The Extent and Impact of Needlestick injuries at the Waikato DHB Dr Michael Kahan Occupational Physician  Waikato  DHB Mar...
<ul><li>Problem Definition </li></ul><ul><li>The Research Question </li></ul><ul><li>Results from Literature Review </li><...
STATEMENT OF THE PROBLEM Needlestick injuries can have serious consequences both for the injured party and their employer....
INCIDENCE RELATED EXPOSURE <ul><li>Incidence of occupational exposure from an infected source: </li></ul><ul><li>Hepatitis...
HEPATITIS B AND C <ul><li>World Wide </li></ul><ul><li>2 billion people infected with  Hepatitis B,Hepatitis  C = 500M </l...
DIAGNOSED HIV IN NZ - 2011 <ul><li>Figure 1 - Number of people diagnosed with HIV in New Zealand through antibody testing ...
WHY SHOULD WAIKATO DHB PRIORITISE NEEDLESTICK REDUCTION? PRIORITISATION OF THE PROBLEM EXTREME HIGH MEDIUM MED/LOW LOW EXT...
<ul><li>Government Health Strategy </li></ul><ul><li>Legislation </li></ul><ul><li>Economic Cost </li></ul><ul><li>Human C...
PRIORITISATION OF THE PROBLEM LEGISLATION HEALTH & SAFETY IN EMPLOYMENT ACT 1992  HPCA ACT HEALTH PRACTITIONER COMPETENCE ...
PRIORITISATION OF THE PROBLEM ECONOMIC AND HUMAN COST ECONOMIC COST DIRECT COSTS HIDDEN COSTS AVERAGE $760 / INCIDENT 130 ...
<ul><li>Impact of Government Health Policy </li></ul><ul><ul><li>Political </li></ul></ul><ul><li>Legislation </li></ul><u...
DEFINING THE PROBLEM WHY NOT ALL SHARPS? SOURCE: Center for Disease Control NEEDLES & SYRINGES OTHER SHARPS 78% 22% SHARPS...
DEFINING THE PROBLEM WHO ARE AT RISK? Waikato DHB:  Percutaneous Injuries / Occupation 2007 0 10 20 30 40 50 60 70 Nurses ...
THE RESEARCH QUESTION: “ Are there deficiencies in our understanding of the incidence and reporting of needlestick injurie...
<ul><li>NEEDLESTICK UNDER-REPORTING IS BETWEEN 26-85% </li></ul><ul><li>DOCTORS & NURSES HAVE DIFFERENT REPORTING BEHAVIOU...
EXPERIMENTAL PROCEDURES SAMPLING 576 2058 100 ASSUMPTIONS: <ul><li>50%  UNDER-REPORTING OF NEEDLESTICKS </li></ul><ul><li>...
RESULTS DEMOGRAPHICS QUESTIONNAIRE RESPONSE RATE - 1346  BY PROFESSION 0 500 1000 1500 2000 2500 NUMBER NURSE DOCTOR MIDWI...
RESULTS EXPERIENCE WITH NEEDLES EFFECT OF EXPERIENCE DISCUSSED LATER 0 50 100 150 200 250 300 350 400 0-9 10-19 20-29 30-3...
RESULTS POLICY AWARENESS NO YES NO RESPONSE NO YES NO RESPONSE QUESTION 3a :  Aware that DHB has a policy for reporting  n...
RESULTS POLICY AWARENESS 55.7% 23.9% 11.1% 3.7% 3.6% 1.9% QUESTION 4 :  Who would you contact first after a needlestick? A...
RESULTS POLICY AWARENESS 55.7% 23.9% 11.1% 3.7% 3.6% 1.9% 0 10 20 30 40 50 60 PERCENTAGE SUPERVISOR HEALTH & SAFETY EMERGE...
RESULTS RECENT NEEDLESTICK HISTORY QUESTION 5 :  Have you had a needlestick in the past 12 months? 90.9% 9.1% 9.1%  OF ALL...
RESULTS RECENT NEEDLESTICK HISTORY QUESTION 5 :  Have you had a needlestick in the past 12 months? 18% 8% 7% 0% 5% 10% 15%...
0 20 40 60 80 100 1 2 3 4 5 6 NO. OF NEEDLESTICKS PRACTITIONERS RESULTS RECENT NEEDLESTICK HISTORY QUESTION 6 :  How many ...
RESULTS UNDER-REPORTING QUESTION 7 :  How many needlesticks were not reported in the past 12 months? 1/3 OF NEEDLESTICKS W...
RESULTS UNDER-REPORTING QUESTION 7 :  How many needlesticks were not reported in the past 12 months? SERIOUS ISSUE REPORTE...
RESULTS UNDER-REPORTING - REASONS QUESTION 9 :  Why didn’t you report your needlestick(s)? 0 2 4 6 8 10 12 14 16 18 No Tim...
RESULTS LOGISTIC REGRESSION  VARIABLES: USED TO EVALUATE THE INFLUENCE OF SEVERAL VARIABLES ON THE VARIABLE UNDER STUDY nu...
RESULTS LOGISTIC REGRESSION - MODELS ONE EXAMPLE: Summary: <ul><li>Only yearswork and gender are related to needlestick fr...
<ul><li>2734 questionnaires sent out – 1346 received completed. </li></ul><ul><li>This is a response rate of 49.2%, which ...
<ul><li>Review the Current Policy. </li></ul><ul><ul><li>Rectify the ‘system error’ of reporting. </li></ul></ul><ul><ul><...
 
RECOMMENDATIONS <ul><li>Review follow-up process. </li></ul><ul><ul><li>Risk Assessment Pack – H&S go to employee </li></u...
 
 
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The Extent and Impact of Needlestick Injuries at the Waikato DHB

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Dr. Michael Kahan
Occupational Health Physician
Waikato Hospital, Hamilton
Michael.Kahan@waikatodhb.health.nz

(P45, Friday 28, Civic Room 1, 2.00)

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The Extent and Impact of Needlestick Injuries at the Waikato DHB

  1. 1. The Extent and Impact of Needlestick injuries at the Waikato DHB Dr Michael Kahan Occupational Physician Waikato DHB Marie Fullerton Workforce Consultant Waikato DHB
  2. 2. <ul><li>Problem Definition </li></ul><ul><li>The Research Question </li></ul><ul><li>Results from Literature Review </li></ul><ul><li>Choice of Research Tool </li></ul><ul><li>Results and Discussion </li></ul><ul><li>Conclusions </li></ul><ul><li>Recommendations </li></ul>OUTLINE
  3. 3. STATEMENT OF THE PROBLEM Needlestick injuries can have serious consequences both for the injured party and their employer. Waikato DHB have had an injury prevention programme in place since 2000 but the reported injury rate had not responded: As a responsible healthcare provider, we need to fully understand needlesticks so that we can develop an effective reduction programme 0 20 40 60 80 100 120 140 160 180 200 2003 2004 2005 2006 2007 2008 Year Reported Needlesticks
  4. 4. INCIDENCE RELATED EXPOSURE <ul><li>Incidence of occupational exposure from an infected source: </li></ul><ul><li>Hepatitis B (HBV) 30% </li></ul><ul><li>Hepatitis C (HCV) 3% </li></ul><ul><li>Human Immunodeficiency Virus (HIV) 0.3% </li></ul>
  5. 5. HEPATITIS B AND C <ul><li>World Wide </li></ul><ul><li>2 billion people infected with Hepatitis B,Hepatitis C = 500M </li></ul><ul><li>1.5M die yearly from chronic Hepatitis B or C </li></ul><ul><li>New Zealand </li></ul><ul><li>120,000 chronic Hepatitis B, C </li></ul><ul><li>Projected to climb – from high prevalence countries </li></ul><ul><li>Leading Cause of: </li></ul><ul><li>Hepatocellular carcinoma (75%) </li></ul><ul><li>Liver related mortality (63%) </li></ul><ul><li>Liver transplant (32%) </li></ul>
  6. 6. DIAGNOSED HIV IN NZ - 2011 <ul><li>Figure 1 - Number of people diagnosed with HIV in New Zealand through antibody testing by year of diagnosis* and means of infection. (* Infection might have occurred some time before diagnosis.) </li></ul>
  7. 7. WHY SHOULD WAIKATO DHB PRIORITISE NEEDLESTICK REDUCTION? PRIORITISATION OF THE PROBLEM EXTREME HIGH MEDIUM MED/LOW LOW EXTREME HIGH MEDIUM MED/LOW LOW LIKELIHOOD CONSEQUENCES MANUAL HANDLING SLIPS TRIPS FALLS ABUSE & VIOLENCE AGGRESSIVE BEHAVIOUR STRESS AIRBORNE CONTAMINANTS MVA BBV EXPOSURE
  8. 8. <ul><li>Government Health Strategy </li></ul><ul><li>Legislation </li></ul><ul><li>Economic Cost </li></ul><ul><li>Human Cost </li></ul><ul><li>Unknown Reporting Levels </li></ul>WHY SHOULD WAIKATO DHB PRIORITISE NEEDLESTICK REDUCTION? PRIORITISATION OF THE PROBLEM OTHER IMPORTANT DRIVERS
  9. 9. PRIORITISATION OF THE PROBLEM LEGISLATION HEALTH & SAFETY IN EMPLOYMENT ACT 1992 HPCA ACT HEALTH PRACTITIONER COMPETENCE ASSURANCE ACT 2003 “ Promote the prevention of harm to all persons within the workplace” “ Protect the health & safety of the public by regulation of practitioners” HSE ACT
  10. 10. PRIORITISATION OF THE PROBLEM ECONOMIC AND HUMAN COST ECONOMIC COST DIRECT COSTS HIDDEN COSTS AVERAGE $760 / INCIDENT 130 INCIDENTS / YEAR TOTAL $99K / YEAR CAN BE >5X DIRECT COSTS <ul><li>ANXIETY </li></ul><ul><li>DEPRESSION </li></ul><ul><li>STRESS </li></ul><ul><li>INABILITY TO WORK </li></ul><ul><li>SERIOUS INCAPACITY </li></ul><ul><li>OR DEATH DUE TO BBV INFECTION </li></ul>HUMAN COST
  11. 11. <ul><li>Impact of Government Health Policy </li></ul><ul><ul><li>Political </li></ul></ul><ul><li>Legislation </li></ul><ul><ul><li>Compliance with HSE Act </li></ul></ul><ul><ul><li>Compliance with HPCA Act </li></ul></ul><ul><ul><li>Risk of prosecution </li></ul></ul><ul><li>Economic Cost </li></ul><ul><ul><li>Could be considerable </li></ul></ul><ul><li>Human Cost </li></ul><ul><ul><li>Devastating for the practitioner </li></ul></ul><ul><li>Under-Reporting </li></ul><ul><ul><li>What level? </li></ul></ul><ul><ul><li>Reasons? </li></ul></ul>PRIORITISATION OF THE PROBLEM SUMMARY STUDY JUSTIFIED
  12. 12. DEFINING THE PROBLEM WHY NOT ALL SHARPS? SOURCE: Center for Disease Control NEEDLES & SYRINGES OTHER SHARPS 78% 22% SHARPS TYPES THAT INJURE PRACTITIONERS NEEDLESTICKS APPROPRIATE
  13. 13. DEFINING THE PROBLEM WHO ARE AT RISK? Waikato DHB: Percutaneous Injuries / Occupation 2007 0 10 20 30 40 50 60 70 Nurses Doctors Laboratory Staff Attendants Dental Staff MRTs Social workers Technicians Occupation Number of Injuries STUDY POPULATION
  14. 14. THE RESEARCH QUESTION: “ Are there deficiencies in our understanding of the incidence and reporting of needlestick injuries to staff at Waikato DHB, and how can we identify deficiencies and optimise the relevant risk management strategy?”
  15. 15. <ul><li>NEEDLESTICK UNDER-REPORTING IS BETWEEN 26-85% </li></ul><ul><li>DOCTORS & NURSES HAVE DIFFERENT REPORTING BEHAVIOURS: </li></ul><ul><ul><li>NURSES REPORT MORE (DIRECTIVES & PROTOCOLS) </li></ul></ul><ul><ul><li>DOCTORS REPORT LESS (KEEP IT “IN HOUSE”) </li></ul></ul><ul><li>NEEDLESTICK RISK INCREASES IF EXPERIENCE IS <5 YEARS </li></ul><ul><li>ORGANISATIONAL & CULTURAL FACTORS INFLUENCE REPORTING </li></ul><ul><ul><li>“ THAT’S THE WAY WE DO THINGS AROUND HERE” </li></ul></ul><ul><ul><li>INTERACTION OF “VALUES” AND “BELIEFS” </li></ul></ul><ul><li>UNDER-ESTIMATION OF PERSONAL RISK IS PREVALENT </li></ul><ul><ul><li>“ I DIDN’T THINK THE PATIENT HAD A BBV” </li></ul></ul><ul><ul><li>“ I DIDN’T HAVE THE TIME TO REPORT THE INJURY” </li></ul></ul>THE LITERATURE REVIEW FINDINGS
  16. 16. EXPERIMENTAL PROCEDURES SAMPLING 576 2058 100 ASSUMPTIONS: <ul><li>50% UNDER-REPORTING OF NEEDLESTICKS </li></ul><ul><li> = 0.05 (Chance of making a Type I error, or “false positive”) </li></ul><ul><li> = 0.20 (Chance of making a Type II error, or “false negative”) </li></ul><ul><li>1-  = 0.80; POWER = 80% </li></ul>NO. OF DOCTORS: 133 NO. OF NURSES / MIDWIVES: 307 BUT : RESPONSE RATE MAY ONLY BE 20% (…PARTICULARLY FOR DOCTORS) SAMPLE FULL POPULATION Doctors Midwives Nurses POPULATION: REQUIRED SAMPLE SIZE:
  17. 17. RESULTS DEMOGRAPHICS QUESTIONNAIRE RESPONSE RATE - 1346 BY PROFESSION 0 500 1000 1500 2000 2500 NUMBER NURSE DOCTOR MIDWIFE PROFESSION ISSUED RETURNED 51.4% 37.0% 75.0% NUMBER PROFESSION ISSUED RETURNED 51.4% 51.4% 37.0% 37.0% 75.0% 75.0% OVERALL RESPONSE RATE 49.2%
  18. 18. RESULTS EXPERIENCE WITH NEEDLES EFFECT OF EXPERIENCE DISCUSSED LATER 0 50 100 150 200 250 300 350 400 0-9 10-19 20-29 30-39 40-49 50+ YEARS OF EXPERIENCE WITH NEEDLES NUMBER OF PRACTITIONERS
  19. 19. RESULTS POLICY AWARENESS NO YES NO RESPONSE NO YES NO RESPONSE QUESTION 3a : Aware that DHB has a policy for reporting needlesticks ? 95.9% 2.6% 1.5% ALL RESPONDENTS
  20. 20. RESULTS POLICY AWARENESS 55.7% 23.9% 11.1% 3.7% 3.6% 1.9% QUESTION 4 : Who would you contact first after a needlestick? ALL RESPONDENTS
  21. 21. RESULTS POLICY AWARENESS 55.7% 23.9% 11.1% 3.7% 3.6% 1.9% 0 10 20 30 40 50 60 PERCENTAGE SUPERVISOR HEALTH & SAFETY EMERGENCY DEPT OTHER INFECTION CONTROL NO RESPONSE PERCENTAGE SUPERVISOR HEALTH & SAFETY HEALTH & SAFETY EMERGENCY DEPT EMERGENCY DEPT OTHER INFECTION CONTROL INFECTION CONTROL NO RESPONSE NO RESPONSE CORRECT 55.7% 23.9% 11.1% 3.7% 3.6% 1.9% QUESTION 4 : Who would you contact first after a needlestick? 80.7% CLAIM FAMILIARITY WITH THE POLICY BUT ONLY 24% KNEW THE FIRST CONTACT ALL RESPONDENTS ALL RESPONDENTS
  22. 22. RESULTS RECENT NEEDLESTICK HISTORY QUESTION 5 : Have you had a needlestick in the past 12 months? 90.9% 9.1% 9.1% OF ALL RESPONDENTS HAVE HAD A NEEDLESTICK IN THE PAST 12 MONTHS. THIS IS EQUIVALENT TO 123 PRACTITIONERS. NO YES ALL RESPONDENTS
  23. 23. RESULTS RECENT NEEDLESTICK HISTORY QUESTION 5 : Have you had a needlestick in the past 12 months? 18% 8% 7% 0% 5% 10% 15% 20% DOCTORS NURSES MIDWIVES
  24. 24. 0 20 40 60 80 100 1 2 3 4 5 6 NO. OF NEEDLESTICKS PRACTITIONERS RESULTS RECENT NEEDLESTICK HISTORY QUESTION 6 : How many needlesticks have you had in the past 12 months? ALL RESPONDENTS 2 PRACTITIONERS HAVE HAD FIVE NEEDLESTICKS IN 12 MONTHS 1 PRACTIONER HAS HAD SIX NEEDLESTICKS IN 12 MONTHS
  25. 25. RESULTS UNDER-REPORTING QUESTION 7 : How many needlesticks were not reported in the past 12 months? 1/3 OF NEEDLESTICKS WERE UNREPORTED REPORTED 113 / 67% UNREPORTED 55 / 33%
  26. 26. RESULTS UNDER-REPORTING QUESTION 7 : How many needlesticks were not reported in the past 12 months? SERIOUS ISSUE REPORTED 113 / 67% UNREPORTED 55 / 33% 1/3 OF NEEDLESTICKS WERE UNREPORTED
  27. 27. RESULTS UNDER-REPORTING - REASONS QUESTION 9 : Why didn’t you report your needlestick(s)? 0 2 4 6 8 10 12 14 16 18 No Time Low risk of BBV - Patient Low risk of BBV - Procedure Other Reasons Not important to report Unaware of Procedure Blamed or In Trouble Confidentiality Concerns NUMBER
  28. 28. RESULTS LOGISTIC REGRESSION VARIABLES: USED TO EVALUATE THE INFLUENCE OF SEVERAL VARIABLES ON THE VARIABLE UNDER STUDY numneedproc NO. OF DIFFERENT NEEDLE TYPES USED gender GENDER OF PRACTITIONER yearswork YEARS WORKED WITH NEEDLES prof PROFESSION (“DOCTOR” OR “NURSE”) EXPLANATORY needinj1 “ YES” TO NEEDLESTICK INJURY IN PAST 12 MONTHS RESPONSE VARIABLE NAME DESCRIPTION TYPE OF VARIABLE
  29. 29. RESULTS LOGISTIC REGRESSION - MODELS ONE EXAMPLE: Summary: <ul><li>Only yearswork and gender are related to needlestick frequency- FOR EVERY 10 YRS OF WORK THERE IS AN 18% DECREASE IN NEEDLESTICK RISK. </li></ul><ul><li>There was increased risk of needlestick injury for male gender. </li></ul><0.001 -1.57 Intercept numneedproc gender (female=1; male=0) yearswork prof (doctor=1, nurse=0) PARAMETER 0.0011 -0.74 0.39 0.044 0.83 Pr > ChiSq 0.05 -0.02 0.06 STANDARD ESTIMATE
  30. 30. <ul><li>2734 questionnaires sent out – 1346 received completed. </li></ul><ul><li>This is a response rate of 49.2%, which is unusually high. </li></ul><ul><li>Response rate by profession: </li></ul><ul><ul><li>Doctors 37%; Nurses 51%; Midwives 75% </li></ul></ul><ul><li>81% of respondents claim to be familiar with the relevant policy, but only 24% identify the first point of contact stated in policy </li></ul><ul><li>There is a 33% under-reporting rate for needlesticks </li></ul><ul><ul><li>Doctors less likely to report than nurses </li></ul></ul><ul><li>Years of work with needles and gender (female) tend to reduce needlestick frequency </li></ul><ul><li>Most common reasons for not reporting a needlestick : </li></ul><ul><ul><li>No time to report it </li></ul></ul><ul><ul><li>Perceived low risk of patient having BBV infection </li></ul></ul><ul><ul><li>Perceived low risk of a particular procedure </li></ul></ul><ul><li>No sub-sampling, transferable to similar health settings in NZ </li></ul>SUMMARY OF FINDINGS
  31. 31. <ul><li>Review the Current Policy. </li></ul><ul><ul><li>Rectify the ‘system error’ of reporting. </li></ul></ul><ul><ul><li>Pre-employment, Hepatitis B vaccination, post exposure management </li></ul></ul>RECOMMENDATIONS <ul><li>Target Educational Programmes. </li></ul><ul><ul><li>Skills : New employees, those < 5 years experience / new skill competency / preparation / procedure </li></ul></ul><ul><ul><li>Supervisors/Managers –support staff to access immediate risk assessment </li></ul></ul><ul><ul><li>Staff Education : Orientation and on the job .New staff – ie Drs, nurses now all access skill simulation for IV training . To aid reporting Lambert card which are carried by all staff </li></ul></ul>
  32. 33. RECOMMENDATIONS <ul><li>Review follow-up process. </li></ul><ul><ul><li>Risk Assessment Pack – H&S go to employee </li></ul></ul><ul><ul><li>Implement Risk Assessment Pack in ED – decrease waiting times </li></ul></ul><ul><ul><li>Community sites use the same kit </li></ul></ul><ul><ul><li>Post Exposure Guidelines [email_address] </li></ul></ul>

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