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

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

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

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

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

Campaign Process Audience Audience Analysis Message Development Message Delivery Evaluation 1234

Campaign Process Audience Analysis 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

OR Safety Blitz Audience Analysis 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 Messages kept fairly non-technical with a few exceptions Ex: surgical grand rounds

Campaign Process Message Development 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

Campaign Process Audience Message Development Message Delivery Evaluation 1234 Audience Analysis

OR Safety Blitz Message Development One message per week 1. Risk of experiencing a sharps injury 2. Passing and loading cause the most sharps injuries 3. Establish a neutral zone 4. Use safer sharps devices Balance between “reviewing old” information and “providing new” information to capture attention

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

OR Safety Blitz Message Delivery 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

OR Safety Blitz Posters Newsletter Articles Paycheck Stuffer Staff Meetings Promotional Items Exhibit Week 1 XXXX Week 2 XXX Week 3 XXXX Week 4 XXXX

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

Campaign Process Evaluation 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 opportunitiesAvailable resources, what questions you want answered, existing opportunities

OR Safety Blitz Evaluation 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

OR Safety Blitz Evaluation 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

OR Safety Blitz Evaluation Evaluation  Suggested actions / improvements:  More physician involvement – esp. anesthesia Include residents and studentsInclude 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

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

Conclusion OR Safety Blitz vs Stop Sticks Campaign 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 stageStudy your audience – check back at each stage Use multiple messages – stay consistentUse multiple messages – stay consistent Use multiple channels – repetitionUse multiple channels – repetition Evaluate your effortsEvaluate your efforts Systematic approach when doing communications Systematic approach when doing communications

Contact Information National Institute for Occupational Safety & Health (800) 35 - NIOSH Ray Sinclair (513)