By Linda Goss
Slips, trips, falls and sharps are widely recognized as potential occupational risks in the healthcare industry. However, there is another dangerous hazard that often goes unnoticed and underreported—splashes.
Splashes, also known as mucocutaneous blood exposures, occur when pathogens are transferred to caregivers when landing on their eyes, nose or mouth. Splashes occur during routine activities such as cutting catheter bags, cleaning bedpans and emptying suction cups.
Just like a sharps incident, these type of exposures can lead to the acquisition of bloodborne pathogens, such as human immunodeficiency virus (HIV), hepatitis B and C. Based on a study conducted by Doebbeling et. al., at the Veterans Administration, they found that in the previous three months, nearly 38 percent of RNs they surveyed experienced a splash. And, they found that more than a quarter of these splashes went unreported.(1)
Occupational exposures such as splashes can result in lost work days, financial burden and can cause emotional distress on the injured healthcare worker. In fact, Saia, et al. found that 60 percent of sampled nurses reported enhanced fear of needles following an exposure, and 42 percent experienced anxiousness, depression and stress.(2)
In order to address this growing risk, we’ll discuss standard precautions to improve infection prevention techniques, such as installing automated disinfection appliances (more commonly known as bedpan washers), showcasing best practices and improving compliance to reduce the risk of splashes.
Identifying the Risks
All infection control programs must begin by identifying the top culprits for occupational exposures. This begins by developing a strategic infection control plan that accesses data specific to the healthcare facility and community. Through this assessment, prevention goals and measures should be prioritized.
The Occupational Safety and Health Association (OSHA) also has developed an infection control plan for public use that specifies how to pinpoint and reduce the risks associated with occupational exposure. Updated annually, and on as-needed basis, the plan addresses activities that increase greatest likelihood to be exposed to blood and body fluids. For example, the plan identifies activities that may put a healthcare worker at risk, such as emptying a foley catheter or bedpan, disposing of hazardous waste and even environmental cleaning.(3)
While splashes are identified as risks in OSHA’s plan, healthcare workers may not perceive them as hazardous and, as a result, may not take the necessary precautions to reduce exposure such as wearing the proper personal protection equipment (PPE). This was evidenced by Weber, et al. who found that during the severe acute respiratory syndrome (SARS) epidemic, healthcare personnel made up 20 percent of those who acquired the virus. By utilizing the correct and proper PPE, healthcare personnel can greatly minimize similar exposure risks.(4)
Infection control plans must thoroughly take into account activities that pose not only the most risk for patients but also are dangerous to healthcare workers.
Reducing the Risk
Along with reinforcing safety techniques, there are number of ways healthcare facility can limit the risk occupational exposures. New engineering controls such as products and room design can make a huge impact on risk reduction.
For instance, many healthcare facilities are increasing infection control with technology such as disinfection appliances. Also called automated bedpan washers, these machines reduce the risk of splash and spray by eliminating the need to manually clean a bedpan. They also can be used to empty urinals, suction cups and other collections devices. All of these routine actions could be a splash risk to healthcare workers. To operate an automated bedpan washer, a health care worker simply has to kick the appliance open and place the bedpan in for it to emptied and sanitized. Ultimately, this limits the time workers spend handling waste, and overall curbs the risk of transmitting infections.
Simple room design improvements such as, relocating sharp containers and adjusting their height, can help facilities reduce the risk of needlestick. In addition, hospitals can increase their number of alcohol-based hand rubs to facilitate better hand hygiene practices.
When choosing the right device and design, facilities need to have the right people at the table. Bedside staff and infection preventionists should be active participants in the selection of safety devices and products. While selecting a product and new design, the ease of use, effectiveness, accessibility and cost should all be considered. Although new technology and renovations can initially be more expensive, the long-term benefits can have substantial cost savings by reducing exposures.
Creating a Culture of Compliance
In a study by Kessler, et. al, it found that over the course of a healthcare worker’s career, 33 percent of workers experienced an occupational exposure and did not report the incident.(5) This could be due partly to the prominence of the risks of sharps and mucocutaneous exposures, which could lead desensitization from healthcare workers.
Therefore, even after incorporating new controls and providing proper PPE, exposures may still continue if healthcare workers do not follow guidelines and standards. Discovering non-compliance and the reasons for it is a difficult task as underreporting of blood and body fluids exposures likely occur, as noted in Kessler’s survey of healthcare students and trainees.
In addition, a study led by Harris and Nicolai, examined knowledge and compliance with universal precautions among emergency medical service providers demonstrated varying degrees of compliance. They found that almost all of the EMS providers reported exposures and expressed concern over the risks. Yet, many were did not always practice wearing gloves or appropriately disposing of contaminated items – both are activities that could lead to possible mucocutaneuous exposure.(6)
To strengthen compliance, it is essential that hospital staff work together to create a culture of safety. This begins by raising awareness of the occupational risks and the consequences associated with them. A facility can also promote this culture by using best practices, preventative techniques and communication if an exposure does occur.
Healthcare facilities should strive to maintain a safe work environment. This can be first be achieved by implementing an exposure control plan and updating it frequently to modify FOR new tasks and/or procedures that affect occupational exposures. This plan should also be shared and promoted in every department of the facility.
To boost compliance of this plan, facilities should continually explore new ways to improve infection prevention techniques. Through vetting all options, such as new technology, room design and new prevention methods, healthcare facilities can ensure that they are taking all necessary precautions to reduce exposures and improving infection control.
Linda Goss is an infection preventionist consultant for MEIKO USA, a disinfection appliance manufacturer, and a consultant for Safe Patient Surveys. She also is an infectious disease nurse practitioner and an infection preventionist at an acute care hospital in Louisville, Ky. Goss has worked in infection prevention for 15 years and is certified in infection control, occupational health nursing, informatics nursing and as an adult nurse practitioner. She has published and presented on numerous infection control topics ranging from surveillance to disinfection and sterilization.
1. Doebbeling BN, Vaughn TE, McCoy KD, Beekmann SE, Woolson RF, Ferguson KJ, Torner JC. (2003). Percutaneous injury, blood exposure, and adherence to standard precautions: are hospital-based health care providers still at risk? Clin Infect Dis, 37(8), 1006-13.
2. Saia M, Hoffmann F, Sharman J, Abiteboul D, Campins M, Burkowitz J, Choe Y, and Kavanaugh S Needlestick Injuries: Incidence and Cost in the United States, United Kingdom, Germany, France, Italy, and Spain. Biomedicine International (2010) 1: 41-49.
3. Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens OSHA: final rule Fed Register 119:56:64004-64182 1910.1030(c)(1)(ii) https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 retrieved December 12th 2014
4. Weber D, Rutala W, and Schaffner W Lessons learned: Protection of healthcare workers from infectious diseases risks Critical Care Medicine 2010 Vol. 38. No. 8.
5. Kessler, C, McGuinn, M Spec, A Christensen, J Baragi, R and Hershow, R Underreporting of blood and body fluid exposures among health care students and trainees in the acute care setting: a 2007 survey American Journal of Infection Control March 2011 Vol. 39 No. 2 pages 129-133.
6. Harris, S Nicolai, L Occupational exposures in emergency medical service providers and knowledge of and compliance with universal precautions American Journal of Infection Control March 2010 Vol 38 No.2 pages 86-92.