Moving the Needle on
Occupational Exposures:
A Q&A with
Lydia Crutchfield
Lydia F.
Crutchfield, MA,
BSN, RN, CLC
Healthcare Hygiene magazine spoke with
Lydia F. Crutchfield, MA, BSN, RN, CLC, executive
president of the Association of Occupational
Health Professionals in Healthcare (AOHP) and
director of Corporate Teammate Health for
Atrium Health, about the significance of the
20 th anniversary of the Needlestick Safety and
Prevention Act, and the work that remains to
reduce occupational exposures.
HHM What do you believe has changed since the
federal Needlestick Safety & Prevention Act (NSPA) of
2000 was signed into law?
Lydia Crutchfield (LC): There have been positive
changes in response to the NSPA. Although the changes have
not made as much impact as desired, we are moving in the
right direction and not moving backward. There has been
more effort put into data collection and analyzing the data
for improvements. Sharps injury incidence/100 FTE from 2000
to 2018 have decreased from 4.4 percent to 2.2 percent and
from 2011-2018 mucocutaneous exposures have decreased
from 27.3 percent to 23.9 percent. 1
HHM Do you think we are trending more positively or
negatively toward sharps injury/occupational exposure
prevention in 2020?
LC: The trend has been positive but much slower than
expected. There are several aspects to consider with this
gradual momentum.
HHM Are there still particular areas of concern that
need to be addressed?
LC: Certainly. To some extent, there may be a prevailing
thought of “It’s not going to happen to me, I’m careful.”
Therefore, needed precautions are not taken when they
should be. It isn’t a matter of clinicians not being educated
on standard precautions, or the correct procedures; they
know what to do. Post exposure/needlestick, if one were to
ask the question, “What could you have done to prevent this
exposure or needlestick?” the healthcare worker could most
likely articulate an appropriate response.
HHM Why do sharps injuries and occupational expo-
sures remain problematic?
LC: We live in a world, and especially a healthcare world,
where things move fast, more is expected with less, increased
stress, etc. These factors cannot be separated from the
workplace and do affect how one does their job. As well,
workplace practices remain in question.
Q
& A
HHM How can they be addressed?
LC: We cannot consider ourselves “one and done,” with
initial education by checking the box. Competency training
is a must and should be done throughout employment
with repeated education and training. 1 There should also
be reminders, safety rounds, any creative ideas to keep the
employee’s safety in the forefront. Implementing policies
and procedures without accountability is futile. However,
accountability should be managed in a way that isn’t punitive
because the prevailing message should be “we are here to
help keep you safe.”
Communication is key. Have creative safety campaigns,
make rates known to all, and share successes with admin-
istration.
Investigate – how, what, why, and prevention. 1 Maintain,
aggregate, and analyze the data.
Engagement – need commitment by staff, leaders, and
administrators. 1
HHM Have occupational exposures been trending up
or down in the last 20 years, and what are you hearing
from your membership?
LC: Concurrently, occupational exposure trends have
remained pretty steady as well. There are times when certain
exposures to the unknown occur, we manage those as best we
can. There are other times when mucocutaneous exposures
are preventable with the appropriate personal protective
equipment (PPE). We have a robust member listserv that
offers a resounding sentiment in one area that relates to eye
splashes that could have been prevented if only eye protection
(goggles, face shields) had been worn. Ideas are shared to
help mitigate these type exposures. There are various eye
protection products on the market including different colors
to help make this particular PPE more appealing.
HHM Any improvement around needlesticks and
national surveillance systems for work-related SIs and
seroconversions?
LC: AOHP is proud of its survey called EXPO-S.T.O.P. (Expo-
sure Survey of Trends in Occupational Practice) Our members
are surveyed annually and these are some of our findings:
• More can be done to improve occupational exposure
and needlestick injuries.
• Current legislation is not enough.
• Sharps injuries have immeasurable emotional impact.
• Sharps injuries costs are a huge burden ($6000/SI, $3.6M/
day to hospitals alone)
• Just HIV/HCV/HBV – No! There are 60 bloodborne
pathogens (26 viruses, 18 bacteria, 3 fungi, 13 parasites).
• More data is needed from as many US hospitals as
possible – there are 6,200 of them.
For the unabridged version of this Q&A, visit: https://www.healthcarehygienemagazine.com/moving-the-needle-on-
occupational-exposures:-a-q&a-with-lydia-crutchfield/
www.healthcarehygienemagazine.com • march 2020
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