Occupational exposure to blood & body fluids in U.S. hospitals: Implications of national policy
Occupational exposure to blood and body fluids (BBF) is a major concern in healthcare, because of the risk of occupationally-associated infections (OAIs). In 2000, the Needlestick Safety and Prevention Act (NSPA) required OSHA to incorporate additional requirements to protect healthcare workers (HCWs) from exposure to BBF. As a nation, we saw needlesticks or percutaneous sharps injuries (PCSIs) decline, but it is uncertain if the decline also represented declines in other BBF exposures, specifically mucotaneous splash and splatter incidents (MSSIs). This study measures the implications of the NSPA and its incorporation into the OSHA BPS by determining whether the ratio of MSSIs to PCSIs (MSSI:PCSI) varied over three study periods: 1995-1999 (prior to NSPA), 2000-2002 (NSPA and OSHA promulgation), and afterwards, in 2003-2007; these comparisons were also made between high and low risk hospital areas. Over 30,000 exposure incidents from nearly 70 U.S. hospitals reporting into the Exposure Prevention Information Network (EPINet™*) were analyzed. Preliminary analysis of MSSI:PCSI indicated no difference by time period. Ratios were higher in low risk (e.g., patient rooms, radiology) compared to high risk hospital areas (e.g., operating room, obstetrics). Because personal protective equipment (PPE) protects workers from MSSI exposures, PPE use was also analyzed for all MSSIs across the study period. Counts and percentages were calculated for high versus low risk areas. For MSSIs, there was more frequent (75%) and a higher odds of PPE use (OR = 1.58, CI 1.35, 1.72) in high risk areas, as compared to low risk hospital areas (25%). The majority of MSSIs involved the eyes (79%) as compared to the nose (6%) and mouth (15%). Sixty-six percent of those incidents occurred in high risk areas. Additionally, appropriate incident-specific PPE use was analyzed and compared, meaning when eye incidents were identified, so was use of eye-appropriate PPE (e.g., eyeglasses, side shields, faceshields or goggles). Masks (31%) and eyeglasses with sideshields (26%) were most frequently worn appropriately in high risk areas, as compared to low risk (12% and 8% respectively). The odds of appropriately wearing masks (OR=1.41, CI 1.63-1.82) and eyeglasses (OR=1.97, CI 1.78, 2.57) were also greater in high as compared to low risk hospital areas. Eye-appropriate PPE was worn most frequently (65%) in high risk areas than other types of PPE type (nose or mouth) (5%). The results of this study suggest that, despite passage of a national policy and a decline in sharps injuries, there has been little change in the overall ratio of MSSIs to PCSIs. There are, however, differences between MSSI and PCSI in low compared to high risk hospital areas. HCWs working in low risk areas are not wearing PPE as frequently and appropriately as those in high risk areas, despite experiencing an MSSI. This study suggests that, whereas additional policy may not be necessary, perhaps a greater focus on preventing exposure incidents in low risk hospital areas is needed.
Occupational health|Public health|Public policy|Health care management
Mitchell, Amber Hogan, "Occupational exposure to blood & body fluids in U.S. hospitals: Implications of national policy" (2013). Texas Medical Center Dissertations (via ProQuest). AAI3611481.