INTERNATIONAL HEALTHCARE WORKER SAFETY CENTER, January 2009

EPINet Report:

2006 Percutaneous Injury Rates

By Jane Perry, M.A., Ginger Parker, M.B.A., and Janine Jagger, M.P.H., Ph.D. I N 2006, T H E I N T E R N AT I O N A L 2006 EPINet Data Findings rates: two facilities had a zero PI Healthcare Worker Safety Center at In 2006, a total of 950 percuta- rate, while four facilities had rates the University of Virginia collected neous injuries (PIs) were reported by over 50 per 100 occupied beds. data on percutaneous injuries and network facilities. The 2006 data The reasons for such variation are blood and body fluid exposures from yielded these findings (the following not fully understood, but may in33 healthcare facilities in the United rates exclude injuries that occurred clude the mix of patients, injury States that use the EPINet surveil- before use): underreporting rates, the extent to lance program to track which a facility has exposure incidents. converted to safety U.S. EPINet 2006 These facilities volundevices, and whether tarily participate in the it is a teaching or nonPercutaneous Injury Rates 33 healthcare facilities (9 teaching, 24 nonteaching) collaborative EPINet teaching institution. Teaching hospitals: average daily census = 2,274; total injuries = 760 Non-teaching hospitals : average daily census = 1,125; total injuries = 190 network coordinated Because of these 100 by the Center, and variables, we cannot 90 their exposure data assume that a 80 are combined into an healthcare facility with 70 60 aggregate database. a low PI rate neces50 The 2006 percutanesarily has a better 40 33 .42 ous injury report and safety record than a 30 16.88 blood and body fluid hospital with a higher 20 10 exposure report are rate. For example, a 0 presented on pages 3 hospital with a high PI Teaching hospitals Nonteaching hospitals and 4, and a list of the rate may do a better facilities that contribjob of educating its International Healthcare Worker Safety Center, University of Virginia, Charlottesville, VA uted data can be found employees about the on page 2. need to report Most of these facilities are part The overall percutaneous injury needlestick injuries or may have of a state-wide network in South rate for all network hospitals was more patients requiring invasive proCarolina coordinated by Palmetto 27.94 PIs per 100 occupied beds. cedures than another facility with a Hospital Trust Services; the others The average PI rate for teaching lower rate. For that reason, comare located in Virginia, Pennsylva- hospitals was 33.42 injuries per 100 paring rates among hospitals may nia, and Nebraska. Nine of the fa- occupied beds. not be very meaningful. It is more cilities are teaching hospitals, and The average PI rate for nonteach- reliable to track injury trends within 24 are nonteaching facilities. ing facilities was 16.88 injuries per a single institution over several Most of the facilities are acute- 100 occupied beds years, and make historical comparicare or tertiary-care hospitals or By comparison, in 2005 the av- sons as prevention measures are medical centers, some of which erage PI rate for teaching hospitals was implemented. have physicians offices, home 34.49 per 100 occupied beds, and for health agencies and other outpatient nonteaching facilities, 15.23 per 100 Blood and Body Fluid Exposettings affiliated with them. Among occupied beds. Thirty-five facilities re- sures the participating facilities is an al- ported data in 2005; the total number In 2006, a total of 250 blood and cohol and drug abuse agency, a of PIs was 1,033. body fluid exposures (BBF) were relong-term acute-care facility, a EPINet data from 2006, as in ported by network facilities. The 2006 skilled nursing facility, and a reha- previous years, revealed great varia- data yielded these findings: bilitation hospital. tion among individual facilities in PI The average blood and body fluid
(* Occupied beds is defined as the ADC for the same year in which the data were collected.)
# of percutaneous injuries per 100 occupied bed s per year

(continued on page 2)

INTERNATIONAL HEALTHCARE WORKER SAFETY CENTER, January 2009

EPINet 2006 Percutaneous Injury Rates (Continued from page 1) (BBF) exposure rate was 7.35 per 100 occupied beds. The average BBF exposure rate for teaching hospitals was 8.44 per 100 occupied beds. The average BBF exposure rate for non-teaching hospitals was 5.15 per 100 occupied beds. By comparison, in 2005 the average BBF rate for teaching and non-teaching facilities was 7.36 per 100 occupied beds. Thirty-five facilities reported BBF data in 2005; the total number of BBF exposures was 286.

U.S. EPINet 2006 Blood and Body Fluid Exposure Rates

33 healthcare facilities (9 teaching, 24 nonteaching) Teaching hospitals: average daily census = 2,274; total exposures = 192 Non-teaching hospitals: average daily census = 1,125; total exposures = 58

50
# of BBF exposur es per 100 occupied beds per year

40 30 20 10 0
8.44

5.15

Teaching hospitals

Nonteaching hospitals

International Health Care Worker Safety Center, University of Virginia, Charlottesville, VA

EPINet Network Hospitals and Healthcare Facilities, 2006

In 2006, 33 hospitals and healthcare facilities participated in a voluntary EPINet data-sharing network coordinated by the International Healthcare Worker Safety Center. For each year of data, we publish an updated list of the participating facilities; we gratefully acknowledge their efforts and contributions. Martha Jefferson Hospital (Charlottesville, VA); Medical University of South Carolina (Charleston, SC); Saint Joseph Hospital (Omaha, NE); Saint Vincent Health Center (Erie, PA). Palmetto H o s p i ta l Tr u s t Needlestick Prevention Demonstration Project, South Carolina (Ed Hall, Rebecca Bender, network coordinators) Abbeville County Memorial Hospital (Abbeville, SC); Allendale County Hospital (Fairfax, SC); Anderson Area Medical Center (Anderson, SC); Bamberg County Memorial Hospital (Bamberg, SC); Barnwell County Hospital (Barnwell, SC); Beaufort Memorial Hospital (Beaufort, SC); Cannon Memorial Hospital (Pickens, SC); Clarendon Memorial Hospital (Manning, SC); Conway Medical Center (Conway, SC); Fairfield Memorial Hospital (Winnsboro, SC); Greenville Memorial Hospital (Greenville, SC); Greenville Hospital System (GHS)Allen Bennett Memorial Hospital (Greer, SC); GHS-Hillcrest Hospital (Simpsonville, SC); GHS-Marshall I. Pickens Hospital (Greenville, SC); GHS-Roger C. Peace Rehabilitation Hospital (Greenville, SC); GHSRoger Huntington Nursing Center (Greer, SC); Kershaw County Medical Center (Camden, SC); Laurens County Hospital (Clinton, SC); Lexington/Richland Alcohol & Drug Abuse Council (West Columbia, SC); Loris Community Hospital (Loris, SC); Marion Regional Healthcare System (Marion, SC); Newberry County Memorial Hospital (Newberry, SC); Patewood Memorial Hospital (Greenville, SC); The Regional Medical Center of Orangeburg and Calhoun Counties (Orangeburg, SC); Self Regional Healthcare (Greenwood, SC); Spartanburg Hospital for Restorative Care (Spartanburg, SC); Spartanburg Regional Medical Center (Spartanburg, SC); Tuomey Regional Medical Center (Sumter, SC); Union Hospital DistrictWallace Thomson Hospital (Union, SC ).

INTERNATIONAL HEALTHCARE WORKER SAFETY CENTER, January 2009

Uniform Needlestick and Sharp-Object Injury Report

U.S. EPINet Network, 2006, 33 healthcare facilities*
126 149 11 344 6 16 74 16 38 14 40 2 1 21 5 6 1 3 12 63 233 6 91 70 333 66 5 33 11 9 6 36 5 43 13.3% 15.7% 1.2% 36.3% 0.6% 1.7% 7.8% 1.7% 4.0% 1.5% 4.2% 0.2% 0.1% 2.2% 0.5% 0.6% 0.1% 0.3% 1.3% 6.7% 24.6% 0.6% 9.6% 7.4% 35.2% 7.0% 0.5% 3.5% 1.2% 1.0% 0.6% 3.8% 0.5% 4.5% Recapping device 24 Withdrawing device from resistant material 18 Other after use, before disposal 102 Putting device into disposal container 49 After disposal, from device: - protruding from disposal container 5 - piercing side of disposal container 2 - left on/near disposal container 2 - left on floor, table or other inappropriate place 56 - protruding from trash bag or inappropriate disposal container 8 Restraining patient 6 Other 75 TYPE OF DEVICE CAUSING INJURY: Disposable syringe 266 Prefilled cartridge syringe 21 Blood gas syringe 14 Syringe, other type 2 Needle on I.V. tubing 6 Winged steel needle 51 I.V. catheter (stylet) 26 Vacuum tube blood collection needle 26 Spinal or epidural needle 1 Unattached hypodermic needle 6 Arterial catheter introducer needle 4 Central line catheter introducer needle 6 Drum catheter 1 Other vascular catheter needle 3 Other non-vascular catheter needle 1 Needle, unknown type 7 Needle, describe 44 Lancet 11 Suture needle 199 Scalpel, reusable 35 Scalpel, disposable 42 Razor 7 Scissors 7 Bovie electrocautery device 14 Bone cutter 1 Towel clip 4 Trocar 1 Fingernails/teeth 3 Retractors, skin/bone hooks 8 Staples/steel sutures 7 Wire 18 Pin 4 Drill bit 7 Pickups/forceps/hemostats 4 Sharp item, not sure what kind 3 Other sharp item (describe) 36 Medication ampule 2 Medication vial 1 Pipette, glass 1 Vacuum tube, glass 1 Glass slide 2 Glass item, unknown type 2 Other glass item 2 2.6% 1.9% 10.9% 5.2% 0.5% 0.2% 0.2% 6.0% 0.9% 0.6% 8.0% 29.3% 2.3% 1.5% 0.2% 0.7% 5.6% 2.9% 2.9% 0.1% 0.7% 0.4% 0.7% 0.1% 0.3% 0.1% 0.8% 4.9% 1.2% 21.9% 3.9% 4.6% 0.8% 0.8% 1.5% 0.1% 0.4% 0.1% 0.3% 0.9% 0.8% 2.0% 0.4% 0.8% 0.4% 0.3% 4.0% 0.2% 0.1% 0.1% 0.1% 0.2% 0.2% 0.2% SOURCE PATIENT IDENTIFIABLE? Yes 890 No 32 Unknown 20 Not available 3

Total cases = 950 (excludes injuries before use); total avg. daily census = 3,400 (*9 teaching/24 nonteaching hospitals)
JOB CATEGORY: M.D. (attending/staff) M.D. (intern/resident/fellow) Medical student Nurse RN/LPN Nursing student Respiratory therapist Surgery attendant Other attendant Phlebotomist/venipuncture/ I.V. team Clinical laboratory worker Technologist (non-lab) Dentist Dental hygienist Housekeeper Paramedic CNA/HHA Laundry worker Security Other student Other WHERE INJURY OCCURRED: Patient room Outside patient room Emergency department Intensive/critical care unit Operating room Outpatient clinic/office Venipuncture Procedure room Clinical laboratories Autopsy/pathology Service/utility area Labor and delivery Home-care Other

94.2% 3.4% 2.1% 0.3%

INJURED WORKER ORIGINAL USER OF SHARP ITEM? Yes 601 64.3% No 312 33.4% Unknown 6 0.6% N/A 16 1.7% SHARP ITEM CONTAMINATED? Yes No Unknown 874 9 56 93.1% 1.0% 6.0%

IF INJURY WAS CAUSED BY A NEEDLE, WAS IT A SAFETY DESIGN? Yes 318 35.8% No 532 59.9% Unknown 38 4.3% IF YES, WAS SAFETY FEATURE ACTIVATED? Yes, fully 24 8.5% Yes, partially 63 22.3% No 196 69.3% IF YES (NEEDLE WAS SAFETY DESIGN), DID INJURY HAPPEN: Before activation of safety feature 173 65.5% During activation of safety feature 54 20.5% After activation of safety feature 37 14.0% DEPTH OF INJURY: Superficial (little/no bleeding) Moderate (skin punctured, some bleeding) Severe (deep stick/cut, profuse bleeding) BODY PART INJURED: Arm Face/head Foot Front Hand, left Hand, right Leg 615 293 30 20 2 4 4 543 338 10 65.6% 31.2% 3.2% 2.2% 0.2% 0.4% 0.4% 59.0% 36.7% 1.1% 65.0% 23.0% 11.9%

ORIGINAL PURPOSE OF SHARP DEVICE: Unknown, N/A 29 3.1% Injection, IM/subcutaneous 214 22.8% Heparin or saline flush 2 0.2% Other injection/aspiration I.V. 21 2.2% Connect I.V. line 3 0.3% Start I.V. or heparin lock 42 4.5% Draw venous blood sample 109 11.6% Draw arterial blood sample 20 2.1% Obtain body fluid/tissue sample 17 1.8% Fingerstick/heel stick 13 1.4% Suturing 210 22.4% Cutting (surgery) 82 8.7% Electrocautery 14 1.5% Contain specimen/pharmaceutical 5 0.5% Place arterial line 20 2.1% Drilling 7 0.7% Other 130 13.9% WHEN INJURY OCCURRED: During use of device Between steps of multistep procedure Disassembling device Preparing instrument for reuse 406 144 22 20 43.2% 15.3% 2.3% 2.1%

GLOVESDid sharp item penetrate: Single pair of gloves 588 Double pair of gloves 208 No gloves 108

INTERNATIONAL HEALTHCARE WORKER SAFETY CENTER, January 2009

U.S. EPINet Network, 2006, 33 healthcare facilities*

Total cases = 250; total avg. daily census = 3,400 (*9 teaching/24 nonteaching hospitals)
JOB CATEGORY: M.D. (attending/staff) M.D. (intern/resident/fellow) Medical student Nurse RN/LPN Nursing student Respiratory therapist Surgery attendant Other attendant Phlebotomist/venipuncture/ I.V. team Clinical laboratory worker Technologist (non-lab) Housekeeper Paramedic Other student CNA/HHA Security Other, describe WHERE EXPOSURE OCCURRED: Patient room Outside patient room Emergency department Intensive/critical care unit Operating room Outpatient clinic/office Blood bank Dialysis Procedure room Clinical laboratories Autopsy/pathology Labor and delivery Home-care Other, describe 15 25 4 105 5 7 10 6 4 6 15 2 6 4 6 6 23 77 4 35 36 40 7 2 1 13 4 3 14 2 12 6.0% 10.0% 1.6% 42.2% 2.0% 2.8% 4.0% 2.4% 1.6% 2.4% 6.0% 0.8% 2.4% 1.6% 2.4% 2.4% 9.2% 30.8% 1.6% 14.0% 14.4% 16.0% 2.8% 0.8% 0.4% 5.2% 1.6% 1.2% 5.6% 0.8% 4.8% EXPOSED PART(s): (more than one item can be checked) Intact skin 59 23.6% Non-intact skin 43 17.2% Eyes (conjunctiva) 154 61.6% Nose (mucosa) 12 4.8% Mouth (mucosa) 29 11.6% Other exposed parts 7 2.8% DID THE BLOOD OR BODY FLUID: (more than one item can be checked) Touch unprotected skin 197 Touch skin through gap between protective garments 32 Soak through protective garment 6 Soak through clothing 4 LENGTH OF TIME BBF IN CONTACT WITH SKIN OR MUCOUS MEMBRANE: Less than 5 minutes 179 74.3% 5-14 minutes 35 14.5% 15 minutes-1 hour 18 7.5% More than 1 hour 9 3.7% AMOUNT OF BBF THAT CAME IN CONTACT WITH SKIN OR MUCOUS MEMBRANE: Small amount (up to 5 cc) 221 92.9% Moderate amount (up to 50 cc) 14 5.9% Large amount (more than 50 cc) 3 1.3% EXPOSURE LOCATION Largest exposure: Arm Face/head Front Hand, left Hand, right Medium-sized exposure: Arm Face/head Front Hand, left Hand, right Leg Foot Smallest exposure: Arm Face/head Front Hand, left Hand, right Leg Foot

Uniform Blood and Body Fluid Exposure Report

82.4% 13.4% 2.5% 1.7%

BARRIER ITEMS WORN AT TIME OF EXPOSURE: (more than one item can be checked) Single pair latex/vinyl gloves 158 63.2% Double pair gloves 19 7.6% Goggles 17 6.8% Eyeglasses (not protective) 15 6.0% Faceshield 13 5.2% Surgical mask 38 15.2% Surgical gown 43 17.2% Plastic apron 2 0.8% Lab coat, cloth (not protective) 3 1.2% Lab coat, other 3 1.2% Other item 20 8.0% CAUSE OF EXPOSURE: Direct patient contact Specimen container leaked/ spilled Specimen container broke IV tubing/bag/pump leaked Other body fluid container spilled/leaked Touched contaminated equipment/surface Feeding/ventilator/other tube separated/leaked/spilled Other, describe Unknown 112 17 2 14 12 3 28 59 2 45.0% 6.8% 0.8% 5.6% 4.8% 1.2% 11.2% 23.7% 0.8% 96.4% 0.8% 2.0% 0.8%

13 173 3 16 21

5.7% 76.2% 1.3% 7.0% 9.3%

9 73 1 7 6 1 1

9.2% 74.5% 1.0% 7.1% 6.1% 1.0% 1.0%

BBF INVOLVED IN EXPOSURE: (more than one item can be checked) Blood or blood products 204 81.6% Vomit 7 2.8% Sputum 14 5.6% Saliva 25 10.0% Peritoneal fluid 3 1.2% Pleural 3 1.2% Amniotic fluid 6 2.4% Urine 9 3.6% Other body fluid 34 13.6% WAS THE BODY FLUID, OTHER THAN BLOOD, VISIBLY CONTAMINATED WITH BLOOD? Yes 161 75.6% No 31 14.6% Unknown 21 9.9%

8 3 4 4 3 1 1

33.3% 12.5% 16.7% 16.7% 12.5% 4.2% 4.2%

SOURCE PATIENT IDENTIFIABLE? Yes 239 No 2 Unknown 5 N/A 2

BBF = blood or body fluids Because more than one item can be checked in this category, percentages total more than 100%.

NOTE: The needlestick and sharp-object injury report and blood and body fluid exposure report that appear on pages 3-4 are based on 2006 data from the EPINet data-sharing network coordinated by the International Healthcare Worker Safety Center at the University of Virginia. (A list of hospitals participating in the network appears on page 2.)