OVERVIEW Ansell Healthcare Products LLC has an ongoing commitment to the development of quality products and services for the healthcare industry. This self-study, Clinical Reference Manual: SHARPS AND ERGONOMIC SAFETY ISSUES IN THE HEALTHCARE SETTING, is one in a series of continuing education services provided by Ansell. This education module examines sharps injuries and ergonomic issues. Accidental sharps injuries and ergonomic issues in the perioperative setting are serious problems. Many healthcare workers acquire infectious diseases from bloodborne pathogens G or injuries in the course of their work. Lifting and moving patients causes at least 12% of nurses to leave the profession each year. The cost of injury and exposure takes an N emotional and financial toll on healthcare workers, their families and the facilities where I T they work. Awareness of the risk associated with these exposures has led to an emphasis T on protection for healthcare workers and patients alike. The Center for Disease Control E (CDC), Occupational Safety and Health Administration (OSHA) and many other professional S organizations have formulated guidelines and regulations as a means of protection and E safety. This education module examines basic strategies and processes that can raise R awareness of and help minimize the risk of sharps and ergonomic injuries. A C PROGRAM OBJECTIVES H Upon completion of this educational activity, the learner should be able to: T L 1. Review the OSHA Bloodborne Pathogen Standard A E 2. Discuss the current state of Healthcare Worker compliance H 3. Discuss facts, statistics and regulations pertaining to sharps and ergonomic safety E 4. Explain the professional standards associated with sharps and ergonomic safety issues H 5. Describe solutions to sharps and ergonomic safety issues T N INTENDED AUDIENCE I The information contained in this self-study guidebook is intended for use by Y healthcare professionals who are responsible for or involved in the following T E activities related to this topic: F • Educating healthcare workers A S • Establishing institutional or departmental policies and procedures C • Decision-making responsibilities for sharps safety and ergonomic products I • Maintaining regulatory compliance with agencies such as OSHA, ANA and CDC M • Managing employee health and infection prevention services O N O G R E D N A S P R A H S INSTRUCTIONS Ansell Healthcare is a provider approved by the California Board of Registered Nursing, Provider # CEP 15538 for 2.5 contact hour(s). Obtaining full credit for this offering depends on completion of the self-study materials on-line as directed below. Approval refers to recognition of educational activities only and does not imply endorsement of any product or company displayed in any form during the educational activity. To receive contact hours for this program, please go to the "Program Tests" area and G complete the post-test. You will receive your certificate via email. N I T AN 85% PASSING SCORE IS REQUIRED FOR SUCCESSFUL COMPLETION T E Any learner who does not successfully complete the post-test will be notified and given S an opportunity to resubmit for certification. E For more information about our educational programs or hand-barrier-related topics, R please contact Ansell Healthcare Educational Services at 1-732-345-2162 or e-mail us at A [email protected] C H Planning Committee Members: T Lori Jensen, RN (employed at Ansell Healthcare at the time of planning of this module) L Patty Taylor RN, BA A Pamela Werner, MBA, BSN, RN CNOR E H As employees of Ansell Mrs. Jensen, Mrs. Taylor and Ms. Werner have declared an affiliation that could be perceived as posing a potential conflict of interest with development of this E H self-study module. T Roy Zacharias Jr., CST, BS, FAST N As an employee of The Meridian Institute, Mr. Zacharias has declared an affiliation that I could be perceived as posing a potential conflict of interest with the development of this Y self-study module. T E F This module will include discussion of commercial products refrenced in generic terms only. A S The information presented herein is intended to provide a general overview C of application and regulations but should not be considered legal advice. I M O N O G R E Ansell Healthcare D Products LLC N A 111 Wood Avenue South, S Suite 210 P Iselin, NJ 08830 R USA A H Tel: 1-800-952-9916 S www.ansellhealthcare.com CONTENTS Test Your Knowledge .............................................1 Definitions.....................................................1 Introduction....................................................2 Sharps Safety ..................................................2 G N OSHA Rights and Duties ..........................................3 I T T OSHA Bloodborne Pathogens Standard ...............................4 E S Sharps Crisis Identified ...........................................5 E R The Crisis Continues .............................................6 A C How Common are Sharps Injuries ...................................7 H T The Cost Impact ................................................7 L A Review: Origins of Healthcare Standards............................. 7 E H OSHA Fact sheet ................................................8 E H Other Influenzing Organizations....................................10 T N Professional Organizational Influence-Sharps Safety ....................11 I Y Resitance to Change ............................................16 T E Facts and Statistics.............................................16 F A Compliance and OSHA Inspection Information.........................18 S C Benefits to complying with Sharps Safety ............................21 I M Ergonomic Workplace Safety......................................22 O N Human Factors Increasing the Risk of Ergonomic Mishaps Contents........22 O G Unsafe Work Conditions..........................................22 R E Regulatory Organizations Influence- Ergonomics.......................23 D Professional Organizational Influence- Ergonomics .....................25 N A Benefits of Complying with Ergonomic Safety .........................28 S P Summary.....................................................29 R A Bibliography ..................................................30 H S Notes........................................................33 TEST YOUR KNOWLEDGE DEFINITIONS OSHA Definitions The following brief quiz will help to develop a starting point for this topic: Engineering Controls means controls that isolate or remove the bloodborne 1. Every member of the surgical team pathogens hazard from the workplace, has a critical role facilitating e.g., sharps disposal containers, self- exposure prevention. sheathing needles, safer medical devices, ❏ ❏ True False such as sharps with engineered sharps 2. Every employer who has employees injury protections and needleless systems. with occupational exposure to blood Work Practice Controls means controls is required to have a written exposure that reduce the likelihood of exposure control plan. by altering the manner in which a task ❏ ❏ True False is performed, e.g., prohibiting recapping of needles by a two-handed technique. 3. The pathogens standard does not require employers to adopt the use Needleless systems means a device that of universal precautions, engineering does not use needles for: controls, work practice controls and (1) The collection of bodily fluids or PPE. withdrawal of body fluids after initial ❏ True ❏ False venous or arterial access is established; (2) The administration of medication or 4. Wyoming was the first state in the fluids; or (3) Any other procedure U.S. to pass no lift law legislation involving the potential for occupational in 2006, to implement safe patient exposure to bloodborne pathogens handling and movement. due to percutaneous injuries from ❏ True ❏ False contaminated sharps. 5. Nursing personnel have the highest Sharps with engineered sharps injury back injury claim rates of any protections means a non-needle sharp occupation or industry. or a needle device used for withdrawing ❏ ❏ body fluids, accessing a vein or artery, True False or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident. T .5 )saxeT( F .4 )eriuqer seod ti( F .3 T .2 T .1 :srewsnA 1 INTRODUCTION immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV)”.2 There are more than 50 million surgeries (30 million in acute care hospitals and 20 Another ongoing issue in healthcare is the in non-hospital settings) performed in US movement and handling of patients and hospitals each year. In the not-so-distant equipment. Lifting and moving patients past, healthcare workers (HCWs) may leads to at least 12% of nurses leaving have considered percutaneous injuries the profession annually.3 Yassi et al G part of the job. That is not the case any (1995) found that lifting and transferring N longer. With the infection prevention patients were two of the most common I T practice regulations recommended by the mechanisms for back injuries among T CDC for Universal Precautions, and OSHA nurses.4 E S enforcing the use of Universal Precautions E and the enactment of the Bloodborne SHARPS SAFETY R Pathogens (BBP) Standard (1991), A there is a strong regulatory influence OSHA C for employers and employees to President Nixon signs the Occupational H T be compliant. Safety and Health (OSH) Act (OSHA) L into law A Additionally, on Nov. 6, 2000, the E H Needlestick and Safety Prevention Act The Occupational Safety and Health was enacted by the 106th Congress. Administration (OSHA) is a federal agency E H This revised the bloodborne pathogens and is a part of the US Dept. of Labor. T standard, in effect under the Occupational It was created 42 years ago with the N Safety and Health Act of 1970 (OSHA) to Occupational Safety and Health Act I include safer medical devices, such as of 1970. Congress created OSHA to Y sharps with engineered sharps injury ensure safe and healthful working T protections and needleless systems, conditions for working men and women E F as examples of engineering controls by setting and enforcing standards A designed to eliminate or minimize and by providing training, outreach, S occupational exposure to bloodborne education and assistance. C pathogens through needlestick and other I Under the Act, the Occupational Safety M percutaneous injuries.1 Accidental sharps and Health Administration (OSHA) was O injuries in the perioperative setting created within the Department of N continue to be a serious and persistent Labor to: O problem. Many healthcare workers G acquire infectious diseases from • Encourage employers and employees R bloodborne pathogens or injuries in the to reduce workplace hazards and to E course of their work. Sharps injuries are implement new or improve existing D an occupational risk for health care safety and health programs; N professionals around the world. According A to Jagger et al, “An estimated 384,000 • Provide for research in occupational S percutaneous injuries are reported by safety and health to develop innovative P health care workers in hospitals in the ways of dealing with occupational R A United States each year, placing them safety and health problems; H at risk of exposure to human S 2 • Establish "separate but dependent The OSH act covers employers and their responsibilities and rights" for employees either directly through federal employers and employees for the OSHA or through an OSHA-approved state achievement of better safety and program. State programs must meet health conditions; or exceed federal OSHA standards for workplace safety and health. • Maintain a reporting and recordkeeping system to monitor job-related injuries There are currently 22 states and and illnesses; jurisdictions operating complete state plans (covering both the private sector • Establish training programs to and state and local government increase the number and competence employees) and 5 - Connecticut, Illinois, of occupational safety and health New Jersey, New York and the Virgin personnel; Islands - which cover public employees only. (Eight other states were approved • Develop mandatory job safety and at one time but subsequently health standards and enforce them withdrew their programs) effectively; and Federal OSHA authority extends • Provide for the development, to all private sector employers with analysis, evaluation and approval one or more employees, as well as of state occupational safety and federal civilian employees in the health programs.5 remaining states. In the remaining jurisdictions where Federal OSHA has authority, hospitals operated by state, territorial or local governments are required to comply with the Bloodborne Pathogens standard with enforcement by the Centers for Medicare and Medicaid Services (CMS) (42 U.S.C. 1395cc(a)(1)(V) and (b)(4) OSHA RIGHTS AND DUTIES OSHA standards are rules that illustrate It is important to note that there are the measures employers are legally OSH Act employer and employee obligated to pursue in order to protect Rights and Duties healthcare workers from hazards. These standards require the use of certain safe Employer responsibilities include practices and equipment, and require but are not limited to; employers to monitor certain workplace hazards. 1. The employer shall furnish a place of employment free from recognized hazards that are causing or likely to cause death or serious physical harm to employees. 3 2. Shall comply with OSHA standards "Where engineering controls will reduce employee exposure either by removing, 3. Shall not restrict an inspection eliminating, or isolating the hazard, they must be used.” CPL 02-02-069 4. May participate in standards development “Employers must select and implement appropriate engineering controls to 5. Are entitled to review citations issued reduce or eliminate employee exposure.” G 6. May seek a variance to a standard N OSHA BLOODBORNE I T 7. Are entitled to protection of PATHOGENS T trade secrets E STANDARD S Employee responsibilities include E The purpose of OSHA’s Bloodborne R but are not limited to; Pathogens Standard, which applies to A workers who are exposed to blood and C 1. Must comply with OSHA body fluids, helps produce a safe H standards/regulations T environment for healthcare workers and L A 2. Can request an inspection patients. The best way to accomplish this E goal is to create a safe environment for H 3. Be afforded appropriate protective healthcare workers and patients by E measures (labels, control techniques, controlling exposure to blood or other H personal protective equipment, potentially infectious materials. T monitoring) to control exposures N to biological or physical agents In 1991, OSHA issued the standard I regulating occupational exposure to Y 4. Shall not be discharged or bloodborne pathogens. This is federal law T discriminated against for filing and spells out specific guidelines that E F complaints with OSHA employers and employees must follow. A Due to this regulation, healthcare workers S 5. Can object to abatement time given saw a significant decrease in bloodborne C to correct violations in a citation disease as a result of compliance. I M 6. Has the right to refuse medical Studies demonstrated that adopting safer O treatment on religious grounds medical devices, such as engineered N sharp injury prevention products and O It is important to note that compliance needleless systems, can be extremely G with OSHA standards/regulations is the effective in reducing accidental sharps R law. Shall means that the referenced E injuries. Therefore, in 2001, OSHA procedure is a requirement. D implemented The Needlestick Safety N For example within the standards you and Prevention Act. A may read; S P 1910.1030 (d)(2)(ii) states, “Engineering R and work practice controls shall be A used to eliminate or minimize H employee exposure.” S 4 SHARPS CRISIS The employer must: IDENTIFIED Take into account innovations in medical procedure and technological The Needlestick Safety and Prevention developments that reduce the risk of Act (the Act) (Pub. L. 106-430) was exposure (e.g., newly available medical signed into law on November 6, 2000 devices designed to reduce needlesticks); because occupational exposure to and document consideration and use of bloodborne pathogens from accidental appropriate, commercially-available, and sharps injuries in healthcare and other effective safer devices (e.g., describe the occupational settings continued to be devices identified as candidates for use, the method(s) used to evaluate those a serious problem. devices, and justification for the The Act mandated the revision of the eventual selection). 1991 OSHA BBP Standard to require the Employee Input use of engineered sharps injury Employers must solicit input from prevention devices. OSHA requires that non-managerial employees responsible employers who have employees with for direct patient care regarding the occupational exposure to bloodborne identification, evaluation, and selection of pathogens must, where appropriate, use effective engineering controls, including effective engineering controls, including safer medical devices. Employees selected safer medical devices, in order to reduce should represent the range of exposure the risk of injury from needlesticks and situations encountered in the workplace. from other sharp medical instruments.6 Documentation of employee input Employers are required to document, in the Exposure Control Plan, how they received input from employees. Recordkeeping Employers who are required to maintain a log of occupational injuries and illnesses under existing recordkeeping rules, must also maintain a sharps injury log. That log will be maintained in a manner that protects the privacy of employees. At a minimum, the log will Listed below is a more detailed summary contain the following: the type and brand of the changes mandated by The of device involved in the incident; location of the incident (e.g., department or work Needlestick Safety and Prevention Act: area); and description of the incident. Exposure Control Plan Modification of Definitions The revision includes new requirements The revision to the bloodborne pathogens regarding the employer's Exposure standard includes modification of Control Plan, including an annual review definitions relating to engineering and update to reflect changes in controls. Two terms have been added technology that eliminate or reduce to the standard, while the description exposure to bloodborne pathogens. of an existing term has been amended. 5 Engineering Controls THE CRISIS Engineering Controls include all control CONTINUES measures that isolate or remove a hazard Accidental exposure to blood and body from the workplace, such as sharps fluids due to sharps injuries continues disposal containers and self-sheathing to be a serious problem in healthcare, needles. The original bloodborne especially in the surgical setting. pathogens standard was not specific After the Needlestick Safety legislation regarding the applicability of various G was implemented, it was noted that engineering controls (other than the N sharps injury rates in nonsurgical settings above examples) in the healthcare setting. I T dropped 31.6%, but increased 6.5% in The revision now specifies that "safer T surgical settings.7 An estimated 384,000 E medical devices, such as sharps with S percutaneous injuries (i.e. sharps injuries) engineered sharps injury protections E and needleless systems" constitute are reported by healthcare workers in the R U.S. each year.8 an effective engineering control, A C and must be used where feasible. Estimates for all health care settings are H that 600,000 to 800,000 needlestick and T Sharps with Engineered Sharps L other percutaneous injuries occur among Injury Protections A health care workers annually. Such E This is a new term which includes H non-needle sharps or needle devices injuries can involve needles or other sharps contaminated with bloodborne E containing built-in safety features that are H used for collecting fluids or administering pathogens, such as HIV, HBV, or HCV.9 T Approximately 23% of those injuries medications or other fluids, or other N occur in the surgical setting.10 Nearly half procedures involving the risk of I (48%) of these injuries occur during the sharps injury. Y use of the item, 30 % occur after the use T Needleless Systems of the item, 11% occur during the E F This is a new term defined as devices disposal of the item, 3% occur during A which provide an alternative to needles recapping used needles, and 8% occur in S for various procedures to reduce the risk other ways.11 The top three sharps injuries C of injury involving contaminated sharps. that occur are from suture needles I M (43.4%), scalpel blades (17%) and Needleless systems means a device O syringes with needles (12%). that does not use needles for: N O A recent survey among surgical residents (1) The collection of bodily fluids or found that 51% of their needlesticks G withdrawal of body fluids after initial R were unreported.12 E venous or arterial access is established; (2) The administration of medication or Unfortunately, in the healthcare setting all D N fluids; or (3) Any other procedure employees are at risk of being exposed A involving the potential for occupational to bloodborne pathogens while at work. exposure to bloodborne pathogens due Surgeons and surgical residents are most S P to percutaneous injuries from often the original users of devices causing R contaminated sharps. these injuries. Nurses and surgical A technicians were most often injured H by devices originally used by others.13 S 6