1. Interdepartmental Collaboration to Reduce Conjunctiva Exposure Risk: Process Improvement to Increase Awareness and Enhance Compliance Victor R. Lange, JD*, MSPH, CRC AOHP 2016 – September 9, 2016 – Myrtle Beach, SC 1

2.  Enable the learner to: › Implement infection prevention and healthcare worker safety improvements at his or her healthcare facility using a similar process improvement program  Outcomes will affect: › Nursing professional development › Staff (risk reduction) › Patients (risk reduction) Learning Outcome 2

3. Learning Objective 1: Define Risks Risks associated with eye mucous membrane contamination 3

4.  Infection risk from blood and body fluid or contaminant contact to the eye is real › Harmful infectious pathogens can transfer through the eye mucous membranes 1-4 › Splashes and sprays to the eyes and face can occur without an apparent “event” and surface contamination can exist even when not visible 5 Staff Risk 4

5.  Insufficient attention is given to preventing infection transmission risk via conjunctiva › Protection required if exposure anticipated 6-10 › However, more than 60% of hospital-reported non-sharp exposures are to the conjunctiva AND greater than 90% of all such eye exposures occur without proper eye protection 11 Protection Shortfalls 5

6. Learning Objective 2: Describe Program Process improvement program that successfully reduced conjunctiva exposure risk 6

7.  Demonstrably improve employee safety with an interdepartmental, collaborative, process improvement program  Reduce eye-splash exposure infection risk through increased risk awareness and enhanced protective eyewear compliance Intended Goals 7

8.  Current state: › 1-3 eye splashes occurring monthly › (Traditionally under-reported)  Desired achievable state: › 75%-100% reduction in eye splashes › (Initial target 70% reduction) Changed State 8

9.  Detailed risk education, including regarding exposure-incidence and best-practice prevention discussions, attended by all clinical staff  Clinical staff adopted a “mask- and glove-level” eye-protection protocol for eyewear use  Easy-to-access, single-use, protective eyewear dispensers installed throughout facility, in Surgery, Med-Surg, Intensive Care, Cardio-Pulmonary Lab, Engineering, and Environmental Services Methods 9

10.  Storyboard used for process summary › Staff reminded to review risk and procedure prior to exposure where a splash or spray may occur  A convenient splash reporting tool was placed near eyewear dispensers for better tracking  Splash exposures and splash “saves” were tracked Methods (Cont’d) 10

11.  Compared to the Prior 12 Months › 100% Reduction in Eye Splashes  In the First 90 Days Alone › 15 Splash Saves  Reported Splash Environments › IV Care, Oral Care, Foley (1 Each) › PEG Tube (2) › Trach Care, General Care (3 Each) › Hemodialysis (4) Results 11

12. House-wide risk education and easy-access reusable eyewear dispensers placed Program Results 12

13. Program Results 13

14. Learning Objective 3: Review Components Key components necessary for a similarly successful process improvement program 14

15.  Facility Collaboration › Among Infection Prevention, Occupational Health, Nursing Education and Executive Management  Staff Education › Educate workforce about risk  Protocol Update › Easy, mask-/glove-level access to appropriate, preferably disposable eyewear at point of use  Helpful Tools › Track, record, and analyze results Key Components 15

16.  Simple, system-wide process improvement program provides an opportunity to increase infection- prevention efforts, reduce eye-exposure risk, and significantly improve healthcare worker safety Conclusion 16

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18. 1. Ando Y., et al. Conjunctivitis following accidental exposure to influenza B virus. Journal of Infection. 2001;42:223-4. 2. Hosoglu, S. et al, Transmission of hepatitis C by blood splash into conjunctiva in a nurse. Am J Infect Control. 2003;31:502–504. 3. Davidson, I., et al. Eye splashes during invasive vascular procedures. Br J Radiol. 1995;68:39–41. 4. McNamara, I.R., et al. Ocular contamination during lesional surgery. J Plast Reconstr Aesthet Surg. 2006;59:263–265. 5. Lange, V. R. Eyewear contamination levels in the operating room: Infection risk. Am J Infect Control. 2014 (4);42:446-447. 6. American National Standard Institute. Occupational and educational personal eye and face protection devices. American Society of Safety Engineers, Des Plaines [IL]. 2003. 7. US Department of Health and Human Services, Centers for Disease Control and Prevention. Workplace Safety & Health Topics: Eye Safety—Eye Protection for Infection Control. 2004. 8. Siegel, J.D., et al. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Am J Infect Control. 2007;35:S65–S164. 9. US Department of Labor. Occupational Safety and Health Administration. Bloodborne Pathogen Standard. 29 CFR 1910.1030. 10. Association of Surgical Technologists. Recommended Standards of Practice for the Use of Eye Protection During Invasive Surgical Procedures. 2008. 11. EPINet®, International Safety Center, 2016. References 18

19. Questions? 19

20. Thank You! 20

21. Eyewear Study Contamination Rates 21

22. Eyewear Study Product Contamination 22