Spring 2014 Journal Summary Abstracts 


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Organization Leadership
Organization Leadership, formerly the President’s Message, is a standing Journal column highlighting current hot topics. In this issue, Executive President Dee Tyler, RN, COHN-S, FAAOHN, discusses the busy work lives of occupational health professionals and how to effectively balance a heavy workload.

Vice President's Update
AOHP's Executive Vice President Dana Jennings, BSN, RN, CCM, provides details about the AOHP Board's strategic planning process, initiated at the 2012 National Conference. She explains the plan's five strategic goals, including work that has already been accomplished, as well as a variety of initiatives in various stages of implementation, that will help to promote AOHP's mission.

Editor’s Column
This standard feature provides commentary from the current Journal Editor, Kim Stanchfield, RN, COHN-S. In this issue, she reflects on how change is the one constant in life. She notifies Journal readers that this issue of the publication features many changes, with more improvements to come in future editions.

Association Community Liaison Report
Through this regular Journal article, MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM, details how AOHP is gaining visibility as an expert regarding occupational health issues. In this edition, she reviews the major components of OSHA's new educational Web resource for healthcare workers, launched January 15, 2014. This resource offers comprehensive materials to help hospitals prevent worker injuries, assess workplace safety needs, enhance safe patient handling programs, and implement safety and health management systems. AOHP is recognized throughout the Web site for contributing vital information.

Research-Driven Practice
Now that AOHP has proven it is Ready to Research, this column has been re-named. Research-Driven Practice better reflects how original research conducted by AOHP members and shared with the membership to encourage practice changes promotes the advancement of occupational health in healthcare. This issue's column presents a review of current literature exploring Effects of Workplace Health Promotion on Injuries, Workers’ Compensation Claims, and Costs: The Evidence for Modifying Health Risks. Findings by article authors Liliana Tenney, MPH, Kaylan Stinson, MSPH and Lee S. Newman, MD, MA, FCCP, FACOEM, provide useful research-based evidence to consider in developing, evaluating and supporting individual workplace wellness initiatives.

Advances in Technology
Tech Talk is now Advances in Technology. This regular Journal column provides readers with helpful information about current technological advances that have the potential to improve the work of occupational health professionals. Column editor Cindy Brumley, RN, provides follow-up to her article in the previous issue focusing on data storage, highlighting data storage options for personal and work use, including USB flash drives and flash memory cards, with a review of obsolescence, durability and preservation actions.

Dicristina, Doris. Successfully Reducing Wingset-related Needlestick Injuries: A combination of institutional culture, staff commitment and semi-passive safety device
A staff-member conversion to hepatitis C due to a phlebotomy-related needlestick injury using a safety-engineered device galvanized Robert Wood Johnson University Hospital staff to further investigate these injuries and to identify a safer phlebotomy-related safety-engineered device. In this article, Doris L. Dicristina, MSHCM, BSN, LNC, COHN-S/CM, LNC, shares with members the journey the hospital undertook in its vigilant pursuit of employee safety and relates successful outcomes in reducing the incidence of needlestick injuries.

Brehm B. and Fenush J. Implementation of a Sharps Hotline: Promoting Needlestick Safety and Enhancing Compliance
Introduction. The Needlestick Safety and Prevention Act created evidenced-based standards to promote practice changes and prevent sharps-related injuries in the workplace by requiring organizations to develop exposure control plans, institute use of safer medical devices and maintain records of sharps injuries. This paper documents how an academic medical center in south central Pennsylvania designed a culture of safety by establishing a task force charged with creating a standardized process for employees to report bloodborne pathogen incidents and receive prompt post-exposure care.

Methods. The task force reviewed the organization's Bloodborne Pathogens Exposure Control Plan, confirming compliance with OSHA standards and existing hospital policies, and identifying process and operational gaps. The team reviewed institutional processes and observed practices to determine breaches in sharps injury reporting, post-exposure care and follow-up treatment. Evaluation of evidence-based practice made it clear that a Sharps Injury Hotline, integrating efforts between Employee Health and the Emergency Department, was essential to support a culture of safety. An interdisciplinary team was then established to design the Hotline and sharps injury/body fluid splash reporting process.

Results. Healthcare workers now have a standardized process and consistent advocate in the event of a sharps injury or blood/body fluid exposure. The new Sharps Injury Hotline has eliminated gaps in treatment and ensures timely and efficient follow-up care. Data collection on sharps injuries has also improved.

Discussion. Promoting a culture of safety among healthcare workers is essential in preventing exposure to bloodborne infections due to sharps injuries. By establishing an open reporting culture through the implementation of a Sharps Injury Hotline, Employee Health has reinforced that every opportunity to identify and prevent sharps injuries leads to risk reduction and prevention of future incidents.

Conclusion. Benefits of implementing a Sharps Injury Hotline were recognized immediately, especially for victims, who now have an effective standardized method for initiating care for a disturbing incident, an advocate throughout the process, and easily accessible treatment, follow-up care and counseling. The Hotline has led to an improved culture of safety across the organization, in addition to promoting advanced care and enhanced record keeping.

When Your Employee is Arrested: Drug Free Workplace Case Reports
Mary C. Floyd, MPH, RN, COHN-S/CM, authors this article, which discusses the importance for hospitals to have a comprehensive drug-free workplace policy and how Employee Relations handled two atypical cases that presented at UF Health Shands Hospital. She explains how she applied valuable information and direction on working with impaired health professionals in her practice that was first presented in the Fall 2013 AOHP Journal article "The Impaired Health Professional," written by John Furman, PhD, MSN, COHN-S, and Mary Dallman, LMFT, CEAP, MAC.

Goris A., Glotzer J., Gemeinhart N., Wojtak L., Zirges C., Babcock M. Reducing Needlestick Injuries from Active Safety Devices: A Passive Safety-Engineered Device Trial
Introduction. Recent estimates indicate that more than 440,000 needlestick injuries occur annually. Active safety engineered devices, the most widely used type of safety engineered device at the trial facility, account for roughly 35% of needlestick injuries there. This paper highlights the findings of how the facility evaluated the incidence of needlestick injuries among its healthcare workers with a new passive safety-engineered device, specifically a subcutaneous retractable needle, compared to an active device.

Methods. Four medicine nursing divisions and one intensive care unit at a 1,250-bed U.S. teaching hospital participated in a passive safety-engineered device trial between May 2011 and January 2012. The existing inventories of subcutaneous active safety-engineered devices were removed from participating units and replaced with the same size “trial” subcutaneous passive devices. Data from healthcare workers' self-reported needlestick injuries were collected in an electronic data repository and evaluated. A Fisher’s exact test was calculated for needlestick injuries and employee productive hours.

Results. During the 30-month pre-trial period, 19 needlestick injuries were reported with a rate of 2.21 per 100,000 employee productive hours. During the nine-month trial period, one needlestick injury was reported with a rate of 0.42 per 100,000 employee productive hours (p≤ 0.05.) Root cause analysis of the single injury revealed improper use of device as opposed to device failure.

Discussion. This study suggests that automatic passive safety-engineered devices decrease needlestick injury rates when compared to active safety-engineered devices. The active device requires a deliberate activation of the safety feature to re-sheath the needle, while the passive device automatically retracts the needle into the barrel of the syringe once medication is delivered, immediately removing the physical hazard. If used appropriately, passive devices eliminate the risk of exposure to bloodborne pathogens because the needle is never exposed outside the patient post-use. Ongoing education and training is critical for healthcare workers to gain acceptance and most effective use of passive safety-engineered devices.

Conclusion. This study confirmed that use of a passive safety-engineered device significantly reduced the subcutaneous needlestick injuries rates compared to the active safety-engineered device.

Transitioning from ICD-9 to ICD-10 Coding: A sea change with lasting ripple effects
Hospital Employee Health departments in the United States are not immune from impacts of the anticipated seismic shift from ICD-9 to ICD-10 medical coding. ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 is already used in most developed countries, making the United States a late adopter. Author Karen O'Hara provides details about the federally mandated conversion to ICD-10 and why it is essential for occupational health professionals to understand the implications of this change and how it is likely to affect their organizations.