WEB0162016 THANK YOU FOR JOINING US THE WEBINAR WILL BE STARTED MOMENTARILY Preventing Occupational Exposures to Bloodborne amp Biological Hazards We Have Only Just Begun Amber Hogan Mitchell DrPH MPH CPH ID: 635481
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AOHP ONLINE EDUCATION PROGRAM WEB016-2016
THANK YOU FOR JOINING US, THE WEBINAR WILL BE STARTED MOMENTARILY.Slide2
Preventing Occupational Exposures to Bloodborne & Biological Hazards: We Have Only Just BegunAmber Hogan Mitchell, DrPH, MPH, CPHSlide3
Step 1
Step 2Slide4
Disclosure
Thank you for participating in this continuing educational activity.Goals/Purpose : To improve knowledge that promotes professional development and enhance the learners contribution of quality health care in Employee/Occupational Health. Successful Completion of this CNEIn order to receive full contact-hour credit for this CNE activity, you must:Attend the full session Complete an evaluation Conflict of Interest (or lack thereof) for Planners & Presenter(s)
A conflict of interest occurs when an individual has opportunity to affect or impact educational content with which he or she may have a commercial interest or a potentially biasing relationship of a financial, professional or personal nature. All planner and faculty/content specialist(s) must disclose the presence or absence of a conflict of interest relative to this activity. All potential conflicts are resolved prior to the planning, implementation or evaluation of the continuing nursing education activity. All activity planning committee members and faculty/content specialist have submitted conflict of interest disclosure forms.
The planning committee members and faculty/content specialist of this CNE activity have disclosed no relevant professional, personal or financial relationships related to the planning or implementation of the CE activity.
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Disclosure (Continued)
Commercial or Sponsor support: UL, EHS Sustainability is providing commercial support for this education activity. AOHP declares that this activity is for educational purposes only and will not promote any proprietary interest of any commercial interest organization providing financial or in-kind support. In accordance with the policies on disclosure of the Accreditation Council for the American Nurses Credentialing Center’s Commission on Accreditation (ANCC), AOHP is responsible for all decisions related to the educational activity. UL, EHS doesn’t participate in any component of the planning process of an educational activity, including: Assessment of learning needs Determination of objectives Selection or development of contentSelection of planners, presenters, faculty, authors and/or content reviewers Selection of teaching/learning strategies Evaluation methods Non-endorsement of products
The approved provider status of AOHP (Association of Occupational Health Professionals) refers only to the continuing nursing education activity and does not imply a real or implied endorsement by
AOHP or the American Nurses Credentialing Center (ANCC) of any commercial product, service or company referred to or displayed in conjunction with this activity, nor any company subsidizing costs related to this activity.
Reporting of Perceived Bias
Bias is defined by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC COA) a preferential influence that causes a distortion of opinion or of facts. Commercial bias may occur when a CNE activity promotes one or more products(s)( drugs, devices, serviced, software, hardware, etc,). This definition is not all inclusive and participants may use their own interpretation in deciding if a presentation is biased.
The Association of Occupational Health Professionals in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.Slide6
THE PRESENTER
Amber Hogan Mitchell, DrPH, MPH, CPHSlide7
DisclosureInternational Safety Center is funded through charitable contributions from medical device and PPE manufacturers, institutions, and societies so that EPINet can be offered to healthcare facilities around the world for free.Slide8
Provide background about the current prevalence of bloodborne and pathogenic diseaseRefresher on policy impact at a national level and growing focus around the world
Provide the latest International Safety Center EPINet summary data on occupational sharps injuries and BBFEs Describe how to use occupational surveillance data to paint a picture of what could be happening in your facility Create targeted approaches to reduce risk and decrease overall occupational illness and infectionReinforce the need to be methodical about surveillance approaches to have the greatest positive impact long termObjectivesSlide9
Current Prevalence of Bloodborne & Biological Pathogen Risks: Occupational ImpactSlide10
The Significance of Public Health in America:
64% Increase in Average Life Expectancy Over 100 Year Period
Source: Ten Great Public Health Achievements -- United States, 1900-1999 MMWR, April 02, 1999 / 48(12);241-243
http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm
Increased years due to medical care advances:
5
yrs
Increased years due to public health advances: 25
yrs
Courtesy Dr. S
PatlovichSlide11
Ten Great Public Health Achievements in the United States, 1900 to 1999
VaccinationsMotor-vehicle safetySafer workplacesControl of infectious diseaseDecline in deaths from coronary heart diseases and strokeSafer and healthier foodsHealthier mothers and babiesFamily planningFluoridation of drinking waterRecognition of tobacco use as a health hazard
Source: Ten Great Public Health Achievements -- United States, 1900-1999 MMWR, April 02, 1999 / 48(12);241-243
http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm
Courtesy Dr. S
PatlovichSlide12
Infectious & Biological Threats are More Prevalent than Ever… and More People are Accessing Healthcare Systems Around the WorldSlide13
PATHOGENS TRANSMITTED THROUGH OCCUPATIONAL EXPOSURE
Blastomycosis dermatitidisBrucellosis abortusCorynebacterium diphteriaeCreutzfeldt-Jakob diseaseCryptococcosis neoformansDengue virusEbolaHepatitis BHepatitis CHepatitis GHerpes Simplex virus Herpes Zoster virusHIVLeptospira icterohaemorrhaglae
Malaria
Mycobacterioum marinum
Mycobacterium tuberculosis
Mycoplasma caviae
Necrotizing casciitis
Plasmodium falciparum
Rickettsia rickettsii
Sporotrichum schenkii
Streptococcus pyogenes
Staphylococcus aureus
Syphilis
Treponema pallidum
Toxoplasma gondii
TuberculosisSlide14
Courtesy Dr. J JaggerSlide15
Hepatitis BGlobally: 2 BILLION People 3 MILLION Refugees
Thanks for Slides from Elise Handelman & Elayne Phillips. BD & McKessonSlide16
Hepatitis C“CDC Warns on Rising Cases of Hepatitis C”
WSJ, May 8, 2015Slide17
“Hepatitis C killed almost 20,000 Americans in 2013. More of us died from hepatitis C than from 60 other infectious diseases combined, including HIV and TB, with ‘baby boomers’ at greatest risk.”Summary source: Preidt
, R. Hepatitis C Now Leading Infectious Disease Killer in U.S. HealthDay; 2016 May 4 Available from: https://www.nlm.nih.gov/medlineplus/news/fullstory_158651.htmlSlide18
Courtesy Dr. J JaggerSlide19
HIVToday, 1.2 Million People in the US are living with HIV.1 in 5 don’t know they are infected and can pass the virus to others.
CDC 2011Slide20Slide21
Emerging and Re-emerging Pathogens
EbolaZikaDiseases in Conflict CountriesMeasles New occupational cases depending on level of immunityCo-Morbidities with Multidrug Resistant Organisms like MRSAPatients with now chronic disease like HCV, HIV with increased prevalence of MRSAHealthcare worker colonizationSlide22
Thank you, Dr. K ReynoldsSlide23
Courtesy Dr. J JaggerSlide24
US Policy Impact of National RegulationsSlide25Slide26Slide27Slide28Slide29Slide30Slide31Slide32
Growing Body of Additional Standards for Biological HazardsSlide33
OSHA Infectious Disease StandardFor non-Bloodborne PathogensCalOSHA Aerosol Transmissible Disease StandardOccupational exposure during “direct patient care”
Worker Infection Control PlanInfectious Agent Hazard AnalysisSlide34
Respiratory Protection Standard
Available online: https://www.osha.gov/Publications/OSHA3767.pdfIncludes Fit Testing for Biological Hazards like TB, FluAerosol transmissible disease (ATD) or aerosol transmissible disease pathogen—Any disease or pathogen requiring Airborne Precautions and/ or Droplet Precautions.Slide35
OSHA Personal Protective Equipment Standard
https://www.osha.gov/SLTC/personalprotectiveequipment/Slide36
http://
www.nytimes.com/2016/06/11/science/lab-worker-in-pittsburgh-is-accidentally-infected-with-zika-virus.html?_r=0Slide37Slide38
Expanding Internationally…Collaborations from Around the GlobeSlide39Slide40Slide41Slide42Slide43
Surveillance Today: International Safety Center & EPINetSlide44
Safety Center OverviewFree Standing 501c3 Non-Profit Research and Education CenterOriginally at University of Virginia, led by Dr. Janine JaggerSince 1992Network of US Hospitals, Contributing Aggregate DataSummary Data Reported Annually
Reports Used to Drive Policy and PracticeSlide45
Global Distribution ModelSlide46
EPINet Distribution Around the World Color-Coded by Language
96 Countries, 24 Languages Slide47
US Distribution Model & Hospital NetworkSlide48
~30 U.S. Hospitals & Health Systems
____________Many Reporting to Aggregate since mid-1990s; Needlestick Safety & Prevention Act / OSHA BPS Champion HospitalsSlide49
Since 1992, acquired for 1,500 U.S. Hospitals and 96 countries!Slide50Slide51Slide52
2014 EPINet Summary DataSlide53
EPINet Incident ReportsContaminated Needlesticks and Sharps InjuriesBlood and Body Fluid Splashes and SplattersIncidents Reported to Employee/Occupational HealthRecordedDe-identified, Aggregate Data Shared with Safety Center
Analyzed Annually, Ratio Created Using Average Daily Census (ADC)Slide54
2014 Summary Sharp Object Injuries (SOIs)24.7 Injury Incident Reports / 100 Average Daily Census (ADC)Compared to 25.2 from AOHP EXPO-STOP27.2 / 100 ADC; Teaching Facilities20.4 / 100 ADC; Non-Teaching FacilitiesSlide55Slide56Slide57
Sharp Object Injury IncidentsEPINet Surveillance Data 2012-2014Slide58
41.2% Safety Device Used
65.8% Safety Feature Not Activated53.3% Before Activation34.0% Fully, Partially ActivatedSlide59
86.6% Safety Devices
66.0% Not Activated52.9% Before Activation33.2% Partially or Fully ActivatedSlide60Slide61
1/4 of all injuries occurring downstream, outside of the control of the user!
Injuries to EVS/housekeeping/hygiene, waste haulers, laboratorians, team members.Slide62
Sharp Injuries Year Comparison
201220132014Total Injuries597508559Doctor28.6%24.823.4Nurse36.236.2
43.3
Patient Room
24.6
28.5
34.2
OR
39.3
36.8
34.6
Disposable Syringe
35.7
31.7
35.2
Safety Mechanism? Yes
36.7
41.6
42.1
Safety
Activated? NO
65.7
70.9
64.6
Still Work to Be DoneSlide63
Using Data to Paint a Picture, Develop Messaging & Targeted Education:American Nurse TodaySlide64Slide65
“Take Action”
InfographicSlide66
Massachusetts Sharps Injury Surveillance Data 2002-2014Compliments of Angela Laramie, MPHangela.laramie@state.ma.usSlide67
Sharps Injuries among Massachusetts
Hospital Workers, 2002-2014, N=40,251Data source: Massachusetts Sharps Injury Surveillance System, 2002-2014**2014 data is provisionalSlide68
Sharps Injuries among Employees of Acute Care Hospitals by Occupation,
Massachusetts, 2002-2014, N=23,811
Data source: Massachusetts Sharps Injury Surveillance System, 2002-2014*
*2014 data is provisionalSlide69
Sharps Injuries among Massachusetts Hospital Workers by SESIP, 2002-2014, N=40,251
Data source: Massachusetts Sharps Injury Surveillance System, 2002-2014**2014 data is provisionalSlide70
Blood & Body Fluid Exposure IncidentsEPINet Surveillance Data 2012-2014Slide71
2014 Exposure Rate / Ratios8.9 incidents reported per 100 Average Daily Census9.4 / 100 ADC Teaching Facilities8.1 / 100 ADC Non-Teaching FacilitiesSlide72
Job CategorySlide73
Location of Incident
52.6% from Direct Patient Contact 22.4% “Other” wound irrigation, vent tube, trach tube, syringe / blood collection splashSlide74
Exposed Part
77.3% Face/MucotaneousSlide75
Total PPE & Barrier Garment Worn
47% indicated only wearing uniform / scrubs
2.8% wearing appropriate eye protectionSlide76
Splash/Splatter Year Comparison
201220132014Total Incidents174141213Doctor13.8%14.9%13.1%Nurse47.749.654
Eyes (Conjunctiva)
60.0
64.5
65.7
Goggles/Faceshield
7.4
8.5
2.8
Patient Room
33.7
28.1
40.4
OR
20.0
20.9
16.9
ED
18.3
14.4
7.5
Increasing Risk for Bedside NursesSlide77Slide78
Clinical Lab Blood & Body Fluid Splash / Splatter Incident DataSlide79Slide80
Bacterial Solution
HIV Viral Load SpecimenPlasmaSerumVaginal SecretionsFetal FibronectinSlide81Slide82
ANA Sharps Injury Prevention Stakeholder GroupSlide83
Stakeholder Call to ActionNeeds to Remain Front and Center on National AgendaBack on National OSHA’s Priority List – National Enforcement Emphasis In-Patient Facilities – Hospitals and Long Term Care Facilities
CDC/NIOSH Call for 21st Century SurveillanceInitiative to Identify Accurate IncidenceUpdate CDC/NIOSH Research Agenda, along with Associated Funding, GrantsImprove Requirement for Frontline Workers to Evaluate Safety DevicesChanging Tide, Rising RiskIncreasing risk as it relates to emerging infectionsIncreasing retirement, educating new employeesImpact related to co-infections/co-morbiditiesSlide84
Critical Reflections & Recommendations for Future EffortsSlide85
Progress, OpportunitiesNational policy has been the result of cross-collaboration between groups, sectors, and disciplines and as such…enormous progress has been made in the US relative to occupational exposures to blood, body fluids, and biological risksThere is clearly still work to be done.
“100% preventable” injuries are still occurringRecapping, Disposable Syringes/Tubes, Other hand (“ditch pinch”)Safety feature activation is less than ideal and injuries occurring from safety features meaning frontline employee feedback is less than idealKey factor in monitoring progress and ongoing challenge areas is to measure, survey exposure incidents and complianceCreate interventions, educational materials, blitzes, campaigns based on targeted dataSlide86
US Healthcare Workers Still Unprepared
No nationalized surveillance system in place for SOI and BBF, therefore EPINet serves as a detailed benchmark for bothIn “low risk” departments (non-OR, non-ED), PPE is only worn 25% of the time during exposure incidentFace PPE is worn only 2-3% of the time when mucotaneous exposure incidents occur~25% sharps injuries occurring downstreamNotable number sharps injuries still 100% preventableLess than 50% with safety mechanism, more than 60% not activatedOSHA Compliance? “Safer” medical devices?Slide87
Recommendations for Future EffortsSlide88
Recommendations
Improve Surveillance of Worker Incidents, Exposures & Near HitsMore Data is More Power - Contribute to a surveillance network today!Mind the HierarchySubstitution & Engineering Controls FirstImprove PPE Compliance; Identify Targeted Steps based on DataFrontline Employee Feedback of DevicesImprove Safety Feature ActivationBegin Campaigns on Preventable Sharps InjuriesDitch the Pinch, Recapping, Leaving on SurfaceExpand into Biological Hazards; Infection Prevention. Make Yourself More RelevantMeasure & Focus on Highest Risk Mucotaneous Exposures; MDROs and BBPsCo-morbidities with CA-MRSA, HIV, HCV
Decreasing Incidence = Worker + Patient SafetySlide89
Industrial Hygiene: Hierarchy of ControlsEliminationSubstitutionEngineering Controls (CSTD)Administrative ControlsWork Practices
Personal Protective EquipmentInstitutionalDepartmentalIndividualBestWorstSlide90Slide91
THANK YOU!amber.mitchell@internationalsafetycenter.orgSlide92
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