Utilizing the Surgical “Time-out” and Hand-off Protocols to Deter High-Risk Needlesticks

Katsevman, G.V. et al. Journal of Hospital InfectionPublished online: November 3 2016

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About 35.7 million healthcare workers face sustaining a needlestick injury worldwide and an estimated 384,000 percutaneous injuries occur annually in United States hospitals alone.1,2 Although needlestick injuries continue to pose a major occupational hazard for healthcare workers, underreporting and a “culture of silence” persist.3 Few papers suggest solutions. We propose a novel solution that will help deter high-risk (i.e., history of human immunodeficiency virus (HIV), bloodborne hepatitis virus, or intravenous (IV) drug abuse) needlesticks in the operating room (OR) and the wards.

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Characterisation of occupational blood and body fluid exposures beyond the Needlestick Safety and Prevention Act

Green-McKenzie, J. et al. (2016) Journal of Infection Prevention17 (5). pp. 226-232

Objective: To describe the use of mandated safety engineered sharps devices (SESDs) and personal protective equipment in healthcare workers (HCWs) with occupational body fluid exposures (BFE) since the Needlestick Safety and Prevention Act.

Methods: Two questionnaires were administered, over 3 years, to HCWs who reported sharps or splash BFEs. Descriptive statistics and chi-square analysis were used.

Results: Of the 498 questionnaires completed, nurses completed 262 (53%), house staff 155 (32 %), technicians 63 (13%) and phlebotomists 11 (2%). Four (1%) completers reported ‘other’ and three (1%) reported unknown. Sharps injuries accounted for 349 (70%) of the BFEs. SESDs were utilised 43% (128/299) of the time with a 54% (70/130) activation rate. Phlebotomists (80%; 8/10) and nurses (59%; 79/267) used SESDs more than doctors (27%; 31/86) and technicians (26%; 10/39) (P <0.0001). Fifty-four percent (185/207) of HCWs reported having had training on SESD use; nurses (64%; 98/154) and phlebotomists (70%; 7/8) significantly more so than house staff (44%; 59/133) and technicians (44%; 21/48) (P <0.05). Most splash BFEs were to the eyes 73% (91/149). Five percent (4/79) of HCWs used protective eyewear.

Conclusions: Systematic regular training, appropriate protocols and iteratively providing the safest SESDs based on HCW experience and technological advances will further reduce the physical and emotional toll of BFEs.

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Occupational health risks associated with the use of germicides in health care

Weber, D.J. et al. American Journal of Infection Control.Volume 44, Issue 5, Supplement, 2 May 2016, Pages e85–e89

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Image source: Cade Martin, Dawn Arlotta // CC0

Environmental surfaces have been clearly linked to transmission of key pathogens in health care facilities, including methicillin-resistant Staphylococcus aureus, vancomycin-resistantEnterococcus, Clostridium difficile, norovirus, and multidrug-resistant gram-negative bacilli. For this reason, routine disinfection of environmental surfaces in patient rooms is recommended. In addition, decontamination of shared medical devices between use by different patients is also recommended.

Environmental surfaces and noncritical shared medical devices are decontaminated by low-level disinfectants, most commonly phenolics, quaternary ammonium compounds, improved hydrogen peroxides, and hypochlorites.

Concern has been raised that the use of germicides by health care personnel may increase the risk of these persons for developing respiratory illnesses (principally asthma) and contact dermatitis. Our data demonstrate that dermatitis and respiratory symptoms (eg, asthma) as a result of chemical exposures, including low-level disinfectants, are exceedingly rare. Unprotected exposures to high-level disinfectants may cause dermatitis and respiratory symptoms. Engineering controls (eg, closed containers, adequate ventilation) and the use of personal protective equipment (eg, gloves) should be used to minimize exposure to high-level disinfectants.

The scientific evidence does not support that the use of low-level disinfectants by health care personnel is an important risk for the development of asthma or contact dermatitis.

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