Outline Ontario Needle Safety Regulation Ontario WSIB data and - - PowerPoint PPT Presentation

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Outline

• Ontario Needle Safety Regulation
• Ontario WSIB data and survey statistics
• Prevention of injury:
• using SEMS
• Solutions from Ontario hospitals
• Components of a comprehensive sharps safety program

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Safety Engineered Medical Sharps

Safety-engineered needle means,

(a) a hollow-bore needle that,

(i) is designed to eliminate or minimize the risk of a skin puncture injury to the worker, and (ii) is licensed as a medical device by Health Canada, or

(b) a needleless device that,

(i) replaces a hollow-bore needle, and (ii) is licensed as a medical device by Health Canada.

(Ontario Regulation 474/07 – Needle Safety)

• Applies to HC work environments where workers use hollow-bore

needles on persons for therapeutic, preventive, palliative, diagnostic

• r cosmetic purposes
• Hospitals
• Doctors’ and dentists’ offices, community health centres, family health teams
• Home care, ambulance, public health, schools, occupational health services

*sharps other than Hollow bore needles can still be dealt with under the general provisions of the Occupational Health and Safety Act and regulations

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Ontario’s Needle Safety Regulation

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Ontario’s Needle Safety Regulations

Summary:

• All hollow bore needles must be safety engineered
• Three exceptions will be allowed based on:
• Cannot locate a safety engineered version commercially
• The worker has reasonable grounds to believe there will be risk of

harm

• There is an emergency or crisis, the supply of safety engineered

needles have been exhausted and waiting for new supplies would present a risk of harm to person or public interest

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Engineered Control-Do safety features work to reduce injuries?

• The CDC has reported on studies that showed that the use of SEMS

among phlebotomists resulted in a reduction of up to 76%. (CDC, 1997)

• NIOSH reports on studies that have reduction of rates ranging from

62% to 88% reduction in injuries (NIOSH, 1999)

• Analysis of EPINet data collected in the USA shows a clear decline

(51%) in the number of sharps injuries after implementation and use

• f safety engineered devices. (Perry, 2005).
• Some hospitals in Ontario have reported large reduction in injuries

within one year after use of safety engineered medical sharps were introduced.

WSIB Data

Health Care Sector Needle Stick Injuries by Claim Type

71 76 74 58 28 1148 1364 1261 995 626 200 400 600 800 1000 1200 1400 1600 2000 2005 2008 2011 2016

Healthcare Needlestick Injuries by Claim Type

Lost Time No Lost Time

Data Source: EIW Claim Cost Analysis Schema, August 2006, December 2012 and Feb 2018 snap shot.

Needle stick LTI Count by Rate Group

2 1 17 2 1 3 2 10 20 30 40 50 60 851 - Homes for Nursing Care 852 - Homes for Residential Care 853 - Hospitals 857 - Nursing Services 858 - Group Homes 861 - Treatment Clinics and Specialized Services 875 - Professional Offices and Agencies

Sum of 2000 Sum of 2005 Sum of 2016

Data Source: EIW Claim Cost Analysis Schema, August 2006, December 2012 and Feb 2018 snap shot.

Needle stick NLTI Count by Rate Group

78 13

289

119 16 33 69 100 200 300 400 500 600 700 800 900 851 - Homes for Nursing Care 852 - Homes for Residential Care 853 - Hospitals 857 - Nursing Services 858 - Group Homes 861 - Treatment Clinics and Specialized Services 875 - Professional Offices and Agencies

Sum of 2000 Sum of 2005 Sum of 2016

Data Source: EIW Claim Cost Analysis Schema, August 2006, December 2012 and Feb 2018 snap shot.

* PSHSA Survey results: In 2016- 13

hospitals recorded 592 Sharps injuries

Needle stick LTI Count by HC Occupation

Data Source: EIW Claim Cost Analysis Schema, August 2006, December 2012 and Feb 2018 snap shot.

ASSISTING OCCUPATIONS IN SUPPORT OF HEALTH SERVICES , 7, 8% CHILDCARE AND HOME SUPPORT WORKERS , 5, 6% CLEANERS , 8, 9% CLERICAL OCCUPATIONS, GENERAL OFFICE SKILLS , 1, 1% MEDICAL TECHNOLOGISTS AND TECHNICIANS (EXCEPT DENTAL HEALTH), 10, 12% NURSE SUPERVISORS AND REGISTERED NURSES , 33, 39% OCCUPATION NOT STATED , 2, 2% OTHER TECHNICAL OCCUPATIONS IN HEALTH CARE (EXCEPT DENTAL) , 9, 11% PARALEGALS, SOC.

• SERV. WRKRS. &
• OCCUPS. IN EDUC. &

REL., NEC, 2, 2% PHYSICIANS, DENTISTS AND VETERINARIANS , 1, 1% POLICE OFFICERS AND FIREFIGHTERS , 5, 6% PSYCHOLOGISTS, SOC. WRKRS., COUNSELLORS, CLERGY & PROBATION , 1, 1% SECURITY GUARDS AND RELATED OCCUPATIONS , 1, 1% TECHNICAL OCCUPATIONS IN PHYSICAL SCIENCES , 1, 1%

2005

ASSISTING OCCUPATIONS IN SUPPORT OF HEALTH SERVICES , 4, 14% CHILDCARE AND HOME SUPPORT WORKERS , 1, 3% CLEANERS , 1, 4% MEDICAL TECHNOLOGISTS AND TECHNICIANS (EXCEPT DENTAL HEALTH), 2, 7% NURSE SUPERVISORS AND REGISTERED NURSES , 10, 36% OCCUPATION NOT STATED , 2, 7% OTHER TECHNICAL OCCUPATIONS IN HEALTH CARE (EXCEPT DENTAL) , 4, 14% PARALEGALS, SOC.

• SERV. WRKRS. &
• OCCUPS. IN EDUC. &

REL., NEC, 1, 4% PSYCHOLOGISTS, SOC. WRKRS., COUNSELLORS, CLERGY & PROBATION , 1, 4% SECURITY GUARDS AND RELATED OCCUPATIONS , 2, 7%

2016

Needle stick LTI Count by HC Occupation

5 10 15 20 25 30 35 A S S I S T I N G O C C U P A T I O N S I N S U P P O R T O F H E A L T H … C H I L D C A R E A N D H O M E S U P P O R T W O R K E R S C L E A N E R S C L E R I C A L O C C U P A T I O N S , G E N E R A L O F F I C E S K I L L S M E D I C A L T E C H N O L O G I S T S A N D T E C H N I C I A N S ( E X C E P T … N U R S E S U P E R V I S O R S A N D R E G I S T E R E D N U R S E S O C C U P A T I O N N O T S T A T E D O T H E R T E C H N I C A L O C C U P A T I O N S I N H E A L T H C A R E … P A R A L E G A L S , S O C . S E R V . W R K R S . & O C C U P S . I N E D U C . & … P H Y S I C I A N S , D E N T I S T S A N D V E T E R I N A R I A N S P O L I C E O F F I C E R S A N D F I R E F I G H T E R S P S Y C H O L O G I S T S , S O C . W R K R S . , C O U N S E L L O R S , C L E R G Y & … S E C U R I T Y G U A R D S A N D R E L A T E D O C C U P A T I O N S T E C H N I C A L O C C U P A T I O N S I N P H Y S I C A L S C I E N C E S

Chart Title

2005 2016

Data Source: EIW Claim Cost Analysis Schema, August 2006, and Feb 2018 snap shot.

PSHSA Survey results- April 2018

13 Ontario Hospitals provided data to 15 questions on Sharps injuries

Rates of Sharps injuries/ 100 FTE

1 2 3 4 5 6 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Rate/ 100 FTE Year

PSHSA Survey results- Sharps injuries/ 100 FTE

A B C D E F G I J K L

PSHSA Survey results- Rates of Sharps injuries/ 100 FTE

0.5 1 1.5 2 2.5 3 3.5 2007 (8) 2010 (10) 2016 (11)

rate

0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Nurses Medical technologists and technicians Physicians Other clinical staff Device cleaning and reprocessing staff Non-clinical support staff

Oc Occupa upation n Gr Group up expe perienc ncing ng the he most sha harps inj njur uries- 2006 2006 and and 2017 2017

2006 2017

PSHSA Survey results

(Weighted average of occupation ranking from Highest to lowest)

syringes/hypodermic needles blood collection needles suture needles IV catheters Scalpel blades

1 2 3 4 5 6

In 2017 what medical devices contributed to the highest number of injuries (rank from 1-5 with 1 being the most frequent)

Score

O p e r a t i n g r

• m

E m e r g e n c y d e p a r t m e n t I n t e n s i v e c a r e d e p a r t m e n t S u p p l y / r e p r

• c

e s s i n g L a b

• r

a t

• r

y O t h e r ( p l e a s e s p e c i f y b e l

• w

)

1 2 3 4 5 6

In 2017, what department experienced the most injuries (rank from 1-5 with 1 being the most frequent)

Score

PSHSA Survey results- April 2018

Question Response

All medical sharps have been replaced with SEMS where a replacement is available 30.77% All hollow bore sharps have been replaced with SEMS where a replacement is available 61.54% SEMS are available but occasional use of conventional devices occurs as per exemptions in the Needle Safety Regulation 69.23% SEMS are available, but some staff are still regularly using conventional devices as per exemptions in the Needle Safety Regulation 23.08% SEMS are available, but several staff are still regularly using conventional devices as per exemptions in the Needle Safety Regulation 0.00% SEMS are available, but some staff are still regularly using conventional devices even though their use does not meet the exemptions in the Needle Safety Regulation 0.00% SEMS are available, but several staff are still regularly using conventional devices even though their use does not meet the exemptions in the Needle Safety Regulation 0.00%

Under reporting is listed as a recurring issue for sharps injuries. Do you feel this is still a concern? Responses Yes 25.00% (3) No 75.00%(9)

Sharps Injury Prevention

Applying Hierarchy of Controls to Biological Hazards

• Medication administration methods that do not require a sharp

(nasal spray, transdermal patch etc. )

• One time use equipment
• Replace injectables with oral meds
• Substituting suturing with adhesives
• Safety engineered needles and sharps
• CSA approved puncture resistant sharps containers
• Immunization programs
• Post exposure protocols
• Environmental cleaning and decontamination
• Gloves/gowns/protective clothing
• Eye/face protection

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Hierarchy of Control

Blood and body fluid exposure can be controlled following the Occupational Hygiene Hierarchy of Controls:

• Control at Source (e.g. elimination or engineered control)
• Control along Path (e.g. work practice controls)
• Control at Worker (e.g. personal protective equipment, immunization)

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Hierarchy of Control

Examples of Control at Source:

• Devices with no actual “sharp”; substituting a “hazardous” item for a

less hazardous one. (Not available for all sharps.)

• Safety engineered devices. Devices with safety features designed into

the product to make the device “safer”. These features may be:

• Active safety feature - requires a voluntary action by the user to engage the

safety device.

• Passive safety feature - safety feature is automatic, or requires no additional

action on the part of the user.

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Desired Features of SEMS

• The device is needle-less or sharp-free
• If the sharp cannot be eliminated, there are built-in safety features
• The safety features are passive
• If active, the safety feature is easily activated with a single hand while

the user’s hand remains behind the exposed sharp

• The user can tell if the safety feature has been activated, e.g., from an

audible click

• The safety feature cannot be deactivated through disposal
• The device is easy to use and practical It comes in a variety of

sizes/gauges

• It is safe and effective for patients

Additional methods of reducing sharps injuries

PSHSA Survey: What other strategies have you used to reduce sharps injuries at your organization?

• Consultant system review.
• Injury reviews using software.
• Launches at product evaluation committee.
• High level support and motivation from CEO/Senior Management ; development
• f program specific protocol; reporting on incidence to staff through newsletter

and communication board; Safety topic as standing item on team meetings; 2 person check when removing/disposing sharps; Audits: Annual audits -Non-SEN audit- Accommodated nurses doing audits.

• Sharps containers
• On-line reporting -implementation of an electronic workplace occurrence

reporting system.

• follow up investigation by leaders

Additional methods of reducing sharps injuries

• Development of a sharps working group to review incidents and identify
• pportunities to improve incident reporting, safe work practices and awareness
• f sharps safety
• Review of products that are frequently involved in sharps exposure and

suggested replacements sought.

• Engagement of the Professional Practice group
• Process changes in the OR
• Training:- by medical device vendor; Annual training at Nursing fares -Refresher

training- Increased our education to new staff and students- Training- combination of e-learning and in-class training

• Outsourced our laundry
• Walk-about education campaign, in-service from product providers
• Mandatory assessment of the hazard and implementation of controls
• Provision of puncture-resistant gloves for housekeeping staff.

Implementing a Sharps Safety Program

1. Management support and leadership 2. Assess program needs 3. Develop program components 4. Implement the program 5. Evaluate the program

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PSHSA Survey: 69.3% of the responding hospitals have used PSHSA's Planning Guide to the Implementation of Safety Engineered Medical Sharps

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Evaluation

• Program Indicators
• Number of new devices implemented
• Number of training sessions
• Audit of staff acceptance/adherence to SEMS
• Program Outcomes
• Injuries
• Incidents
• Number of reports vs. previous reporting
• Use of rates?

PSHSA.ca @PSHSAca Public Services Health & Safety Association

• n LinkedIn

youtube.com/PSHSA 416-250-2131 (toll free: 1-877-250-7444)

Henrietta Van hulle hvanhulle@pshsa.ca