Becker's Clinical Quality & Infection Control

18 Executive Briefing T he Occupational Safety and Health Administration re- quires hospitals and other employers to have protocols in place to protect workers from exposure to blood- borne pathogens, but incidents of this nature still occur. In addition to harming employees, these accidents are costly to a hospital's bottom line. According to Amber Hogan Mitchell, DrPH, president and executive director of the International Safety Center, the expo- sure of healthcare workers' eyes to patients' blood and body fluids has always been a safety concern. That said, there is a growing risk of eye exposure incidents today because more people are living with chronic bloodborne infections, includ- ing HIV and hepatitis C. These patients are in and out of the hospital and may be co-infected with other multi-drug resistant organisms healthcare workers can contract via eye exposure. "Typically, we've focused on preventing healthcare-asso- ciated infections in patients, but now, more so than ever, we're thinking about occupational-associated infections and illnesses that happen when there are fluid splashes or splatters. These incidents can result in worker exposures to not just common pathogens, but also to emerging infectious diseases …." says Dr. Mitchell. Victor Lange, director of infection prevention at Promise Hospital of San Diego, says the industry's increased focus on overall quality improvement has made hospitals re-evaluate the seriousness of eye exposures and new measures to avoid them. The scope of splash and spray incidents In a paper titled "Occupational Risk on the Rise: Turning a Blind Eye" posted on infectioncontrol.tips, Dr. Mitchell reports the rate of eye exposures in healthcare workers has steadily increased from 60 percent in 2012 to 64.7 percent in 2013 and then to 65.7 percent in 2014. Although personal protec- tive equipment can prevent incidents of exposure, PPE use is extremely low, which suggests the rate of eye exposure events will continue to trend upward. Estimates suggest roughly 69 percent of all non-sharp relat- ed healthcare worker injuries are associated with exposure to the eye(s), according to Mr. Lange. Additionally, some studies suggest up to 85 percent of eye exposure incidents occur with- out proper eye protection in place. "There is a constant pressure on healthcare workers to see more patients in a smaller amount of time, to fill beds and to work longer shifts," says Dr. Mitchell. "With all of those institu- tional pressures and with the focus on the needs of the patient, healthcare workers are less likely to report an exposure if it happens, or report it in a timely manner." Because many exposures are swept under the rug and not reported, any data that does exist on splash and spray inci- dents and eye exposures is "varied and under-representative," according to Dr. Mitchell. Still, she has done her best to analyze the scope of the problem with what data is available. The International Safety Center collects data on all kinds of occupational safety events, including eye exposures and splash and spray incidents. Hospitals have the option to include data on the direct financial costs of employee eye exposures. The direct costs some hospitals chose to report in 2014 include those relating to: • Bloodborne pathogen testing for both the patient whose fluids splashed the healthcare worker and the worker himself or herself • Service costs, including laboratory fees, diagnostic tests and post-exposure prophylaxis • The worker's time away from the job and the cost of a substitute healthcare worker "Based on our splash and splatter data from hospitals, many incidents were OSHA-reportable, meaning the employee required some kind of medical follow-up," said Dr. Mitchell. "The direct costs to the hospitals reporting incidents to her center were about $19,000 for one year — this does not even include the workers' compensation cost burden." However, Dr. Mitchell says there is a real need to fund a study that captures the true financial burden of eye exposure incidents in hospitals. While direct costs are helpful to an ex- tent, they do not capture how splash and spray incidents affect workers' compensation, insurance costs, wage replacement, medical treatment, emotional burden or rehabilitation. The root causes behind eye exposure The manner in which a healthcare worker is exposed to a patient's body fluids varies from incident to incident, but sever- al factors tend to contribute to these adverse events, including: 1. Poor access to protection. Proper PPE — including eye- wear — is not always easily or readily available when healthcare workers need to act at a moment's notice to care for patients. During these emergencies, workers don't always have time to Calculating the Cost of Eye Exposure Incidents Among Healthcare Workers Sponsored by:

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