The medical profession can be a risky business, and one of the main risks is exposure to infected blood. Smiths Medical has developed an innovative Safety Risk Assessment programme to help healthcare facilities to identify potential risks. Willy Winderickx, Preventieadviseur, Sint-Franciskusziekenhuis, Heusden-Zolder and Tony Wynen, Preventie en Bescherming, Mariaziekenhuis, Overpelt talk to Practical Patient Care about this assessment and the outcome.
About one million medical professionals and auxiliary staff experience a needle stick injury (NSI) each year in Europe, which can put them at risk of exposure to blood-borne pathogens. The European Directive 2010/32/EU was set forth to provide a safe working environment for the healthcare sector. Smiths Medical’s Safety Risk Assessment programme, which can help to identify potential risks, has resulted in a unique collaborative project with two Belgian hospitals.
Methods
The comprehensive risk assessment was completed in collaboration with Smiths Medical and the prevention advisers of both hospitals. It included an overview of institutional policies and procedures, a confidential hospital employee survey, analysis of the number of cases of exposure to blood-borne pathogens (no identifying information was provided to Smiths Medical) and department rounding.
The risk analysis comprised two parts. Part one calculated the level of risk using sharp injury probability and blood exposure severity. Probability scores (on a scale of 1-5) were established by calculating a standardised injury ratio (SIR), which was then used to calculate expected sharp injury rates using Belgian data. The severity risk score (1-4) was based on the amount of blood exposure: low (1) indicated an NSI with a sterile sharp object, or blood or body fluid coming into contact with intact skin; medium (2) meant exposure to non-intact skin or dermatitis; serious (3) was for blood splashes to the conjunctivae, IM injections, subcutaneous injections or a puncture from a suture needle; and critical (4) referred to injuries from a hollow bore needle, a cut from surgical instrument, or an NSI from blood collection or an IV catheter. The sharp injury probability and the blood exposure severity scores were multiplied to give a total score.
Part two addressed the elements of the EU directive. A score was calculated by multiplying the availability of policies/procedures by current system preparedness.
Results
In analysing the results of the confidential employee survey, knowledge gaps were identified in the following areas: procedures for protecting employees, reasons for not reporting exposure, personal experiences when an exposure was reported, and use of standard precautions. During rounding, safety issues such as overfilled needle containers, observations of re-capping or lack of personal protective equipment were immediately corrected.
Following the results of the Stick to Safety Risk Assessment, Sint-Franciskusziekenhuis expanded its safety provisions and reported an increased awareness of NSI reporting practices. After one year, NSI occurrences decreased by 16%. Further analysis of the NSIs showed that 50% of them occurred after using the needle, prompting awareness that immediate disposal is necessary to safeguard colleagues.
The Stick to Safety Risk Assessment at Mariaziekenhuis had a greater impact than any other awareness campaign, resulting in the lowest number of reported NSIs in the past ten years. Unit rounding and conversations with the staff had a positive effect, resulting in good work-practice standardisation throughout the hospital.
Conclusions
The staff and doctors at the two modern Belgian hospitals were positive and heavily involved in the risk assessment, which resulted in a three-phase action plan. In each phase, safe work practices, personal protective equipment and conversion to safety devices are implemented when potential risks are identified.
The Stick to Safety Risk Assessment has met current European and Belgian legislation concerning the protection of employees against risks of exposure to biological agents. It also proved to be a worthwhile time investment, as it has taught the institutions how they can bring about valuable improvements. Its success has also led to the planning of future campaigns.
All this goes to show that it is possible to make hospitals safer for all the people who work there.
