Question

Prevention of needlestick injury in healthcare settings among healthcare workers. Develop quality and safety implementation plan on this topic following given format  below and please see the criteria also which is given below.

Introduction (150 words)

- Rational for Q&S improvement, (200 words)

- Q&S intervention/improvement (300 words)

- Implementation plan (400 words)

- Conclusion (100 words)

Criteria:

- Establishment of the need for the quality and safety improvement to occur

- Appropriateness of the implementation plan for ensuring appropriate stakeholders are informed, aware, and/ or trained on the changes that will be occurring

- Feasibility of the of the implementation plan

- Use of academic tone and language to convey message in a professional and concise manner including proper use of spelling and grammar on slides

Answer 1

Introduction:

Prevention of percutaneous injuries and other blood exposures is an important step in preventing the transmission of bloodborne viruses to healthcare personnel. Epidemiologic data on sharps injury events, including the circumstances associated with occupational transmission of bloodborne viruses, are essential for targeting and evaluating interventions at the local and national levels. 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. Occupational exposure to bloodborne pathogens from needlesticks injuries is a serious problem, but it is often preventable.An effective sharps injury prevention program includes several components that must work in concert to prevent healthcare personnel from suffering needlesticks and other sharps-related injuries. This plan is designed to be integrated into existing performance improvement, infection control, and safety programs.

Rational for Q&S improvement:

Injuries from needles used in healthcare and laboratory settings are associated with the occupational transmission of more than 20 pathogens. HBV, HCV, and HIV are the most commonly transmitted pathogens during patient care. Although occupational HIV and hepatitis seroconversion is relatively rare, the risks and costs associated with a blood exposure are serious and real. Costs include the direct costs associated with the initial and follow-up treatment of exposed healthcare personnel, which are estimated to range from $71 to almost $5,000 depending on the treatment provided. Costs that are harder to quantify include the emotional cost associated with fear and anxiety from worrying about the possible consequences of an exposure, direct and indirect costs associated with drug toxicities and lost time from work, and the societal cost associated with an HIV or HCV seroconversion; the latter includes the possible loss of a worker’s services in patient care, the economic burden of medical care, and the cost of any associated litigation. Data from the National Surveillance System for Health Care Workers (NaSH) show that nurses sustain the highest number of percutaneous injuries. However, other patient-care providers (e.g., physicians, technicians), laboratory staff, and support personnel (e.g., housekeeping staff), are also at risk. Nurses are the predominant occupational group injured by needles and other sharps, in part because they are the largest segment of the workforce at most hospitals. NaSH data show that the majority (39%) of injuries occur on inpatient units, particularly medical floors and intensive care units, and in operating rooms. Injuries most often occur after use and before disposal of a sharp device (40%), during use of a sharp device on a patient (41%), and during or after disposal (15%).

Q&S intervention/improvement:

1. Universal (now standard) precautions is an important concept and an accepted prevention approach with demonstrated effectiveness in preventing blood exposures to skin and mucous membranes. However, it focuses heavily on the use of barrier precautions (i.e., personal protective practices) and work-practice controls (e.g., care in handling sharp devices) and by itself could not be expected to have a significant impact on the prevention of sharps injuries. Although personal protective equipment (e.g., gloves, gowns) provide a barrier to shield skin and mucous membranes from contact with blood and other potentially infectious body fluids, most protective equipment is easily penetrated by needles.

2. Hierarchy for sharps injury prevention, the first priority is to eliminate and reduce the use 13 of needles and other sharps where possible. Next is to isolate the hazard, thereby protecting an otherwise exposed sharp, through the use of an engineering control. When these strategies are not available or will not provide total protection, the focus shifts to work-practice controls and personal protective equipment.

3. Alternatives to Using Needles. Healthcare organizations can eliminate or reduce needle use in several ways. The majority (~70%) of U.S. hospitals (83) have eliminated unnecessary use of needles through the implementation of IV delivery systems that do not require (and in some instances do not permit) needle access. This strategy has largely removed needles attached to IV tubing, such as that for intermittent (“piggy-back”) infusion, and other needles used to connect and access parts of the IV delivery system. Such systems have demonstrated considerable success in reducing IVrelated sharps injuries.

Other important strategies for eliminating or reducing needle use include:

- Using alternate routes for medication delivery and vaccination when available and safe for patient care,

- Reviewing specimen collection systems to identify opportunities to consolidate and eliminate unnecessary punctures, a strategy that is good for both patients and healthcare personnel.

4. Engineering Controls.:In the context of sharps injury prevention, engineering controls include sharps disposal containers and needles and other sharps devices with an integrated engineered sharps injury prevention feature. The emphasis on engineering controls has led to the development of many types of devices with engineered sharps injury prevention features. safety feature should accomplish the following:

- Be an integral part of the device,

■ Be simple and obvious in operation,

■ Be reliable and automatic,

■ Provide a rigid cover that allows the hands to remain behind the needle,

■ Ensure that the safety feature is in effect before disassembly and remains in effect after disposal,

■ Ensure the user technique is similar to that of conventional devices,

■ Minimize the risk of infection to patients and should not create infection control issues beyond those of conventional devices,

■ Have minimal increase in volume, relative to disposal,

■ Be cost effective.

Moreover, features designed to protect healthcare personnel should not compromise patient care.

Work-practice Controls.: Work-practice controls are an important adjunct for preventing blood exposures, including percutaneous injuries, in surgical and obstetrical settings because the use of exposed sharps cannot be avoided. Operating room controls include: ■ Using instruments, rather than fingers, to grasp needles, retract tissue, and load/unload needles and scalpels; ■ Giving verbal announcements when passing sharps; ■ Avoiding hand-to-hand passage of sharp instruments by using a basin or neutral zone; ■ Using alternative cutting methods such as blunt electrocautery and laser devices when appropriate; ■ Substituting endoscopic surgery for open surgery when possible; ■ Using round-tipped scalpel blades instead of pointed sharp-tipped blades; and ■ Double gloving

Multi-component Prevention Approaches:

■ Education,

■ A reduction in the use of invasive procedures (as much as possible),

■ A secure work environment, and

■ An adequate staff-to-patient ratio.

Other interventions include:

Formation of a needlestick prevention committee for compulsory in-service education programs;

■ Out-sourcing of replacement and disposal of sharps boxes;

■ Revision of needlestick policies; and

■ Adoption and evaluation of a needleless IV access system, safety syringes, and a prefilled cartridge needleless system

Feasibility of the of the implementation plan:

Healthcare personnel have difficulties changing long-standing practices.The same holds true for devices with safety features-healthcare organizations have difficulty convincing healthcare personnel to adopt new devices and procedures. Psychosocial and organizational factors that slow the adoption of safety practices include: ■ Risk-taking personality profile, ■ Perceived poor safety climate in the workplace, ■ Perceived conflict of interest between providing optimal patient care and protecting oneself from exposure, ■ Belief that precautions are not warranted in some specific situations, ■ Failure to anticipate the potential for exposure, and ■ Increased job demands that cause work to be hurried.

Personnel most readily change their behavior when they think that: ■ They are at risk, ■ The risk is significant, ■ Behavior change will make a difference, and ■ The change is worth the effort.

Implementation plan:

1. Develop Organizational Capacity: Representation from senior-level management is important to provide visible leadership and demonstrate the administration’s commitment to the program. The team should also include persons from clinical and laboratory services who use sharp devices, as well as staff with expertise in infection control, occupational health/industrial hygiene, in-service training or staff development, environmental services, central service, materials management, and quality/risk management, as available. Regardless of the type or size of the organization, a multidisciplinary approach is essential to identify health and safety issues, analyze trends, implement interventions, evaluate outcomes, and make recommendations to other organizational components.

2. Assess Program Operation Processes: The proposed program model includes five operational processes. These include: 1) Institutionalize a culture of safety in the work environment, 2) Implement procedures for reporting and examining sharps injuries and injury hazards, 3) Analyze sharps injury data for prevention planning and measuring performance improvement, 4) Select sharps injury prevention devices (e.g., devices with safety features), and 5) Educate and train healthcare personnel on sharps injury prevention. The team should conduct a baseline assessment of each of these processes to determine where improvements are needed.

3. Prepare a Baseline Profile of Sharps Injuries and Prevention Activities: After assessing program operations, the next step is to develop a baseline profile of injury risks in the institution. This information, along with the information gleaned from the baseline assessment, will be used to develop an intervention action plan.

Develop a profile of how injuries are occurring and a list of current prevention strategies. The following questions may help guide the development of this profile, but other questions may be added. ■ What occupational groups most frequently sustain sharps injuries? ■ Where do sharps injuries most frequently occur? ■ What devices are most commonly involved in sharps injuries? ■ What circumstances or procedures contribute to sharps injuries? ■ What sharps injuries pose an increased risk for bloodborne virus transmission? ■ Has the organization taken steps to limit the unnecessary use of needles by healthcare personnel? If so, how has this been done? ■ What devices with engineered sharps injury prevention features have been implemented? ■ Is there a list of recommended work practices to prevent sharps injuries? ■ What communication tools have been used to promote safe sharps handling techniques? ■ Is there a policy/procedure for determining the appropriate location of sharps containers? ■ Who is responsible for removing/replacing sharps containers?

4. Determine Prevention Priorities: Not all problems can be addressed at once, so healthcare organizations must decide which sharps injury problems should receive priority attention.

a) Sharps Injury Prevention Priorities: Determine priorities based on injuries that pose the greatest risk for bloodborne virus transmission. Determine priorities based on the frequency of injury with a particular device. Determine priorities based on a specific problem contributing to a high frequency of injuries.

b) Program Process Improvement Priorities: Leadership teams might consider selecting one problem in each of the processes or focus only on one of the processes for performance improvement.

5. Develop and Implement Action Plans: The first focuses on implementing and measuring interventions to reduce specific types of injuries. The second measures improvements that are the result of the program processes.

a) Action Plan to Reduce Injuries: Based on the list of priorities, set targets for reducing specific types of injuries over a designated period (e.g., six months, one year). Substitute a non-sharp alternative for performing a procedure. Implement a device with currently recognized engineered sharps injury prevention features, Recommend a change in work practice.Change a policy or procedure. Provide targeted education of healthcare personnel.

Identify Indicators of Performance Improvement. Indicators are tools for measuring progress; they tell when a goal is reached. It is important to include measures other than simply the number of injuries occurring.

b)Action Plan to Measure Program Performance Improvement: The baseline profile will identify the strengths and weaknesses of the organization’s sharps injury prevention activities. With this information, the team can create a list of priorities for performance improvement and then decide how to accomplish the necessary tasks.

6. Monitor Program Performance: The team should consider developing a monthly or quarterly schedule for reviewing performance improvement. Not all areas targeted for improvement need to be reviewed at each team meeting. By spreading these over the year, the team can spend more time on each issue.

Conclusion: Many strategies to reduce sharps injuries focus on individual- or job/task-level improvements (e.g., implementing appropriate safety devices, using safe work practices). However, sharps injury prevention in the context of a broader organizational perspective of safety, namely institutionalizing a culture of safety to protect patients, personnel, and others in the healthcare environment is much needed. A culture of safety permeates all aspects of the work environment. It encourages every individual in an organization to project a level of awareness and accountability for safety. The process of designing, implementing, and evaluating a sharps injury prevention program is continuous.