A common truism is that “you can’t have patient safety without worker safety” — which makes intuitive sense, but lacks definitive data.
A potential landmark study attempting to link the two has drawn the support of some major agencies and organizations, including the National Institute for Occupational Safety and Health (NIOSH) and the Association of Occupational Health Professionals in Healthcare (AOHP).
The study will be conducted at the unit level of some 100 hospitals. Researchers will assess such factors as compliance with standard infection control precautions to protect workers and patients, blood exposures and needlesticks to HCWs, hospital-associated infections, and an overall assessment of the safety culture.
“The gap this study is addressing is that there is a focus on the healthcare worker and occupational health safety, and then there is the other side — the folks that look at patient safety,” says lead researcher Amanda Hessels, PhD, MPH, RN, CIC, CPHQ, associate research scientist in the Columbia University School of Nursing in New York City. “As a registered nurse myself, I [understand] that whether or not I adhere to standard precautions could impact not only my safety, but my patients’ safety as well. These are really overlapping goals, and [this research] is a unique way to leverage both of these priorities.”
In that regard, the researchers are reaching out not only to employee health professionals, but their colleagues in the Association for Professionals in Infection Control and Epidemiology (APIC). The AOHP recently encouraged its members to support the study, and some employee health professionals are coming on board as the research begins this year.
“I am hearing from occupational health professionals who are interested in this,” Hessels says. “Again, they are overburdened, overworked, as you know; they deal with the outcomes of these exposures. They are also very interested in understanding factors that influence healthcare workers’ behaviors — whether it is an active decision or an oversight. What are the factors that influence those behaviors?”
Three Important Public Health Issues
Standard infection control precautions with all patients have long been recommended, but there is a surprising lack of definitive data about what role they actually play in protecting the patient and the healthcare worker. Thus, the study will assess whether high compliance with standard precautions actually translates to lower worker blood exposures and needlesticks, and fewer healthcare-associated infections (HAIs).
“The aims of the study focus on three really important public health problems: high [exposure] rates to healthcare workers, high rates of HAIs, and low levels of standard precautions adherence,” Hessels says. “Another study aim is designed to test whether a more positive patient safety environment is associated with a greater portion of standard precaution adherence.”
The study, “Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes,” is being funded by NIOSH and the CDC. If successful, not only would establishing this link directly benefit patients and workers, but it has the potential to elevate the status and validate the value of the specialty of occupational health.
Participants will receive basic training on standard precautions at the onset to ensure everyone understands and is using the same basic principles.
“The training is to reiterate their existing knowledge base and refresh their understanding of the standard precautions recommendations, which are some 20 years old, so that we are all on the same page initially,” she says. “In collecting these observational data, we will be training a national cadre of nurses, infection preventionists, and others to do something similar to what they do in their day-to-day work, which is observational surveillance. We’re going to, for the first time, use tools that are standardized and have some reliability and validity so we can compare across sites.”
PPE, Injection Safety
There will be elements of the study designed to offset the Hawthorne effect, which essentially means people change their behavior when they know they are being observed.
“There is more in the emerging literature about the Hawthorne effect and surveillance methodology,” she says. “As you know, collection of observational data is considered the gold standard. I would be remiss if we didn’t acknowledge that there is a terrific interplay in looking at data in concert — different types of data, observational data, electronically obtained data, etc. For these data, the Hawthorne effect is being minimized by the observer collecting data on routine healthcare in a manner in which they are situated in a space or a place where they are not interacting with either the HCWs or the patients; they are really part of the environment, really just collecting data on the standard the workflow. This is a snapshot of activities and behaviors.”
As employee health professionals know, standard precautions recommended by the CDC apply to all patients. According to the CDC, standard precautions include hand hygiene, use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure.1 In addition, safe injection practices and handling equipment in a manner to prevent transmission of infectious agents is recommended. Respiratory hygiene also was added to standard precautions after the emergence of SARS in 2003, directing patients to cover coughs and sneezes when they first present to a healthcare setting.
“I’m finding in the number of phone calls from people that are interested and reaching out to me from across the nation is that they want their team on board to undergo this training and to assist,” Hessels says. “In other words, there is more than one person per site that is interested in participating. I think that is a unique and a very telling finding about how very important this [topic] is to folks on the front lines of preventing both healthcare worker exposures and hospital-associated infections.”
The observational study will assess compliance with the standard precautions measures, including the following.
- Hand hygiene before touching a patient, after touching patient, and after contact with patient environment/surroundings.
- Don gloves when touching blood, body fluids, secretions, excretions, contaminated items, touching patient mucous membranes, and non-intact skin during invasive procedures.
- Remove gloves immediately following procedure/indication for glove usage.
- Don gown when performing procedures and patient-care activities when there will be contact of clothing/exposed skin with blood/body fluids, secretions, and excretions.
- Remove gown immediately following procedure/indication for gown usage.
- Don mask, eye protection (goggles), and face shield during procedures and patient care activities likely to generate droplets, aerosolization, or splashes or sprays of blood, body fluids, and secretions, especially during suctioning and endotracheal intubation.
- Immediately place used sharps in puncture-resistant container.
REFERENCES
- CDC. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Isolation Precautions 2007: http://bit.ly/2pgeBcg.
A common truism is that “you can’t have patient safety without worker safety” — which makes intuitive sense, but lacks definitive data.
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