Splashes - A forgotten hazard
Jacie Volkman, MPH, CIC
You've probably heard of slips, trips, fall and sticks, as common hazards in long-term facilities. But what about splashes?
Splashes, or mucocutaneous blood exposures (a splash that contains blood that lands on a caregiver where it could transfer a pathogen to the eyes, nose or mouth), can occur during routine activities, such as washing bedpans, emptying urine bottles or cutting catheter bags.
These exposures can potentially put employees at risk for contracting infectious diseases, such as Hepatitis C and C.diff.
In a three-month study conducted by Doebbeling et. al. at the V.A., roughly 38% of RNs had experienced some sort of mucocutaneous blood exposure.1 They also found that only about 73% of these injuries were reported.
Another study by Gershon et. al. surveyed many different types of healthcare workers found that about 29% of respondents had some sort of exposure incident in the previous six months, of which, only about 44% were reported.2
This same study showed high personal protective equipment compliance when dealing with sharps but astonishingly low compliance when dealing with splash risks. Only 40% of healthcare workers reported wearing eye shields when there could be a splash, and just 35% wear a mask when there could be a splash to the mouth!
These high rates of possibly life-threatening incidents (and low compliance) in healthcare facilities are alarming, though perhaps not surprising due to the nature of splashes. Splashes occur during tasks healthcare workers complete dozens of times a day. This frequency presents more opportunities for risk while also desensitizing them to the danger — making nurses and caregivers less likely to wear the proper protection.
Furthermore, caregivers are dissuaded from reporting an exposure simply because of the hassle, loss of time from work and cost of care involved. If a worker is exposed, they must go through a rigor of tests and paperwork.
We should also consider the emotional cost to the exposed individual.
Addressing the Issue
If an organization commits itself to a culture of compliance, it will not only improve the health of the employees, but also the health of the organization. With employees taking less time off of work for sick days and time away for testing because of exposure, employers can save dollars, and ultimately help keep their staff safer.
A safety-oriented culture can be made even more effective through modifications to what equipment is made available and how.
For instance, have in stock masks that have a clear plastic eye shield attached. If these are the only masks accessible, it removes the option to leave eyes exposed when a mask is worn. Increase usage of these masks by storing them in a way that makes them visible, which will provide a cue to the caretaker to don the appropriate PPE. Some facilities use see-through cabinetry. This approach also assists with ensuring equipment is stocked and ready for use.
Many organizations also are adapting the tactics developed to increase hand washing compliance to improve compliance rates for the proper use of PPE. Furthermore, revisiting training and best practices, even with veteran nurses, also can positively impact compliance rates.
Beyond PPE, there are ways to eliminate, or at least drastically minimize, splash-causing tasks. Across the developed world, disinfection appliances—also known as bedpan washers—have long been incorporated in healthcare facilities, such as long-term care facilities and hospitals, to cut back on splashes. The U.S. healthcare market is beginning to pick up this trend.
A disinfection appliance can be installed in a patient room or soiled utility room. They eliminate the need to empty urinals, bedpans, suction canisters and other collection devices by hand. Not to mention actually cleaning the equipment, which often results in splash back.
The pressures to ensure patient and employee safety are mounting, which makes it all the more important for healthcare providers to look beyond the most attention grabbing culprits and begin examining processes that we've come to accept but can be drastically improved.
Jacie Volkman, MPH, CIC is an infection control consultant for MEIKO USA, a disinfection appliance manufacturer. She also is the director of Infection Prevention at Mission Health System and owns Safe Patient Surveys Inc, an Infection Prevention consulting company.
1. Doebbeling BN, Vaughn TE, McCoy KD, Beekmann SE, Woolson RF, Ferguson KJ, Torner JC. (2003) Percutaneous injury, blood exposure, and adherence to standard precautions: are hospital-based health care providers still at risk? Clin Infect Dis, 37(8), 1006-13.
2. Gershon RR, Karkashian CD, Grosch JW, Murphy LR, Escamilla-Cejudo A, Flanagan PA, Bernacki E, Kasting C,Martin L. (2000) Hospital safety climate and its relationship with safe work practices and workplace exposure incidents. Am J Infect Control, Jun;28(3), 211-21.