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Using Mega-Data to Beat Bloodborne Exposures
Terry Grimmond, FASM, BAgrSc, GrDpAdEdLinda Good, PhD, RN, COHN-S
Amber H. Mitchell, DrPH, MPH, CPH
AOHP National Conference, Baltimore MD, Sept 2019
Learning Objectives
1. Identify Current Trends for Bloodborne Exposure Incidents
2. Present 2018 EXPO-S.T.O.P. Results
3. Present 2018 EPINet* Summary Report Data* Exposure Prevention Information Network; International Safety Center
4. Use Mega-Data to Beat Future Bloodborne Exposures• Strategies for Preventing Injuries and Exposures
Current Trends for Bloodborne Exposure Incidents
OCCUPATIONAL HEALTH AND SAFETY RISKS
Sharps Injuries / 100 ADC: EPINet & EXPO-STOPWhere were we at in 2017?
SI per 100 ADC
Year
0.0
10.0
20.0
30.0
40.0
15 16 17
EPINet EXPO-STOP
EXPO-S.T.O.P. 2018 Survey Data
EXPO-S.T.O.P Hospitals - 2011-2018
Year HospitalsHospital
size (ADC)Number US states
2011 125 6 - 975 292012 157 5 - 985 322013 94 1 - 984 282014 94 1 - 984 282015 182 1 - 924 382016 170 1 - 898 382017 224 2 - 950 33
2018 174 1 - 946 33
46% Teaching
Participating states
EXPO-STOP SI Rates 2011 2016 2017 2018SI/100 Occupied Beds 24.0 27.0 27.7 27.8
• Non-teaching hospitals 17.8 17.5 16.5 17.3
• Teaching hospitals 27.4 33.3 32.4 32.8
SI/100 FTE 1.9 2.3 2.5 2.2• Non-teaching hospitals 1.3 2.0 2.0 1.9
• Teaching hospitals 2.0 2.5 2.7 2.4
Nurse SI/100 Nurse FTE N/Av 2.8 2.7 2.8
• Non-teaching hospitals N/Av 3.1 2.7 2.6
• Teaching hospitals N/Av 2.7 2.7 2.9
EXPO-STOP Annual Trends: Who gets stuck?
SI Cohort 2011 2016 2017 2018
Nurse SI as % of Total SI N/Av 36.4% 37.6% 38.9%
Doctor SI as % of Total SI N/Av 35.6% 32.7% 31.2%
Surgery SI as % of Total SI 37.2% 39.0% 39.9% 42.8%
EXPO-STOP Annual Trends: Mucocutaneous
2011 2016 2017 2018
MC as % of Total Exposures 27.3% 26.2% 25.6% 26.9%
MC/100 ADC 9.0 11.2 9.6 9.3
•Non-teaching hospitals 7.1 6.5 6.0 6.4
•Teaching hospitals 10.1 13.9 10.9 10.5
MC/100 FTE 0.69 0.82 0.87 0.76
•Non-teaching hospitals 0.59 0.58 0.72 0.78
•Teaching hospitals 0.71 0.92 0.93 0.76
In Summary…. SI/100 FTE: EXPO-STOP Trends 2015-2018
2.12.3
2.52.2
0.0
1.0
2.0
3.0
2015 2016 2017 2018
SI per100FTE
Year
EPINet Data INTERNATIONAL SAFETY CENTER
What is EPINet?
✓Surveillance system database: International Safety Center
✓Microsoft Access Database available to Microsoft Office users
✓It is not software and does not require IT support
✓It is free to use
✓Individual employee exposures are entered by dropdowns
✓Customized, de-identified reports can be generated by facility
EPINET DISTRIBUTION AROUND THE
WORLD COLOR-CODED BY
LANGUAGE96 COUNTRIES, 24 LANGUAGES
In use around the world since 1992. FREE: https://internationalsafetycenter.org/use-epinet/
Summary of Needlesticks and Sharp Object Injuries (SOI) per 100 ADC; EPINet
y = 1.21x + 27.09
0
10
20
30
40
50
2014 2015 2016 2017 2018
Total Injuries Teaching Non-Teaching Linear (Total Injuries)
SOI per 100 ADC
Sharp Object Injury & Needlestick Summary Data; N=34 US Health Systems, EPINet 2018
Doctor Attending 16.4%
Doctor Resident/Intern
16.8%
Nurse 34.8%
Surg Attend
Technologist
C.N.A or HHAPhlebotomist/Med Tech
Clinical Lab
Other
Medical Student Nursing Student
19
Disposable Syringe
Suture
ScalpelWinged Steel …
IV Stylet
Vacuum Tube w Needle
All Others
Other Needle
Pre-Filled Cartridge Blood GasRetractors, Hemostat
Wires
Lancets 1%
Scissors
Razors
Glass
Unknown
24.1%
24.8%Only 34% indicate they were
using a sharp with injury protection (engineering control); 65.9% did NOT activate safety feature
24.2% Insulin Syringes
Sharp Object Injury & Needlestick Summary Data: N=34 US Health Systems, EPINet 2018
44.3% in OR22.4% in Patient/Exam Room
Safety Extends through Use & Life Cycle of Device
20
• 25.5% of all Injuries Reported are to “NON-USER”
• This includes a colleague, team member, or someone downstream including EVS, laundry
Blood & Body Fluid Exposure Incidents per 100 ADC; EPINet
y = 0.61x + 9.35
0
4
8
12
16
2014 2015 2016 2017 2018
All Facilities Teaching Non-Teaching Linear (All Facilities)
BBFE Per100 ADC
Blood & Body Fluid Exposure Incident Summary Data; N=34 facilities, EPINet 2018
Eyes57.6%
Nose
Mouth
Intact Skin
Non-Intact SkinOther
Eyes Only by Percent Compared to all Other BBFE Incidents
65.7 66.9 64.9
48.157.6
2.86.7 5.9
36.4
y = -3.5x + 71.14
y = 0.35x + 3.91
0
20
40
60
80
2014 2015 2016 2017 2018
PER
CEN
T O
F TO
TAL
YEAR
EYES EYE Protection Use Linear (EYES) Linear (EYE Protection Use)
Blood & Body Fluid Exposure Incident Summary Data: N=34 Facilities, EPINet 2018
Patient Room38.7%
Outside Pt Room
ED 12.6%ICU/CCU
OR/PACU23.3%
Procedure Room
Clin Lab
L&D Home CareOutpatient Clinic
Total PPE & Barrier Garment Worn During BBFE Incident: 2018
Which barrier garments were worn at the time of exposure?
% of Total Records
Single pair of gloves 33.4%
Double pair of gloves 5%
Protective Eyewear / Goggles 2.8%
Eyeglasses (not protective) 6.7%
Eyeglasses with sideshields 0.6%
Faceshield 3.0%
Surgical mask 9.1%
Surgical gown 0%
Plastic apron 0.4%
Labcoat / Scrub Jacket, cloth, (not protective) 0%
Respirator 0%
Other 3.0%
Wearing
appropriate
eye protection
6.4%
Use Mega-Data to Beat Future Bloodborne
Exposures
Strategies for Preventing Injuries and Exposures
EXPO-STOP Top “Exposure Safe” Hospitals - 2018
• Excela Health PA
•Geisinger Health PA
•Child. H. Kings Daughters VA
•Amita Health XXXX IL
• St’Brook Southampton H. NY
•Calvary Hospital, NY
• Indiana Reg Med Center PA
• Sentara Careplex Hospital VA
• Silver cross IL
•BJC Memorial RHS IL
Teaching Non-Teaching
High Impact Practices of Exposure-Safe Hospitals
•Education & Training
•Communication
•Investigation
•Engagement
Good & Grimmond. “Exposure Injury Reduction Strategies: Results that Protect Lives” AOHP Journal (Vol. 38. No. 4 Winter 2018)
To Summarize
• Global Prevalence of Bloodborne Disease Impacts Public & Occupational Health
• Sharps Injuries and Needlesticks trends year over year are INCREASING
• Blood and Body Fluid Exposures trends year over year are INCREASING
• PPE Use is Poor
• The majority of injuries and exposures are occurring in patient / exam rooms where healthcare personnel are not protected
• Inaccessibility and/or non-use of sharps with injury protection and PPE
Mega Data Driven Next Steps & ‘Take Aways’
•Focus on highest prevalence sharps exposures: Sutures-- blunt tip sutures, alternative skin closures
•Focus on highest prevalence splash exposures: Eyes-- improving eye protection accessibility & use
Mega Data Driven Next Steps & ‘Take Aways’
•Encourage Surveillance & Reporting
•Leadership commitment is crucial
•Get leadership buy-in with Process Improvement communication
Mega Data Driven Next Steps & ‘Take Aways’
• Frontline employee input on devices
• Repeated Education & Training of staff in SED use
• Annual search for safer devices
• Immediate activation of SED & immediate disposal
ALL are required by OSHA BPS
Be assertive and unrelenting with your prevention strategies
Thank you!
In conclusion…
Resources & ReferencesResources
Resources
INTERNATIONALSAFETYCENTER.ORG
https://tdict.org/
37
https://www.osha.gov/SLTC/etools/hospital/index.html
Contact Information
Terry Grimmond, FASM, BAgrSc, GrDpAdEd&Tr
Linda Good, PhD, RN, COHN-S
Amber H Mitchell, DrPH, MPH, CPH
