Infection Control Today - 02/2004: Perspectives

Our Occupational Exposures Went Up ... And We Are Thrilled!

By Sally Nickerson, RN

It is estimated that 35 percent to 40 percent of all percutaneous injuries occur in the operating room (OR). As advocates for employee safety, our employee health department does an ongoing proactive evaluation of all occupational exposures. We noticed that our OR had wonderful rates, almost nonexistent. Certainly nowhere near the average rate reported nationally.

The OR is dedicated to invasive procedures that require the use of scalpels and needles. It also involves contact with blood and body fluids. Although OR personnel have training and expertise in their specialties, spills and slips with sharps still happen. Sharps injury prevention in the OR did not appear to be necessary in our facility, if you looked at the number of reported incidents.

The View from Occupational Health

We had no trouble getting reports from OR technicians, nurses, or medical students. They understood employee protocols and had managers who were able and ready to educate them should they fail to comply. But what about physicians? Who can control a surgeon? Occasionally, a shred of information would reach us, teasing us, like a confidential HIV report in our lab files with, presumably, the employee health physician ordering on an unfamiliar patient name. We could then safely surmise that a physician had been poked and wanted to know the status of the source patient, but who was it? Like Sherlock Holmes, we would try to track down the information. Sometimes a PACU nurse tossed a crumb of information to us, calling an order for an exposure panel to be placed because “Dr. So and So got poked in surgery.” But rarely was there paperwork listing the specifics of the event.

When the Occupational Safety and Health Administration (OSHA) 300 log came out with its insistence on records for needle safety, we panicked. How would we ever obtain this required information from the surgeons in the OR? We couldn’t even get them to complete an incident report!

With the muscle of the requiring agency behind us and fear of fines and job loss before us, we developed a condensed, one-page version of our own employee “HIV/Hepatitis Post Exposure Evaluation and Recommendations” form, and dressed it in living color. Minimal OSHA-required information (the type, brand, model of the sharp) was bordered in red. Legible name of the surgeon and source patient name are highlighted in yellow, with other exposure risk information bordered in yellow. We used a blue border for the signature box. Interestingly enough, the OR staff were thrilled with a simplified reporting mechanism, and started passing them out. In the past few months I have seen more physicians in my office bringing the form with them than ever before.

The answer to the question, “Who can control surgeons?” is simple. They are busy people with very tight time constraints. They are willing to cooperate, if it is something they can accomplish quickly and efficiently. The new and improved occupational exposure reporting form accomplished this, and with little education or fanfare, quickly became a success.