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Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program

 

Workbook Overview

Slide 1
Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program

A Program designed for: Infection Control & Occupational Health Personnel, Healthcare Administrators, Sharps Injury Prevention Committees

Speaker Notes: [This slide set describes the problem of sharps injuries in healthcare settings and introduces the audience to the Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program.  In addition to frontline healthcare personnel, the intended audience for this slide set includes healthcare administrators and decision makers in order to increase administrative and leadership “buy-in” for the implementation of a comprehensive sharps injury program.]

Slide 2
The Problem of Sharps Injuries
CDC estimates ~385,000 sharps injuries annually among hospital-based healthcare personnel*
Sharps injuries are a hazard

• Increased risk for bloodborne virus transmission
• Cost to workers and healthcare system

*Panlilio AL, et al. Infect Control Hosp Epidemiol, 2004

Speaker Notes: CDC estimates that approximately 385,000 injuries with used needles and other sharp devices occur among hospital-based healthcare personnel each year in the United States.  That’s over 1,050 injuries a day!  Many more occur in other healthcare settings such as home care, nursing homes, and emergency services.  Sharps injuries increase the risk for the transmission of bloodborne viruses, and are costly to workers and to the healthcare system.

Slide 3
Sharps Injuries Are Preventable
Preventability of Needlestick Injuries involving
Hollow-bore Needles in 78 NaSH Hospitals,
June 1995 to December 2004 (n=11,625)

Pie Chart illustrating:
Undetermined = 18%
Non-preventable = 18%
Preventable = 64%

Speaker Notes: CDC collects sharps injury data from healthcare facilities through the National Surveillance System for Healthcare Workers (or NaSH). Data from the NaSH system show that most sharps injuries from hollow-bore needles are preventable.  A majority (64%) of all hollow-bore needle-related injuries can be prevented by using needles only when necessary, using devices with engineered safety features and properly using the safety features on these devices, following proper work practices (such as not recapping used needles), and properly disposing of needles after use.  It is essential that employees receive training on the use of safety devices before they are implemented and during the initial phases of implementation to ensure that they are familiar and comfortable with the use of the safety features.

Preventability is determined after taking into account the device used, the procedure being performed, and when the injury occurred relative to the procedure and activation of the safety feature.

Slide 4
Hepatitis B virus (HBV) Risk from
Percutaneous Injury = 6%-30%*

Hepatitis C virus (HCV) Risk from
Percutaneous Injury = Approx. 2%

Human immunodeficiency virus (HIV) Risk from
Percutaneous Injury = 0.3%

*Risk applies to unvaccinated workers only

Speaker notes: Sharps injuries are an important concern because they increase the risk for the transmission of bloodborne viruses.  The bloodborne viruses that are of primary concern for transmission from percutaneous injuries during patient care are hepatitis B and C viruses, and human immunodeficiency virus (or HIV), the virus that is associated with AIDS.  The average risk of transmission after an occupational percutaneous exposure varies by bloodborne virus. As you can see, healthcare personnel are at higher risk of being infected with HBV following a sharps injury than HCV or HIV.  Fortunately, there is a vaccine that protects exposed healthcare personnel from getting HBV.  The average risk of HCV transmission after a percutaneous exposure to HCV-infected blood is approximately 1 in 50 exposures.  The average risk of HIV infection after a percutaneous exposure to HIV-infected blood is about 1 in 300 exposures.

Slide 5
The Costs of Sharps Injuries

• Medical costs
  
• – $71 to ~$5,000 per exposure*
  
• Lost time from work
  
• Emotional cost
  
• Long-term costs

* O’Malley EM, et al. Infect Control Hosp Epidemiol, 2007

Speaker notes: Although an occupational exposure to HIV and hepatitis viruses rarely results in infection, the risks and costs associated with blood exposure are serious and real. Some of the direct costs are those associated with the initial and follow-up laboratory testing and treatment of exposed healthcare personnel, which are estimated to range from $71 to just under $5,000 depending on the treatment provided.

However, many costs are much more difficult to quantify. These costs include the direct and indirect costs associated with employee follow-up, lost time from work due to the common side effects of drug therapy, and the emotional costs associated with fear and anxiety about the possible consequence of an exposure. 

Some long-term costs include the possible loss of a skilled worker's services in patient care due to infection, the economic burden of medical care for affected individuals, and the cost of any associated litigation that may result due to an exposure.

Slide 6
Needlestick Safety and Prevention Act (2000)

• Federal OSHA standard requires:
  • Use of engineering and work practice controls
    
  • Recordkeeping on a Sharps Injury Log
    
  • Written Exposure Control Plan

Speaker notes: Recent changes in federal legislation have been made in order to prevent the occurrence of sharps injuries in healthcare settings.  The federal Needlestick Safety and Prevention Act was passed by Congress in 2000; this legislation mandated the revision of the 1991 Bloodborne Pathogens Standard to require the use of engineered sharps injury prevention devices whenever possible.  Furthermore, the Act requires that employers maintain a Sharps Injury Log that at a minimum records the type and brand of device involved in the incident, the work area where the injury occurred, and an explanation for how the injury occurred. 
Employers must also develop a written Exposure Control Plan.

Slide 7
Exposure Control Plan

• Must reflect changes in technology use for prevention
  
• Document annual consideration, evaluation of safer sharps devices
  
  • Employers are required to solicit input from direct patient care personnel regarding the identification and selection of engineering and work practice controls.

Speaker notes: This Exposure Control Plan must reflect changes in technology that eliminate or reduce exposures to bloodborne pathogens, and document considerations and evaluations of engineered sharps injury prevention devices on an annual basis.  In addition, non-managerial employees responsible for direct patient care must be included in the process of identifying, evaluating, and selecting engineering and work practice controls.

Slide 8
Recent OSHA Citations

• July 2003: Fined nursing home $92,500 for “serious” and “willful” violations
  
  • Levied maximum fine for willful violations: failure to utilize sharps safety devices
    
• September 2003: Hospital fined $9,000
  
  • Complaint filed by staff that safety-engineered devices were not available

Source:  Advances in Exposure Prevention

Speaker notes: Since the inception of the Needlestick Safety and Prevention Act in 2001, OSHA has cited healthcare facilities for failing to follow the revised Bloodborne Pathogen Standard.  For example, one nursing home was fined a total of $92,500 in July 2003 after “serious” and “willful” violations of the Standard were noted.  The willful violations led OSHA to level the maximum fine for this violation category.

In another citation, a hospital was fined $9,000 by OSHA in Sept. 2003 after OSHA received complaints from hospital staff stating that safety-engineered devices were not available to the staff. 

Among federal OSHA states, between October 1, 2005 and September 30, 2006, the Bloodborne Pathogen Standard was the most frequently cited standard in hospitals, representing 42% of all citations.

Slide 9
Image of Workbook

Speaker notes: The Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program was developed by CDC to provide a practical plan to help healthcare organizations prevent sharps injuries.

Slide 10
Purpose of Workbook

• Assist healthcare facilities to organize a sharps injury prevention program
  
• All-in-one tool that helps:
  
  • Develop and maintain a program
    
  • Enhance or augment existing programs

Speaker notes: This Workbook  is designed to assist healthcare facilities in organizing a sharps injury prevention program.  For those facilities that do not currently have a sharps injury prevention program, this Workbook  can guide the development and maintenance of such a program. The Workbook  also contains many tools that can enhance or augment existing sharps injury prevention programs.

Slide 11
The Workbook will help…

• Assess a facility’s sharps injury prevention program
  
• Document a prevention plan and implementation of activities
  
• Evaluate the impact of prevention measures

Speaker notes: This Workbook provides tools to:
help assess a facility’s sharps injury prevention program,
develop, implement, and document a comprehensive sharps injury prevention plan, and
evaluate the impact of prevention interventions.

Slide 12
Contents of the Workbook

• Overview of sharps injury epidemiology and prevention strategies
  
• Organization-wide method of developing prevention program
  
  • Based on model of Continuous Quality Improvement (CQI)
    
• Program model of operational processes
  
• Program resources

Speaker Notes:Arranged into four basic parts:
The Workbook  contains an extensive overview of the epidemiology of sharps injuries and injury prevention strategies. 
The Workbook  provides guidance for developing a sharps injury prevention program that is designed to integrate into existing performance improvement, infection control, and safety programs.  It is based on a model of continuous quality improvement (or CQI), an approach that successful healthcare organizations are increasingly adopting.  This prevention program, therefore, is aimed at continually improving all processes involved in the delivery of quality services and products.
The Workbook  outlines a sharps injury prevention program model that involves five operational processes.  These processes or activities form the backbone of an effective sharps injury prevention program. 
Finally, the Workbook  not only provides information on how to form or enhance a sharps injury prevention program, but also gives the necessary resources to be more effective in reducing injuries by providing a toolkit of forms and surveys and providing a list of additional websites and resources.

Slide 13
Organizational Steps

1. Develop organizational capacity
   – Form a multidisciplinary leadership team
   
2. Assess the operational processes of the prevention program
   
3. Prepare a baseline profile of sharps injuries and current prevention activities

Speaker Notes: The organizational steps outlined in the Workbook  are designed to ensure that a sharps injury prevention program is integrated into existing safety programs; reflect the status of the current prevention activities of a facility; and target areas for improving the performance of a prevention program.  There are six organizational steps in the Workbook.

1. An important first step is the development of organizational capacity for the prevention program.  The Workbook  provides guidance on how to form a multidisciplinary leadership team in which members are jointly responsible for eliminating sharps injuries in a facility.  It should be noted that representation from senior-level management is important in order to provide visible leadership and demonstrate the administration’s commitment to personnel safety.
2. Additionally, the Workbook  provides the necessary tools and guidance to assist with the assessment and documentation of current operational processes of a sharps injury prevention program.  These processes will be discussed in more detail later in this presentation.
3. The Workbook also provides the tools and forms to prepare and present a baseline profile of the sharps injuries that are occurring as well as prevention measures that have already been implemented. Using these tools will help to clarify who is getting injured most often, where these injuries are occurring, how the injuries are occurring, and what clinical procedures are conducted at the time of injury.  In addition, these tools outline efforts to help facilities identify, select and implement safety devices and eliminate the use of conventional devices.

Slide 14
Organizational Steps (cont’d.)

4. Determine prevention priorities
   
5. Develop and implement Action Plan
   – Action plan focuses on reducing injuries and improving program activities
   
6. Monitor performance improvement

Speaker Notes:

4. Once completed, the baseline injury profile and process assessment tools can help effectively prioritize prevention efforts and improve upon the processes of a prevention program.
5. Future prevention strategies can be outlined in the Action Plan found in the Workbook , providing a “road map” that charts a course for improvement.
6. The final step involves monitoring the performance of prevention activities over time.  This involves repeated assessments of progress at specified intervals in order to demonstrate improvements are being made and to identify any emerging priorities.

Slide 15
Operational Processes
Essential activities of any
sharps injury prevention program

Speaker notes: The Workbook  identifies operational processes (or activities) that are essential to a comprehensive sharps injury prevention program.

Slide 16
Operational Processes

• The 5 processes:
  • Develop an institution-wide culture of safety in the work environment
    
  • Promote reporting of sharps injuries and injury hazards
    
  • Analyze sharps injury data for prevention planning
    
  • Select/evaluate sharps injury prevention devices
    
  • Educate and train healthcare personnel

Speaker notes: These five operational processes include:
the development and consideration of a culture of safety in the work environment;
the promotion of prompt reporting of any sharps injuries as well as potential injury hazards;
analysis of sharps injury data in order to plan interventions;
the consideration and implementation of sharps injury prevention devices; and
education and training of healthcare personnel about sharps injuries and injury hazards.

The next few slides will describe each operational process in more detail.

Slide 17
Operational Processes:
Culture of Safety

Culture of safety: the shared commitment of management and employees to ensure the safety of patients and personnel

• Measures of safety culture are linked to:
  
  • Reductions in sharps injuries
    
  • Personnel compliance with safe work practices
    
  • Availability of devices with engineered safety features
• Workbook contains:
  • Strategies for creating a culture of safety
    
  • Survey form for measuring the safety “climate” among personnel

Speaker Notes:A culture of safety can be defined as the shared commitment of management and employees to ensure the safety of patients and personnel. The concept of a culture of safety is gaining recognition as an important factor in both guarding patient safety and protecting healthcare personnel. Recent studies in some healthcare organizations have noted that areas that have stronger perceived safety cultures have fewer sharps injuries than those areas with weaker perceived safety cultures.  Measures of safety culture have also been linked to personnel compliance with safe work practices and the availability of devices with engineered safety features.

The Workbook  contains strategies for creating a culture of safety within healthcare organizations.  The toolkit contains a sample survey that measures the general safety “climate” of the work environment of healthcare personnel.  By assessing this safety climate, one can begin to assess the culture of safety and discover ways in which the safety culture might be improved.

Slide 18
Operational Processes: 
Injury Reporting

• Under-reporting of sharps injuries continues to be an issue at healthcare facilities
  
  • Varies by occupation, department and facility
    
  • Is influenced by the safety culture and safety climate
    
• CDC NaSH data from 38 hospitals, 1996-2003
  
  • only 45% of total injuries are reported

Speaker notes: Another important element of a sharps injury prevention program is the level of reporting of sharps injuries.  Under-reporting of injuries continues to be a problem at most healthcare organizations.  Data from 38 facilities using CDC’s NaSH system mirrors this problem: from 1996 through 2003, only 45% of sharps injuries sustained among survey respondents were actually reported to their hospital’s occupational health or infection control departments.  In other words, the actual number of injuries occurring at a hospital facility could be almost twice the number known.

Slide 19
Operational Processes:
Injury Reporting (cont’d.)

• Workbook tools:
  • Reporting survey
    
  • Blood and body fluid exposure report form
    
  • Sharps injury hazard observation and report forms
    
  • Root cause analysis form

Speaker notes: The Workbook  contains tools that identify the levels of under-reporting in an organization. 
A sample reporting survey form can be given to personnel to estimate the number of unreported injuries that occur by occupation and work unit.
A sample blood and body fluid exposure report form gathers the necessary injury information to identify problems. 
Other forms document, for administrative personnel, specific sharps injury hazards observed in the course of conducting environmental rounds and “near miss” events.
A root cause analysis tool is also provided to direct investigations of the underlying organizational factors that could lead to a sharps injury.

Slide 20
Operational Processes: 
Analysis of Data

• Analysis of sharps injury data drives prevention planning
  
• Workbook features:
  
  • Instructions for compiling and analyzing data
    
  • Directions for calculating sharps injury rates

Speaker notes: Sharps injury data must be compiled and analyzed if it is to be used for prevention planning. The Workbook  provides guidance on how to compile data from injury and hazard reports, and gives directions on how to perform simple, yet informative, analyses with sharps injury data.  Information is also provided for choosing appropriate denominators for calculating sharps injury rates. 

Slide 21
Operational Processes:
Selection/Evaluation of Devices

• A Systematic approach for selecting devices ensures:
  
  • comprehensive review of devices
    
  • thorough selection process
• Key elements of this approach:
  
  • Team input
    
  • Review current device use, prioritize devices for consideration
    
  • In-use evaluation of new devices 

Speaker notes:A significant amount of effort should be spent on selecting and evaluating safer sharps devices. The Workbook presents a systematic approach to determining and documenting those devices that will best meet the needs of healthcare facilities.  Key elements of this approach include forming a team to oversee the review of current device uses, prioritizing the devices to be considered for possible introduction to patient care, and planning the evaluation of new products.  Additionally, it is crucial that new devices are tested and used by the personnel that are going to be using them in the future.

Slide 22
Operational Processes:
Selection/Evaluation of Devices (cont’d.)

• Workbook tools:
  • Survey of device use (by department or unit)
    
  • Device pre-selection worksheet
    
  • Device evaluation form

Speaker notes: The Workbook  provides tools for helping healthcare facilities with the process of selecting and evaluating new devices.
A sample survey can be distributed to departments or units to assess their current device uses and needs. 
A device pre-selection worksheet is provided for product evaluation teams or committees to help determine the relevant criteria needed for a candidate safer sharps device. 
A sample device evaluation form is provided for distribution to front-line personnel who will be using candidate devices.  Using such a form promotes standardization of the evaluation criteria and enhances the ability to compare responses among different healthcare organizations.  By using this sample form (rather than a manufacturer-provided form), potential biases are reduced or eliminated. 

Slide 23
Operational Processes: 
Education and Training of Personnel

• Workbook features:
  • General guidance on sharps injury prevention education and training
    
  • List of websites of other educational resources

Speaker notes:Another important element of a sharps injury prevention program is the education and training of healthcare personnel in sharps injury prevention. As part of the program planning process, careful thought should be given to how and when training should be provided to ensure that those who need training receive it, and that the content is relevant to those who are being trained.  The Workbook gives general tips on providing opportunities for education and training of personnel, as well as a list of websites that provide educational resources. 

Slide 24
Other Resources

• Sections on safe work practices and problem-specific strategies for preventing sharps injuries
  
• Cost analysis
  
  • Sample form for estimating cost of needlesticks
    
  • Sample form for estimating device-specific injury costs
    
  • Sample form for estimating device implementation costs

Speaker notes: Other Workbook resources include sections that contain recommended safe work practices for sharps injury prevention and some problem-specific strategies for preventing injuries. 
Additionally, there are a variety of tools that are available to assess some of the costs associated with sharps injuries. Sample forms are provided for estimating both the injury costs related to specific device types and for estimating the costs of implementing safer devices. 

Slide 25
Images of three posters developed by CDC for printing and displaying.

Speaker notes: CDC has also provided three posters pertaining to sharps safety that are available for purchase on the Sharps Safety website. The link to this site is http://www.cdc.gov/sharpssafety/resources.html.

Slide 26
Summary

• Sharps injuries are an important concern
  
  • Increased risk of disease transmission
    
  • High costs to personnel and healthcare system
    
• Most sharps injuries are preventable
  
• Needlestick Safety and Prevention Act requires prevention efforts be undertaken

Speaker notes: In summary, sharps injuries are an important concern in healthcare facilities.  These injuries increase the risk of bloodborne pathogen transmission to healthcare personnel.  The prophylaxis of and treatment for these pathogens are costly both to workers and the healthcare system.  However, most sharps injuries are preventable.  The Needlestick Safety and Prevention Act now requires that prevention efforts be undertaken by all healthcare facilities.

Slide 27
Summary (cont’d.)

• Workbook is a comprehensive collection of valuable resources
  
• Valuable in development of sharps injury prevention program
  
• Potential to enhance current prevention activities

Speaker notes: The Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program is a comprehensive collection of valuable resources that provides the tools to develop an effective sharps injury program and enhance current prevention activities.  Healthcare organizations can ensure that a prevention program is well-documented when the Workbook principles and methods are implemented.  These principles and methods may also help healthcare organizations meet the worker safety requirements for accrediting organizations, as well as federal OSHA requirements. 

Slide 28
Summary (cont’d.)

• Useful Workbook tools may benefit other organizational processes by:
  
  • Enhancing teamwork
    
  • Improving perceptions of safety culture
    
  • Reducing costs due to more effective, focused prevention efforts

Speaker notes:The tools that are provided in the Workbook may also benefit other organizational processes.  For example, the multidisciplinary, team-based approach to forming a sharps injury prevention committee may enhance teamwork in other areas of an organization.  Furthermore, by measuring employees’ perceptions of safety culture, a broader picture of overall safety climate may be gained, which could help to improve patient safety in the process.  Introduction of the principles and methods presented in the Workbook could lead to cost savings due to more effective and focused sharps injury prevention efforts.

Slide 29
Blank slide
Speaker notes: Remember, it takes a team to eliminate sharps injuries. 
[Suggestion:  user may wish to add a staff photo on this slide]

Slide 30
Optional Extra Slides
[The following slides display surveys and forms that are available in the Workbook.  The final slide provides a suggested format to graphically display a facility’s sharps injury data.]

Slide 31
Image of Survey to Measure Healthcare Personnel’s Perceptions of a Culture of Safety form
[Sample page of Survey to Measure Healthcare Personnel’s Perceptions of a Culture of Safety]

Slide 32
Image of Survey of Healthcare Personnel on Occupational Exposure to Blood and Body Fluids form
[Sample page of Survey of Healthcare Personnel on Occupational Exposure to Blood and Body Fluids]

Slide 33
Image of Baseline Sharps Injury Profile Worksheet
[Sample page of Baseline Sharps Injury Profile Worksheet]

Slide 34
Image of Baseline Injury Prevention Activities Worksheet
[Sample page from Baseline Injury Prevention Activities Worksheet]

Slide 35
Image of Sharps Injury Prevention Program Action Plan worksheet
[Example of how to use the Sharps Injury Prevention Program Action Plan worksheet]

Slide 36
Image of Sample page of Blood and Body Fluids Exposure Report Form
[Sample page of Blood and Body Fluids Exposure Report Form]

Slide 37
Image of Sample page of Form for Performing a Simple Root Cause Analysis of a Sharps Injury or “Near-Miss” Event worksheet
[Sample page of Form for Performing a Simple Root Cause Analysis of a Sharps Injury or “Near-Miss” Event worksheet]

Slide 38
Image of Sample page of Device Evaluation Form
[Sample page of Device Evaluation Form]

Slide 39
Sharps Injuries at [insert your hospital name] by Distribution of Safety Device
Image of sample bar-chart

[The purpose of this slide is to allow your facility to present a graphic distribution of the sharps injuries at your facility.  The format of this slide, as well as the numbers shown, are for example only. YOU CAN ADD DATA SPECIFIC TO YOUR HOSPITAL BY DOUBLE-CLICKING ON THE CHART TO OPEN UP THE DATASHEET.]

Slide 40
Sharps Injuries at
[insert your hospital name] by Device

Image of sample bar-chart

[The purpose of this slide is to allow your facility to present a graphic distribution of the sharps injuries by device at your facility.  The format of this slide, as well as the numbers shown, are for example only. YOU CAN ADD DATA SPECIFIC TO YOUR HOSPITAL BY DOUBLE-CLICKING ON THE CHART TO OPEN UP THE DATASHEET.]

Slide 41
Sharps Injuries at
[insert your hospital name] by Work Location

Image of sample bar-chart

[The purpose of this slide is to allow your facility to present a graphic distribution of the sharps injuries by work location at your facility.  The format of this slide, as well as the numbers shown, are for example only. YOU CAN ADD DATA SPECIFIC TO YOUR HOSPITAL BY DOUBLE-CLICKING ON THE CHART TO OPEN UP THE DATASHEET.]

Slide 42
Sharps Injuries at [insert your hospital name] by Occupational Group

Image of sample bar-chart

[The purpose of this slide is to allow your facility to present a graphic distribution of the sharps injuries by occupational group at your facility.  The format of this slide, as well as the numbers shown, are for example only. YOU CAN ADD DATA SPECIFIC TO YOUR HOSPITAL BY DOUBLE-CLICKING ON THE CHART TO OPEN UP THE DATASHEET.]