J. P. Gurria1,3, H. Nolan1, S. Polites1, K. M. Arata4, A. Muth5, L. Phipps4, R. A. Falcone1,2,3 1Cincinnati Children’s Hospital Medical Center,General And Thoracic Surgery,Cincinnati, OH, USA 2University Of Cincinnati,Surgery,Cincinnati, OH, USA 3Cincinnati Children’s Hospital Medical Center,Trauma Surgery,Cincinnati, OH, USA 4Cincinnati Children’s Hospital Medical Center,Operating Room,Cincinnati, OH, USA 5Cincinnati Children’s Hospital Medical Center,Occupational Safety And Environmental Health,Cincinnati, OH, USA
Introduction:
Blood-borne pathogen exposure (BBPE) among health care employees represents a significant safety and resource burden with over 380,000 events reported annually across hospitals in the United States. The perioperative environment is a high-risk area for BBPE and efforts to reduce exposures are not well defined. The incidence of patients with blood-borne pathogen infections is often under-appreciated and therefore the risk from of BBPE is not appreciated. A multi-disciplinary group of nurses, surgical techs, surgeons and employee health specialists worked collaboratively to develop and implement a BBPE prevention bundle to reduce exposures and therefore the overall number of Occupational Safety and Health Administration (OSHA) recordable cases.
Methods:
A BBPE prevention bundle including mandatory double gloving, safety zone on the sterile field, engineered sharps injury prevention devices on all needles, and clear communication around passing of sharps was created in an evidence-based, collaborative fashion at our institution and implemented for all perioperative staff. After an initial pilot period from January through July 2016 with one surgical division, the bundle implementation was spread throughout our entire perioperative system. We monitored exposures as both, days between exposures, and total number of exposures comparing baseline period of fiscal year (FY) 2015 to the post-implementation periods of FY 2016 and FY 2017. Analysis by specialty, role, location, type of injury, and timing was performed.
Results:
During the study period the number of surgical procedures remained relatively constant (35,000/FY). During the pre-implementation period, 45 OSHA recordable cases were reported. During implementation year, (FY16), cases decreased to 38 (15% decrease); while in the late post-implementation period of FY17, only 22 cases were reported (42% additional decrease), for a total of 52% decrease (p<0.022). The mean number of days between injuries significantly increased from 2.5 to 16.3 over the study period (FIGURE 1). For FY17, the main cause and type of BBPE was a needle stick while suturing (63%). By role, clinical fellows and attendings combined had the most injuries (54.6%). Among divisions: pediatric surgery (18%), operating room staff (18%) and orthopedics (13.6%) had the most events.
Conclusion:
A comprehensive and multi-disciplinary approach to employee safety, focused on reduction of BBPE, resulted in a significant progressive annual decrease of injuries among perioperative staff. Efforts to change the culture of safety and implement a successful bundle into a complex environment, benefited from the support and diversity of a widely representative team.
