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OSHA cracks down, cuts OR injuries
TN OSHA expects safer practices
It is notoriously difficult to convince surgeons to change their methods and tools in the operating room to improve sharps safety. But in Tennessee, stubbornness is apt to lead to a citation from the Tennessee Occupational Safety and Health Administration (TOSHA).
A "special emphasis program" honed in on the bloodborne pathogen hazards in the operating room, and TOSHA has made it clear that they expect to see safe work practices (such as double-gloving and hands-free passing of instruments) and safer devices (such as blunt suture needles and safety engineered scalpels).
From October 2006 to October 2010, TOSHA conducted 175 inspections and issued 1,280 citations for serious hazards, 10 for repeat hazards, and 57 for other than serious hazards. The total fines: $587,000. Needless to say, those citations have received some attention, and they have made a difference. TOSHA's modest goal was to reduce sharps injuries in the state's hospitals and ambulatory surgery centers by 10% over five years. In four years, the sharps injuries dropped by 14.5% in hospitals and by 17.1% in surgery centers. The reductions came despite an emphasis on better recordkeeping.
"There's an increased awareness. Most everybody's on board," says Jan Cothron, manager of health compliance at TOSHA in Nashville.
Cothron and her colleagues knew it would be a challenge to address sharps safety in the OR. For example, an analysis of sharps injury data showed that injuries rose by 6.7% in the OR from 1993 to 2006 while they declined by 31.6% elsewhere in the hospital. Cothron knows the burden of needlesticks, both in actual costs and in repercussions for the health care worker. She was stuck 34 years ago when she managed a blood-testing lab for a doctor's office. She was pregnant at the time but never reported the injury. She worried, over the years, that the source patient had hepatitis, but she was never tested.
As she travels the state, Cothron also hears from healthcare workers who have had needlesticks and have contracted hepatitis B or C. "We're trying to stop these [events] however we can," she says.
ORs must comply with law
Since the federal Needlestick Safety and Prevention Act was passed in 2000 and the U.S. Occupational Safety and Health Administration beefed up its Bloodborne Pathogen Standard, safety needles have become commonplace. Everywhere, that is, except the OR.
Tennessee has its own law, passed in 1999, which requires the use of safety devices and the reporting of sharps injuries within six days of an incident. "People are not complying with this law," Cothron says bluntly. TOSHA's job was to make sure they complied, through awareness, compliance assistance, and enforcement, she says.
Cothron began by obtaining baseline data. TOSHA requested submission of sharps injury logs from the state's 161 hospitals and 158 ambulatory surgery centers. The logs and previous inspections revealed common problems, including removing scalpel blades with forceps or hands, hand-washing contaminated surgical instruments without cut-resistant gloves, failure to use safer devices, hands-free passing or double-gloving, and lack of compliance by anesthesiologists and surgeons.
TOSHA offered free seminars across the state and compliance assistance. The agency also created randomized inspection lists of hospitals and surgery centers. "We developed a checklist and provided it to participants" to indicate what TOSHA would look for in inspections, says Cothron. "Are people double gloving where they can? Are they using blunt tip suture needles where appropriate? "We're interviewing employees to find out if these [measures] that are in written programs are being implemented."
If surgical kits came with non-safety devices, TOSHA informed hospitals and surgery centers that they must replace those items with a safety-engineered device. Exceptions to using safety-engineered devices needed to be explained in writing, and they needed to be specific to a procedure. After all, the American College of Surgeons has endorsed the use of blunt suture needles and safety scalpels.
"We've had hospitals tell surgeons, 'It's a condition of employment at our hospital,'" says Cothron.
This tough stance has paid off. From 2009 to 2010, TOSHA found that sharps injuries stayed steady or declined at 106 out of 161 (65%) hospitals and 125 out of 158 (80%) ambulatory surgery centers. Some individual facilities had dramatic results. One hospital system experienced a 58% decrease in suturing injuries from 2001 to 2010, Cothron says.
"Overall, it's made work safer for the employees," she says.