Occupational Exposure to Blood
Occupational Exposure to Blood
It wasn’t enough simply to caution healthcare practitioners to be careful with needles. It was the widespread availability of safety-engineered devices and the passage of safety legislation that really drove hospitals to take action. Today, the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), requires healthcare institutions to identify, evaluate and implement safer medical devices to protect their workers against needlestick injuries (NSIs) and occupational exposure to blood, referred to as bloodborne pathogens (BBPs).
Even though it is common knowledge that you can contract a virus from an infected patient’s needle, there is still a surprisingly high acceptance for occupational exposure to blood from device splatter, leakage and spills. The limited availability of blood control catheter technologies have left many clinicians accepting blood exposure as part of the job. As a result, there is a tendency for clinicians to incur unnecessary risk and believe that the risk of Mucocutaneous Exposure (MCE) to blood and bodily fluid is low. There is a pervasive attitude of “it won’t happen to me.” A recently published article on the reporting of occupational exposure to blood and bodily fluids shows that of the 23% of healthcare workers that have had a MCE, 83% went unreported.
The Needlestick Safety and Prevention Act became law in 2000, requiring that healthcare facilities create, maintain and update information on commercially available blood control catheters and technology designed to eliminate or minimize occupational exposure to bloodborne pathogens. As new technology becomes available, healthcare facilities are required to solicit and document input from healthcare workers with direct patient contact. In 2001, OSHA revised the Bloodborne Pathogens Standard to require:
Healthcare workers to use safer medical devices in order to reduce the risk of injury from needlesticks and other sharp medical instruments
Healthcare workers to keep a record of injuries from needlesticks and other sharp medical instruments in a sharps injury log
Healthcare workers to be involved in the identification, evaluation and selection of safe needles and sharp devices.
A recent report from the International Healthcare Worker Safety Center at the University of Virginia shows that nurses are at greatest risk, experiencing nearly 50% of reported occupational exposure to blood or bodily fluid. According to this report, the average blood and body fluid (BBF) exposure rate was 7.4 per 100 occupied beds. Today, there is agreement among experts that healthcare settings have become much safer environments for workers and patients. At the same time, these experts ask what more can be done.
The CDC estimates that each year 385,000 needlesticks and other sharps-related injuries are sustained by hospital-based healthcare personnel, an average of 1,000 sharps injuries per day. Although healthcare workers can be exposed to more than 60 pathogens, three are of most concern, including HIV, hepatitis B (HBV) and hepatitis C (HCV). That’s because these are the most likely to be transmitted through percutaneous injuries and because they can cause severe illness.
It is often unknown what type of pathogens any particular patient may harbor; so every time a clinician starts an IV using a traditional PIVC, they are putting themselves at risk for the consequences of occupational exposure to blood. Healthcare workers underestimate the risk of viral transmission, even when a patient is known to be Hepatitis (HVB or HCV) positive. Poor compliance with the use of personal protective equipment (PPE) has been a longstanding problem. Ninety-eight percent of the respondents to a recent survey of safety professionals said they had observed workers in their organizations who failed to wear the necessary PPE at some point while on the job.
Patients are also sensitive to blood exposure. The sight of their own blood is distressing and leads them to question the level of skill of the clinician starting the IV. Considering that more than 300 million PIVCs are placed each year in U.S. hospitals, the toll on workers, patients and healthcare organizations is high.
During a traditional IV insertion, clinicians are still not protected completely from possible occupational exposure to bloodborne pathogens (BBP). With active needle safety technology, the user needs to do something to “make it safe.” And during IV catheter insertions, blood often leaks out of the end of the catheter as the clinician makes the connection between the catheter and extension tubing. Healthcare workers do what they can to prevent occupational exposure to blood, but they are not always successful. Complete and reliable occlusion, or the compression of the vessel to stop blood flow during the process, is technique-dependent and often not achieved during IV catheter insertion. In one recent study occlusion was successful at preventing leakage only about 40% of the time.
The rest of the time, amounts anywhere from a few drops up to pools of blood leak out, requiring the high cost of extra supplies and interruptions in nursing workflow in order to clean up the blood spills. Until recently, availability of blood-control technology for short-peripheral IV catheters was extremely limited.
Infection and Viruses
The implications for the safety of healthcare workers are tremendous. As an example, HBV can persist in the environment for prolonged periods and can remain infective in dried blood at room temperature for more than a week. Infective concentrations of HBV have been detected on environmental surfaces in the absence of visible blood. Its ability to remain stable outside the human host supports other evidence that HBV infection may occur through direct and indirect means of transmission.
At the end of 2008, the Centers for Disease Control (CDC) estimated that 1,178,350 persons in the United States were living with HIV infection. And in 2009, the organization estimated that 3.2 million persons in the United States alone have chronic HCV infection. These devastating statistics have strengthened the need for blood control catheters and technology.
When contamination of other surfaces such as bed rails, scrubs, shoes, floors or equipment happens, blood residue can be transferred to healthcare workers, housekeeping staff and visitors who might come in contact with these surfaces. Pathogens can also be taken home on a clinician’s shoes or scrubs. Because of evidence linking outbreaks directly to the handling of healthcare laundry, recommendations have been made that hospital linens be laundered, shipped and stored in a manner that minimizes exposure to environmental contaminants. Cross contamination often results because nurses are busy, hospitals are understaffed, there are too many patients who demand immediate medical attention, and not enough housekeeping staff is assigned.
Management of blood splatter and blood leakage is costly, time consuming and a burden to most clinicians. There has been a recent proliferation in the marketplace of new “blood control” PIVCs, or blood control catheters, to address the problem of continued occupational exposure to blood for healthcare workers. Most of these new devices use a valve technology in the catheter to prevent blood leakage that only works one time. If the clinician draws blood as part of the IV insertion procedure, which is very common practice, they still must occlude the vein before attaching extension tubing in order to prevent blood leakage from the hub.
An integrated IV catheter system offering closed system blood control with passive needle encapsulation is the most effective form of blood containment. The NovaCathTM Integrated IV Catheter system, a cutting-edge blood control catheter, integrates pre-attached tubing and a multi-use clamp to allow complete blood control. It is a closed system that features integrated IV stabilization technology, full needle encapsulation, and passive needle safety. The passive safety feature requires no additional steps to activate and prevents the user from bypassing the safety mechanism. The NovaCath passive safety technology with complete needle encapsulation is designed to increase healthcare worker safety and ensures the highest level of compliance with OSHA sharps safety regulations. In addition, the NovaCath’s advanced tubing management provides a 180-degree fluid path turn that eliminates the external “J-Loop.” This fluid path turn minimizes potential complications associated with tubing snags and PIVC dislodgement, including the risk of occupation exposure to blood.
NovaCath is the only FDA 510(k) cleared Safety IV Catheter system and patent protected technology that uniquely offers Advanced Catheter Stabilization, Next Generation Tubing Management and Passive Needle Encapsulation. To view a demo video, click here.