Transcript Diapositiva 1

The New Directive applying the EU
Framework Agreement:
Facts and numbers
Gabriella De Carli , MD
Department of Epidemiology and Pre-Clinical Research
National Institute for Infectious Diseases L. Spallanzani
Rome, Italy
on behalf of the SIROH-IRAPEP groups
Ministero della Salute-Progetti AIDS ISS e Ricerca Corrente IRCCS
In depth study on the socio economic, health and environmental
impacts of a possible Community initiative on the protection of EU
HCW against blood borne infections due to NSI
Kick off meeting
Brussels, 29th January 2008
ENSI
Expert team on
Needle Stick Injuries
3
From an aspect of benefit for the health care worker it seems best to implement a Legislative
initiative at Community level to amend Directive 2000/54/EC, in order to introduce stricter
specific measures for prevention and protection, namely:
• the training of workers in the safe use and disposal, and in the correct handling of
containers;
• the modification of work practices which pose a risk of needle injury;
• a complete end to the recapping of needles;
• the use of instruments with safety features;
• the use of safe and effective systems to minimise the use of cannulae;
• the general provision of written instructions and notices indicating the procedures to be
followed in the event of an accident involving needles or other medical sharps;
• immediate and effective response and follow-up to any accidental exposure, including
rapid post-exposure prophylaxis;
• the offer of vaccination against hepatitis B to all workers who may come into contact with
needles and other medical sharps;
• the recording in a special register of all injuries caused by needles or other medical sharps
Reduction potential 90%
It should be taken in mind that technological improvements can only
be part of the solution, but that effective guidance of the HCW is
5
necessary to reduce NSI to the best extent.
Four good reasons
to report an occupational exposure
• It is important for your own health: it allows the
prompt administration of a prophylaxis, if
available, or of a therapy whenever indicated, and
the prevention of secondary transmission
(spouse, family)
• It protects you: the epidemiological investigation
allows to identify the source and the possible
risks, and to demonstrate a causal relationship to
receive workers’ compensation in case an
infection should develop;
• It allows to identify the causes and prevent other
exposures: we need the data to support
preventive interventions!
• …..It is mandatory by law
Updated situation - Hospitals adopting NPD
per year
30
25
20
15
30/35 had
adopted at
least one NPD
+ SIOP 33/52
10
5
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
SIROH 2010
Type of NPD adopted
0
Other
Lancet
VTPS-st
5
10
butterfly
ABG syringe
VPTS-but
15
20
Blood donation set
IV catheter
Updated situation-NPD adoption
• 21 hospitals provided detailed data on 63
NPD
• In 68.2% CD were completely replaced by
NPD; in the remaining 31.8% of cases, CD
are still available (but increasingly
abandoned)
• One third implemented in single units or
department (frequently ED, infectious
diseases, pediatrics), mostly IV catheter
Percutaneous exposures per 100 full-time
equivalents, by job category and area
SIROH, Italy
Housekeeper
MD
Nurse
Midwife
12
Technician
10
GM general medicine
MS medical specialties
8
%
GS general surgery
6
SS surgical specialties
4
ID infectious diseases
ICU intensive care
2
D dialysis
0
L laboratory
GM
MS
GS
SS
ID
ICU
D
L
O
O other
Puro V, De Carli G, Petrosillo N, Ippolito G and the
SIROH Group. Infect Control Hosp Epidemiol 2001;
22:206-10.
High-risk percutaneous exposures
per 100 full-time equivalents, by job category and area
Housekeeper
MD
Nurse
Midwife
Technician
12
%
GM general medicine
10
MS medical specialties
GS general surgery
8
SS surgical specialties
6
ID infectious diseases
4
ICU intensive care
D dialysis
2
L laboratory
0
GM
MS
GS
SS
ID
ICU
D
L
O
O other
Puro V, De Carli G, Petrosillo N, Ippolito G and the
SIROH Group. Infect Control Hosp Epidemiol 2001;
22:206-10.
Occupational infections following percutaneous or mucous exposures
Bacterial
Syphilis 1913
Viral
Herpes Simplex 1962
Protozoal
Toxoplasmosis 1951
Haemorragic fevers
Diphteritis 1923
(Ebola/Marburg) 1974
Malaria 1972
Leptospirosis 1937
Herpes Zoster 1976
Leishmaniasis 1997
Scrub typhus 1945
Hepatitis B 1982
HIV 1984
Hepatitis nAnB 1987
Creutzfeldt-Jakob 1988
Herpesvirus simiae 1991
Gonhorrea 1947
Brucellosis 1966
Rocky Mountain
Spotted Fever 1967
Mycoplasmosis 1971
Mycobacteriosis 1977
Staph.aureus 1983
Strept.pyogenes 1980
- necrotizing fasciitis 1997
Tuberculosis 1931
- from HIV+ 1998
Corynebact. striatum 1998
Hepatitis C 1992
Simian immunodeficiency virus
1994
Dengue 1998
Hepatitis G 1998
HTLV II 2006
Chikungunya 2006
HCV-NS3 recombinant vaccinia
virus 2007
Hepatitis E 2007
Cytomegalovirus 2008
Vaccinia virus 2008
Lujo virus 2008
Fungal
Blastomycosis 1903
Sporotrichosis 1977
Cryptococcosis 1985
- from HIV+
1994
Tumors
Human colonic
adenocarcinoma 1986
Sarcoma 1996
Jagger J, De Carli G, Perry J et al. In
Wenzel RP: Prevention and Control of
Nosocomial Infections, 2003. Updated
03/10
8 out of 35 not preventable
5 of these could possibly have been
prevented by passive devices
Could
have been prevented
Follow up
1
32 occupational
5 cases of
spontaneous
resolution
6 cases of
chronic active
hepatitis
occupational
acute hepatitis B
despite PEP
Resolved
No seroconversion
HCV
Infections (19942009)
(3 refused tx, 1
interrupted
because of AE,
1 retired, 1 normal
ALT tx not
recommended)
2 occupational
HIV infections
21 Sustained
Virologic
10 had
Response
psychological
consequences
(8 treated during
10
(1acute
hadhep,
PTSD)
treated for CAH, 3
treated
during
7 needed
acute and CAH)
redeployment,
1 pending
Average Device-specific Injury Rates per 100,000 Devices Used: Needlestick
Prevention Devices (n=3,300,000) vs. Conventional Devices (n=3,600,000)
(IV catheters, blood-collection winged-steel needles, arterial blood gas syringes)
SIROH, 16 hospitals, 2003-2006
10
9
8
7
6
5
4
3
2
1
0
CD
NPD
De Carli G, Puro V, Jagger J. Needlestick-prevention devices: we should already be there.
J Hosp Infect 2009;71:183-4.
8°
7°
6°
5°
2°
4°
NPD
3°
CD
11
11
11
10
8
7
4
4
3
637851
419100
541481
518326
373492
307478
192142
184533
199180
209581
315930
344664
331644
400624
73512
106313
108528
Ba
s
hosp
1°
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
el
in
e
Rate per 100,000 devices
Injury rate per 100,000 IV catheters
10 hospitals+1 regional system, SIROH 1999-2009
An in depth analysis of NPD injuries in 8
hospitals revealed that accidents occurred:
-before safety mechanism activation was
possible (35%);
-during activation (30%);
-due to failure of safety feature (15%)
- 20% of NPD were not activated, mostly by
workers with a work experience <2 or >15
years, due to lack of training and reluctance
in changing previous techniques,
respectively.
Clause 6 Elimination, prevention and
protection
-sharps containers as close as possible
--overall prevention policy
---training
----conducting health surveillance procedures
---use of personal protective equipment
--free of charge vaccination
-information on vaccination