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Tracking BBF Exposures: The Implementation of the Exposure Prevention Information Network (EPINet™ at VIHA)
July 2006
| Principal Investigator: | Annalee Yassi (Occupational Health and Safety Agency for Healthcare in B.C.) and Philip Bigelow (University of British Columbia) |
| Co-investigators: | Robert Hogg (University of British Columbia); Janine Jagger (University of Virginia) |
For more information about this study please contact George Astrakianakis.
Issue
Blood and body fluid (BBF) exposures present a major risk to health care workers. Injuries from needle sticks and other sharp objects, as well as splashes of blood or body fluids, can expose health care workers to pathogens such as human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV).
These exposures can be minimized through a BBF Exposure Control Plan (ECP) that includes a good system for tracking exposure incidents. The aim of this project was to lay the foundation for an effective BBF ECP within the Vancouver Island Health Authority by implementing a tracking system called the Exposure Prevention Intervention Network (EPINet™) system, the gold standard in BBF surveillance. As a separate study, a questionnaire survey was also conducted to gather additional data regarding baseline (pre ECP implementation) worker perceptions of risk and about the reporting and occurrence of BBF injuries.
Key findings
- A total of 1,577 BBF exposures were reported in VIHA between January 1, 2000 and November 14, 2005.
- Nurses as a group reported the highest total number of BBF exposures due to injuries from needle sticks and other sharp objects as well as from splash injuries.
- Laboratory workers had the highest exposure incidence when calculated as an injury rate.
- Other occupations that do not normally handle needles or other sharp instruments incurred almost 25% of the reported needle stick and other sharp object injuries.
- Exposure incidents often occurred without the use of personal protective equipment or appropriate safety procedures.
- There is significant underreporting of BBF exposures.
Objectives
- To implement the EPINet™ system within VIHA and integrate it into the existing WHITE™ database.
- To use the EPINet™ system to collect preliminary data within VIHA.
Method
The EPINet™ system was installed and data collection and analysis procedures were established. A pre-implementation survey of workers was conducted in 2003-2004 using a questionnaire that gathered data on BBF exposure risk factors, rates of near-misses, exposures and reporting of exposures.
Historical BBF-related data from January 1, 2000 to September 30, 2004 were converted and integrated into the database. After entering the historical data, collection of current data using the EPINet™ system began.
Exposure rates were calculated for three VIHA facilities using bed occupancy data. This allowed for comparisons of rates between these facilities, as well as with other B.C. health authorities and international data published by the International Healthcare Worker Safety Center at the University of Virginia.
Results
- A total of 1,577 BBF exposures were reported in VIHA between January 1, 2000 and November 14, 2005.
- Data suggest that the greatest exposure is in the acute care setting, with exposures also occurring in long-term care and community settings.
- The largest number of injuries occurred in the following settings: operating room, surgical, general medical and Intensive Care Unit (ICU).
- Nurses as a group reported the highest total number of BBF exposures due to injuries from needle sticks and other sharp objects as well as from splash injuries.
- Laboratory workers had the highest exposure incidence when calculated as an injury rate.
- Other occupations that do not normally handle needles or other sharp instruments incurred almost 25% of the reported needle stick and other sharp object injuries.
- Personal protective equipment was in use in less than 10% of the BBF splash exposures.
- Almost one third of reported needle stick and sharp object injuries occurred during the disposal of sharps, recapping a needle or due to a sharp device being left in an inappropriate location.
- Questionnaire data indicated that many BBF exposures are not reported. For example, over 80% of the needlestick injuries to nurses were unreported. One cause of underreporting is the exclusion of doctors and contracted workers from the tracking system when they are not directly employed by VIHA.
Conclusions
The project has demonstrated the successful implementation of the EPINet™ system for monitoring BBF exposure incidents at the health authority level in B.C., as well as its integration into the existing Workplace Health Indicator Tracking and Evaluation (WHITE™) database developed by the Occupational Health and Safety Agency for Healthcare (OHSAH).
The data suggest there is often inadequate use of personal protective equipment, particularly for BBF splash exposures.Future directions
The WHITE™ EPINet™ system will be used in future to continue monitoring BBF exposures and efforts in prevention and post exposure intervention. A BBF Exposure Control Plan for VIHA that will involve the use of the WHITE™ EPINet™ system is in development, and this work is being supported by OHSAH.
Another critical use of the system for future development is monitoring and evaluating the effectiveness of safety engineered devices being implemented within VIHA. Using the existing features of the WHITE™ EPINet™ system, the health authority will be able to track incidents according to the type of device used. To enhance the value of the system, work is also needed to improve reporting of exposures and to implement the data linkage that would allow additional analysis of injury rates and economic impacts of exposures.
Future research is also needed on the root causes of BBF injuries as well as ways to improve the promotion of safety culture within health organizations, in order to improve the prevention of BBF injuries. A WorkSafeBC-funded study is currently underway examining worker perceptions of risk of BBF-related injury after the implementation of an ECP and safe needle technology to reduce the risk of exposure.
Publications and conference presentations
Results were presented at: The 12th Conference on Occupational Hazards to Health Care Workers: Narrowing the Knowledge and Action Gaps. September 13 – 14, 2006, Seattle, Washington.