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Becton, Dickinson and — BD Medication Delivery Solutions Virtual Event 2020 (MDS20)
50 slides from Becton, Dickinson and's conference presentation, April 2020
Slide 1: Presentation disclaimer
These presentations were developed by the respective presenter(s), and the findings, interpretations, and conclusions contained or expressed with them do not necessarily reflect the views of BD. To the extent these presentations relate to specific products, such products should always be used in acc
Slide 2: The importance of safety
The importance of safety Gabriella De Carli, MD on behalf of the Italian Study Group on Occupational Risk of HIV (SIROH) Department of Epidemiology, Pre-clinical Research and Advanced Diagnostics National Institute for Infectious Diseases “L. Spallanzani” - IRCCS, Rome, Italy www.inmi.it - SIROH - s
Slide 3: Fever nursing quotation
“Many nurses avoid as far as possible the care of infectious disease cases, and for two reasons: they realize their insufficient training and fear the possible consequences. Fever nursing aims, fundamentally, at Both these obstacles can be removed by a these two objects: the intelligent care of thor
Slide 4: Proper admission and supervision of patients
“..Proper admission and supervision of patients. Exact diagnosis is difficult and impossible in a certain percentage of cases. These unrecognized cases are one of the most important sources of disease in any community and particularly in a general hospital. The admitting officer should realize this
Slide 5: The Brick Wall of Safety
The Brick Wall of Safety Needle and Sharps Injuries Prevention Patients’ safety Safety-engineered Banning of Elimination of devices recapping unnecessary needles Sharps Response Raising Awareness containers & follow-up Reporting & Work Organization Vaccination Recording Education & Personal Protecti
Slide 6: P inf. = P x E x F
P inf. = P x E x F Pinf. = Probability to acquire an occupational infection P = Probability that sources are BBV-infected (prevalence) E = Efficacy of transmission F = Frequency of exposure
Slide 7: Raising Awareness: HBV, HCV and HIV prevalence
Raising Awareness HBV (HBsAg+) 15 Millions in the European region (1.6%) 257 worldwide HCV (HCV RNA+) HIV 14 Millions in the New diagnoses and rates per European region (1.2%) 100 000 71 worldwide population WHO (LSHTM) 2015 2008-2017 WHO (ECDC) 2018
Slide 8: HIV seroconversion rate following exposure to blood
Quantification of risks HIV Seroconversion rate (SC), following exposure to blood SIROH, 1986-2017 Type of exposure SC/exp % rate 95% CI 1986-1996 Percutaneous 3/2066 0.14 0.03-0.42 pre-HAART Mucous cont. 2/486 0.41 0.05-1.48 Non-intact skin 0/547 0 -0.67 1997-2017 Percutaneous 1/1516 0.07 0.006-0.3
Slide 9: HCV seroconversion rates following exposure to blood
Quantification of risks HCV seroconversion (SC) rates, following exposure to blood SIROH, 1994-2017 HCV Type of exposure (blood only) SC/exp % rate 95% CI Percutaneous exposure 41/13737 0.32 0.21-0.39 Hollow-bore, blood-filled needle 36/3640 1.00 0.69-1.36 Hollow-bore needle 1/3943 0.03 .006 -0.14 S
Slide 10: HBV Vaccination
Ss = eo o oS “4 o 8 Source: Joint UNICEF—-WHO reporting form African Region Region of the Americas Eastern Mediterranean Region European Region South-East Asia Region Western Pacific Region Global
Slide 11: Occupational infections acquired through needlestick or sharps injury
Cases of occupational infections or diseases acquired through a needle or sharps injury in the health care or laboratory setting (by year of publication of the first report in the literature) Raising Awareness De Carli G, Abiteboul D, Puro V. Biochem Med (Zagreb) 2014; 24:45-56
Slide 12: Emerging infectious diseases
Novel coronavirus Wuhan Diphteria Measles CCHF Disease X Using a large-scale meta- transcriptomic approach, we discover 214 vertebrate- associated viruses in reptiles, amphibians, lungfish, ray-finned fish, cartilaginous fish and jawless fish. The newly discovered viruses appear in every family or g
Slide 13: Ebola: doctors divided on IV therapy in Africa
Ebola Doctors Are Divided on IV Therapy in Africa By DONALD G. McNEIL Jr. JAN. 1, 2015 NYT Medical experts seeking to stem the Ebola epidemic are sharply divided over whether most patients in West Africa should, or can, be given intravenous hydration, a therapy that is standard in developed countrie
Slide 14: Risk factors for acquiring an occupational infection
Characterization of risks Risk factors for acquiring an occupational infection following a percutaneous exposure Risk factor Added risk of Added risk of acquiring HIV acquiring HCV (adj. OR, CI 95%)1 (adj. OR, CI 95%)2 Deep injury 15,34 (6,01-41,05) 155,2 (7,1-3417,2) Visible blood on the device 6,1
Slide 15: Map of risk: Device involved in NSI by area
Map of risk: Device involved in NSI by area Surgical area Critical area Medical area Laboratory Non hospital setting Services Hollow-bore, Hollow-bore, Aghi blood-filled blood-filled cavi pieni di sangue Aghi cavi non pieni Hollow-bore, di sangue injection Lancet Lancet Lancetta Ago da sutura Suture
Slide 16: Map of risk: Procedure being performed when NSI occurred
Map of risk: Procedure being performed when the NSI occurred Capillary Suturing sampling 3660, 5% 10864, 15% Other 17238, 23% Venous blood drawing 9864, 13% 4098, 5% Incision 2175, 3% Arterial blood 9844, 13% 16854, 23% drawing Peripheral injection vascular access ED: RR of sustaining a NSI with IV
Slide 17: Percutaneous exposures by job category and area
Percutaneous exposures per 100 full-time equivalents, by job category and area SIROH, Italy Housekeeper MD Nurse Midwife 12 Technician 10 GM general medicine 8 MS medical specialties % 6 GS general surgery SS surgical specialties 4 ID infectious diseases 2 ICU intensive care 0 D dialysis GM MS GS SS
Slide 18: High-risk percutaneous exposures by job category and area
High-risk Percutaneous exposures per 100 FTE, by job category and area SIROH, Italy Housekeeper MD Nurse 12 Midwife 10 Technician 8 GM general medicine 6 MS medical specialties % GS general surgery 4 SS surgical specialties 2 ID infectious diseases 0 ICU intensive care GM MS GS SS ID ICU D L O D dia
Slide 19: Risk Assessment
Risk of infection Critical Fistula needle Spinal needle IV catheter stylet Phlebotomy needle according to the amount of blood or other body Serious Thoracentesis Scalpel Lancet Surgical fluid potentially inoculated Paracentesis instruments through a needlestick or cut Medium Culture inoculation IV i
Slide 20: Introduction of safety devices
introduction of safety devices Safety-engineered devices
Slide 21: NSI rate versus percentage of safety devices used
Safety-engineered devices Percentage of SED used Punture x100000 dispositivi convenzionali e di sicurezza 10,00 100 9,00 90 8,00 80 % dispositivi di sicurezza usati 7,00 70 6,00 60 5,00 50 4,00 40 3,00 30 2,00 20 1,00 10 0,00 0 0 1 2 3 4 5 6 7 8 NSI per 100,000 used Anni dall'introduzione Years from
Slide 22: The Needlestick Safety and Prevention Act
The Needlestick Safety and Prevention Act (6/11/2000) 38% (95% CI: 35% - 41%) 23,908 injuries (85 hospitals in 10 states) 21 Safety-engineered devices
Slide 23: Needlestick rates, conventional vs safety-engineered devices
Needlestick rates, conventional vs safety-engineered devices 12 22 SIROH hospitals, 1997-2010. Injury rate per 100,000 used devices 10 8 Y = - 0·483x + 9.237 R² = 0·590 6 4 Y = - 0·162x + 2·904 Conventional R² = 0·823 2 Safety 0 Baseline 1 2 3 4 5 6 7 8 9 Proportion of safety devices use 56·1% 52·2%
Slide 24: Efficacy of safety hollow-bore, blood-filled devices
Efficacy of safety hollow-bore, blood-filled devices 22 SIROH hospitals, 1997-2010 20 Injury rate per 100,000 used devices 18 16 Baseline Concurrent 14 Safety active Safety passive 12 10 8 6 4 2 0 Phlebotomy set Winged needle set IV catheter ABG syringe Lancet Baseline vs. Concurrent 0.001 0.028 0.0
Slide 25: Needlestick rate per 100,000 IV catheters
Needlestick rate per 100,000 IV catheters 10 hospitals, SIROH 15 14 13 Rate per 100,000 devices 12 11 10 9 8 7 6 5 4 3 2 1 0 -1 Baseline 1° 2° 3° 4° 5° 6° 7° Hospitals 10 10 8 8 7 6 3 2 Conventional 480851 376100 346923 323404 305270 305649 61742 Devices Safety 79581 93370 108289 126447 110052 51912
Slide 26: Safety-engineered devices
Safety-engineered devices Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the HICPAC. Am J Infect Control 2007;35:S65-164.
Slide 27: NSI rates by type of safety-engineered device
Needlestick Injury Rates According to Different Types of Safety- Engineered Devices: Results of a French Multicenter Study TABLE 1. Needlestick Injury (NSI) Incidence Rates According to the Type of Safety-Engineered Device No. of No. of No. of NSIs/1 x 10° Type of device devices purchased NSIs repor
Slide 28: Education/training + safety-engineered devices
Tarigan LH, Cifuentes M, Quinn M, Kriebel D. Infect Control Hosp Epidemiol. 2015 Jul;36(7):823-9. Education/training (6 studies) -34% (0.66, 0.50-0.89) Safety-Engineered Devices (SED) (5 studies) -49% (0.51, 0.40-0.64) Education/training + SED -62% (0.38, 0.28-0.50) Education and Training Safety-eng
Slide 29: Technological improvements are only part of the solution
It should be taken in mind that technological improvements can only be part of the solution. HCW must be aware, concerned and participate actively to reduce NSI to the best extent.
Slide 30: EU Directive on the prevention of sharps injuries
EU Directive on the prevention of sharps injuries: a joint effort
Slide 31: Health and safety of HCW is paramount
• Health and safety of HCW is • Never assuming that there is no risk, paramount and closely linked to the • employers and HCW shall work health of patients. together, to create a safe working To achieve the safest possible working environment, [for which] environment,[we must:] • a combination of pl
Slide 32: Needlestick-prevention devices implementation in 100 SIROH hospitals
SAFETY-ENGINEERED Needlestick-prevention devices implementation in 100 DEVICES SIROH hospitals (June 2013) Which type of risk assessment? Answer: • Analysis of NSI in previous years: 16 hospitals • Risky procedure in high-risk unit: 10 hospitals • Units with high prevalence of bloodborne pathogens:
Slide 33: Time trend of NSI by job category
Time trend of NSI by job category - SIROH, 1994-2016 (n=83883 out of 87540) 3750 3500 3250 3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0 Physician Surgeon Laboratorian Midwife Lab technician Housekeeper/Nurse aid Nurse
Slide 34: Time trend of NSI by type of involved device
Time trend of NSI by type of involved device - SIROH, 1994-2016 1800 1600 1400 1200 1000 800 600 400 200 0 Hollow-Bore, Blood-Filled Needle H-B, Non-BF Needle Sharps Lancet Scalpel Suture needle Glass
Slide 35: Registered nurses: temporal trend of NSI by procedure
Registered nurses: temporal trend of NSI by procedure 1600 1400 1200 1000 Cutting (surgery) Injection Peripheral vascular access 800 Arterial blood drawing Venous blood drawing Fingerstick 600 Suture Other 400 200 0 94-95 96-97 98-99 00-01 02-03 04-05 06-07 08-09 10-11 12-13 14-15
Slide 36: Implementation of safety devices, Italian National Safety Observatory 2017
Implementation of devices integrating a safety mechanism Italian National Safety Observatory – 2017 – 97 hospitals Nurses Safety managers n=180 n=135 Hypodermic needles (IM injection) 36% 22% 37% 24% Drug administration (needleless, safety, blunt) 36% 22% 37% 30% Safety syringes (subcutaneous inject
Slide 37: Decrease of reported exposures in French hospitals
Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in French Hospitals, 2003-2012: Results of the French National Network Survey, AES-RAISIN N. Hloret, MD, PhD;! O. Ali-Brandmeyer;' F. L’Hériteau, MD;? C. Bervas, MD;° S. Barquins-Guichard;* G. Pelissier, PhD;? D. Abiteboul, MD;°
Slide 38: Grimmond T. Occup Med 2019
Grimmond T. Occup Med (Lond). 2019 Aug 22;69(5):352-358.
Slide 39: Reduction of needlestick injuries by 48% in 1 year
Reduction of needlestick injuries by 48 % in 1 year : Effects of improvement of the safety concept according to the European Union Council directive 2010/32/EU at a large regional hospital • In 2016 the NSI safety concept at a large regional hospital (Leverkusen, Germany) was improved according to 2
Slide 40: Reduction of unnecessary needles
Reduction of necessary needles • Reduce the number of blood drawings/blood tests • Reduce peripheral IV catheter insertion • inserting an IV catheter without a clear indication, or a daily reassessment of its indications, represents a risk of infection for the patient, and the possibility of a NSI f
Slide 41: Patients' safety
Patients’ safety
Slide 42: Replacement of necessary needles
Replacement of necessary needles
Slide 43: Slide 43
Slide 44: Elimination of unnecessary needles
Elimination of unnecessary needles • Glucose sensor • Buttonhole technique to access fistula in dialysis patients (blunt needles) • sutureless fixing • 2-way or multiple access to avoid piggyback
Slide 45: Four good reasons to report an occupational exposure
Four good reasons to report an occupational exposure • It is important for your own health: it allows the prompt administration of a prophylaxis, if available, or of a therapy whenever indicated, and the prevention of secondary transmission (spouse, family) • It protects you: the epidemiological inv
Slide 46: Response & follow up
4 Back to Table of Contents 4 Prev Euro: Euro TOWE EURC ORIGINAL ARTICLES Euroroundup Citation for heal NiewA: EUROPEAN RECOMMENDATIONS FOR THE MANAGEMENT OF HEALTHCARE WORKERS OCCUPATIONALLY EXPOSED TO HEPATITIS B VIRUS AND HEPATITIS C VIRUS V Puro’, G De Carli’, S Cicalini*, F Soldani*, U Balslev?
Slide 47: Response & follow up: costs of exposures
Response & follow up Direct + indirect costs = Int$ 747 (range 199-1691) Direct costs (9 studies) = Int$ 425 (48-1516); indirect costs (6 studies), Int$322 (152-413). Modeling studies had higher disaggregated and aggregated costs, but data-driven studies showed a greater variability
Slide 48: Intangible costs of occupational injuries
Intangible costs of occupational injuries • Costs of intangible aspects of HCW injuries, such as anxiety and distress, could equal costs associated with the medical evaluation of these injuries • The impact of being at risk of developing a bloodborne infection has effects on: personal and family l
Slide 49: Slide 49
Slide 50: The Brick Wall of Safety
The Brick Wall of Safety Needle and Sharps Injuries Prevention Patients’ safety Sharps Safety-engineered Personal Protective containers devices Equipment Elimination of Banning to unnecessary needles recapping Vaccination Education and Raising Awareness Information Training Recording & reporting of
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