are complementary and fall under the same concern.
The Single Document is therefore not the only
element of the evaluation: assessment is above all an
approach.
As observed by a French National Network Survey
of occupational blood exposures in Healthcare
facilities (AES-Raisin Network), between 2008 and
2015, the overall ABE incidence rates per 100 beds
decreased significantly by 23%; however, ABE
remained avoidable in 32% of cases.
The number of reported injuries year-on-year may
remain similar despite Directive compliance, but
numbers looked at in isolation may be misleading,
and standardisation of the data collected using
appropriate denominators and developing rates is
absolutely imperative.
In Poland, the risk assessment is prepared at least
once every two years, unless there have been changes
before in a given workplace. The Injury Regulation
also provides that a risk assessment is also carried out
after occurrence of an injury incident to verify
previous applications.
Assessing the risk of NSI, as opposed to recording
individual mistakes, remains the aim of risk
assessment as set out in the EU Directive, and the
effectiveness of its implementation across Member
States varies.
NSI data collection is not mandatory nationally in
any of the countries involved in this analysis.
However, there are national requirements, or hospital
networks recording data on NSI on a voluntary basis,
in all countries, so that some benchmarking will be
possible.
Given the continuing reports of NSI, what is the
institutional and human cost burden?
Economic and human impact of NSI
Debra Adams provided an overview of the
reputational damage, psychological effect and disease
and legal implications of NSI in the UK.
NHS Resolution (formerly NHS Litigation
Authority) seeks to ensure that valuable NHS
resources are focused on benefitting patients,
resolving concerns and helping to improve safety.
Its main contribution to the NHS is to manage the
cost that arises when things go wrong, and to help
prevent the same thing recurring.
In the years 2012–2017, 1213 of the 1833 claims
(66%) for NSIs made to NHS Resolution were
successful. 6 They involved 914 downstream workers
and 137 clinical staff, pertained to non-compliance
with standard infection control precaution,
inadequate disposal of clinical waste, overfull sharps
bins, not using SEDs and not using personal
protective equipment, and cost more than £4million.
Delegates discussed the most significant costs
encountered on a human and organisational level,
both direct and indirect (See Box 1):
Mitigation of costs is dependent on the prevention
of NSI, and might be supported by the following:
• nurturing an institutional culture of safety
• actively learning from incidence of NSI
• incentivising work participation in procedures
• formalising a protocol for reducing the time-to-test
result, which is a major barrier to NSI reporting
• running CME/CPD workshops in prevention of NSI
• championing quality improvement initiatives from
within the workforce as opposed to a top-down
approach
• NSI benchmarking is an issue that should be
implemented sooner rather than later
• convincing insurance companies that HCW and
patient safety are linked
• capitalising on the fact that anecdotal evidence/
patient stories, not just cost, has a profound effect on
the Board: because the CEO answers to the Board and
the Non-Executive Directors, a strong patient story
can definitely win hearts and minds. And if you are
providing a poor service and your HCW are getting
NSI, no CEO will want to sustain the reputational
damage
• integrating the cost of the devices into the cost of
the procedure
• realising that money spent by a hospital on
treatment of NSI is money wasted: direct cost savings
will never compensate for the cost of SED, and
wasted cost must factor into consideration of return
on investment.
Above all, remember that cost alone is insufficient
justification for failure to implement SED uptake.
The cost of NSI to the institution and to the HCW,
direct and indirect, can be immense, and the only
way to mitigate these costs is through the prevention
of NSI.
Contribution of safety-engineered devices
SEDs are a technical measure to reduce risk of
exposure by modifying or isolating the hazard. In
consideration of advantages and disadvantages of
different SED designs, and optimal design for new
safety needles, delegates identified the following
preferred features:
• devices that are intuitive – you will always have staff
turnover who may be (temporarily) without training
• blunt needles for drug preparation
• audible activation
• ergonomic design
• not bulky
• needle alignment, such that the bevel (tip) of the
needle is not obscured
• devices that meet the needs of hospital nurses
• hard surface activation results in splatter
contamination – AVOID
• an active system, i.e. it is reassuring to use a system
that you must actively activate NOTE: the delegate
from The Netherlands voiced a preference for
passive systems that become safe without any activity
from the healthcare worker.
A NOTE ON PROCUREMENT: most hospitals across
Europe are moving from a points-based criterion
to selection based primarily/principally on cost. And
the price argument will always win unless a business
case can be made that incorporates patient stories
and anecdotal evidence. For this reason, the choice
not to buy SEDs may be driven simply and entirely
by cost.
But to repeat an earlier conclusion, combining
behaviour-changing training with SEDs is more
effective than either intervention on its own.
Conclusion
After exhaustive discussion of the need to collect
benchmarking data in the drive to reach toward zero
NSI, the delegates agreed that what was needed was
not more costly surveillance and analysis, but
a Healthcare Worker Safety Day for sentinel hospitals
across the EU, with active observers trained to focus
on data from a set list of requirements. Is there
a sharps injury policy? Have SED risk assessments
been conducted? What percentage of healthcare
workers have been trained in correct sharps
management and NSI prevention? Are lessons learned
from NSI disseminated throughout the organisation?
What SEDs are available? What recapping has
occurred in that day? What appears in the sharps
containers? And it would be apt to publish such
a study in May 2020, to mark the tenth anniversary
of the release of Council Directive 2010/32/EU.
This roundtable was
funded by BD
References
1 Directive 2010/32/EU -
prevention from sharp injuries
in the hospital and healthcare
sector of 10 May 2010
implementing the Framework
Agreement on prevention from
sharp injuries in the hospital and
healthcare sector concluded by
HOSPEEM and EPSU (Text with
EEA relevance)
2 https://hospeem.org/wp-
content/uploads/2019/09/
HOSPEEM_EPSU_-Follow-up-
Report-Directive-201032EU.pdf
3 The Health and Social Care
Act 2008: code of practice on
the prevention and control of
infections
4 Tarigan LH, Cifuentes M,
Quinn M, Kriebel D. Prevention
of needle-stick injuries in
healthcare facilities: a meta-
analysis. Inf Control Hosp
Epidemiol 2015;36:823–9
5 Safer Sharps Regulations
(2013)
6 https://resolution.nhs.uk/
wp-content/uploads/2017/05/
NHS-Resolution-Preventing-
needlestick-injuries-leaflet-
final.pdf
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