Year after year,
blood and body
fluid exposures
to the head
— including
the eyes, nose,
and mouth
— continue
to be the most
prevalent
exposure type.”
— Amber Hogan
Mitchell, DrPH,
MPH, CPH
The failure to activate safety-engineered
devices is a chronic issue that needs to be
addressed by infection preventionists and
other healthcare stakeholders in concert
with manufacturers.
“Depending on the infrastructure
of a healthcare facility, either infection
prevention or occupational/employee
healthcare responsible for exposure
incident follow-up, surveillance and
recordkeeping for sharps injuries and
needlesticks,” Mitchell says. “They are
often also responsible for managing frontline
worker sharps injury prevention (SIP)
device evaluation. Since they have firsthand
knowledge and feedback from employees,
they are the essential mechanism for providing
information to manufacturers and
distributors about current devices on the
market and ideas for how to innovate. In
turn, those manufacturers and distributors
are a resource for ongoing high-quality
training and education on the safe use of
their devices, including activation of the
SIP mechanism and proper disposal. None
of this works without systems in place
that feedback information from users to
manufacturers and vice versa.”
Mitchell continues, “Facilities using EPINet have the ability to
monitor SIP device use as well as the circumstances surrounding
sharps injuries. This includes being able to know what percentage
of injuries occur with SIP devices and whether the SIP feature
was activated. In 2019, 52.2 percent of the time, employees
indicated they were using a SIP device, but 71.6 percent of the
SIP mechanisms were not activated. This is disheartening. It
can mean that the injury occurred during use because they
patient jumped or jarred or the employees opposite hand was
stuck during a skin pinch up. This is a perfect example of how
careful attention to conducing mini ‘time-outs’ during the use
of a sharp device so that all attention is on the procedure for not
just the clinical team, but the patient as well. It is also a useful
example of how important it is to feedback information about
how injuries occurred both to other staff members – to prevent
future injuries and to manufacturers as an impetus to create
more innovative designs.”
Blood & Body Fluid Exposure Incidents per 100
ADC; EPINet
16
14
12
10
8
6
4
2
0
y = 0.21x + 11.29
2015 2016 2017 2018 2019
All Facilities Teaching Non-Teaching Linear (All Facilities)
Blood & Body
Fluid Exposure
Incident
Summary
Data; N=36
facilities,
EPINet 2019
Non-Intact Skin
Intact
Skin
Mouth
Other
Nose
Eyes
48.1%
(+multiple
locations)
She adds, “This is also an illustration of how important it is for
frontline, non-managerial staff to be involved in device evaluation,
selection, and implementation. It is more likely that they will
use a device safely, including activation of the SIP mechanism if
they are very familiar with the device and it was chosen
because they thought it the best for the procedure it is
used for. This is not only a requirement of the OSHA
Bloodborne Pathogens Standard, but also an effective
way to improve safety.” Mitchell directs clinicians to View
EPINet Report for Needlestick and Sharp Object Injuries. Needlestick
When it comes to blood and body fluid exposures,
Sharps
Summary
the EPINet data again reveal that nurses are the most
often exposed (352/55.1 percent), with physicians and
CNAs coming in a distant second at 5.6 percent. Patient rooms
(272/42.9 percent), operating rooms/recovery areas (102/16.1
percent) and emergency departments (101/15.9 percent) were
the most frequent locations of exposures. Sharp items were most
often contaminated with blood or blood products (277/42.9
percent), saliva (74/11.5 percent) or fluids designated as “other”
(175/27.1 percent).
Of concern, the body fluid was visibly contaminated with
blood in 292 (48.4 percent) incidences, which is notable during
the COVID-19 pandemic, when daily we are learning more about
how the SARS-CoV-2 virus is transmitted. The eyes (conjunctiva)
were splashed in 310 (48.1 percent) cases, with intact-skin contact
reported in 157 (24.3 percent) incidences. Of concern is that the
article of personal protective equipment (PPE) worn at the time
of the exposure was a single pair of gloves (201/1.2 percent),
while just 39 (6.0 percent) wore eyeglasses (not protective), or
eyeglasses with side shields (7/1.1 percent), protective eyewear/
goggles (5/0.8 percent) or a face shield (11/1.7 percent).
“Year after year, blood and body fluid exposures to the
head — including the eyes, nose, and mouth — continue to be
the most prevalent exposure type,” Mitchell confirms. “From
EPINet data, we know that 42.9 percent of mucocutaneous
exposures occur in the patient or exam room and of those, 88.1
percent are to the face/head. When those exposures occur,
only 6.9 percent of employees indicate that they were wearing
face protection (goggles, face shield, surgical mask, etc.) at the
time of the exposure. This must change, especially now during
the time of a global pandemic where healthcare workers are at
extremely high risk of SARS-CoV-2 exposure and illness. In this
case, improving protection with increasing use of face PPE, can
prevent not only bloodborne pathogen exposure, but exposure to
this or any future infectious disease, including flu. 2020 EPINet
data should tell a very different story, compared to years past since
18 august 2020 • www.healthcarehygienemagazine.com