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Reduction of Sharps Injuries with a Reusable Sharps Containment Safety Device - A 28 Hospital Study
www.ajicjournal.org Vol. 37 No. 5
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Presentation Number: 15-177
Improving Influenza Vaccination Rates in a Community Medical Center Vicki V. Sweeney, RN, Infection Preventionist; Thomas Spiller, RN, Occupational Health; Cassie Davenport, BSN, RN, Director of Quality and Patient Safety, Williamson Medical Center, Franklin, TN; Titus L. Daniels, MD, MPH, Hospital Epidemiologist, Williamson Medical Center, Department of Medicine, Division of Infectious Diseases, Vanderbilt School of Medicine, Nashville, TN Issue: Annual healthcare worker (HCW) influenza vaccination is recommended by the Centers for Disease Control and Prevention (CDC). However, influenza vaccination rates among HCWs remain low. The State of Tennessee requires HCWs to be vaccinated or to sign a declination statement. This initiative resulted in a 69% influenza vaccination rate for HCWs at our institution during the 2007-2008 influenza season. To improve vaccination rates further, an intense influenza vaccination campaign was developed. Project: A process improvement team reviewed reasons for refusing the influenza vaccine during the 2007-2008 influenza season. Based on this review, educational materials were developed to address knowledge gaps and myths associated with influenza vaccination. All Departments were challenged to attain a 90% influenza vaccination rate. Full administrative support was provided for all initiatives, including a meeting that concluded with vaccination of 100% of the directors, led by the Chief Executive Officer, who received the first influenza vaccine of the season. Departments achieving at least 90% vaccination rates were publicly recognized by the Hospital Epidemiologist and Director of Patient Safety and Quality. In addition to designated vaccination sites available to all work shifts, a mobile vaccination cart was developed and taken to each unit/department to offer vaccinations ‘‘on-site.’’ Preservative-free and needleless vaccine was made available to HCWs to accommodate those who previously expressed concerns about vaccine preservative and/or a fear of needles.HCWs refusing the influenza vaccine were encouraged to view the ‘‘CDC recommends Flu vaccination video,’’ to learn how influenza impacts patients and their families. All HCWs refusing influenza vaccination were required to list a reason for refusal. Verification of medical contraindications was not required. An informational session with the Hospital Epidemiologist was available for those refusing. Results: A total of 1406/1456 (96.6%) eligible employees were contacted, of which 1208 (84.0%) received the vaccine. Comparing the 2007-2008 and 2008-2009 influenza seasons, substantially more HCWs listed allergy [20/341 (5.9%) vs. 38/198 (19.2%), respectively] or ‘‘no reason’’/‘‘don’t believe in vaccines,’’ [156/341 (45.7% vs. 160/198 (80.8%), respectively] as reasons for refusal. Lessons Learned: Administrative support, free vaccine, needleless and preservative-free vaccine, vaccinating HCWs at their work location, and intensifying educational efforts are essential to improve influenza vaccination rates among HCWs. Unfortunately, these efforts appear unable to achieve vaccination rates .90%. Requiring documentation of medical and religious contraindications seems necessary to avoid inappropriate selection of these reasons for refusal of HCW vaccination. Presentation Number: 15-178
Reduction of Sharps Injuries with a Reusable Sharps Containment Safety Device - A 28 Hospital Study Suzann Bylund, RN, BA, CPDM, Director, Workers Compensation, Ascension Health, St. Louis, MO; Ron Fink, Mr, Director, Contracting, Support Services, Ascension Health, St Louis, MO; Terry R. Grimmond, FASM, BAgrSc, GDAdEd&Tr, Clinical Director, The Daniels Corporation, Hamilton, New Zealand; Candace Anglea, RN, BSN, CIC, ICP, St Thomas Hospital, Nashville, TN; Lou Beeke, RN, Benfit Specialist, Borgess Medical Center, Kalamazoo, MI; Angela Callahan, RN, MSN, Director, Employee Health Services, Mount St Mary’s Hospital, Lewiston, NY; Erik Christiansen, BA, Coordoinator, Workers Compensation, Carondolet Health, Kansas city, MO; Kelly Flewelling, RN, Human Resources Specialist, St Mary’s Hospital, Amsterdam, NY; Kaye McIntosh, RN, ICP, St Vincents Hospital, Bridgeport, CT; Kay Richter, RN, Practice Facilitator, St Vincents Health, Indianapolis, IN; Monica Vitale, RN, ICP, The Heart Center, Indianapolis, IN Background/Objectives: Sharps containers are associated with sharps injuries (SI) but are seldom examined in intervention studies. To continue the health group’s efforts to reduce SI, the impact of a reusable sharps
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American Journal of Infection Control June 2009
collector (RSC), reported to decrease Container-associated SI (CASI) and other After-procedure SI, was examined. Methods: The RSC (Sharpsmart, Daniels Sharpsmart Inc) was adopted by 14 of the health-group’s hospitals (Grp1) between Dec 2005 and Feb 2007. All participated in a Before-After intervention study concluding in Feb 2008. All hospitals currently used sharps safety devices and no new hospital-wide SI reduction-strategy occurred during the study period. Employee descriptions of their SI were obtained retrospectively from each hospital’s SI Log for 12 months prior and 12 months after adoption of the device. SI were categorized as: During-procedure; Afterprocedure but Before Disposal; CASI; and Inappropriate Disposal. CASI comprised: pierced container; protruding sharp; during deposit; bounce out; or sharp left on container. Categories of SI were enumerated per 1000 full time equivalent staff (FTE). In addition, a contemporaneous cohort study was conducted by examining SI rates per 1000 FTE for 2006 & 2007 from 14 similar-sized hospitals not using the RSC (Grp2) to determine if elapsed time or other variables may have influenced Grp1 hospital results. Prior to introduction of the RSC, all hospitals used disposable sharps containers (Covidien, BD) with the exception of one Grp2 hospital. were statistically analyzed using Chi2 analysis; Risk Ratios and Confidence limits determined; and p # 0.05 regarded as significant. Results: Prior to the study, no significant difference was observed in Total SI or CASI between Grp1 or Grp2 hospitals. FTE in Grp1 hospitals was 6% and 4% higher than Grp2 hospitals in yr 1 and 2 respectively. In Grp1 hospitals 1,003 SI were assessed among an average of 19,818 FTE, and in Grp2 hospitals 1,067 SI were assessed among an average of 18,942 FTE. Following adoption of the RSC in Grp1 hospitals, although During-procedure SI rose significantly, CASI and Afterprocedure SI fell significantly. Hospitals not using the RSC had no significant SI reduction. In Yr2, Grp1 hospitals had significantly less CASI and Total SI than Grp2 hospitals.
Table 1. Impact of the RSC on SI Rates per 1000FTE Grp1 Hospitals (RSC in Yr2)
Yr 1: Yr 2: % Change p value RR 95% CL
Grp2 Hospitals (No RSC)
During Procedure
Container associated
Inappropriate Disposal
All SI After-procedure
Total SI
Container associated
Total SI
11.8 15.1 +28% 0.004 1.2 1.08-1.52
2.9 0.6 -81% .0.001 0.19 0.10-0.36
2.1 1.6 -23% NS 0.77 0.48-1.21
13.9 9.8 -30% .0.001 0.70 0.59-0.85
25.7 24.9 -3% NS 0.97 0.86-1.10
2.8 2.6 -7% NS 0.93 0.63-1.37
28.0 28.3 +1% NS 1.01 0.90-1.14
Conclusions: The RSC was associated with significant SI reductions and deemed an effective SI-reduction strategy.
Presentation Number: 15-179
Success of Flu Vaccine for Employees: Collaborative Approach to Increasing the Number of HCW Participation in Flu Campaign Jean M. Albany, RN, BSN, Infection Preventionist; Donna Montagna, RN, BSN, Occupational Health Manager; Jerry Zuckerman, MD, Network Hospital Epidemiologist; Steve Sivak, MD, Chairman, Department of Medicine; Terry Stine, MSN, Clinical Director, Nursing, Albert Einstein Healthcare Network, Philadelphia, PA Issue: Vaccination of health care workers (HCW) is recommended strategy for prevention and spread of influenza in hospitals. Prior to 2007, employee participation in flu vaccine ranged between 30-40%. In 2007-08 the Employee flu vaccination rate improved to 59%. This was a result of an enhanced flu vaccine campaign. Strong leadership supported the multifaceted Employee flu vaccination program. This included funds for Flu vaccine education,
E141
Presentation Number: 15-177
Improving Influenza Vaccination Rates in a Community Medical Center Vicki V. Sweeney, RN, Infection Preventionist; Thomas Spiller, RN, Occupational Health; Cassie Davenport, BSN, RN, Director of Quality and Patient Safety, Williamson Medical Center, Franklin, TN; Titus L. Daniels, MD, MPH, Hospital Epidemiologist, Williamson Medical Center, Department of Medicine, Division of Infectious Diseases, Vanderbilt School of Medicine, Nashville, TN Issue: Annual healthcare worker (HCW) influenza vaccination is recommended by the Centers for Disease Control and Prevention (CDC). However, influenza vaccination rates among HCWs remain low. The State of Tennessee requires HCWs to be vaccinated or to sign a declination statement. This initiative resulted in a 69% influenza vaccination rate for HCWs at our institution during the 2007-2008 influenza season. To improve vaccination rates further, an intense influenza vaccination campaign was developed. Project: A process improvement team reviewed reasons for refusing the influenza vaccine during the 2007-2008 influenza season. Based on this review, educational materials were developed to address knowledge gaps and myths associated with influenza vaccination. All Departments were challenged to attain a 90% influenza vaccination rate. Full administrative support was provided for all initiatives, including a meeting that concluded with vaccination of 100% of the directors, led by the Chief Executive Officer, who received the first influenza vaccine of the season. Departments achieving at least 90% vaccination rates were publicly recognized by the Hospital Epidemiologist and Director of Patient Safety and Quality. In addition to designated vaccination sites available to all work shifts, a mobile vaccination cart was developed and taken to each unit/department to offer vaccinations ‘‘on-site.’’ Preservative-free and needleless vaccine was made available to HCWs to accommodate those who previously expressed concerns about vaccine preservative and/or a fear of needles.HCWs refusing the influenza vaccine were encouraged to view the ‘‘CDC recommends Flu vaccination video,’’ to learn how influenza impacts patients and their families. All HCWs refusing influenza vaccination were required to list a reason for refusal. Verification of medical contraindications was not required. An informational session with the Hospital Epidemiologist was available for those refusing. Results: A total of 1406/1456 (96.6%) eligible employees were contacted, of which 1208 (84.0%) received the vaccine. Comparing the 2007-2008 and 2008-2009 influenza seasons, substantially more HCWs listed allergy [20/341 (5.9%) vs. 38/198 (19.2%), respectively] or ‘‘no reason’’/‘‘don’t believe in vaccines,’’ [156/341 (45.7% vs. 160/198 (80.8%), respectively] as reasons for refusal. Lessons Learned: Administrative support, free vaccine, needleless and preservative-free vaccine, vaccinating HCWs at their work location, and intensifying educational efforts are essential to improve influenza vaccination rates among HCWs. Unfortunately, these efforts appear unable to achieve vaccination rates .90%. Requiring documentation of medical and religious contraindications seems necessary to avoid inappropriate selection of these reasons for refusal of HCW vaccination. Presentation Number: 15-178
Reduction of Sharps Injuries with a Reusable Sharps Containment Safety Device - A 28 Hospital Study Suzann Bylund, RN, BA, CPDM, Director, Workers Compensation, Ascension Health, St. Louis, MO; Ron Fink, Mr, Director, Contracting, Support Services, Ascension Health, St Louis, MO; Terry R. Grimmond, FASM, BAgrSc, GDAdEd&Tr, Clinical Director, The Daniels Corporation, Hamilton, New Zealand; Candace Anglea, RN, BSN, CIC, ICP, St Thomas Hospital, Nashville, TN; Lou Beeke, RN, Benfit Specialist, Borgess Medical Center, Kalamazoo, MI; Angela Callahan, RN, MSN, Director, Employee Health Services, Mount St Mary’s Hospital, Lewiston, NY; Erik Christiansen, BA, Coordoinator, Workers Compensation, Carondolet Health, Kansas city, MO; Kelly Flewelling, RN, Human Resources Specialist, St Mary’s Hospital, Amsterdam, NY; Kaye McIntosh, RN, ICP, St Vincents Hospital, Bridgeport, CT; Kay Richter, RN, Practice Facilitator, St Vincents Health, Indianapolis, IN; Monica Vitale, RN, ICP, The Heart Center, Indianapolis, IN Background/Objectives: Sharps containers are associated with sharps injuries (SI) but are seldom examined in intervention studies. To continue the health group’s efforts to reduce SI, the impact of a reusable sharps
E142
American Journal of Infection Control June 2009
collector (RSC), reported to decrease Container-associated SI (CASI) and other After-procedure SI, was examined. Methods: The RSC (Sharpsmart, Daniels Sharpsmart Inc) was adopted by 14 of the health-group’s hospitals (Grp1) between Dec 2005 and Feb 2007. All participated in a Before-After intervention study concluding in Feb 2008. All hospitals currently used sharps safety devices and no new hospital-wide SI reduction-strategy occurred during the study period. Employee descriptions of their SI were obtained retrospectively from each hospital’s SI Log for 12 months prior and 12 months after adoption of the device. SI were categorized as: During-procedure; Afterprocedure but Before Disposal; CASI; and Inappropriate Disposal. CASI comprised: pierced container; protruding sharp; during deposit; bounce out; or sharp left on container. Categories of SI were enumerated per 1000 full time equivalent staff (FTE). In addition, a contemporaneous cohort study was conducted by examining SI rates per 1000 FTE for 2006 & 2007 from 14 similar-sized hospitals not using the RSC (Grp2) to determine if elapsed time or other variables may have influenced Grp1 hospital results. Prior to introduction of the RSC, all hospitals used disposable sharps containers (Covidien, BD) with the exception of one Grp2 hospital. were statistically analyzed using Chi2 analysis; Risk Ratios and Confidence limits determined; and p # 0.05 regarded as significant. Results: Prior to the study, no significant difference was observed in Total SI or CASI between Grp1 or Grp2 hospitals. FTE in Grp1 hospitals was 6% and 4% higher than Grp2 hospitals in yr 1 and 2 respectively. In Grp1 hospitals 1,003 SI were assessed among an average of 19,818 FTE, and in Grp2 hospitals 1,067 SI were assessed among an average of 18,942 FTE. Following adoption of the RSC in Grp1 hospitals, although During-procedure SI rose significantly, CASI and Afterprocedure SI fell significantly. Hospitals not using the RSC had no significant SI reduction. In Yr2, Grp1 hospitals had significantly less CASI and Total SI than Grp2 hospitals.
Table 1. Impact of the RSC on SI Rates per 1000FTE Grp1 Hospitals (RSC in Yr2)
Yr 1: Yr 2: % Change p value RR 95% CL
Grp2 Hospitals (No RSC)
During Procedure
Container associated
Inappropriate Disposal
All SI After-procedure
Total SI
Container associated
Total SI
11.8 15.1 +28% 0.004 1.2 1.08-1.52
2.9 0.6 -81% .0.001 0.19 0.10-0.36
2.1 1.6 -23% NS 0.77 0.48-1.21
13.9 9.8 -30% .0.001 0.70 0.59-0.85
25.7 24.9 -3% NS 0.97 0.86-1.10
2.8 2.6 -7% NS 0.93 0.63-1.37
28.0 28.3 +1% NS 1.01 0.90-1.14
Conclusions: The RSC was associated with significant SI reductions and deemed an effective SI-reduction strategy.
Presentation Number: 15-179
Success of Flu Vaccine for Employees: Collaborative Approach to Increasing the Number of HCW Participation in Flu Campaign Jean M. Albany, RN, BSN, Infection Preventionist; Donna Montagna, RN, BSN, Occupational Health Manager; Jerry Zuckerman, MD, Network Hospital Epidemiologist; Steve Sivak, MD, Chairman, Department of Medicine; Terry Stine, MSN, Clinical Director, Nursing, Albert Einstein Healthcare Network, Philadelphia, PA Issue: Vaccination of health care workers (HCW) is recommended strategy for prevention and spread of influenza in hospitals. Prior to 2007, employee participation in flu vaccine ranged between 30-40%. In 2007-08 the Employee flu vaccination rate improved to 59%. This was a result of an enhanced flu vaccine campaign. Strong leadership supported the multifaceted Employee flu vaccination program. This included funds for Flu vaccine education,