injuries ; to be taken up by the Quality Unit, Public Health Department • Use of safety needles in facilities • A new Sharps Injuries Surveillance (SIS) has been introduced in 2007. Study on effectiveness of this system need to be conducted.

  30. Limitation Underreporting This has resulted in incomplete data thus reducing the actual number of injuries as well as the proportions of workers affected and subsequently the management and follow up of the cases

  31. Follow up rates for sharps injuries in health care workers is poor - Dedicated staff and documented reminder system will help in improving the follow up rates.No standardized management protocol on sharps injuries - Occupational Health Unit, Ministry of Health has developed guidelines on management of health care workers exposed to sharps injuries and infected with blood borne diseases. - Adherence to this new guidelines is important to prevent and manage sharps injuries in the country. Conclusion

  32. ACTION PLAN

  33. ACTION PLAN

  34. THANK YOU FOR YOUR ATTENTION If you don’t have time to solve problems, How come you always have time to do it wrong again. (Unknown)

  35. Thank you

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