Occupational Exposures

[Redl, Leanne]

*Looking to review out of hours occupational exposure management. Which department and occupational group manage occupational exposures in (a) office hours and (b) out of office hours. For out of hours management whose responsibility is it to
*risk assess incident
*counsel and consent recipient and source (+ BBV risk assessment of source)
*follow up recipient and source

Leanne Redl
Clinical Nurse Consultant
Infection Prevention Surveillance Service
Tuesday/ Wedesday/ Friday
Ext 28325
Clinical Nurse Specialist
Intensive Care Unit
Monday/ Wednesday/ Friday
Ext 27209
Royal Melbourne Hospital

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[Wilson, Fiona L (Infection Control)]

We use our After Hours Administrators (nurses) and have done for many years. Our process is the same no matter what time of day the incident occurs – a quick outline of our process:

NSI to staff memeber who reports to IC (in hours) or AHA (out of hours).
Staff to ED for HepBsAB level and serum for storage (we either meet up with them in ED or back in their work area and explain the risks re BBV transmission and the follow up process. We do not test the staff member for BBV at the time of incident; we have their serum in storage so we can test at a later date if this is required.

Recipient bled for HIV, Hep C and Hep B – consent done by IC in hours (as we are accredited to do HIV consents) and by the covering RMO after hours. For pts who cannot consent (due to illness) we use Schedule 3 or 4 of the Health Act 1058 (although this has recently changed to the Health and Wellbeing act and I have not quite gone through it all to ensure the relevant section is Schedule 3 or 4 yet). We use interpreters for instances where we cannot speak the patients language; we never use the patients relatives/family etc for interpreting or for gaining consent – consent has to be given by the patient (or the Senior Authorised Medical Officer in cases where the patient is unable to consent due to illness).
We do not do individual risk assessments on all of our NSI – we treat them all the same irrespective of whether they were a significant injury (hollow bore needle used for taking blood etc) or less significant injury (insulin needle). We would only do a risk assessment if the source refuses to be bled or there is an unknown source and we always refer these staff directly to ID

In terms of follow up – we do it by exception so we tell the staff member that if there are any results that of concern they will be contacted that day (or night). These are really for staff who need PEP for Hep B or HIV exposure; they are contacted by Infectious Diseases Consultant (who is notified by micro). All other staff are requested to contact a particular medical officer for their HepBsAB results the next working day.

We have had this process in place for ~10 years now and have had no major issues.

Fiona Wilson
Manager, Infection Control
Western Health
Phone: 8345 6666 pager 506
Fax: 83456973
email: fiona.wilson@wh.org.au

—–Original Message—–
From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU]On Behalf
Of Redl, Leanne
Sent: Friday, 19 February 2010 8:35 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] Occupational Exposures

* Looking to review out of hours occupational exposure management. Which department and occupational group manage occupational exposures in (a) office hours and (b) out of office hours. For out of hours management whose responsibility is it to
* risk assess incident
* counsel and consent recipient and source (+ BBV risk assessment of source)
* follow up recipient and source

Leanne Redl
Clinical Nurse Consultant
Infection Prevention Surveillance Service
Tuesday/ Wedesday/ Friday
Ext 28325
Clinical Nurse Specialist
Intensive Care Unit
Monday/ Wednesday/ Friday
Ext 27209
Royal Melbourne Hospital

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[Michael Wishart]

Hi Joe

Have seen many and varied increases in exposures over the years, some related to devices (such as introduction of pen needles), some to changes in practice (increase in IM medication use due to drug changes). Also have seen increases due to better reporting (mainly in theatre areas with surgeons and anaesthetists).

Have worked in many facilities that use microscopes / loupes/ magnifying headsets and even robots, and not seen an increase in needlesticks or a cluster of needlesticks relating to use of these. Handling of any sharps during procedures is always an issue, and strategies surrounding this include good communication within the operating team (discussing sharps handling before the procedure is useful), use of safety devices where available, and use of transfer trays and safe zones. I would suggest that handling sharps where vision is limited comes mainly under the communication one, and partly also safe zones. A bit like not putting any part of your body over the zone in which hand suturing is occurring, to allow the operator to pull upwards safely with their stitch as needed. It is about raising awareness of staff involved in the procedure as to where the sharps may be, and what needs to happen to maintain safety.

Good luck with this.

Cheers
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email

Good morning everyone
Just curious to find out if any other healthcare facilities have ever experienced an abnormal increase in occupational exposures at any time? What were the common contributing factors and were they linked?

Also, for healthcare facilities that are performing surgery with microscopes or loupes – have you had occupational exposures when staff move sharps outside their field of vision? If you have, what strategies did you put in place to reduce the risk?

Thanks

Joe

Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

———————————————————————————————

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[Marilyn Harris]

Hi Joe,

I was laughing as I read your opening line “Just curious to find out …”.

I’m sure there’s a few of us who have noticed “abnormal” events.

This one had a common contributing factor.
A couple of years ago I noticed an abnormal increase in NSI and discovered that some nurses were using their fingers to remove the needle from the ‘insulin pen’ for patients.
The Product Information describes ‘how to safely remove the needle when a patient is not able to do so’ – however I discovered that the nurses had not read it.
So, I made a one-page poster with photographs, summarising that procedure and referring the nurses to the full Product Information.
The poster is displayed in the Medication Rooms, and I tell the story and show it at Orientation.
Those types of NSI now rarely occur.

There was also one week, in April a few years ago, when the OH&S Coordinator had daily reports of staff injuries and I received daily reports of occupational exposures. Really made us wonder what was going on. There were no common factors for facility or procedure or anything. Just a statistical blip?

Regards,
Marilyn

Marilyn Harris

CNC Infection Prevention | Population Health | Justice Health & Forensic Mental Health Network
Level One Dawn de Loas. Locked Bag 130 Silverwater Mail Centre, NSW 1811
Tel 02 9289 5482 | Pager 02 9937 2506 | Mob 0417 472 612 | Fax 02 9289 5486
marilyn.harris@justicehealth.nsw.gov.au
Our Values: Care, Clear Communication, Honesty, Professionalism, Respect

[Description: \jhintranetWWWimagesjhsig.jpg]

Good morning everyone
Just curious to find out if any other healthcare facilities have ever experienced an abnormal increase in occupational exposures at any time? What were the common contributing factors and were they linked?

Also, for healthcare facilities that are performing surgery with microscopes or loupes – have you had occupational exposures when staff move sharps outside their field of vision? If you have, what strategies did you put in place to reduce the risk?

Thanks

Joe

Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

———————————————————————————————

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[SAWMH.ICC]

Hi Marilyn and Joe,

A few year ago this was also the case here. We have now a policy in place, stating that in case a patient are not able to dial-up their own insulin pen, or are unable to remove the needle or administer the insulin for themselves, an insulin vial is ordered from the pharmacy and nurses use disposable syringes to administer it safely. The only time we see incidents now is when nurses don’t follow the policy.

Regards

Marlize Senekal
Infection Prevention and Control Coordinator
St. Andrew’s War Memorial Hospital
457 Wickham Terrace, Spring Hill
Brisbane
Ph. 07-3834 4444
Ext. 4328, Pg. 0328

________________________________

Hi Joe,

I was laughing as I read your opening line “Just curious to find out …”.

I’m sure there’s a few of us who have noticed “abnormal” events.

This one had a common contributing factor.
A couple of years ago I noticed an abnormal increase in NSI and discovered that some nurses were using their fingers to remove the needle from the ‘insulin pen’ for patients.
The Product Information describes ‘how to safely remove the needle when a patient is not able to do so’ – however I discovered that the nurses had not read it.
So, I made a one-page poster with photographs, summarising that procedure and referring the nurses to the full Product Information.
The poster is displayed in the Medication Rooms, and I tell the story and show it at Orientation.
Those types of NSI now rarely occur.

There was also one week, in April a few years ago, when the OH&S Coordinator had daily reports of staff injuries and I received daily reports of occupational exposures. Really made us wonder what was going on. There were no common factors for facility or procedure or anything. Just a statistical blip?

Regards,
Marilyn

Marilyn Harris

CNC Infection Prevention | Population Health | Justice Health & Forensic Mental Health Network
Level One Dawn de Loas. Locked Bag 130 Silverwater Mail Centre, NSW 1811
Tel 02 9289 5482 | Pager 02 9937 2506 | Mob 0417 472 612 | Fax 02 9289 5486
marilyn.harris@justicehealth.nsw.gov.au
Our Values: Care, Clear Communication, Honesty, Professionalism, Respect

[cid:image002.jpg@01CDF996.A9A64830]

Good morning everyone
Just curious to find out if any other healthcare facilities have ever experienced an abnormal increase in occupational exposures at any time? What were the common contributing factors and were they linked?

Also, for healthcare facilities that are performing surgery with microscopes or loupes – have you had occupational exposures when staff move sharps outside their field of vision? If you have, what strategies did you put in place to reduce the risk?

Thanks

Joe

Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

———————————————————————————————

Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children’s Hospital Network (Randwick Campus) Confidentiality Notice

This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.

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[Joe-Anne Bendall]

Hi. Thanks for your comments. It has been an interesting time for us, as each of the incidents were different the only common factor has been fatigue.

Thanks

Joe

Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital| ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of SAWMH.ICC
Sent: Thursday, 24 January 2013 7:27 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Occupational Exposures

Hi Marilyn and Joe,

A few year ago this was also the case here. We have now a policy in place, stating that in case a patient are not able to dial-up their own insulin pen, or are unable to remove the needle or administer the insulin for themselves, an insulin vial is ordered from the pharmacy and nurses use disposable syringes to administer it safely. The only time we see incidents now is when nurses don’t follow the policy.

Regards

Marlize Senekal
Infection Prevention and Control Coordinator
St. Andrew’s War Memorial Hospital
457 Wickham Terrace, Spring Hill
Brisbane
Ph. 07-3834 4444
Ext. 4328, Pg. 0328

________________________________
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Marilyn Harris
Sent: Wednesday, 23 January 2013 17:38
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Occupational Exposures
Hi Joe,

I was laughing as I read your opening line Just curious to find out ….

Im sure theres a few of us who have noticed abnormal events.

This one had a common contributing factor.
A couple of years ago I noticed an abnormal increase in NSI and discovered that some nurses were using their fingers to remove the needle from the insulin pen for patients.
The Product Information describes how to safely remove the needle when a patient is not able to do so however I discovered that the nurses had not read it.
So, I made a one-page poster with photographs, summarising that procedure and referring the nurses to the full Product Information.
The poster is displayed in the Medication Rooms, and I tell the story and show it at Orientation.
Those types of NSI now rarely occur.

There was also one week, in April a few years ago, when the OH&S Coordinator had daily reports of staff injuries and I received daily reports of occupational exposures. Really made us wonder what was going on. There were no common factors for facility or procedure or anything. Just a statistical blip?

Regards,
Marilyn

Marilyn Harris

CNC Infection Prevention | Population Health | Justice Health & Forensic Mental Health Network
Level One Dawn de Loas. Locked Bag 130 Silverwater Mail Centre, NSW 1811
Tel 02 9289 5482 | Pager 02 9937 2506 | Mob 0417 472 612 | Fax 02 9289 5486
marilyn.harris@justicehealth.nsw.gov.au
Our Values: Care, Clear Communication, Honesty, Professionalism, Respect

[cid:image002.jpg@01CDF996.A9A64830]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Joe-Anne Bendall
Sent: Wednesday, 23 January 2013 7:31 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Occupational Exposures

Good morning everyone
Just curious to find out if any other healthcare facilities have ever experienced an abnormal increase in occupational exposures at any time? What were the common contributing factors and were they linked?

Also, for healthcare facilities that are performing surgery with microscopes or loupes have you had occupational exposures when staff move sharps outside their field of vision? If you have, what strategies did you put in place to reduce the risk?

Thanks

Joe

Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital| ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

———————————————————————————————

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This email message has been virus-scanned. Although no computer viruses were detected, Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children’s Hospital Network (Randwick Campus) accept no liability for any consequential damage resulting from email containing any computer viruses.

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Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

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