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A3.1 Using EPINet Surveillance Data to Support Public Policy-Jagger J
The Exposure Prevention Information Network (EPINet) surveillance system tracks occupational sharps injuries and blood exposures in more than 1,000 health care facilities in the U.S. A network of 84 U.S. hospitals have contributed EPINet data to a national research database at the University of Virginia since 1992. These data support prevention initiatives, and have influenced legislation and government agency policy actions. Four examples show how surveillance data have been used: 1) In 1992 the FDA was petitioned to issue a national Safety Alert to advise against the unnecessary use of hypodermic needles for accessing IV ports. The justification for the alert was backed up by needlestick surveillance data. The Safety Alert was issued in April 1992; 2) In 1998 EPINet and NaSH (CDC) data supported the petition for a government advisory on the hazards of glass microhematocrit tubes. In February 1999 the FDA, OSHA, and NIOSH (CDC) issued a joint Safety Advisory promoting the transition to plastic or plastic-wrapped capillary tubes; 3) California's law AB 1208, requiring safety engineered sharp medical devices, has challenged by groups seeking exemptions, such as physicians in office-based practices. Their claim that there is no significant risk of sharps injuries in physicians' outpatient offices was refuted by an analysis of 925 cases of such injuries in the EPINet database. The exemption was denied. 4) Another debate emerged in California. Some groups maintained that the required conversion to safety engineered sharps devices would eliminate the need for sharps disposal containers. An analysis of nearly 1,000 injuries from safety devices in the EPINet database revealed that injuries still occurred during and after disposal, supporting the continuing need for sharps disposal containers.
Other factors contributing to the support of these policy issues will also be discussed.
A3.2 Health Risks in Correctional Health Care Workers: Recent Findings-Gershon R, Mitchell C, Vickers D, Felknor S, Nemhauser J, Trout D, Ballard R, Vlahov D
We are currently completing a two-year epidemiological study designed to characterize the prevalence of occupational exposure to infectious disease in correctional health care workers (CHCWs). Because of the unique characteristics of the correctional healthcare setting, which must balance "custody and care" issues, standard infection control and employee health practices typical of community hospitals may be difficult to achieve. This in turn may present challenges for containing the risk of exposure to infectious agents such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and tuberculosis (TB). To better quantify and characterize infectious disease risk, a study was conducted of CHCWs recruited from four different state correctional systems. The following elements were included: Risk assessment questionnaire (e.g., exposure risk factors-community vs. occupational) Serological testing for prevalence of antibodies to HBV and HCV Tuberculin skin test (TST) reactivity HBV vaccination history and current vaccine status.
Preliminary results obtained from over 400 CHCWs are as follows: 10% of CHCWs have evidence of positive HBV serology 16% are TST reactive 3.1% are HCV positive 55 % show evidence of vaccination against HBV.
We are still in the data collection phase, and shortly after that we will begin analyses to determine the risk factors for infection. At this early stage it is difficult to determine if these rates, which appear to be higher than generally reported for hospital-based healthcare workers, are related to work or community risk factors. Information obtained from the completed analyses will be helpful in developing effective preventive strategies specific for this population of healthcare workers.
A3.3 Improved Compliance with Universal Precautions Among Operating Room and Emergency Department Personnel for Two Years following an Educational Intervention-Kim L, Jeffe D, Evanoff B, Freeman B, Fraser V
We designed and implemented an educational intervention including a hands-on clinical procedure training program aimed at reducing exposures to bloodborne pathogens in the operating room (OR) and emergency department (ED). Participants included OR personnel in cardiothoracic, general, gynecological and orthopedic surgery, and ED personnel at Barnes-Jewish Hospital, a 1,000-bed tertiary care hospital from 6/96 through 8/98. At baseline, and at 1 and 2 yrs. after an educational intervention, observers recorded information about personal protective equipment (PPE), sharps transfers, and blood and body fluid exposures.
In the OR, use of PPE increased significantly at 1 yr. after training and was sustained at 2 yrs. for all specialties and staff subgroups. Observers recorded 597 HCWs during 76 cases at baseline and 783 HCWs during 103 cases at 1 yr. and 502 HCWs during 66 cases at 2 yrs. following education. Use of proper eye protection by HCWs improved from (baseline 322/597 [54%] vs. 1 yr. 516/783 [66%], p<.001) and was sustained at 2 yrs. after training (337/502 [67%], p<.001). Use of double gloves by HCWs improved from (baseline 97/344 [28%] vs. 1 yr. 250/477 [52%], p<.001) and was sustained at 2 yrs. after training (185/311 [60%], p<.001). Observed needlestick and body fluid exposure rates decreased from 8.5/100 hrs. at baseline to 4.7/100 hrs. at 1 yr. (p=.091) and to 4.0/100 hrs. at 2 yrs., (p=.068).
In the ED, staff were more compliant with UP following the educational intervention. Observers recorded 752 HCWs during 88 trauma cases at baseline and 811 HCWs during 119 cases at 1 yr. following education. Full compliance with PPE during trauma resuscitations improved from (baseline 335/752 [45%] vs. 1 yr. 542/811 [67%], p<.001). Compliance with PPE by HCWs performing or assisting an invasive procedure improved from (baseline 202/304 [66%] vs. 1yr. 280/357 [78%], p<.001). This educational intervention significantly improved compliance with UP. OR and ED personnel in this study showed an increased use of protective eyewear, double gloves, and experienced fewer occupational exposures.
A3.4 A Community Hospital Intervention Program to Prevent Percutaneous Injury Among Health Care Workers-Doebbeling BN, Beekmann SE, McCoy KD, Ferguson KJ, Woolson RF, Vaughn TE, Torner JC, Grosch JW, Murphy L
Infection control practitioners (ICPs) in all Iowa and Virginia hospitals and Iowa health care workers (HCWs) at risk for blood exposure were surveyed to identify institutional factors associated with standard precautions (SP) adherence and percutaneous injury (PI). Institutional safety climate, particularly job demands and feedback, was related to high SP adherence and PI rates.
A community hospital-based intervention program based on these results was developed emphasizing joint management/employee focus groups, goal setting, training to monitor SP adherence, and provision of feedback. A randomized, controlled trial of institutional-level interventions was implemented using a pre- post-test design. Three community hospitals were randomly assigned to either: 1) unit level (UF), or 2) institutional level feedback (IF). ICPs and co-workers were trained to observe and monitor SP adherence. Feedback was provided monthly via graphical reports.
Follow-up surveys of workers were collected approximately 12 months following the intervention. Outcomes of primary interest include estimation of adherence with specifically recommended SP measures, plans to adhere in the future (Stages of Change), and rates of occupational injury and exposure. The UF hospital had higher proportions of HCWs without blood exposure in prior 3 months at follow-up than IF hospitals (odds ratio [OR] = 1.41, CI95=1.00-1.99, p=0.028), but comparable PI proportions (OR =0.96, CI95 =0.89-1.03, p>0.20). In linked pre- and post data, handwashing adherence increased significantly (p<0.05), although there were no significant exposure differences. In HCWs assessed at only one point in all three intervention hospitals, both mean blood exposures (rate difference=-0.73, CI95=-1.33, -0.13) and PI (rate difference=-0.08, CI95=-0.16, 0.00) were significantly lower among those assessed at follow-up.
This community hospital-based intervention using goal setting and SP feedback had an important impact on both mucocutaneous and PI exposure. Further study is needed to find the most effective and efficient programs to best protect community HCWs.
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