Karen Daley, PhD (c), MS, MPH, RN Needlestick Injuries Conference Dublin 2006 Critical Exposure: My Story

My Story Details of injury Occupational health follow-up

Decision to go public Personal considerations Putting a face to the issue Making some sense out of it

Needlestick injuries in the US What we knew in 1999: Incidence/frequency estimates Significant underreporting More than 20 BBP (most often hep C) 1000 HCW infections reported/yr Data quality inconsistent Prevention possible

Hepatitis C: An Emerging Silent Epidemic 4M estimated cases in US; 170M worldwide 4X more prevalent than HIV in US pop HCWs 3rd highest occupational risk grp Long latency period with 85% chronic infection; 20-25% develop cirrhosis No current vaccine or prophylaxis Early detection and treatment key

Needlestick injuries in the US What we didn’t know: Actual numbers of injuries Actual number of infected workers Injury device specific information Device evaluation information

Needlestick injury costs Lost work/productivity/treatment Occupational health follow-up Studies suggested $1500-$3000 per exposed worker without injuries/yr = $900M-$1.8B One infected worker: $500,000-$1M over lifetime

Potential costs of injuries Human costs Insured costs: medical f/u, HIV prophylaxis, treatment, disability, lost time Uninsured costs: paid wages, OT, replacement workers, clerical/supervisor time Organizational losses

Safer needle technology in 1999 Available for more than two decades 1000 products on current market 250 FDA approved Poor market penetration (15%) Effectiveness varies (need data) Cost implications/benefit

Cost of technology (1999) Standard blood-drawing device: aver $.07 Safety needle devices: aver $.28 more Up front conversion/incremental costs One study: 300 bed hospital:$17,000 Safety device costs have declined as market penetration increased

Most effective technologies Active vs. passive Designs: shield; sheath; retractable Disposal systems Prevent over 80% of injuries

A Journey Beyond the Personal Massachusetts Nurses Association legislation State advocacy Federal advocacy

2000 Federal Needlestick Safety & Prevention Act Amends OSHA BBP standard Requires use of safer devices Frontline nurses and other healthcare workers participate in device selection and evaluation

Federal legislation components Device/injury data collection and logs Written exposure control plan with annual update Ongoing education/training of workers

Where we are today in US Indicators of progress: Market conversion to safety devices Increase in number of OSHA inspections Reduction in number of injuries due to conventional devices Overall decline in number of injuries