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Sharps Safety In the
Operating Room
Creating an Injury Prevention Program
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Objectives
Discuss the regulations that impact an OR
Sharps Safety program
Describe the issues that effect sharps
safety in the OR
Discuss a process for creating an OR
sharps safety program
Identify barriers to the implementation of a
sharps safety program
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Bloodborne pathogens are
viruses or infectious
agents carried by human
blood and body fluids.
They can enter our bodies
and cause disease and
immune deficiencies, whichcan sometimes lead to death.
HIV, HBV, HCV
Epidemiology of Bloodborne Diseases:
HCV
H I V
http://www.disasterrelief.org/Disasters/011221drigresistance/Images/virus.jpghttp://www.niddk.nih.gov/health/digest/ddnews/win00/images/1hepc_virus.jpg -
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Transmission of Bloodborne Pathogens
Blood & Body Fluids-from accidents, illnesses, medical procedures,
research samples and handling medical waste
Disease Transmission
-through cuts, punctures, contact with broken skin,contact with mucous membranes
Bloodborne Pathogen Prevalence*
Hepatitis B 1 in 20
Hepatitis C 1 in 50
HIV 1 in 250
Prevalence in an average population, prevalence is higher for
at risk populations
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HIV Hep B Hep CHIV &
Hep C Any
26% 4% 35% 17% 38%
Prevalence of HIV, Hepatitis B and Hepatitis C
Among Surgery Patients
* Weiss, Makary, Wang, Syin, Pronovost, Chang & Cornwell
Annals of Surgery, Volume 241, Number 5, May 2005
Prevalence of Bloodborne Pathogens in an Urban,
University-Based General Surgical Practice*
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Percentage of Patients with HIV &
Hepatitis C for 4 common operations
0
10
20
30
40
50
60
70
lymph nodebiopsy
drainage ofsoft tissue
abscess
open ventralhernia repair
small bowelresection
* Weiss, Makary, Wang, Syin, Pronovost, Chang & Cornwell
Annals of Surgery, Volume 241, Number 5, May 2005
HIV +
Hep C +
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The Bloodborne Pathogens Standard
Promulgated by OSHA in 1991
Purpose: to protect all workers who may comeinto contact with human blood or body fluids as a
routine part of their job Revised in 2001
New definitions
Additional requirements regarding safety devices
Sharps Injury Log
29 CFR 1910.1030 Full text & additional information can be
found on the OSHA website at:www.osha.gov/pls/oshaweb/owadisp.show_document?
_p_table+STANDARDS&p_id=10051
29
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t t
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o nt omm ss on tan ar sSharps Safety
Human Resources Standards
HR.01.04.01 (2) The hospital orients its staff tothe key safety content before staff providescare, treatment, and services. Completion ofthis orientation is documented.
HR.01.04.01 (4) The hospital orients staff ontheir specific job duties, including those relatedto infection prevention and control.
HR.01.05.03 Staff participate in ongoingeducation and training. Human Resources. In Comprehensive Accreditation Manual: CAMH for
Hospitals. The Official Handbook. Oakbrook Terrace, IL: JointCommission;2009: HR.01.04.01 (2) (4); HR.01.05.03.
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Healthcare Workers Exposed to
Blood/Body Fluids
Physician
30%
Nurse44%
Technician
13%
Other4%
Clerical
1%
Dental
1%
Students
3%
Housekeeping
3%
Research
1%
NaSH data, 23 hospitals, 1995-1999
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Hollow-bore needles and other devices associated with
percutaneous injuries in NaSH hospitals, by % total percutaneous
injuries (n=4,951), June 1995July 1999. (Source: CDC [1999].)
Needlestick Risk
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Causes of percutaneous injuries with hollow-bore needles in NaSH
hospitals, by % total percutaneous injuries (n=3,057), June 1995July
1999. (Source: CDC [1999].)
Needlestick Risk
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Creating a Sharps Safety Program
in the OR
Engineering Controls Tools, instruments, sharps shelters
Work Practices Safe zone, double gloving, one-hand re-capping only when
unavoidable
Making Changes Assembling committee, evaluating product and selecting safety
sharps, participating in education & in safety conversion
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Implementation Suggestions
Use scalpel blades with safety blades
Reusable Disposable
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Implementation Suggestions
Use mechanical /instrument tissue
retraction
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Implementation Suggestions
Use blunt retractors
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Implementation Suggestions
Alternative cutting methods
Cautery
Harmonic scalpel
Cautery
Harmonic Scalpel
http://www.ophthalmic.hyperguides.com/tutorials/oculoplastics/congenital/slide3.asphttp://www.ophthalmic.hyperguides.com/tutorials/oculoplastics/congenital/slide3.asp -
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Implementation Suggestions
Adopt a hands-free technique of passing suture
needles and sharps between perioperative team
members
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Implementation Suggestions
Use a one handed or instrument assistedsuturing technique to avoid finger contact
with needles
Use control-release or pop-off needles
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Implementation Suggestions
Double glove during all surgical
procedures
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Sharps disposal
Closable orange or red, leakproof
puncture resistant containers
Located close to the point of use
maintained upright
Replaced routinely and not allowed to
overfill
Wall mounted
Floor mounted
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Sharps disposal: new containers
Safety sharps containers
Goal: to Prevent Needlesticks
Counter-balanced drop in
prevents childrens fingers from
getting in
Automatically closes at full
prevents overfilling
Reusable sharps containers
Goal: to reduce landfill waste
Outside contractor removes
contaminated sharps, cleans container
and returns it
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Worker Responsibilities
Observe regulations
Comply with methods available to protect
yourself
Practice using safety devices
Use safety devices
Actively participate in evaluation and safety
conversion process
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Worker Responsibilities
Reporting Exposures Employers required by OSHA to document all staff
exposures to blood / body fluids anonymously
OSHA 300 Log
Sharps Injury Log
Location, job title, description of incident, type
& brand of sharps involved
Source testing, risk analysis & post-exposure
prophylaxis if indicated
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Employer Responsibilities
Comply with regulations
Create a safety-oriented culture
Encourage reporting Analyze data
Provide training
Evaluate devices Establish safe staffing patterns
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Implementation Statistics
In a nationwide survey 71% of respondents indicated they had not evaluated
use of blunt tip suture needles in the OR
2% had fully implemented blunt tip suture needles
14% of respondents had implemented safety scalpelsinto the OR
AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting
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BARRIERS TO
IMPLEMENTATION
Psychosocial and organizational factors
Attitude/Resistance to Change
Shortcomings associated with safety devices
Perceived cost associated with engineered
devices
Inadequate training
Time limitations
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Overcoming Obstacles to
Compliance
Frequent and multiple training methods
Multidisciplinary sharps injury prevention plan
Educate new employees and incoming residents and
medical students
Multidisciplinary sharps safety committee
Network with other facilities
Involve front-line workers in evaluation and selection of
safety devices
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Overcoming Obstacles to
Compliance
Collaborate with personnel who use the device
and facilitate change
Discuss current research
Work with resistant team members Remove old technology when new is trialed and
available
Create a Culture of Safety
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Whats new
Collaboration with NIOSH Memorandum ofUnderstanding
Alliance with OSHA
ACS statement on the use of blunt suture Needles
Letter to ACS CDC National Sharps Injury Prevention Meeting
9/12/2005
ACS Statement on Blunt Suture Needles 6/05
OSHA Safety and Health Information Bulletin: Use ofBlunt-Tip Suture Needles to Decrease PercutaneousInjuries to Surgical Personnel 3/07
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Further resources
www.aorn.org http://www.osha.gov/OshDoc/data_BloodborneFacts/bbf
act01.pdf http://www.osha.gov/SLTC/bloodbornepathogens/index.
html http://www.cdc.gov/sharpssafety/ http://www.cdc.gov/niosh/topics/bbp/
http://www.jointcommission.org/ http://www.isips.org/
http://www.nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/occupationalhealth/SafeNeedles/NeedlestickPrevention.aspx
www.premiersafetyinstitute.org
http://www.aorn.org/http://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdfhttp://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdfhttp://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.cdc.gov/sharpssafety/http://www.jointcommission.org/http://www.jointcommission.org/http://www.jointcommission.org/http://www.isips.org/http://www.premiersafetyinstitute.org/http://www.premiersafetyinstitute.org/http://www.isips.org/http://www.jointcommission.org/http://www.jointcommission.org/http://www.cdc.gov/sharpssafety/http://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdfhttp://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdfhttp://www.aorn.org/ -
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Developed by
Deborah G. SprattRN, MPA, CNAA, CNOR
Edited by
Mary J. Ogg
RN,MSN, CNOR