1. Injection Safety: Updates from Michigan and the U.S. October 9, 2015 Emily Goerge, MPH, MSN, RN, CIC

2. Objectives Discuss examples of unsafe injection practices that can lead to healthcare-associated transmission of pathogens Describe available training materials to educate staff

6. Principles of Injection Safety ▫Guiding principle:  One needle, one syringe, one time

7. Principles of injection safety ▫Single-Dose Vials  To be used for only ONE patient ▫IV Bags  Not to be used as a common source ▫Multi-dose Vials  Use a new, sterile needle and syringe each time enter the vial ▫Fingerstick devices and insulin pens  Never to be shared ▫Glucometers  If must be shared, ensure cleaned according to manufacturers instructions prior to each use

8. Why injections? Unsafe practices put patients and healthcare workers at risk ▫Infectious and non-infectious events The adverse events are PREVENTABLE Can happen in a variety of settings ▫Acute care, long-term care, ambulatory care Just takes one mistake… …or it may involve many unsafe practices

9. Injection Safety Outbreaks Between 2008 and 2013 there have been 38 healthcare-associated outbreaks of hepatitis B or C: ▫385 patients acquired HBV or HCV ▫Over 100,000 persons were notified of being at risk ▫94% of these outbreaks occurred in outpatient settings These outbreaks likely represent only the ‘tip of the iceberg’: ▫Asymptomatic carriage ▫Most cases undiagnosed

10. Reporting Report possible outbreaks Report cases (of viral hepatitis) Importance of case reporting and follow-up ▫Control the spread of disease ▫Exploring risk factors for specific disease  We encourage all LHDs to follow-up on cases of acute and chronic HCV; especially in priority populations

12. What is Michigan doing? ▫2013 Survey -- ASCs

13. What is Michigan doing?

14. 2014 Survey – LTC Facilities

15. What is Michigan doing? ▫Injection Safety website  www.michigan.gov/injectionsafety www.michigan.gov/injectionsafety  Modules  Most 10 minutes or less in length  Address topics such as: o Injection Prep and Admin, o 3 Simple Rules for Diabetes Care, o Drug Diversion

16. www.michigan.gov/injectionsafety

17. What is Michigan doing? ▫Member of One and Only Campaign  www.oneandonlycampaign.org www.oneandonlycampaign.org  Monthly conference calls  Healthcare facilities are also welcome to join the One and Only Campaign  www.oneandonlycampaign.org/content/one-only- campaign-members www.oneandonlycampaign.org/content/one-only- campaign-members ▫Drug Diversion  MI NADDI Chapter  www.naddi.org/aws/NADDI/pt/sp/home_page www.naddi.org/aws/NADDI/pt/sp/home_page

19. What about on a national level? One and Only Campaign ▫Drug Diversion http://www.oneandonlycampaig n.org/content/risks-healthcare- associated-infections-drug- diversion

20. U.S. Outbreaks Associated With Drug Diversion by Healthcare Providers, 1983-2013 www.cdc.gov/injectionsafety/drugdiversion

21. ▫Oncology and pain clinic patients ▫FAQ document for healthcare providers ▫Healthcare Provider brochure http://www.oneandonlycampaign.org/

22. Video http://www.oneandonlycampaign.org/content/audio-video

23. Recent updates From the One and Only Campaign ▫FDA label on multidose insulin pens  http://www.fda.gov/Drugs/DrugSafety/ucm435271. htm http://www.fda.gov/Drugs/DrugSafety/ucm435271. htm ▫WHO – worldwide use of smart syringe  http://www.who.int/mediacentre/news/releases/20 15/injection-safety/en/ http://www.who.int/mediacentre/news/releases/20 15/injection-safety/en/

24. Recent Updates From CDC ▫September 11, 2015 CDC issued Health Advisory alerting facilities to review procedures for cleaning, disinfecting and sterilizing reusable medical devices  Include glucometers  http://emergency.cdc.gov/han/han00382.asp http://emergency.cdc.gov/han/han00382.asp

25. Other important tools ▫CDC has toolkit to assist with patient notification  http://www.cdc.gov/injectionsafety/pntoolkit/index.html http://www.cdc.gov/injectionsafety/pntoolkit/index.html ▫Investigation guide  http://www.cdc.gov/hepatitis/outbreaks/healthcareinvestigationguid e.htm http://www.cdc.gov/hepatitis/outbreaks/healthcareinvestigationguid e.htm ▫CDC’s Sharps Safety for Healthcare Workers webpage: http://www.cdc.gov/sharpssafety/?s_cid=dhqp_019 http://www.cdc.gov/sharpssafety/?s_cid=dhqp_019  Workbook  Teaching Tools

26. Things to consider in your facility How well do you know your healthcare workers’ injection safety knowledge and practice? ▫What about in your outpatient areas and clinics? How are your controlled substances monitored? Do you perform any chart review on viral hepatitis patients that seroconvert or have acute disease?

27. What can ICPs do? Survey your healthcare workers to determine areas of need Educate staff Encourage staff to intervene/report unsafe injection practices Perform chart review on new viral hepatitis cases Report potential HAIs to local/state health departments (even if only one case!)

28. Take Home Points Always perform safe injection practices Be aware of possibility of drug diversion in facility Investigate suspicious cases; acute cases to rule out HAI transmission Report possible outbreaks to LHD, State HD

30. Thank You! Emily Goerge, MPH, MSN, RN, CIC Viral Hepatitis Nurse Consultant GoergeE@michigan.gov **NEW** MDHHS-Hepatitis@michigan.gov MDHHS-Hepatitis@michigan.gov www.michigan.gov/hepatitis www.michigan.gov/injectionsafety