Thank you for attending in person. I have a dress right here and I'm sure plenty of people virtually. I'm talking about comparing needle stick injury and muticaneous incident surveillance among healthcare workers before and during the COVID-19 pandemic. So as we all can understand, healthcare workers are at an increased risk to needle stick injuries, which isn't very shocking considering that their occupations often include doing work that involves needles and this has become even more prevalent during the COVID-19 pandemic where we're putting shots into people's arms but we're also neglecting at times to prevent injury in those workers who are putting the shots into arms. Since 1991, OSHA recognized that there was a blood-borne pathogen emergency essentially and put together a standard to prevent worker injury to blood-borne pathogen exposure, yet the incidence to needle stick injuries and other blood-borne exposures remained high and that's why in the year 2000, the Needle Stick Safety and Prevention Act was passed where there was a greater emphasis on engineering controls. As we all know, well excuse me, as some may know, there are the hierarchy of controls where you have PPE as the lowest level protection and you use higher levels of protection, for example, administrative controls and engineering controls where you work in safety features to prevent the injury or illness. And once again, during the COVID-19 pandemic, there has been mass vaccination programs but yet a lack of surveillance to workers who may be exposed to needle stick injuries. That's why back early on in the pandemic, my co-author and I, Dr. Amper Mitchell, who is the director of the International Safety Center and I am a scientific advisor with them, put together a call for action to better emphasize needle stick injury prevention. One year later, we have accumulated data to look at that incidence of needle stick injuries amongst workers using a system that spans over 100 countries and presented in 25 different languages, a surveillance system called EpiNet, which is available freely online through the International Safety Center and it also includes year-by-year data on various occupational injuries as it relates to sharps and needle sticks, as well as exposure to blood and bodily fluid. So you can see here is an example of the form. It's pretty robust. It carries a number of items to better understand the facility and aggregate the facility so that way we don't use any personal identifiers in understanding those blood-borne and bodily exposures, as well as needle stick injuries. These are all, once again, freely online. At the end, I'll have the resource page and of course you can talk to me and I can get you the resources, but it's at internationalsafetycenter.org and you can get the information there and become part of the system if you need to. So I want to go over the 2020 EpiNet data as it relates to needle sticks and sharps. We looked at the needle stick and sharp injuries per year comparing teaching and non-teaching, which is pretty essential because you understand at a teaching university hospital, you're more likely to be hurt because you are learning this, as opposed to non-teaching universities. And we used ADC, which is average daily consensus. It's a funny denominator, but it works to compare across different facilities, which is the number of residents worked versus the total working days that are available within a month. And in this data, you could see that the needle stick sharp injuries have dropped within the last five years. However, if you go back and look at it through essentially many more years, if not decades, you could see a fluctuation in that. So there still is a need, a continued need to prevent these injuries. So across 41 United States health systems, we found that the most injuries occurred in doctors and nurses, which is not revelating information here. But what we do see is a big chunk in the pie, the green piece, called UTTER. And UTTER is the environmental service workers, the waste haulers, the cleaners, so the folks downstream in the process. While we emphasize so much to protect our doctors and nurses from needle stick injuries, is that training and education being communicated and emphasized at the lower downstream levels? And it appears to be challenging. Now, 43.7 percent of these injuries occur in the operating room, and 26 percent of them occur within the patient and exam room. So once again, I pan out. You can see once again the sharp injury and needle stick summaries. And on our website, we also have infographics, because data can get pretty boring. I'm not sure if anybody was excited by that last graph, but using this information, we try to summarize a lot of the information pretty quickly for folks who need to hand it out and understand it. And I'm just going to go through it piece by piece right now. So the most frequent injuries occur within sutures, as well as disposable syringes. While 6.9 percent, not an overwhelming number, occur in wing needle and tube colliders, it is important to note that those needles are blood filled, so exposure to that is even more dangerous. When we looked at the data, we found that less than 37 percent were using a safety feature. So what is the point of having a safety feature if people are not using it? And when we did have folks who had a safety feature, two-thirds of them weren't even activating the safety feature anyway. Now this is an example of the printout of the data. You can see the percentages for each thing that I just essentially went over. And once again, emphasizing that 20 percent of these injuries are occurring to the non-user. So once again, we need to emphasize training and education and programs that protect downstream workers, such as laundry workers and waste haulers. And I want to also go over the mutacaneous exposure incidence of splashes and splatters. Here we also see a bit of a decline in blood and body fluid exposures, per 100 ADC. While you may look at this data and say, okay, great, it's going down, I find, and most people find that that sort of injury, I mean, excuse me, exposure is underreported anyway. People feel that it is part of the job to get splashed with blood. Therefore, it's underreported. And you go back to much of this, it is underreported because of the stigma and perception that a worker may face by getting injured and also the high demands of our facility workers who are administrating needles, where they are faced with short staffs, difficult work hours, excruciating burnout. This talk isn't emphasized on nurses and the occupational risks that they're exposed to and the conditions that they're working in, but working conditions and the working environment obviously play a strong role, as well as the perceptions and stigmas that workers may face in the jobs that they have to do. So while we see there being a slight decline, I just want you guys to bear back that this is heavily underreported information, especially when it comes to blood and body exposure to fluids. Now, we do understand that COVID-19 can spread, for example, through the eyes. And even with this information, when we had 80% of the exposures are to the head, only about one-tenth of them were wearing any eye protection. So we know the risk to COVID-19. We have something that's so prominent in today's discussions of worker protection and safety, but yet, knowing that eye protection is vital, knowing what you are doing, knowing that much of this is related to, for example, COVID-19 vaccinations, folks weren't wearing eye protection when they were exposed. Now, we've seen, once again, a decline in eyes being the main injury point and eye protection slightly, if you want to call it slightly, improving. But much of the data continues to be unreported. So we know that the risk to COVID-19 is high, if you want to call it slightly, improving. But much of the data continues to be unreported. We also want to look at face protection, comparing 2019 to 2020. And you've got to bear in mind that 2020, the COVID-19 pandemic started a little bit into the year, March, when it became more declared. But yet, we all in facilities are aware that hospitals were preparing for that even before that. And while eye protection slightly increased, surgical masks flew off the roof. Some of you, I get to see your faces today, so that's a joy. But at the end of the day, when it came to the higher level protection, which we know protects a worker, grows and protects a person, a respirator, we saw no change because there were no reports of it. Nobody was wearing respirators when they were exposed in our data. So even with a respiratory infectious disease taking over much of our protection of two workers and with an emphasis that exists perpetually in using the last line of defense with personal protective equipment rather than stronger protections like training. And I know I've emphasized training a lot. I'm a contractor with the worker training program at the NIH, so I have a special heart to training. There's still that lack of reliance to it. So some main takeaways, we saw that nurses sustained the bulk of injuries as well as physicians, but there were lack of emphasis on those downstream workers. We saw that insulin needles were made a large portion of the incidents as well as suture injuries and that the bulk of them were not using a safety device and that the nurses were, over half of them were affected by splashes and splatters. We also did a chi-square analysis, and we're continuing to do that to statistically look for differences between the demographics that we collect. You know, percentage of nurses and doctors has changed significantly between 2020 and 2020. Yet, in some other things, for example, the patient room or location in the operating room have not been so significant. That's a little switch over there. The sharp safety features has been a significant difference from 2020 to 2019. As I mentioned back in the early stages of the pandemic, myself and the director of the International Safety Center worked together to have a call to action, and we emphasize using institutional controls. So on top of the already existing hierarchy controls, using a full facility engagement of those leaderships and management supervisors to create a greater sense of safety culture. It really doesn't help to have all these engineering controls in place if folks don't care to use it or they don't see the benefit of using it. We need to make workers understand through their training and education, through developing worker training programs, through dialogue and policies and plans, working with the unions and representation and representatives at the unions, having more robust exposure assessments and ability to survey incidents can help us better monitor these injuries. As I mentioned, as you've seen throughout all the graphs, every time I showed you a bar graph, I had to tell you, well, you know, that's probably underreported. Well, it's probably underreported. It's probably underreported. It's probably underreported. It's probably underreported. Well, you know, that's probably underreported. Well, there's this asterisk next to it. We need better data to better inform our decisions, and we need to have an environment, a working environment that encourages our health care workers to come forward when they are injured. I have met countless workers who have had an injury to a needle stick, even if the person they were working with who had that needle stick injury, for example, had an infectious disease such as HIV or other infectious diseases. And what we've seen over and over again is those workers were afraid to come forward. Maybe they were in a teaching university. Maybe they were early in their career. Maybe they didn't have a robust reporting system. Or maybe, quite simply, they had to go to the next patient and just didn't even have time to care about themselves. So my main pitch is that you all go to the internationalsafetycenter.org and look up this data. It's probably a much better way than I could ever present it. There are a number of resources, you know, TrueOSHA, NOSHA, CDC, also trading information with the NIHS Worker Training Program to help you all. And I'll leave my email up here as well as Dr. Amber Mitchell's email if you have any questions that I don't do a good job of answering right now. So thank you very much, everyone. Yeah, there you go. Appreciate it. Does anybody have any questions? I don't see any in the chat. What's the best practice of the data you've got in terms of institution? Okay, thank you. Sorry about that. Yeah, well, I was just curious as to what's best practice. I mean, everybody's trying to shoot for zero. Nobody that I'm aware of is close to that. And so, I mean, we can learn from each other about programs to decrease that. And I just wondered if there are three or four places that seem to have a better run at this than the majority of us. So thank you for your question. I would turn that on its head, right? I would rather have a reporting, greater reporting of what's going on. Because I think the numbers that, well, I believe in and know through all this data, that the numbers we're getting are malarkey, right? We're not getting the real data that we need. I would rather have even greater representation of our data. This data that we have right here is pretty unique. It's pretty wide ranging and unlike anywhere else. So it's hard for me to say compared to another place where we see lower numbers. And generally, we see lower numbers when there's training and education and greater emphasis on engineering controls. You know, you go to a university hospital, their big name, I don't want to name names because we're on live right here, but they'll preach. We're here to protect the workers, right? And they'll lack a union. They'll lack ability to mobilize and to communicate their issues. They'll have a 15-minute training, quotation marks here, training. And there really is a lack of a robust surveillance system, even if they're very big name universities and institutions. And if that exists, some are so prominent in people's cultures, what do you think about the local clinics, right? So when I look at that data, what I hope to see in the going future is greater reporting of the numbers because I know what we're seeing right now is much lower than what is true. I would agree to that, yes. All right, well, it sounds like we're doing pretty good. Thank you, everyone. Appreciate it. Bye.

needle stick injury

healthcare workers

COVID-19 pandemic

EpiNet

underreported incidents