OR Manager - September 2019 - 37

AMBULATORY
SURGERY CENTERS
Continued from page 35
* emptying or transporting open containers
of fluids and specimens
* managing patients during trauma or
codes
* managing patients who spit.
Tasks for which face shields are
strongly recommended include:
* performing respiratory care such as
turning and other tasks with low risk
for splashes
* performing bedside care that poses
low risk for splashes
* performing procedures completed
in any location with low risk for
splashes.
Additional guidelines state personal
eyeglasses and contacts are not considered
adequate eye protection, and face
shields need to be changed between
patients. Noncompliance is subject to
disciplinary action.
The Occupational Safety and Health
Administration (OSHA) standard
1910.1030(d)(3)(ii) regarding use of
PPE was used as a reference for this
policy, along with 1910.1030(d)(3)(x),
which speaks specifically to the use of
masks and eye protection when the potential
for splashes exists.
Increasing compliance is crucial
for safety
Historically, the OR has been second
only to patient rooms in the number of
reported sharps-related injuries. The
environment presents the perfect storm
of intensity, blood, and sharps and
other devices that can cause injury. In
addition, stress, pressure to turn over
rooms, understaffing, fatigue, and lack
of training increase the potential for
injury.
Most sharps injuries in the OR are
caused by suture needles, followed by
scalpel blades and syringes. Hands-free
zones have proven to be a best practice
for preventing injures, but compliance
can be challenging.
" Ambulatory surgery centers [ASCs]
are a fast-paced environment, so emwww.ormanager.com
As
many as 50%
of needlesticks go
unreported.
ployees need to be knowledgeable regarding
the facility's exposure control
procedures, and these practices must
become routine. In the surgical team
environment, everyone must adhere to
the practice, " says Jan Kleinhesselink,
BSHM, RN, CPHQ, chief clinical officer
at Lincoln Surgical Hospital (Charon
Shared Services), Lincoln, Nebraska,
and a surveyor for the Accreditation
Association for Ambulatory Healthcare
(AAAHC).
Sabin says being distracted or in a
hurry can contribute to noncompliance.
" Staff go on autopilot and don't pay
attention to their surroundings, or their
patient may be in distress, so they skip
PPE. " She notes that it's critical to have
PPE readily available in a consistent
location to help staff comply with use.
Kleinhesselink agrees: " Employees
practice may drift, and they may lose
awareness of the exposure risks associated
with their role. It's similar to
running a yellow light; when nothing
bad happens, we become complacent.
When that occurs, employees may not
consistently follow recommended exposure
control practices. "
To ensure compliance, Kleinhesselink
suggests auditing and confirming
that department leadership is aware of
daily practice.
" When an injury does occur, it is
necessary to review the incident and
analyze processes; action taken should
be based on problems identified, " she
says. " Formal audits are important,
but if you witness an employee drifting
from procedure, for example, wearing
glasses instead of goggles, coach the
employee at the time. Discuss behavior
and determine if barriers and process
issues need to be addressed to reduce
the risk of recurrence. "
Kleinhesselink says exposure control
practices increasingly are a focus at
ASCs-especially the use of PPE during
the instrument decontamination process.
UnityPoint requires annual education
for bloodborne pathogen exposure and
collaborates with infection control when
changes in policy, procedures, or equipment
occur.
" Ongoing training and monitoring of
compliance with exposure control practices
are key, particularly when employees
in ASCs often have multiple roles,
which can include handling contaminated
items, " Kleinhesselink says.
Establish procedures for
managing exposures
It is recommended that facilities have
policies and procedures for exposure to
bloodborne pathogens that define what
testing is needed for the employee
and the patient, and what information
is given to the patient. The need for
follow-up testing will depend on the results
of initial tests.
" The testing can be an emotional
experience for the employee, " Gibbons
says. " It has the potential to impact the
lives of our healthcare workers and their
families. "
It can take weeks or months to confirm
that the injured person is free of
infection, and-depending on the type
of exposure-testing may need to continue
for a prolonged period of time.
Employee assistance programs may be
of value if the need for counseling is
identified. Managers need to maintain
communication with employees who will
require ongoing testing.
UnityPoint has a Bloodborne Pathogen
Committee with representatives
from all disciplines who monitor all exposures,
develop education for new devices,
and coordinate projects related
to bloodborne pathogens, Sabin says.
Leadership is also represented to help
reinforce changes in policy.
Continued on page 39
OR Manager | September 2019 37
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