Sharps Injuries in the Operating Room

1. Sharps Injuries in the Operating Room Amanda M. Gust, MPH Raymond C. Sinclair, PhD Pat Hickey, RN, BSN, MS, CNOR Alice Weiss, RN Carmen Garcia, RN National Institute for Occupational Safety and Health Centers for Disease Control and Prevention August 1, 2002

2. Introduction / Objectives • Sharps injury prevention activities • Information & education campaign • Stop Sticks Campaign • Operating Room Safety Blitz • Campaign Process • Communications campaign are sustained • “Can campaign methods be used to effectively prevent occupational sharps injuries?”

3. Stop Sticks Campaign • Columbia, SC—5-year pilot project • Goal: • Raise awareness among health care workers regarding exposure to BBPs from sharps injuries • Increase exposure prevention behaviors • Target Audience: • Clinical HCWs • Non-clinical HCWs • Health care administrators • Six (6) primary facilities

4. Stop Sticks Campaign • Aims to deliver information and education • BBPs, exposure prevention methods, device evaluation, & PEP • Multiple messages • Multiple channels • Multiple times • Interventions • Posters, newsletter articles, workshops, in-service trainings, website, PSAs, direct mail, exhibits, safety fairs, mini-campaigns

5. OR Safety Blitz • February 2002 • 1 month long • Largest community hospital • 24 operating rooms • ~150 OR staff • OR has highest rate of sharps injury • Reduce injuries by going “back to the basics”

6. Campaign Process Audience Message Development Message Delivery Evaluation Audience Analysis 1 2 3 4

7. Campaign Process • Audience Analysis • The more you know the better • Demographic characteristics • Attitudes & knowledge • Existing circumstances • Information gathering methods • Surveys, employee records, small groups, one-on-one, staff meetings • Tailor campaign & messages accordingly

8. OR Safety Blitz • Audience Analysis • Occupation – Techs, Nurses, Surgeons • Education– 2-15 years of additional schooling • Attitudes about safety – various stages (Ex: Neutral Zone) • Environment – Fit campaign into current working conditions Messages kept fairly non-technical with a few exceptions Ex: surgical grand rounds

9. Campaign Process • Message Development • Relative risk, prevention strategies, & treatment options • Content should lead to increased knowledge • Clear / simple messages with frequent repetition • Develop messages simultaneously • Avoid contradiction • Creative & appealing • Pilot draft messages before use

10. Campaign Process Audience Message Development Message Delivery Evaluation Audience Analysis 1 2 3 4

11. OR Safety Blitz Message Development One message per week • Risk of experiencing a sharps injury • Passing and loading cause the most sharps injuries • Establish a neutral zone • Use safer sharps devices Balance between “reviewing old” information and “providing new” information to capture attention

13. Campaign Process • Message Delivery • Set a strategic schedule for dissemination • Coordinate message release • Ex: risk of sharps injuries info. about safer sharps devices device evaluation • Method of delivery & number of repetitions • Use several channels • Numerous choices • Strengths & weaknesses vary • Repetition

14. OR Safety Blitz • Message Delivery • Use pre-existing channels if appropriate (we had several) • Six (6) channels of communication • Posters (over the scrub sinks) • Newsletter articles • Mandatory bi-monthly staff meetings • Paycheck stuffer • Device fair exhibit • Promotional items

20. OR Safety Blitz

21. Campaign Process • Evaluation • Coherent & systematic plan • Determine indicators • Exposure to message / campaign is often overlooked, but important • If campaign exposure is determined, look for changes • Awareness, knowledge, attitudes, motivations, behaviors • Campaign feedback – likes / dislikes

22. Campaign Process • Evaluation • Injury reduction difficult to measure • Awareness, infrequent occurrences, campaign length • Set up comparison • Pre-test / post-test • Methods of data collection • Focus groups, surveys, interviews, beh. obs. • Choosing methods • Available resources, what questions you want answered, existing opportunities

23. OR Safety Blitz • Evaluation • Pre-test given during week 1 – (n = 90 / 150) • Post-test 1 month after completion of blitz – (n = 37 / 150) • General make-up between pre / post-test comparable • Q = During my time of employment in the OR, I have experienced a sharps injury: • Never = 35% • 1-3 times = 49% • More than 3 times = 9% • No answer = 7% • Respondents valued all 4 methods of reducing sharps injuries • Safer techniques, neutral zone, improved communications, increased training

24. OR Safety Blitz • Evaluation • Campaign feedback • All were aware of OR campaign • 71% felt the campaign had an effect on the way they do their work • Most preferred: posters, safety fair, & neutral zone demonstration

25. OR Safety Blitz • Evaluation • Suggested actions / improvements: • More physician involvement – esp. anesthesia • Include residents and students • Implement what we have learned • Increased campaign impact? • Speaker with a negative outcome • More staff input • Next steps: • Follow-up & continued emphasis of safety practices • Implementation of safety techniques & device

26. OR Safety Blitz • Lessons Learned • Importance of close communication • Posters and newsletter articles • Paycheck stuffer • Evaluation • Pre / post-test coordination • Behavioral observations • Campaigns may work in OSH • Only positive feedback – “we want more” • Content added to residency orientation • Blitz approach used for JCAHO activities

27. Conclusion • OR Safety Blitz vs Stop Sticks Campaign • Department, Facility, or Community level • Still contains all four (4) processes • Study your audience – check back at each stage • Use multiple messages – stay consistent • Use multiple channels – repetition • Evaluate your efforts • Systematic approach when doing communications

28. Contact Information National Institute for Occupational Safety & Health (800) 35 - NIOSH www.cdc.gov/niosh Ray Sinclair (513) 533-8172 Rsinclair@cdc.gov