A cluster of needlestick injuries on one hospital floor turned out to come from sharps containers placed where staff couldn't easily reach them. The fix — moving the containers — is the kind of result CDC wants healthcare organizations to get from regular, structured risk assessment. Healthcare personnel face infectious exposures that vary with their duties and other factors, and section 3 of CDC's guideline Infection Control in Healthcare Personnel (Part I: Infrastructure and Routine Practices) sets out how to find and reduce them.
The recommendations
| For | Recommendation | |
|---|---|---|
| 3.a | Healthcare organization leaders and administrators | Meet regularly with occupational health services (OHS) leaders to review risk assessment results, set performance goals, and charge departments and individuals with reducing risks |
| 3.b | OHS leaders and staff | Conduct, or collaborate with other departments on, regular risk assessments and risk reduction activities |
| 3.c | OHS leaders and staff | Tell organization leaders and departments about hazards found, and about risk reduction plans, progress and priorities |
Depending on the organization and the risk, OHS may lead the work or collaborate with departments such as infection prevention and control. Examples include bringing services to off-site locations during work hours and working with supply management so staff have the right personal protective equipment (PPE). Solutions are chosen using the hierarchy of controls, from eliminating a hazard down to PPE.
The hierarchy of controls, from most effective (top) to least. Credit: Centers for Disease Control and Prevention.
Examples in practice
| Hazard found | How it was assessed | Fix (type of control) |
|---|---|---|
| Surgeons' needlesticks when suturing fascia with sharp needles | Review of sharps injury logs (e.g., OSHA 300 forms) | Policies requiring blunt-tipped suture needles for fascia (elimination/substitution) |
| Sharps injuries on one unit, linked to badly placed sharps containers | Sharps injury logs | Move the containers somewhere accessible (engineering) |
| Injuries with a new safety syringe; staff reported no training | Sharps injury logs | Train staff on new products before use (administrative) |
| Lowest flu vaccination coverage at a free-standing outpatient site with no on-site shots | Immunization records and interviews | Offer vaccination on site during work hours (administrative) |
| TB infections among staff on one hospital unit over six months | Health records and interviews | Repair the faulty negative pressure in an airborne infection isolation room (engineering) |
| Staff coming to work ill over six months, for fear of consequences or lack of paid sick leave | Health records and interviews | Make sick leave policies non-punitive and tell staff about the change (administrative) |
What regulators require
Assessment is supported or required by federal, state and local rules, payers and accreditors. Among the requirements:
- OSHA requires logs of work-related injuries and illnesses meeting certain criteria, including infectious exposures; workplace evaluations of the Exposure Control plan; and evaluation of respiratory hazards, with a respiratory protection program if needed. It also offers online tools such as a job hazard analysis booklet and "eTools."
- CMS requires some organizations to report staff flu vaccination coverage to CDC's National Healthcare Safety Network as a Condition of Participation.
- The Joint Commission requires a staff flu vaccination program with incremental coverage goals and reporting of vaccination rates to key stakeholders.
Section 1, Leadership and Management, and section 2, Communication and Collaboration, contain related recommendations.
Sources
Based on "3. Risk Assessment and Reduction," Infection Control in Healthcare Personnel, Part I: Infrastructure and Routine Practices, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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