Talbot Thomas R, Wang Deede, Swift Melanie, St Jacques Paul, Johnson Susan, Brinsko Vicki, Thayer Valerie, Dail Teresa, Feistritzer Nancye, Polancich Shea
Department of Medicine, Division of Infectious Diseases, and Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
Infect Control Hosp Epidemiol. 2014 Nov;35(11):1383-90. doi: 10.1086/678417. Epub 2014 Sep 24.
Exposure of healthcare personnel to bloodborne pathogens (BBPs) can be prevented in part by using safety-engineered sharp devices (SESDs) and other safe practices, such as double gloving. In some instances, however, safer devices and practices cannot be utilized because of procedural factors or the lack of a manufactured safety device for the specific clinical use. In these situations, a standardized system to examine requests for waiver from expected practices is necessary.
Before-after program analysis.
Large academic medical center.
Vanderbilt University Medical Center developed a formalized system for an improved waiver process, including an online submission and tracking site, and standards surrounding implementation of core safe practices. The program's impact on sharp device injuries and utilization of double gloving and blunt sutures was examined.
Following implementation of the enhanced program, there was an increase in the amount of undergloves and blunt sutures purchased for surgical procedures, suggesting larger utilization of these practices. The rate of sharp device injuries of all at-risk employees decreased from 2.32% to 2.12%, but this decline was not statistically significant (P = .14). The proportion of reported injuries that were deemed preventable significantly decreased from 72.7% (386/531) before implementation to 63.9% (334/523; P = .002) after implementation of the enhanced program.
An enhanced BBP protection program was successful at providing guidance to increase safe practices and at improving the management of SESD waiver requests and was associated with a reduction in preventable sharp device injuries.
通过使用具有安全设计的锐器装置（SESDs）和其他安全操作，如双层手套，可以部分预防医护人员接触血源性病原体（BBPs）。然而，在某些情况下，由于程序因素或缺乏针对特定临床用途的安全装置，无法采用更安全的装置和操作。在这些情况下，需要一个标准化系统来审查免除预期操作的申请。
前后程序分析。
大型学术医疗中心。
范德比尔特大学医学中心开发了一个正式系统，以改进豁免程序，包括一个在线提交和跟踪网站，以及围绕核心安全操作实施的标准。该计划对锐器装置伤害以及双层手套和钝头缝线使用情况的影响进行了研究。
实施强化计划后，用于外科手术的内层手套和钝头缝线的采购量有所增加，表明这些操作的使用更为广泛。所有高危员工的锐器装置伤害率从2.32%降至2.12%，但这一下降在统计学上并不显著（P = 0.14）。在强化计划实施后，报告的被认为可预防的伤害比例从实施前的72.7%（386/531）显著降至63.9%（334/523；P = 0.002）。
强化的血源性病原体防护计划成功地为增加安全操作提供了指导，改进了SESD豁免申请的管理，并与可预防的锐器装置伤害减少相关。
