Healthcare Worker Safety More than replacing devices

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Healthcare Worker SafetyMore than replacing
devices

• April 1st, 2008

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Sharps and Needlestick Injury Facts

• 70,000 - 107,000 incidents each year in Canada
• 10 of incidents are high risk
• Incident rate rising e.g. 136 increase in
  lost-time injuries in Ontario from 1998 to 2001
• 58 of sharps injuries are unreported

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Sharps Injuries have a Serious Personal Impact

• 6 12 months waiting to know test results
  serious impact on individuals and families
• Treatment is debilitating
• Job impacts
• HCV is a serious health risk
• Chronic infection in 75 - 85 of patients
• Active liver disease in 70 of these patients

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Who has these injuries?
SOURCE Health Canada Surveillance of
Healthcare Workers exposed to Blood/Body Fluids
and Bloodborne Pathogens.
Canadian Needle Stick Surveillance Network
1 April, 2000 to 31 March, 2001
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When do these injuries occur?
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Significant Injury Reduction is Possible

• Reduction in Injuries
• CDC
• 75 reduction in injuries
• U of Virginia - EPINET
• 85 reduction from engineering controls
• 95 reduction from comprehensive approach
• Toronto East General
• 80 reduction in total injuries
• 100 reduction in blood collection injuries

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National Survey - Manitoba

• First to legislate mandated environment
  announced in Sept 04
• Bill 23 The Workplace Safety and Health
  Amendment Act (Needles in Medical Workplaces)
• Passed into law effective January 2006
• Change process is currently underway 3 year
  plan lead by WRHA

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National Survey - Saskatchewan

• Minister of Labour announced mandated environment
  at SFL Congress Sept 04
• Regulations passed fall 2005 requirement in
  2006
• Mandates use of SEMD in all workplaces where
  there is the risk of a sharps injury

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National Survey Nova Scotia

• New regulations passed Summer 06
• Safe Needles in Healthcare Workplaces Act
• Mandates use of SEMD
• Applies to all health care workplaces
• Fines up to 250k

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National Survey - Ontario

• Ministry of Labour conducted audits fall 2004
  generated inconsistent activity
• April 05 Martell tables private members bill
  mandating SEMD
• April 05 Min of Health announces 11.6 million
  one-time funding funds allocated for every
  acute care facility
• August 07 announcement of regulation (474/07) to
  mandate use of SEMD hospitals in 08, all other
  workplaces in 09

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Quebec, New Brunswick, Newfoundland and PEI

• Quebec approach still to be defined
• New Brunswick NBNU, NBGEU, CUPE have campaign
  underway
• Newfoundland stakeholder report into MoL MoH
• PEI 100 converted to SEMD

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National Survey B.C. Leads the Way

• Updated regulations in 1998. Hierarchy of risk
  reduction beginning with engineering controls -
  required the use of SEMD but did not specify this
• Fines to VIHA prompted province-wide conversion
• Updated regulations Jan 1, 2008 mandates SEMD
  device that provides the highest level of
  safety

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National Survey B.C. Leads the Way

• New regulations highest level of safety and
  broad definition of biohazards including pandemic
  influenza
• Unique roles and dialogue between stakeholders
  BCNU, WorkSafe BC, Health Regions and OHSAH
• Broad implementation of sharps devices
• Concurrent implementation at FHA
• WHITE system VIHA Exposure Control Plan

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National Survey B.C.

• If more than one type of safety-engineered hollow
  bore needle or safety-engineered medical sharp is
  available in commercial markets, the needle or
  sharp that provides the highest level of
  protection from accidental parenteral contact
  must be used.
• Based upon information from manufacturers,
  independent testing agencies, objective product
  evaluation, or other reliable sources.
• Vendors must provide training.

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BCNU Focus Group Findings

• Time available to do training and education is
  compromising change efforts.
• Management must provide active support for the
  change process.
• Successful implementation of sharps safety
  technology can improve the overall culture of
  safety.

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Culture of Safety Still Much To Do
VIHA Survey Statistics Have you reviewed the
VIHA BBF Exposure Control Plan? 20 Have you
reviewed the VIHA BBF Exposure Control Plan with
your staff? 9 For what percentage of your
employees that may be occupationally exposed to
blood and other body fluids, do you have
documentation indicating that each employee has
received specific BBF Education/Training? 25
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From adoption to compliance

• Compliance still inconsistent within certain
  provinces e.g. Alberta, British Columbia
• Challenges within certain areas
• Pharmacy
• Anaesthesia
• Nuc. Med., ENT

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Key Success Factors

• Executive level leadership/sponsorship is
  essential
• Proactive Clinical Leadership (Risk Management
  and/or OHSS)
• Robust Business Plan
• Implementation plan that considers broader change
  management challenges. Framed within context of
  creating a culture of safety
• Strong Education and Training (safety and
  clinical)
• Sharing best practices creation of reference
  sites

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Comprehensive Approach

• U. of Virginia 83 reduction from engineering
  controls. 94 reduction from comprehensive
  approach
• Elements of Comprehensive Approach
• Exposure Control Plan
• Use of Safety-engineered medical devices
• Training Education about risks and prevention
• Sharps Injury Log
• Post Exposure Control Plan
• Creation of a culture of safety organizational
  capacity

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Healthcare Worker SafetyMore than replacing
devices

• April 1st, 2008