Canadian Occupational Safety

August/September 2014 13 to health-care workers, after back and shoulder injuries, says Betty Metzler, manager of staff health at Sunrise Health Region in Yorkton, Sask. "We think that one needlestick injury is too many," she said. "We like that 'Mission Zero' as a goal, so we don't have any needlestick injuries, and that is what our aim is going to be." A needlestick injury can run the gamut from a simple first-aid case to lost time or a workers' compensation case, says Sarman. If a worker is pricked, the patient could be carrying a blood borne ill- ness and the prick could introduce pathogens for hepatitis B, C or HIV into the health-care worker, says Janice Ward, manager of organizational qual- ity and safety at TEGH. Depending on the injury and the profile of the source patient, a variety of controls are put in place to protect the worker. And the employee's blood work is monitored six weeks, three months, six months and one year post-incident at TEGH. Aside from the physi- cal health, the mental health of the worker post-incident is also a concern. There can be health anxiety, post-traumatic stress disorder and depression as a consequence of sev- eral months rollout of post-exposure testing and treatment, says Andrea Chambers, author of the IWH study. When she interviewed workers for her study, mental health is what they dis- cussed the most. "An injury can trickle into their personal life and coming home from their job and telling their spouse and children they have had this expo- sure can be particularly challenging, and people can have a very different thought process towards their career as a heath-care worker, what their job means, so there is a whole array of complexity after an injury," she says. causes The IWH study identified three major pathways to needlestick injuries: • Patient action: Injuries sometimes occur during a procedure and as a result of patient action, such as a difficult patient who is aggressive, combative or non-co-operative. These injuries are quite problem- atic in areas such as emergency and mental health. • Sharps disposal: Injuries can also be linked to improper disposal of SENs, such as not engaging the safety engineered device before put- ting the needle in the container, or using overfilled sharps disposal bins. This is of particular concern for housekeeping staff because if they are pricked, it is harder to treat them appropriately because the source patient is unknown. • During activation: The most common injury seen during activa- tion is when a worker is using a SEN that has an active design. positiVe influences The IWH report outlines many best practices for ensuring the successful implementation of SENs. • External support: Product vendors play an important role in the imple- mentation process. They can offer needs assessments, product sugges- tions, product evaluation, training and followup consultations. "These are services that come with no cost implications for the hospital and they result in transferring work- load off the organization. Product vendors do have a vested interest in get- ting their product working and in place, but it seems in this system transition that came out to be quite a huge advantage for hospitals," says Chambers. • Management support: Support from upper management helps facilitate a smoother transition to SENs. Their support is important in implementing better safety devices, such as passive needles. Senior leadership at TEGH is a very strong advocate for staff safety which helped with the early implementation of SENs, says Ward. "The cost of safety engineered needles is undoubtedly more expen- sive than the old ones, so there is a financial cost and yet it is important to ensure our staff are safe. There really was no pushback; it was the right thing to do," she says. • Implementation champion: A key support in the transition to SENs is an implementation champion, which could take various forms, such as a health and safety director or a front-line worker. "This is pretty key… Having some- body on board who is very passionate about needlestick injury prevention, who can see it from the beginning to the end, to really be the supporter of the whole rollout of these devices," says Chambers. "It helps when it's someone high up for sure, but front- line workers now have a bit more power, maybe they don't always rec- ognize that." cHallenges There are a variety of challenges to implementing safety engineered nee- dles, found the report. • Change fatigue: Some employees reported feeling frustrated with working in an environment that is constantly changing. The organizations participating in the study that experienced the most change fatigue were the ones that transitioned to SENs in direct response to regulation, which provided a 12-month period for compliance. Hospitals that were not constrained by the compliance date could implement smaller and more proactive changes, which were better received by workers, says the report. • Performance and productivity: In her report, Chambers observed an apparent conflict between the learning curve associated with the new devices and the impact this has on employee performance and patient care. The initial transition had the unintended consequence of temporarily having a negative effect on performance. "These are devices that some front- line workers have been working with for 20, 25 years… You can take the example of people who draw blood for a living; they would be working with a specific type of needle their entire lives. And for quite a few of the devices, there is a well-known period of adaptation," says Chambers. "They really do value their performance and productivity." • Finding time to train: Training is a crucial component to effective SEN rollout, but setting aside time for all employees to complete the training — especially when shifts are distrib- uted 24-7 — is a common problem among hospitals. "You need to be creative and do the best you can," says Ward. "We do have someone coming in the earlier hours, so if you have a night shift worker, you have a trainer come in at 6 a.m. and they're not going off until 7:30 a.m., so you can capture them then. And we have people coming in on the weekends to capture those weekend workers." Having the vendor come in and pro- vide hands-on training is an effective approach, says Sarman. The vendor does this at the initial rollout of a new product and is also available for refresher training. Vendor training is preferred over the train-the-trainer approach, found the IWH report. "They're getting the information from the root: This is exactly how you need to use the device. When you have (train-the-trainer) it can be like tele- phone: When you're passing along the message, things can get lost and get- ting it from the source seems to have a lot of advantages," says Chambers. organizational culture An important influence on the success- ful rollout of the SEN implementation is an organization's existing occupa- tional health and safety management systems, says the IWH report. A culture that has existing practices in place for new health and safety equipment, promotes the use of new safety products and practices, and encourages the report of injuries and near misses is important. "The culture of safety needs to be nurtured more. Staff need to be encour- aged to report and do proper followup because they many times think this has gone on for years and nothing bad has ever happened… (or) 'This is just part of my job,'" says Metzler. "The employee needs to take care of themselves. Their health is first and foremost and then they can take care of the patient." communication Ongoing communication is impor- tant in preventing needlestick injuries. Making use of newsletters, posters and targeted emails that describe recent injuries and explain how to report and prevent them are effective activities, says the IWH report. Many employees involved in the study were unaware needlestick injuries contin- ued to occur. TEGH always has an occupational health and safety topic of the month, and "needlestick injuries" is a recur- ring choice. "It's a quick one-pager that's sent out to the managers and supervisors that they can use in their huddles before shifts, staff meetings or include it on their distribution list to their staff," says Sarman. "It's trying to keep certain things out in the forefront and educate the staff on what to do." Communication was a key com- petent to successfully implementing safety engineered needles at TEGH in 2004, and it continues to be an important component of preventing these injuries going forward. "With an expectation and training and support, we were able to actually get staff through it and I think as long as you keep communicating and lis- tening and being supportive, it can be done," says Ward. "It's just having the same message and everybody singing from the same song sheet: 'It's a good staff safety initiative.'"

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