Dr. Michael Kahan Occupational Health Physician Waikato Hospital, Hamilton Michael.Kahan@waikatodhb.health.nz (P45, Friday 28, Civic Room 1, 2.00)

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

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

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

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

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. 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. 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?”

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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