- Email: [email protected]
Needlestick Safety and the Unfinished Agenda
Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145
S83
Agar Diffusion Test and quantitatively using the ATCC 100-2004 Method. The antibacterial activity was then validated on human hand using the ASTM E1174 - 06 Standard Method. Finally, the potential of the antibacterial paper to induce primary or cumulative irritation and/or allergic sensitization was evaluated using the Human Repeated Insult Patch Test.
RESULTS: The dry antibacterial paper was shown to be active against various Gram positive and Gram negative human pathogens, including multi-resistant bacteria with reduction rates exceeding 99.97% after a persistence time of 30 minutes. Up to 3.24 log reduction on human hands was observed in the clinical trial with S. marcescens and E. coli. This bacteriostatic effect persists for up to 2 hours and was fully compatible with application of alcohol gel sanitizer. The clinical trial did not show any dermal irritation or allergic sensitization. Moreover, the potential of migration of BC from hands to water was negligible.
Presentation Number 8-355 Needlestick Safety and the Unfinished Agenda Mary Foley PhD, RN, Chairperson Safe in Common/Director at the Center for Nursing Research and Innovation at the, Safe In Common/University of California San Francisco (UCSF) School of Nursing ISSUE: 2013 is the 15th anniversary of the first legislation requiring safety devices with the passage of AB1208 in California. Other state legislation and the passage of the Federal Needlestick Safety and Prevention Act in 2000 led to rapid adoption of safety engineered medical devices; however, introduction of new technology plateaued shortly after the Act. There is considerable evidence that sharps injuries to HCWs persist, even when safety devices are used. A broad Massachusetts study would extrapolate to about 200,000 needlesticks annually at an unreimbursed cost approaching 3/4 billion dollars.
CONCLUSIONS: Eighty percent of infections are transmitted by hands, yet most people wash and dry their hands inadequately. CascadesÒ antibacterial paper towel compensates for people’s imperfect hygiene practices by reducing residual bacteria left on hands after washing. Its inhibition activity was demonstrated in vitro and in vivo. This antibacterial paper towel provides a simple and effective way to further reduce bacterial contamination and transmission. This product is classified as an OTC hand wash antiseptic drug product and complies with the U.S. FDA tentative final monograph.
PROJECT: On Nov. 14th, 2012,Safe in Common (SIC), a non-profit organization of healthcare safety advocates dedicated to eradicating needlestick and sharps-related injuries held the first in a series of online events designed to create a dialogue among those with concerns over pervasive needlestick and sharps injuries. “The Unfinished Agenda” was the first in a series of critical discussion among the nation’s foremost healthcare personnel safety experts and the frontline workers who face needlestick and sharps danger began the steps toward a unified plan to address the shortcomings in injury
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013
S84
Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145
prevention. The event invited interest from some 1,000 healthcare workers from 15 countries who registered to listen and participate in a live discussion and interviews and videos with student nurses, key opinion leaders and healthcare workers all over the U.S. The discussion captured an important look at the history of needlestick safety and was the beginning of a push to all stakeholders to go beyond the status quo to create a safer environment of care for all involved. RESULTS: The most telling aspect of the event was the unique perspective SIC gathered from the opportunity to poll 650 attendees on targeted questions. This first event picked up where federal regulations left off more than 12 years ago as an examination of modern needlestick safety e past, present and future e from its roots in the 1980s HIV/AIDS crisis to where we stand today. A panel of experts took the opportunity to poll attendees on a variety of topics, including, “Have sharps injuries been eliminated where you work?” to which a resounding 78 percent answered “no.” Some 15 percent said it was not applicable and a mere four percent said “yes.” When asked “what should be the greatest priority to eliminate sharps injuries,” some 53 percent of attendees answered “new engineering solutions with automatic safety features.” The other responses were “stronger enforcement of frontline worker input in device selection” (21.5 percent), “Stronger OSHA enforcement of 2000 Needlestick Act” (12.9 percent), “Inclusion of HCW injury rates in reimbursement metrics” (7.2 percent), and “Standardized national reporting to a central database” (5.3 percent). In reviewing the poll results, Dr. Mary Foley, Chairperson of Safe in Common, said, “These events are highlighting the shortcomings in protecting healthcare personnel and reinvigorating the conversation to eradicate sharps injuries and increase safety across the continuum of care. We need to equip healthcare leaders and personnel with action items and tools to revitalize the conversation about safety within their own organizations, and encourage renewed innovation for better devices to serve the safety needs of the entire healthcare continuum.” NOTE: Similar questions were asked of attendees at APIC 2011 by an exhibitor with corroborating results: seeking permission to include results LESSON LEARNED: The event confirmed that sharps injuries persist, and that there is broad interest in finally eliminating them. There is a thirst for superior product solutions and acknowledgement that elements of the 2000 Act is not being followed nor enforced consistently. The event identified the myriad concerns and demands for action from doctors, nurses, healthcare personnel, and administrators whose unity is needed to introduce long-overdue innovation. There is awareness and demand for a safer work environment for the healthcare personnel who save American lives each day. The industry needs unified efforts to spark innovation and change across the healthcare spectrum.
Presentation Number 8-356 TB in a Healthcare Worker e Exposure Management of Patients, Families and Personnel Pearl Orenstein N, BA, DIA, IPAC Coordinator, Jewish General Hospital; Anne Desmarais N, IPAC CNS, Jewish General Hospital; Lara Maalouf N, IPAC Educater, Jewish General Hospital; Barbara Amihod N, IPAC Educater, Jewish General Hospital; Fernanda Cordiero N, IPAC Educater, Jewish General Hospital; Silvana Perna N, IPAC CNS, Jewish General Hospital ISSUE: We are a 637 bed tertiary care university affiliated hospital that has both a multicultural patient population and personnel . In December 2011, a Health Care Worker (HCW) employed on an Oncology /Palliative Care unit, was diagnosed with active cavitary
pulmonary Tuberculosis (TB). After reviewing all data it was determined that she was probably infectious since July 2011. The HCW worked in close contact with other HCWs, patients and families. Consequently this resulted in an intensive investigation to determine whether transmission of TB had occurred. PROJECT: Infection Prevention and Control (IPAC) coordinated and monitored three separate groups who worked together to create effective contact tracing, including tools and multilingual information sheets: 1. Occupational Health and Safety informed, tested and followed, if required, all personnel in contact with the index case. 2. Public Health Department contacted the patients and family members on the island of Montreal. 3. IPAC contacted those in the rest of the province of Québec and Canada. A standardized communication tool was created. Facilitation of radiology appointments and parking access for exposed contacts were organized. RESULTS: Of all the exposed patients and family members who underwent testing no one showed evidence of active tuberculosis. However, nine employees were found to be newly infected with TB. In total 241 exposed patients, 74 exposed family members and 121 HCW were contacted ; none of whom had active disease. LESSON LEARNED: The contact-tracing investigation was a laborintensive and arduous process for IPAC personnel, Occupational Health and Safety and Public Health members. It was an emotional and difficult process for all of the exposed persons: employees as well as family members. This type of problem could be avoided in the future by ensuring that all employees are aware of the signs and symptoms of communicable diseases. They should be informed that they must seek medical advice so that they do not work when they are ill and risk transmitting disease to colleagues.
Presentation Number 8-357 A Novel Two-Tiered Approach to Increase Healthcare Worker Influenza Vaccination Rates Ann North RN, MSN, CIC, Director of Infection Prevention and Control, Carolinas Hospital System; Donna Brown RN, Employee Health Nurse, Carolinas Hospital System; Kevin Shea MD, Chief Medical Officer, Caroinas Hospital System; Denise Frederick RN, BSN, Infection Preventionist, Caroinas Hospital System ISSUE: Our hospital’s healthcare worker influenza vaccination rate averaged approximately 57% over the past 6 years. Creative strategies utilized by Employee Health to improve our rate have not resulted in significant and sustained gains. Employees who decline vaccination sign a declination statement indicating their reason(s) for doing so. Fear of side effects and personal choice are most often sighted. PROJECT: In order to achieve the 90% rate established by the Department of Health and Human Services’ Healthy People 2020, our hospital established modest incremental goals, beginning with 66% for the 2012-2013 season. We implemented a novel two-tiered approach to reach this year’s goal: (1) all employees who have direct patient contact will either receive the influenza vaccine, or wear a mask during episodes of patient contact through March 2013, (2) employees who choose the latter option will receive a personal letter of education from the Chief Medical Officer, an Infectious Disease physician, individualized to their reason for declination. We directed our efforts towards those who declined because of fear of side effects and personal choice, rather than for allergy/religion, as that is the group in which we had the opportunity to affect change. RESULTS: Our goal was exceeded within the first ten weeks of the campaign. 72.9% of our employees received the influenza vaccine
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013
S83
Agar Diffusion Test and quantitatively using the ATCC 100-2004 Method. The antibacterial activity was then validated on human hand using the ASTM E1174 - 06 Standard Method. Finally, the potential of the antibacterial paper to induce primary or cumulative irritation and/or allergic sensitization was evaluated using the Human Repeated Insult Patch Test.
RESULTS: The dry antibacterial paper was shown to be active against various Gram positive and Gram negative human pathogens, including multi-resistant bacteria with reduction rates exceeding 99.97% after a persistence time of 30 minutes. Up to 3.24 log reduction on human hands was observed in the clinical trial with S. marcescens and E. coli. This bacteriostatic effect persists for up to 2 hours and was fully compatible with application of alcohol gel sanitizer. The clinical trial did not show any dermal irritation or allergic sensitization. Moreover, the potential of migration of BC from hands to water was negligible.
Presentation Number 8-355 Needlestick Safety and the Unfinished Agenda Mary Foley PhD, RN, Chairperson Safe in Common/Director at the Center for Nursing Research and Innovation at the, Safe In Common/University of California San Francisco (UCSF) School of Nursing ISSUE: 2013 is the 15th anniversary of the first legislation requiring safety devices with the passage of AB1208 in California. Other state legislation and the passage of the Federal Needlestick Safety and Prevention Act in 2000 led to rapid adoption of safety engineered medical devices; however, introduction of new technology plateaued shortly after the Act. There is considerable evidence that sharps injuries to HCWs persist, even when safety devices are used. A broad Massachusetts study would extrapolate to about 200,000 needlesticks annually at an unreimbursed cost approaching 3/4 billion dollars.
CONCLUSIONS: Eighty percent of infections are transmitted by hands, yet most people wash and dry their hands inadequately. CascadesÒ antibacterial paper towel compensates for people’s imperfect hygiene practices by reducing residual bacteria left on hands after washing. Its inhibition activity was demonstrated in vitro and in vivo. This antibacterial paper towel provides a simple and effective way to further reduce bacterial contamination and transmission. This product is classified as an OTC hand wash antiseptic drug product and complies with the U.S. FDA tentative final monograph.
PROJECT: On Nov. 14th, 2012,Safe in Common (SIC), a non-profit organization of healthcare safety advocates dedicated to eradicating needlestick and sharps-related injuries held the first in a series of online events designed to create a dialogue among those with concerns over pervasive needlestick and sharps injuries. “The Unfinished Agenda” was the first in a series of critical discussion among the nation’s foremost healthcare personnel safety experts and the frontline workers who face needlestick and sharps danger began the steps toward a unified plan to address the shortcomings in injury
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013
S84
Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145
prevention. The event invited interest from some 1,000 healthcare workers from 15 countries who registered to listen and participate in a live discussion and interviews and videos with student nurses, key opinion leaders and healthcare workers all over the U.S. The discussion captured an important look at the history of needlestick safety and was the beginning of a push to all stakeholders to go beyond the status quo to create a safer environment of care for all involved. RESULTS: The most telling aspect of the event was the unique perspective SIC gathered from the opportunity to poll 650 attendees on targeted questions. This first event picked up where federal regulations left off more than 12 years ago as an examination of modern needlestick safety e past, present and future e from its roots in the 1980s HIV/AIDS crisis to where we stand today. A panel of experts took the opportunity to poll attendees on a variety of topics, including, “Have sharps injuries been eliminated where you work?” to which a resounding 78 percent answered “no.” Some 15 percent said it was not applicable and a mere four percent said “yes.” When asked “what should be the greatest priority to eliminate sharps injuries,” some 53 percent of attendees answered “new engineering solutions with automatic safety features.” The other responses were “stronger enforcement of frontline worker input in device selection” (21.5 percent), “Stronger OSHA enforcement of 2000 Needlestick Act” (12.9 percent), “Inclusion of HCW injury rates in reimbursement metrics” (7.2 percent), and “Standardized national reporting to a central database” (5.3 percent). In reviewing the poll results, Dr. Mary Foley, Chairperson of Safe in Common, said, “These events are highlighting the shortcomings in protecting healthcare personnel and reinvigorating the conversation to eradicate sharps injuries and increase safety across the continuum of care. We need to equip healthcare leaders and personnel with action items and tools to revitalize the conversation about safety within their own organizations, and encourage renewed innovation for better devices to serve the safety needs of the entire healthcare continuum.” NOTE: Similar questions were asked of attendees at APIC 2011 by an exhibitor with corroborating results: seeking permission to include results LESSON LEARNED: The event confirmed that sharps injuries persist, and that there is broad interest in finally eliminating them. There is a thirst for superior product solutions and acknowledgement that elements of the 2000 Act is not being followed nor enforced consistently. The event identified the myriad concerns and demands for action from doctors, nurses, healthcare personnel, and administrators whose unity is needed to introduce long-overdue innovation. There is awareness and demand for a safer work environment for the healthcare personnel who save American lives each day. The industry needs unified efforts to spark innovation and change across the healthcare spectrum.
Presentation Number 8-356 TB in a Healthcare Worker e Exposure Management of Patients, Families and Personnel Pearl Orenstein N, BA, DIA, IPAC Coordinator, Jewish General Hospital; Anne Desmarais N, IPAC CNS, Jewish General Hospital; Lara Maalouf N, IPAC Educater, Jewish General Hospital; Barbara Amihod N, IPAC Educater, Jewish General Hospital; Fernanda Cordiero N, IPAC Educater, Jewish General Hospital; Silvana Perna N, IPAC CNS, Jewish General Hospital ISSUE: We are a 637 bed tertiary care university affiliated hospital that has both a multicultural patient population and personnel . In December 2011, a Health Care Worker (HCW) employed on an Oncology /Palliative Care unit, was diagnosed with active cavitary
pulmonary Tuberculosis (TB). After reviewing all data it was determined that she was probably infectious since July 2011. The HCW worked in close contact with other HCWs, patients and families. Consequently this resulted in an intensive investigation to determine whether transmission of TB had occurred. PROJECT: Infection Prevention and Control (IPAC) coordinated and monitored three separate groups who worked together to create effective contact tracing, including tools and multilingual information sheets: 1. Occupational Health and Safety informed, tested and followed, if required, all personnel in contact with the index case. 2. Public Health Department contacted the patients and family members on the island of Montreal. 3. IPAC contacted those in the rest of the province of Québec and Canada. A standardized communication tool was created. Facilitation of radiology appointments and parking access for exposed contacts were organized. RESULTS: Of all the exposed patients and family members who underwent testing no one showed evidence of active tuberculosis. However, nine employees were found to be newly infected with TB. In total 241 exposed patients, 74 exposed family members and 121 HCW were contacted ; none of whom had active disease. LESSON LEARNED: The contact-tracing investigation was a laborintensive and arduous process for IPAC personnel, Occupational Health and Safety and Public Health members. It was an emotional and difficult process for all of the exposed persons: employees as well as family members. This type of problem could be avoided in the future by ensuring that all employees are aware of the signs and symptoms of communicable diseases. They should be informed that they must seek medical advice so that they do not work when they are ill and risk transmitting disease to colleagues.
Presentation Number 8-357 A Novel Two-Tiered Approach to Increase Healthcare Worker Influenza Vaccination Rates Ann North RN, MSN, CIC, Director of Infection Prevention and Control, Carolinas Hospital System; Donna Brown RN, Employee Health Nurse, Carolinas Hospital System; Kevin Shea MD, Chief Medical Officer, Caroinas Hospital System; Denise Frederick RN, BSN, Infection Preventionist, Caroinas Hospital System ISSUE: Our hospital’s healthcare worker influenza vaccination rate averaged approximately 57% over the past 6 years. Creative strategies utilized by Employee Health to improve our rate have not resulted in significant and sustained gains. Employees who decline vaccination sign a declination statement indicating their reason(s) for doing so. Fear of side effects and personal choice are most often sighted. PROJECT: In order to achieve the 90% rate established by the Department of Health and Human Services’ Healthy People 2020, our hospital established modest incremental goals, beginning with 66% for the 2012-2013 season. We implemented a novel two-tiered approach to reach this year’s goal: (1) all employees who have direct patient contact will either receive the influenza vaccine, or wear a mask during episodes of patient contact through March 2013, (2) employees who choose the latter option will receive a personal letter of education from the Chief Medical Officer, an Infectious Disease physician, individualized to their reason for declination. We directed our efforts towards those who declined because of fear of side effects and personal choice, rather than for allergy/religion, as that is the group in which we had the opportunity to affect change. RESULTS: Our goal was exceeded within the first ten weeks of the campaign. 72.9% of our employees received the influenza vaccine
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013