Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program

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1. Page 1

   Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program

2. Page 2

   WELCOME!

   • Welcome to the CDC website on Sharps Safety. Here you will find the Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program, which has been developed by CDC to help healthcare facilities prevent needlesticks and other sharps-related injuries to healthcare…
   • …
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   TABLE OF CONTENTS

   • INFORMATION ABOUT THE WORKBOOK
   • Introduction
   • Overview of the Program Plan
   • Information Provided
   • How to Use the Workbook
   • Target Audience
   • Value of the Workbook to Healthcare Organizations
   • OVERVIEW: R
   • ISKS AND PREVENTION OF SHARPS INJURIES IN HEALTHCARE PERSONNEL
   • …
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   OPERATIONAL PROCESSES

   • Institutionalize a Culture of Safety in the Work Environment
   • Introduction
   • Strategies for Creating a Culture of Safety
   • Measuring Improvements in the Safety Culture
   • Implement Procedures for Reporting and Examining Sharps Injuries and Injury Hazards
   • …
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   REFERENCES

   • Education and Training of Healthcare Personnel
   • Introduction
   • Healthcare Personnel as Adult Learners
   • Opportunities for Educating and Training Healthcare Personnel
   • Content for an Orientation or Annual Training on Sharps Injury Prevention
   • Teaching Tools
   • APPENDIX A: TOOLKIT
   • …
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   APPENDIX E: Measuring the Cost of Sharps Injury Prevention

   • E-1 Sample Worksheet for Estimating the Annual and Average Cost of Needlesticks and Other Sharps-Related Injuries
   • E-2 Sample Worksheet for Estimating Device-Specific Percutaneous Injury Costs
   • …
7. Page 7

   INFORMATION ABOUT THE WORKBOOK

   • Introduction
   • Occupational exposure to bloodborne pathogens from needlesticks and other sharps injuries is a serious problem, but it is often preventable. The Centers for Disease Control and Prevention (CDC) estimates that each year 385,000 needlesticks and other…
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   Information Provided

   • The Workbook includes several sections that describe each of the organizational steps and operational processes. A toolkit of forms and worksheets is included to help guide program development and implementation. The Workbook also contains:
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   Value of the Workbook to Healthcare Organizations

   • This Workbook contains a practical plan to help healthcare organizations prevent sharps injuries. Once implemented, the program will help improve workplace safety for healthcare personnel. …
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    OVERVIEW: RISKS AND PREVENTION OF SHARPS INJURIES IN HEALTHCARE PERSONNEL

    • Introduction
    • Prevention of percutaneous injuries and other blood exposures is an important step in preventing the transmission of bloodborne viruses to healthcare personnel. …
    • …
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    Hepatitis B Virus

    • National hepatitis surveillance provides yearly estimates of HBV infections in healthcare personnel. These estimates are based on the proportion of persons with new infections who report frequent occupational blood contact. …
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    Human Immunodeficiency Virus

    • The first case of HIV transmission from a patient to a healthcare worker was reported in 1986 (48). Through December, 2001, CDC had received voluntary reports of 57 documented and 140 possible episodes of HIV transmission to healthcare personnel in the United States…
    • …
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    Epidemiology of Needlesticks and Other Sharps-related Injuries

    • Data on needlesticks and other sharps-related injuries are used to characterize the who, where, what, when, and how of such events. Aggregated surveillance data from the National Surveillance System for Health Care Workers (NaSH) are used…
    • …
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    Figure 1. Occupational Groups of Healthcare Personnel Exposed to Blood/Body Fluids;

    • NaSH, 6/95 to 12/03 (N=23,197)*
    • Research
    • 1%
    • Clerical/Admin Dental
    • 1%
    • 1%
    • Student
    • Housekeeping/ 4%
    • Other 4%
    • Maintenance
    • 3%
    • Nurse 44%
    • Technician
    • 15%
    • Physician
    • 28%
    • Missing values not included in the total n.
    • …
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    Figure 2. Work Locations Where Blood/Body Fluid Exposures Occurred; NaSH, 6/95 to 12/03

    • (N=23,140)*
    • Waste/laundry/ central supply (1%)
    • Labs (5%)
    • Other (5%)
    • Emergency room (8%)
    • Operating room (25%)
    • Outpatient
    • (8%)
    • Inpatient
    • (40%)
    • Procedure room (9%)
    • OB/
    • Medical/Surgical ward
    • Intensive care unit
    • 13%
    • …
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    What Devices Are Involved in Percutaneous Injuries?

    • Although many types of sharps injure healthcare personnel, aggregate data from NaSH indicate that six devices are responsible for nearly eighty percent of all injuries (Figure 4). These are:
    • Disposable syringes (30%)
    • Suture needles (20%)
    • …
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    Figure 5. Injury Risk by Device Type

    • Device-related factors also influence percutaneous injury risks. A 1988 article by Jagger et al. (62) demonstrates that devices requiring manipulation or disassembly after use (such as needles attached to IV tubing, winged steel needles, and IV catheter stylets)…
    • …
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    Injury Prevention Strategies

    • tions. Observational studies of operative procedures have recorded some type of blood exposure to healthcare personnel in 7% to 50% of exposures; in 2% to 15% of exposures, the event is a percutaneous injury-usually from a suture needle (65-69). …
    • …
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    • of needles and other sharps where possible. Next is to isolate the hazard, thereby protecting an otherwise exposed sharp, through the use of an engineering control. When these strategies are not available or will not provide total protection, the focus shifts to work-practice controls and personal…
    • …
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    • Be an integral part of the device,
    • Be simple and obvious in operation,
    • Be reliable and automatic,
    • Provide a rigid cover that allows the hands to remain behind the needle,
    • Ensure that the safety feature is in effect before disassembly and remains in effect after disposal,
    • …
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    number in IV- related PI declined from 61 to delivery related 10 (78.7%); total PI declined

    • Assessment
    • of IV-delivery
    • related PI during
    • six month period
    • post intervention
    • implementation
    • compared to historic
    • data
    • Study Design and Population
    • Results
    • Comments
    • Number of IV- There were two IV-delivery
    • …
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    bluntable phlebotomy number of PIs*

    • Study Design and
    • Population
    • Outcome Measure
    • Phlebotomy PI rate 10
    • months pre-intervention was
    • 28/100 employees during
    • 120,000 venipunctures;
    • Period I, 26/100
    • employees during 120,000
    • venipunctures; Period II,
    • 5/100 employees during
    • 70,000 venipunctures. An
    • …
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    catheter PI rate per dropped 84%, from

    • Three-center study of 3cc Monoject Safety
    • PI 60 days pre- and Syringe® with sliding
    • post- implementation sheath
    • of safety syringe
    • Younger et al. (1993) (97)
    • Safety IV catheter
    • Three-hospital pre/ post implementation
    • study
    • Jagger (1996)
    • One-handed
    • …
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    al. 2002 (98) study of a safety needle in Needle Protector® for per 100,000

    • Results
    • Pre-post implementation study comparing two safety devices used for
    • phlebotomy
    • Twelve month prospective Safety-Lok 3ml safety
    • syringe
    • before-and-after trial of safety syringe, needleless
    • Interlink IV system
    • IV system
    • …
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    • In 1998, OSHA published a Request for Information in the Federal Register on “engineering and work practice controls used to minimize the risk of occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps.” There were 396 responses to this request; several…
    • …
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    Multi-component Prevention Approaches

    • Experts agree that safety devices and work practices alone will not prevent all sharps injuries (102, 108-112). Significant declines in sharps injuries also require:
    • Education,
    • A reduction in the use of invasive procedures (as much as possible), A secure work…
    • …
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    • that greater levels of management support were associated with more consistent adherence with universal precautions (specifically, never recapping needles), while increased job demands was found to be a predictor of inconsistent adherence (81). …
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    Healthcare Personnel Acceptance

    • Healthcare personnel have difficulties changing long-standing practices. This observation is borne out by studies conducted in the years following implementation of universal precautions, when observed compliance with recommended practices was not satisfactory (13…
    • …
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    The Need for Guidance

    • According to the authors of the American Hospital Association injury prevention guide (112), facilities that have adopted or are adopting safety technologies find the process to be complex and exacting. Successful injury prevention programs require:
    • …
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    ORGANIZATIONAL STEPS

    • This section describes a series of organizational steps that are designed to ensure that a sharps injury prevention program:
    • Is integrated into existing safety programs,
    • Reflects the current status of an institution's prevention activities, and Targets appropriate areas for…
    • …
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    • als management, and quality/risk management, as available. Regardless of the type or size of the organization, a multidisciplinary approach is essential to identify health and safety issues, analyze trends, implement interventions, evaluate outcomes, and make recommendations to other organizational…
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    Model for a Leadership Team

    • Staff Representation
    • Contributions/Strengths
    • Administration/Senior
    • Management
    • Communicate the organization’s commitment to worker safety; and Allocate personnel and fiscal resources to meet program goals.
    • Infection Control/
    • Healthcare Epidemiology
    • …
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    • Although the leadership team should include a small core group of clinical staff, other staff from areas such as radiology, anesthesiology, respiratory therapy, surgery, hemodialysis, intensive care, pediatrics, and other units might be invited to participate in a particular discussion or as part of…
    • …
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    KEY POINTS: Program Operation Processes

    • Five processes support a sharps injury prevention program
    • A baseline assessment of these processes is necessary for effective program planning
    • Areas for review include:
    • Assessment of the Culture of Safety
    • Procedures for sharps injury reporting
    • …
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    Toolkit Resource for this Activity:

    • Survey to Measure Healthcare Personnel’s Perceptions of a Culture of Safety (see Appendix A-2)
    • Assessing Procedures for Sharps Injury Reporting
    • Most healthcare organizations have procedures for reporting and documenting employee needlesticks and other percutaneous…
    • …
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    Step 3. Prepare a Baseline Profile of Sharps Injuries and Prevention Activities

    • product evaluation committee reports, lists of manufacturers contacted, device lists) that can be used to measure process improvement. …
    • …
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    Step 4. Determine Prevention Priorities

    • What circumstances or procedures contribute to sharps injuries?
    • What sharps injuries pose an increased risk for bloodborne virus transmission?
    • Has the organization taken steps to limit the unnecessary use of needles by healthcare personnel? …
    • …
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    Step 5. Develop and Implement Action Plans

    • Program Process Improvement Priorities
    • Leadership teams might consider selecting one problem in each of the processes or focus only on one of the processes for performance improvement. …
    • …
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    Change a policy or procedure

    • Provide targeted education of healthcare personnel
    • The intervention action plan should reflect each strategy used and describe the steps, time line, and responsibility for implementation.
    • Identify Indicators of Performance Improvement. Indicators are tools for measuring…
    • …
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    Step 6. Monitor Program Performance

    • The one question asked repeatedly during the
    • KEY POINTS
    • assessment of operational processes is: What
    • Designing Action Plans
    • data can be used to measure performance improvement for each process? Once identified, data from each of these processes
    • …
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    OPERATIONAL PROCESSES

    • The following section describes five operational processes that are viewed as essential elements of any sharps injury prevention program. Toolkit resources to assess, implement, or evaluate these processes are included in the appendices.
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    OPERATIONAL PROCESSES

    • Institutionalize a Culture of Safety in the Work Environment
    • Introduction
    • Many strategies to reduce sharps injuries focus on individual- or job/task-level improvements (e.g., implementing appropriate safety devices, using safe work practices). …
    • …
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    • hazards, yet perform successfully because they treat safety systematically. Such organizations are termed “high reliability organizations” and are found in the aviation, nuclear power and manufacturing industries as well as parts of the military, where safety climate (employees’ perceptions about…
    • …
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    Strategies for Creating a Culture of Safety

    • due to medical errors in U.S. hospitals each year. Although the report acknowledges that causes of medical error are multifaceted, the authors repeatedly emphasize the pivotal role of safety culture. …
    • …
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    • Involve Personnel in the Planning and Implementation of Activities That Promote a Safe Healthcare Environment. Involving personnel from various areas and disciplines while planning and implementing activities improves the culture of safety and is essential to the success of such an initiative. …
    • …
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    Measuring Improvements in the Safety Culture

    • Data from four possible sources can measure how improvements in safety culture affect sharps injury prevention:
    • Staff surveys on perceptions of a safety culture in the organization and reporting of blood and body- fluid exposures (Appendices A-2 and A-3),
    • …
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    OPERATIONAL PROCESSES

    • Implement Procedures for Reporting and Examining Sharps Injuries and Injury Hazards
    • Introduction
    • Most healthcare organizations have procedures to report and document employees’ exposures to blood and body fluids. …
    • …
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    • Characteristics of a Report Form. In the past, healthcare organizations typically used one report form to document any type of incident involving a patient or employee (e.g., fall, medication error, sharp injury). …
    • …
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    • Device failure,
    • Operator error (e.g., failure to activate the safety feature), or
    • Other circumstances (e.g., movement of the patient that precluded use of the safety feature).
    • As with any medical product, if the device or equipment is potentially defective, the lot number and information about the…
    • …
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    Develop a Process for Examining Factors That Led to Injury or “Near Miss”

    • Toolkit Resource for This Activity:
    • Environmental Rounds Hazard Observation Form and Sharps Injury
    • Hazard Observation Form (see Appendix A-8)
    • While data on needlesticks are important for examining outcomes, it is also very…
    • …
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    • Root cause analysis focuses on the relationship between the event and the following possible factors:
    • Patient assessment
    • Staff training or competency
    • Equipment
    • Work environment
    • Lack of information (or misinterpretation of information)
    • Communication
    • …
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    OPERATIONAL PROCESSES

    • Analyze Sharps Injury Data
    • Introduction
    • Sharps injury data must be compiled and analyzed if they are to be used for prevention planning. This section describes:
    • How to compile data from injury and hazard reports.
    • How to perform simple and complex analyses.
    • …
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    • Timing of occurrence of injuries (e.g., during use, after use/before disposal, during/after disposal); and
    • Circumstances of injuries (e.g., during use of the device in a patient, while cleaning up after a procedure, as a result of improper disposal of a device).
    • …
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    • in size and scope of operation. It found considerable variation depending on the selection of the denominator (140). Therefore, the calculation of injury rates should be considered as one of many tools available to monitor sharps injury trends within a facility, but should be used with caution when…
    • …
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    Using Control Charts for Measuring Performance Improvement

    • Calculating Procedure- and Device-specific Injury Rates. Procedure- and device-specific injury rates are also useful for defining injury risks and measuring the impact of interventions. …
    • …
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    Benchmarking

    • ficult to interpret. It indicates only whether a rate is changing, not why. Also, safety improvements may be masked by improved reporting. For purposes of measuring performance improvement, the basic calculations described above will prove most reliable.
    • …
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    OPERATIONAL PROCESSES

    • Selection of Sharps Injury Prevention Devices
    • Introduction
    • The process of selecting engineered sharps injury prevention devices gives healthcare organizations a systematic way to determine and document which devices will best meet their needs. …
    • …
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    Step 1. Organize a Product Selection and Evaluation Team

    • Healthcare organizations should designate a team to guide processes for the selection, evaluation, and implementation of engineered sharps injury prevention devices. …
    • …
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    Step 3. Gather Information on Use of the Conventional Device

    • should consider only one device type at a time. Consideration of more than one device type might be appropriate if the devices have different purposes (e.g., intravenous catheters and finger/heelstick lancets). …
    • …
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    Step 5. Obtain Information on Available Products

    • Packaging. Changes or differences in device packaging may affect waste volume, ease of opening, and the ability to maintain aseptic technique. Also examine instructional material on or in packaging to determine if it is clear and useful in guiding…
    • …
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    Step 6. Obtain Samples of Devices Under Consideration

    • Arrangements should be made to contact manufacturers or vendors to obtain samples of products for consideration. Once obtained, look at the devices based on the design and performance criteria and other issues that are important. …
    • …
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    Step 8. Develop a Product Evaluation Plan

    • versus multiple use); these should be added as needed. Additional suggestions for designing or selecting an evaluation form are to:
    • Avoid questions that the product selection and evaluation team can answer. Unless there is a specific issue, there is no need…
    • …
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    • A team approach, using in-house staff and device manufacturer’s representatives, is one effective way to provide training. In-house staff know how products are used in a facility, including any unique applications, but manufacturer’s representatives understand the design and use of the safety…
    • …
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    • devices. In addition, categorize individual comments so they provide a better picture of the clinical experience with the device.
    • Consider calculating response rates by occupation and clinical area and analyzing data by these variables, if the volume of responses permits. …
    • …
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    Step 11. Perform Post-implementation Monitoring

    • These questions are not easy to answer. Furthermore, it is counter to the prevention plan to return to a conventional device once one with a safety feature has been introduced, and it may raise questions among staff. …
    • …
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    OPERATIONAL PROCESSES

    • Education and Training of Healthcare Personnel
    • Introduction
    • Another important element of a sharps injury prevention program is the education and training of healthcare personnel in sharps injury prevention. …
    • …
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    Opportunities for Educating and Training Healthcare Personnel

    • Perhaps the most obvious opportunity for teaching prevention of sharps injuries is during the initial orientation and annual bloodborne pathogen training required by OSHA. …
    • …
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    Teaching Tools

    • Safety culture initiatives.
    • If the training is primarily lecture, methods to make the training more interesting might include:
    • Presentation of case studies of exposures (protect the confidentiality of workers involved). At the end of the case presentation, the trainer might engage the…
    • …
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    REFERENCES

    • Panlilio AL, Orelien JG, Srivastava PU, Jagger J, Cohn RD, Carco DM, the NaSH Surveillance Group; the EPINet Data Sharing Network. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997- 1998.Infect Control Hosp Epidemiol…
    • …
70. Page 70
    • Sohn S, Eagan J, Sepkowitz KA. Safety-engineered device implementation: does it introduce bias in percutaneous injury reporting? Infect Control Hosp Epidemiol 2004; 25(7):543-
    • Doebbeling BN, Vaughn TE, McCoy KD, Beekmann SE, Woolson RF, Ferguson KJ, Torner JC. …
    • …
71. Page 71
    • Gruninger SE, Siew C, Chang S-B et al. Human immunodeficiency virus infection among dentists. J Am Dent Assoc 1992;123:57.
    • Lettau LA, Blackhurst DW, Steed C. Human immunodeficiency virus testing experience and hepatitis B vaccination and testing status of healthcare workers in South Carolina…
    • …
72. Page 72
    • Hernandez ME, Bruguera M, Puyuelo T, Barrera JM, Sanchez Tapia JM, Rodes J. Risk of needle-stick injuries in the transmission of hepatitis C in hospital personnel. J Hepatol 1992;16:56-8.
    • Sodeyama T, Kiyosawa K, Urushihara A et al. Detection of hepatitis C virus markers and hepatitis C virus…
    • …
73. Page 73
    • Ippolito G, Puro V, DeCarli G, the Italian Study Group on Occupational Risk of HIV. The risk of occupational human immunodeficiency virus infection in health care workers. Arch Intern Med 1993;153:1451-8.
    • CDC. Update: human immunodeficiency virus infections in health-care workers exposed to blood of…
    • …
74. Page 74
    • Ippolito G, Puro V, Heptonstall J et al. Occupational human immunodeficiency virus infection in health care workers: worldwide cases through September 1997. Clin Infect Dis 1999;28:365-83.
    • Mast ST, Woolwine JD, Gerberding JL. Efficacy of gloves in reducing blood volumes transferred during simulated…
    • …
75. Page 75
    • Smith DA, Eisenstein HC, Esrig C, Godbold J. Constant incidence rates of needle-stick injury paradoxically suggest modest preventive effect of sharps disposal systems. J Occup Med 1991;34:546-51.
    • five-year study of needlestick injuries: signifi- Haiduven DJ, DeMaio TM, Stevens DA. …
    • …
76. Page 76
    • ECRI (Emergency Care Research Institute). Needlestick-prevention. Health Devices 1999;28:381-408.
    • ECRI (Emergency Care Research Institute). Needlestick-prevention devices. Health Devices 2000;29:75-81.
    • ECRI. Sharps Safety and Needlestick Prevention 2001. ECRI (formerly Emergency Care Research…
    • …
77. Page 77
    • Lewis JFR, Short LJ, Howard RJ, Jacobs AJ, Roche NE. Epidemiology of injuries by needles and other sharp instruments: minimizing sharp injuries in gynecologic and obstetric operations. Surg Clin North Am 1995;75:1105-21.
    • …
78. Page 78
    • Jackson M, Chiarello LA, Gaynes RP, Gerberding JL. Nurse staffing and health care-assoicated infections: proceedings from a working group meeting. Am J Infect Control 2002; 30(4):199-206.
    • Stone PW, Clarke SP, Cimiotti J, Correa-de-Araujo R. Nurses’ working conditions: implications for infectious…
    • …
79. Page 79
    • Kretzer EK, Larson EL. Behavioral interventions to improve infection control practices. Am J Infect Control 1998;26:245-53.
    • Ott JS. The organizational culture perspective. Pacific Grove, California: Brooks/Cole Publishing Company, 1989.
    • …
80. Page 80
    • Benneyan JC. Statistical quality control methods in infection control and hospital epidemiology, Part II: chart use, statistical properties, and research issues. Infect Control Hosp Epidemiol 1998;19:265-83.
    • Enger EL, Mason J, Holm K. The product evaluation process: making an objective decision. …
    • …
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    APPENDIX A - TOOLKIT

    • This toolkit contains a variety of sample forms that may be downloaded for use by healthcare organizations in developing or enhancing an organization’s sharps injury prevention program. These forms may be adapted as desired to best meet the organization’s needs. …
    • …
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    A-1 Baseline Program Assessment Worksheet

    • This sample worksheet is designed to help healthcare organizations perform a one-time baseline assessment of activities or processes that support a sharps injury prevention program. …
    • …
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    SAMPLE Baseline Program Assessment Worksheet

    • How are front-line healthcare personnel involved in identifying
    • and removing sharps injury hazards?
    • What strategies does the organization use to identify hazards in
    • the work environment?
    • Identification and Removal of Sharps Injury Hazards
    • …
84. Page 84
    • What data sources (e.g., written or observational surveys, incident reports) are used to measure improvements in the
    • organization’s safety culture?
    • Safety Culture Data Sources
    • How is accountability for safety assessed and documented
    • during annual performance evaluations?
    • …
85. Page 85
    • What data sources are used for monitoring improvements in sharps injury reporting? (e.g., reporting surveys,
    • changes in injury reporting trends)
    • How has healthcare personnel compliance with the organization’s policy for reporting been assessed?
    • …
86. Page 86
    • What data sources (e.g., committee reports) are used to monitor improvement in sharps injury data
    • analysis?
    • What committee(s) review(s) the data?
    • How often are summary reports on injury trends prepared? Who receives copies of this information?
    • What denominator is used to calculate injury rates?
    • …
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    4. Identification, Selection, and Implementation of Prevention Interventions

    • What data sources (e.g., changes in procedure, committee reports) are used to monitor improvements in methods used to select and
    • implement new interventions?
    • How are other prevention interventions (e.g., work practices,
    • …
88. Page 88

    5. Education and Training of Healthcare Personnel on Sharps Injury Prevention

    • What data sources (e.g., staff development reports, curriculum changes, training evaluations) are used to measure improvement in
    • the training of healthcare personnel?
    • What training tools are used?
    • …
89. Page 89
    • A-2 S
    • urvey to Measure Healthcare
    • Personnel Perceptions of a Culture of Safety
    • This sample survey will help healthcare organizations measure how their employees perceive safety. The questions are designed to provide a picture of the culture of safety as it generally applies to healthcare personnel…
    • …
90. Page 90

    SAMPLE Survey to Measure Healthcare Personnel’s Perceptions of a Culture of Safety

    • The Sharps Injury Prevention Program at ___ is conducting an anonymous, voluntary survey of staff to assess how well we are doing in promoting safety in our healthcare organization. …
    • …
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    Sample Survey to Measure Healthcare Personnel’s Perceptions of a Culture of Safety

    • SUMMARY REPORT
    • Date survey initiated:
    • Date of report:
    • Number of forms distributed:
    • Number returned:
    • Response rate: ___ %
    • Method of Distribution
    • …
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    Comments:

    • 7. E
    • mployee/management collaboration on safety
    • 8. Safety training
    • 9. Provision of safer technology
    • 10. Non-punitive reporting environment
93. Page 93

    A-3 Survey of Healthcare Personnel on Occupational Exposure to Blood and Body Fluids

    • This survey helps assess reporting of occupational exposure to blood and body fluids by your healthcare personnel as well as the efficiency of your organization’s postexposure management system. …
    • …
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    Sample Cover Letter

    • Dear (staff member, healthcare worker, employee),
    • [Name of organization] is conducting a survey to assess our program for reporting and managing occupational exposures to blood and body fluids. …
    • …
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    Sample Survey of Healthcare Personnel on Occupational Exposure to Blood and Body Fluids

    • If you have questions or problems completing this form, please ask for help.
    • 1. Which of the following best describes your occupation/work area? (Check one.)
    • Nursing staff
    • …
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    Part B. Postexposure Experience

    • 7. If you had an exposure that you did not report, please indicate the reasons for not reporting: (Check all that apply.)
    • I did not have time to report
    • I did not know the reporting procedure
    • I was concerned about confidentiality
    • …
97. Page 97

    Sample Survey of Healthcare Personnel on Occupational Exposure to Blood and Body Fluids

    • SUMMARY REPORT
    • Date survey initiated:
    • Date of report:
    • Number of forms distributed:
    • Number returned:
    • Responses by shift:
    • Overall response rate:
    • Method of Distribution
    • ___ Inserted in pay envelopes
    • ___ Mailed
    • …
98. Page 98

    Number eligible to respond

    • Total/% Skin and MM exposures reported
    • Total # MM exposures (range per person)
    • Number/% reporting a Mucous Membrane (MM)
    • exposure
    • Total/% PI reported
    • Total # PI exposures (range per person)
    • Response rate (%)
    • Number/% reporting a percutaneous injury (PI)
    • Occupational Group
    • …
99. Page 99

    8. Postexposure care experience

    • Highest possible score per survey = 35
    • Mean score (total of all items / number of respondents):___ Range: ___ (lowest total score) to: ___ (highest total score)
    • Individual Item Scores
    • Mean Score
    • Seen in a timely manner
    • Given sufficient information
    • …
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     A-4 Baseline Institutional Injury Profile Worksheet

     • This worksheet is designed to help healthcare organizations organize baseline data on sharps injuries and identify priorities for intervention. Data elements include the occupations of injured healthcare personnel, devices associated with injuries…
     • …
101. Page 101

     Sample Baseline Sharps Injury Profile Worksheet

     • The goal of this worksheet is to organize sharps injury data for the purpose of identifying immediate priorities for intervention.
     • How many injuries have been reported?
     • Year
     • # Injuries
     • …
102. Page 102

     In the past year, what proportion of injuries that occurred due to the following circumstances?

     • Circumstance
     • # of Injuries
     • % of Injuries
     • Manipulating needle in patient
     • Manipulating needle in IV line
     • Suturing
     • Recapping
     • Discarding sharp into container
     • Discarding sharp improperly
     • During clean-up
     • Other
     • …
103. Page 103

     Based on this assessment, what are the top 5 priorities we should address?

104. Page 104

     A-5 Baseline Injury Prevention Activities Worksheet

     • This worksheet is intended as a method for documenting the implementation of specific injury prevention interventions. The focus is on engineered sharps injury prevention devices, but other strategies are included as examples. …
     • …
105. Page 105

     Sample Baseline Injury Prevention Activities Worksheet

     • 1. What engineered sharps injury prevention devices have been implemented in the facility?
     • Conventional Device Type
     • Name/Manufacturer of Safety
     • Device Implemented
     • Implementation Year
     • Scope of Use*
     • Hypodermic needle/syringe
     • …
106. Page 106

     3. Where in the facility are sharps collection containers placed?

     • Each patient room
     • Medication carts
     • Each procedure room
     • Soiled utility rooms
     • Laundry Laundry
     • Other
     • 4. Is the facility using any communication tools to promote safe handling of sharps? If so, what are they?
     • …
107. Page 107

     A-6 Sharps Injury Prevention Program Action Plan Forms

     • These forms are designed to help organizations develop and implement action plans to track and measure their prevention interventions. The first form is specifically designed for prevention initiatives, such as implementation of devices with…
     • …
108. Page 108

     Sample Sharps Injury Prevention Program Action Plan: Prevention Initiatives

     • 7/year
     • 2/year
     • Injuries with
     • butterfly needles during disposal
     • Other improper disposal injuries
     • P 4/1/01
     • IP 4/1/01
     • IP 4/1/01
     • P 4/1/01
     • A- Set up meeting with housekeeping and nursing staff
     • to discuss possible solutions
     • …
109. Page 109

     Sample Sharps Injury Prevention Program Action Plan: Prevention Initiatives

     • Baseline #
     • Injuries/
     • Time Period ±
     • Prevention Strategies£
     • Implementation *
     • Status/Date/
     • Person Responsible
     • Post Intervention # Injuries/Time
     • Period ±
     • Pending (P) In Progress (IP) Completed (C)
     • ± Year, Quarter, Month
     • …
110. Page 110

     Sample Sharps Injury Prevention Program Action Plan: Process Improvement

     • Problem
     • Safety culture, sharps injury reporting, education, etc.
     • Process of Concern *
     • Action Items
     • Status/Date
     • Outcome
111. Page 111

     A-7 Blood and Body Fluid Exposure Report Form

     • The following form was developed to aid healthcare organizations in collecting information on occupational exposures to blood and body fluids. Information on exposure characteristics (e.g., exposure location, type of exposure, device involved, and…
     • …
112. Page 112
     • Exposure Event Number:
     • Sample Blood and Body Fluid Exposure Report Form
     • Facility name: ___
     • Name of exposed worker:
     • Last: ___ First: ___ ID #: ___
     • Date of exposure: ___/___/___
     • Time of exposure: ___:___
     • AM
     • PM
     • (Circle)
     • Job title/occupation: ___ Department/work unit: ___
     • …
113. Page 113

     Section IV. Exposure and Source Information

     • Exposure Event Number:
     • A. Exposure Details: (Check all that apply.)
     • 1. Type of fluid or material (For body fluid exposures only, check which fluid in adjacent box.)
     • Blood/blood products
     • Visibly bloody body fluid*
     • Non-visibly bloody body fluid*
     • …
114. Page 114

     Section V. Percutaneous Injury Circumstances

     • Exposure Event Number:
     • A. What device or item caused the injury?
     • Hollow-bore needle
     • Other sharp objects
     • Hypodermic needle
     • Bone chip/chipped tooth
     • Bone cutter
     • Bovie electrocautery device
     • Bur
     • Explorer
     • Extraction forceps
     • Elevator
     • Histology cutting blade
     • …
115. Page 115

     Exposure Event Number:

     • C. When and how did the injury occur? (From the left hand side of page, select the point during or after use that most closely represents when the injury occurred. In the corresponding right hand box, select one or two circumstances that reflect how the injury happened.)
     • …
116. Page 116

     Section VI. Mucous Membrane Exposures Circumstances

     • Exposure Event Number:
     • A. What barriers were used by the worker at the time of the exposure?
     • (Check all that apply.)
     • Gloves
     • Goggles
     • Eyeglasses
     • Face Shield
     • Mask
     • B. Activity/Event when exposure occurred (Check one.)
     • Patient spit/coughed/vomited
     • …
117. Page 117

     A-8 Sharps Injury Hazard Observation and Report Forms

     • Healthcare organizations that collect information on sharps injury hazards in the work environment may find the following forms useful. The first form (A-8-1) is for organizations that perform systematic environmental rounds and provides a means…
     • …
118. Page 118

     (Name of Healthcare Organization)

     • A-8-1 Sample Sharps Injury Hazard Observations
     • During Environmental Rounds
     • Date:
     • Time:
     • Facility Location:
     • Name of Observer(s):
     • Were any sharps injury hazards identified during the observation?
     • Yes
     • No
     • …
119. Page 119

     (Name of Healthcare Organization)

     • A-8-2 Sample Sharps Injury Hazard Observation or “Near Miss”
     • Event Report Form
     • Date:
     • Time:
     • Location in facility where hazard was observed:
     • Building
     • Department/Unit
     • Floor
     • Description of the hazard or “near miss” event:
     • Name of person reporting:
     • Phone:
     • …
120. Page 120

     A-9 Sample Form for Performing a Simple Root Cause Analysis of a Sharps Injury or “Near Miss” Event

     • This form was developed to assist healthcare organizations determine the factors that may have contributed to a reported sharps injury (A-7) or a situation where a sharps injury could have occurred…
     • …
121. Page 121

     Sample Form for Performing a Simple Root Cause Analysis of a Sharps Injury or “Near Miss” Event

     • Event tracking Number:
     • Description of Event Under Investigation
     • Event: Date___/___/___ Time ___ AM PM
     • Weekday:___
     • Location: ___
     • Details of how the event occurred:___
     • Contributing Factors
     • …
122. Page 122

     EVENT TRACKING NUMBER:

     • Root Cause Analysis Action Plan
     • Risk Reduction
     • Strategies
     • Measure(s) of Effectiveness
     • Action item #1
     • Action item #2
     • Action item #3
     • Action item #4
     • Action item #5
     • Responsible Person(s)
123. Page 123

     Sample Trigger Questions for Performing a Root Cause Analysis of a Blood or Body Fluid Exposure

     • 1. Issues related to patient assessment
     • Was the patient agitated before the procedure?
     • Was the patient cooperative before the procedure?
     • Did the patient contribute in any way toward the event?
     • …
124. Page 124

     A-10 Occupation-Specific Rate-Adjustment Calculation Worksheet

     • The data analysis section of this Workbook, Operational Processes, Analyze Sharps Injury Data, discusses the adjustment of occupation-specific injury rates based on levels of compliance with injury reporting policies. …
     • …
125. Page 125

     Sample Occupation-Specific Rate-Adjustment

     • Calculation Worksheet
     • Occupational Group:
     • Calculate the percentage of unreported injuries for the occupation:
     • 1. From the reporting survey, record the number of injuries these workers say they sustained___.
     • …
126. Page 126

     A-11 Survey of Device Use

     • This tool is designed to help product evaluation teams or committees determine how devices are used in their healthcare organization. Department heads, nursing units, or their designees should complete this form. The example uses a hypodermic needle/syringe. …
     • …
127. Page 127

     Sample Cover Memo

     • TO:
     • FROM:
     • DATE:
     • SUBJECT:
     • Heads of all departments and nursing units
     • (Name of workgroup)
     • Survey of device use
     • The elimination of percutaneous injuries associated with the use of (Type of Device) is a priority of your Sharps Injury Prevention Program Committee. …
     • …
128. Page 128

     Survey of Device Use

     • (Example: Hypodermic Needle/Syringe)
     • Department/Nursing Unit
     • Person Completing Form
     • Phone
     • 1. Does your department/nursing unit use hypodermic needles and syringes?
     • Yes (Go to next group of questions.)
     • No (Stop here and return this form.)
     • …
129. Page 129
     • 6. Is the hypodermic needle/syringe used with other equipment where compatibility might be a concern when considering other devices?
     • Yes (Please explain.)
     • No
     • 7. Does your department/nursing unit need to be able to change needles after drawing medication?
     • Yes
     • No
     • …
130. Page 130

     A-12 Device Pre-Selection Worksheet

     • This worksheet will help product evaluation teams or committees discuss and determine relevant criteria when considering a particular sharps injury prevention device. The form may be completed individually or collectively. …
     • …
131. Page 131

     Sample Device Pre-Selection Worksheet

     • Comment:
     • Other:
     • Device allows easy visualization of
     • medication.
     • Device allows easy visualization of flash-
     • back.
     • Device permits reuse of the needle on the same patient during a procedure (e.g., local
     • anesthesia).
     • Device permits needle changes.
     • No
     • Yes
     • …
132. Page 132

     If yes, what is the level of importance

     • Comment:
     • Other:
     • Device is available in all currently used sizes.
     • Device can be used for all the same purposes for
     • which the conventional device is used.
     • Specialty areas (e.g., OR, anesthesiology,
     • radiology) can use the device.
     • …
133. Page 133

     If yes, what is the level of importance

     • Comment:
     • Other:
     • The safety feature is easy to recognize and
     • intuitive to use.
     • A visible or audible cue provides evidence of
     • safety feature activation..
     • The safety feature is integrated into the device (i.e., does not need to be added before use).
     • …
134. Page 134

     If yes, what is the level of importance

     • Comment:
     • Other:
     • The device will not require changes in the size or
     • shape of sharps containers.
     • The device will not increase the volume of sharps
     • waste.
     • Comment:
     • The company has a history of being responsive
     • when problems arise.
     • …
135. Page 135

     A-13 Device Evaluation Form

     • This form was developed to collect the opinions and observations of healthcare professionals regarding a device with an engineered sharps injury prevention feature. Use of this form will help healthcare organizations make final decisions about the acceptability of a…
     • …
136. Page 136

     Sample Cover Letter

     • Date
     • Dear (e.g., staff member, healthcare worker, employee):
     • (Name of organization) is conducting a survey to evaluate a device with an engineered sharps injury prevention feature. Your feedback on this product is important in order to identify safer devices that allow us to…
     • …
137. Page 137

     Sample Device Evaluation Form

     • Product:
     • Date: ___
     • [Filled in by healthcare facility]
     • Department/Unit: ___
     • Position/Title: ___
     • 1. Number of times you used the device.
     • 1-5
     • 6-10
     • 11-25
     • 26-50
     • More than 50
     • 2. Please mark the box that best describes your experiences with the device. …
     • …
138. Page 138

     Neither

     • Strongly
     • Disagree Agree nor
     • Disagree
     • Disagree
     • Agree
     • Strongly Agree
     • Special Questions about this Particular Device
     • [To be added by healthcare facility]
     • Overall Rating
     • Overall, this device is effective for both patient/ resident care and safety.
     • …
139. Page 139

     APPENDIX B - Devices with Engineered Sharps Injury Prevention Features

     • Devices with Engineered Sharps Injury Prevention Features
     • Introduction
     • This section describes various ways safety features have been incorporated into the most commonly used conventional needles and other sharp devices to protect…
     • …
140. Page 140

     Concept of “Active and Passive” Safety Features

     • Other products have also been developed to promote safer work practices, such as needle recapping devices and IV line stabilizers. These products can have an important role in prevention. …
     • …
141. Page 141
     • The following websites provide information on the various safety devices that are currently available.
     • Notice: Clicking the links below will leave the CDC Website. We have provided links to these sites because they have information that may be of interest to you. …
     • …
142. Page 142

     APPENDIX C - Safe Work Practices for Preventing Sharps Injuries

     • Work practices to prevent sharps injuries are typically presented as a list of specific practices to avoid (e.g., recapping used needles) or to use (e.g., disposing in appropriate sharps disposal containers). …
     • …
143. Page 143

     During a Procedure That Involves the Use of Needles or Other Sharp Devices:

     • Maintain visual contact with the procedure site and location of the sharp device.
     • When handling an exposed sharp, be aware of other staff in the immediate environment and take steps to control the location of the sharp to…
     • …
144. Page 144

     After Disposal:

     • Visually inspect sharps containers for evidence of overfilling before removal. If a sharps container is overfilled, obtain a new container and use forceps or tongs to remove protruding devices and place them in the new container.
     • …
145. Page 145

     APPENDIX D - Problem-Specific Strategies for Sharps Injury Prevention

     • The following is a table of problems that are often associated with sharps injuries. These particular problems are often complex, and factors related to their occurrence must be explored to identify appropriate interventions. …
     • …
146. Page 146

     Problem-Specific Strategies for Sharps Injury Prevention

     • Problem
     • Injuries during specimen transfer
     • Downstream injuries (i.e., injuries to housekeepers, laundry, and maintenance workers, and/or injuries associated with improper disposal of sharp devices)
     • Possible Prevention
     • Strategies
     • …
147. Page 147

     Problem

     • Injuries during sharps disposal
     • Problem Assessment
     • Possible Prevention
     • Strategies
     • Where are these injuries occurring?
     • Change the position of the sharps container
     • Is there any pattern by occupation, location, or device?
     • Change the type of sharps container
     • …
148. Page 148

     APPENDIX E — Measuring the Cost of Sharps Injury Prevention

     • Introduction
     • One of the processes associated with implementing a sharps injury prevention program is measuring the economic impact of prevention interventions, particularly as the latter contribute to a reduction in sharps injuries. …
     • …
149. Page 149

     Direct costs

     • There are two direct costs that are generally borne by a healthcare organization when a sharp injury occurs. These are:
     • Cost of baseline and follow-up laboratory testing of an exposed healthcare worker and testing the source patient, and
     • …
150. Page 150

     Cost of Postexposure Prophylaxis (PEP)

     • Most of the cost of postexposure drugs will be for HIV PEP. However, there may be times when hepatitis B immune globulin is provided. The cost to the institution’s pharmacy to purchase each drug (not what it would charge a patient) should be the basis for…
     • …