is your bbp exposure control plan in...

IsYourBBPExposureControlPlaninControl?

SethA.Clarenbach,MS,CSP

©2017EHSSENTIALS


EducaGonalObjecGves•  OverviewofBloodbornePathogenExposureControlPlanRequirements&HotTopics

•  DeepDiveintoSurgery

©2017EHSSENTIALS


29CFR1910.1030•  ExposureControlPlan•  MethodsofCompliance•  HepaGGsBVaccinaGon&Post-ExposureEvaluaGon&Follow-up•  CommunicaGonofHazardstoEmployees(BBPTraining)

©2017EHSSENTIALS


•  Availability•  ReviewedandUpdated•  NewTechnology•  SaferMedicalDevices•  Inputfromnon-managerialstaff•  ExposureDeterminaGon

(vaccinaGonrequirement,etc.)

•  1910.1030(c)(1)(iv)(A)–  Reflectchangesintechnology

thateliminateorreduceexposuretobloodbornepathogens

–  StandardInterpretaGons•  MeeGngtheannualreviewof

(safety)sharpsonhand?

ExposureControlPlan

©2017EHSSENTIALS


•  UniversalPrecauGons•  EngineeringandworkpracGce

controls–  Handwashing–  Recapping/bendingnot

allowed•  Mechanicaldevice(bestchoice)

•  Onehandedscoop(notrecommended)

MethodsofCompliance

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•  HBVvaccineavailability•  Nocosttoemployee•  Within10workingdays•  Ifdeclinesmustdocument,andis

sGllavailable•  Labtests•  Accreditedlaboratory•  Nocosttoemployee

•  Post-exposureprophylaxisandmonitoring(basedonsourcepaGenttesGng)–  4thgeneraGontestsallows4

monthscleanbillofhealth–  Immunosuppressed

employees

HBV&Post-ExposureEvaluaGon&Follow-up

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•  Signage/Labeling–  Storage–  TransporGng

•  EducaGonandTraining•  Recordkeeping&Training

Records

CommunicaGonofHazardstoEmployees

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•  HandsFreeInstrumentPassing•  LimitaGonsofSafetyDevices•  DisposalContainers•  SafetySutures•  ScalpelCovers•  PersonalProtecGveEquipment

(appropriate)

•  Alwaysbringdata!•  Riskofbeingstuckfromaneedle,

scalpel,orsomeothersharpobject

•  Twowaystreet-DualExposure(paGents<->healthcareworkers)

CaseStudy:Surgery

©2017EHSSENTIALS


HierarchyofControls•  EngineeringControls-controlsthatisolateorremovethebloodborne

pathogenshazardfromtheworkplace(e.g.,self-sheathingneedles,needlelessIVadministraGonsystems,sharpsdisposalcontainers).Mosteffec)vecontroltype.

•  WorkPrac2ceControls-controlsthatreducetheriskofexposurethroughopGmizingtaskperformance/workmethods(e.g.,hands-freepassing).

•  PersonalProtec2veEquipment-specializedclothingorequipmentwornforprotecGon.Leasteffec)ve/reliablecontroltype.

MostEffecGve

LeastEffecGve

Poten2alImprovementOpportuni2es

DegreeofChallengeEasy MoreDifficult

HandsFreePassing

BluntSutures

Non-sutureskinclosuremethods(staples,glue,etc.)

SharpsDisposal

DoubleGloving

ImprovedRepor2ng*

ImprovedAnalysis*

Major

Improvem

ent

Minor

Improvem

ent

ExpectedIm

pact

ScalpelCovers

*SupporGveimprovements,notmuchbythemselves

©2017EHSSENTIALS


•  Indirecttransferofsharpsinstruments

•  Onesharp–Oneperson•  NeutralZone•  Flexible,adaptabletechnique

HandsFreeInstrumentPassing

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HandsFreeInstrumentPassing•  3,765operaGons•  Handsfreepassingtechnique(>75%passes)in42%ofcases•  Events:injury,contaminaGon,gloveperforaGon

Decreasedeventsby60%

StringerB,etal.EffecGvenessofthehands-freetechnique(HFT)inreducingoperaGngtheatreinjuries.OccupEnvironMed2002

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•  Simple•  Effec2ve•  Efficient

•  ProtectourpaGentsandourselves

•  Whencanapply?

•  Howomen?

HandsFreeInstrumentPassing

DisposalContainers

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LimitaGonsofSafetyDevices•  EPINetdata(2014):

–  42.3percentofemployeesreporGnganincidentwereusingadevicewithasafetyfeatureorsafetymechanismwhentheywereinjured.

–  Ofthoseusingasafetydevice,64percentdidnotacGvatethesafetyfeature.

•  20.2percentoftheinjuriesoccurreda:erthesafetyfeaturewasacGvated.

•  30percentofinjuriesoccurredduringacGvaGonofthesafetyfeature.•  “PassivelyacGvatedsafety”devicesarebeperthansafetydevices

requiringacGvaGon.

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Disposal•  What’sthecurrentroommake-up?•  LocatedandeasilyaccessiblebyacGviGes•  Appropriatesizeforitemsbeingused•  Getinatthebeginningduringthedesignphase•  KnowtheregulaGon;topscanbeoffwhileinthesurgicalseungmakingit

easiertodisposeof(mustputtoponwhiletransporGng)•  Don’tforgetdownstreamemployeesinthewastestream(easytoignore)

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Scalpel-relatedInjuriesDeepscalpelcutsarethehighestriskexposuresfortheHCWandalsomostlikelytoresultinapaGentexposure.•  Safetyscalpels:

–  “Thereisinsufficientevidencetosupportregulateduseofsafetyscalpels.Injury-reducGonstrategiesshouldemphasizeprovenmethods,includingdouble-gloving,bluntsutureneedlesanduseofhands-freesharpstransfer.*”

–  DevicesallowingsinglehandedbladeremovalandcaptureappeartobeatleastaseffecGveasasafetyscalpel.“Werecommenduseofasingle-handedscalpelbladeremoverincombina)onwithHFPT[handsfreepassingtechnique]asthiscanpoten)allyprevent5)mesasmanyinjuriesassafetyscalpels.#

*UseofsafetyscalpelsandothersafetypracGcestoreducesharpsinjuryintheoperaGngroom:Whatistheevidence?DeGirolamoKM,CourtemancheDJ,HillWD,KennedyA,Skarsgard,EDCanJSurg.2013Aug;56(4):263–269.doi:10.1503/cjs.003812#ModelingtheeffecGvenessofdifferentsafetydevices'abilitytoreducescalpelbladeinjuries.InternaGonalJournalofRiskandSafetyinMedicine,vol.20,no.1-2,pp.83-89,2008Foranoverviewofotherscalpelsafetydevices,seethesecondandsubsequentcategoriesathpp://www.isips.org/page/safety_product_list_s_uSpecificexampleshpp://www.isips.org/page/safety_products/retractable_scalpelhpp://www.isips.org/page/safety_products/safety_scalpels__weighted

©2017EHSSENTIALS


Suture-relatedinjuriesAbouthalfofallsharpsinjuriesaresuture-related.Residents/fellowsatgreatestrisk.•  ModifiedGp/“blunt”sutures

–  69%reducGonininjuriescomparedtohigherrisksutures*–  Workwellformuscleandfascia;notgoodforskinorgutorvascular–  InusebyOb-GynatBrigham&Women’sHospital,UCDavisMedicalCenter.–  Requiresmoreforce,‘pops’.Trialsoflessthan3weekstypicallyunsuccessful.–  Highercostoffsetbysavingfromfewerinjuries.

•  UsesuturesubsGtutes,e.g.staples(includingself-absorbing),adhesives,etc.•  Usetechniquesthatavoidcontactwiththesutureneedle

–  e.g.Single-HandedNeedleHolderLoading;SaferandMoreEfficientCuGcularSGtch#*BluntversussharpsutureneedlesforprevenGngpercutaneousexposureincidentsinsurgicalstaff.ParantainenA,VerbeekJH,LavoieMC,PahwaM.CochraneDatabaseofSystemaGcReviews2011;Issue11.Art.No.:CD009170.DOI:10.1002/14651858.CD009170.pub2.)#Single-HandedNeedleHolderLoading:ASaferandMoreEfficientCuGcularSGtchGardnerES;Goldberg,LHDermatologicSurgery.27(6):594–596,Jun2001

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•  Alwaysdoubleglove•  Splashes–asyoucontrol

needlesGcksbbpsplashesgoup(WarnerHudson,MedicalDirector@UCLA)

•  Punctureresistantgloves

•  Imperviousgowns;findingtherightgownfortherightjob

•  Comfortisthekeyhere

PersonalProtecGveEquipment

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TakeAway•  Pickyourbaples•  Nosingleanswer•  HandsFreePassingisGreat•  DisposeofCarefully•  Youareyourownworstenemy

©2017EHSSENTIALS


AddiGonalReferencesHandsFreeTechnique•  Verycomprehensiveandsimplevideoonhandsfreetechnique–16minuteslong.it’savailablethroughthelinkinthe

middleofthispage:hpp://www.medicalcenter.virginia.edu/safetycenter/internetsafetycenterwebpages/safetyinsurgery/safetyinsurgery.html

•  “InoperaGonswithgreaterthan100mlbloodloss…,thereducGoninthe[injury]ratewas59%(95%CI23%to72%).–  Effec)venessofthehands-freetechniqueinreducingopera)ngtheatreinjuries.OccupEnvironMed.2002Oct;59(10):

703-7.PMID:12356932•  “HFT-associatedreducGoninratewas35%.”

–  Hands-FreeTechniqueintheOpera)ngRoom:Reduc)oninBodyFluidExposureandtheValueofaTrainingVideo.PublicHealthRep.2009;124(Suppl1):169–179.PMCID:PMC2708668

•  “OfsevenORstudiesinwhichanobserverorcirculaGngnurserecordedexposures,therewasapercutaneousinjuryin1.7-15%ofallsurgeries,andamucocutaneouscontaminaGonin6.2-50%ofallsurgeries.

–  Hands-freetechnique:preven)ngoccupa)onalexposureduringsurgery.(Review)JPerioperPract.2006Oct;16(10):495-500.PMID:17069398

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AddiGonalReferencesOverview•  StanfordHealth’s3minutevideoontheiriniGaGvestoeliminatesharpsinjuries:

hpps://youtu.be/mpm_7pNn5GM

IndirectimpactsofNeedles2ckinjuries•  NeedlesGckinjuries:causes,preventabilityandpsychologicalimpact.WickerS,SGrnAV,RabenauHF,von

GierkeL,WutzlerS,StephanC.PMID:24526576DOI:10.1007/s15010-014-0598-0ProspecGve12monthobservaGonalstudyofmedicalstaffandstudentsatFrankfurtUniversityHospitalwhohadhadaneedlesGckinjury(NSI)(n=370).AnalysisofthecompletedquesGonnaires(232/370)foundstress(48.3%)andGredness(36.6%)commonlycontributedtotheNSIand>80%oftherespondentswereconcernedabouttheconsequences.HigherlevelsofanxietywerereportedwhenthepaGentwasknowntohaveachronicvirusinfecGon.

•  Infec)on.2014Jun;42(3):549-52.doi:10.1007/s15010-014-0598-0.Epub2014Feb14.

©2017EHSSENTIALS


AddiGonalReferencesDoubleGloving•  Doubleglovingtoreducesurgicalcross-infec)on.CochraneDatabaseSystRev.2006Jul19;

(3):CD003087.PMID:16855997

Scalpel-relatedinjuries•  Foranoverviewofotherscalpelsafetydevices,seethesecondandsubsequentcategoriesat

hpp://www.isips.org/page/safety_product_list_s_u–  hpp://www.isips.org/page/safety_products/retractable_scalpel–  hpp://www.isips.org/page/safety_products/safety_scalpels__weighted

QuesGons?

SethA.Clarenbach,MS,CSP—MayoClinic

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