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 40percent of all percutaneous injuries occur in the operating room (OR). Asadvocates for employee safety, our employee health department does an ongoingproactive evaluation of all occupational exposures. We noticed that our OR hadwonderful rates, almost nonexistent. Certainly nowhere near the average ratereported nationally.

The OR is dedicated to invasive procedures that require theuse of scalpels and needles. It also involves contact with blood and bodyfluids. Although OR personnel have training and expertise in their specialties,spills and slips with sharps still happen. Sharps injury prevention in the ORdid not appear to be necessary in our facility, if you looked at the number ofreported 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 whowere able and ready to educate them should they fail to comply. But what aboutphysicians? Who can control a surgeon? Occasionally, a shred of informationwould reach us, teasing us, like a confidential HIV report in our lab fileswith, presumably, the employee health physician ordering on an unfamiliarpatient name. We could then safely surmise that a physician had been poked andwanted to know the status of the source patient, but who was it? Like SherlockHolmes, 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 gotpoked in surgery. But rarely was there paperwork listing the specifics of theevent.

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 couldnt even get them to complete an incident report!

With the muscle of the requiring agency behind us and fear offines and job loss before us, we developed a condensed, one-page version of ourown employee HIV/Hepatitis Post Exposure Evaluation and Recommendationsform, and dressed it in living color. Minimal OSHA-required information (thetype, brand, model of the sharp) was bordered in red. Legible name of thesurgeon and source patient name are highlighted in yellow, with other exposurerisk information bordered in yellow. We used a blue border for the signaturebox. Interestingly enough, the OR staff were thrilled with a simplifiedreporting mechanism, and started passing them out. In the past few months I haveseen more physicians in my office bringing the form with them than ever before.

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

Sally Nickerson is a three-year diploma graduate of SwedishCovenant Hospital in Chicago. She has worked at Metropolitan Hospital since 1987and began her role as employee health nurse in 1995.