Download The Unprotected Eye

Interdepartmental Collaboration to
Reduce Conjunctiva Exposure Risk:
Process Improvement to Increase
Awareness and Enhance Compliance
Victor R. Lange, JD*, MSPH, CRC
1
AOHP 2016 – September 9, 2016 – Myrtle Beach, SC
Learning Outcome

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)
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Learning Objective 1:
Define Risks
Risks associated with eye mucous
membrane contamination
3
Staff Risk

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
4
Protection Shortfalls

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
5
Learning Objective 2:
Describe Program
Process improvement program
that successfully reduced
conjunctiva exposure risk
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Intended Goals
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

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Changed State

Current state:
› 1-3 eye splashes occurring monthly
› (Traditionally under-reported)

Desired achievable state:
› 75%-100% reduction in eye splashes
› (Initial target 70% reduction)
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Methods



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
9
Methods (Cont’d)

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

10
Results

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)
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Program Results
2.5
Number of Eye Splash/Spray Incidents Reported
Before and After Program Implementation
2
Number of Incidents
Linear (Number of Incidents)
House-wide risk education
and easy-access reusable
eyewear dispensers placed
1.5
1
0.5
0
Number of Incidents
Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun14
14
14
14
14
14
14
14
14
14
14
14
15
15
15
15
15
15
1
0
1
0
1
0
0
1
0
0
2
0
1
0
0
0
0
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Program Results
Splash Save Reports March 1 - June 2, 2015
4.5
4
4
3.5
3
2.5
3
3
2
2
1.5
1
0.5
1
1
1
0
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Learning Objective 3:
Review Components
Key components necessary for a
similarly successful process
improvement program
14
Key Components

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
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Conclusion

Simple, system-wide
process improvement
program provides an
opportunity to
increase infectionprevention efforts,
reduce eye-exposure
risk, and significantly
improve healthcare
worker safety
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References
1.
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10.
11.
Ando Y., et al. Conjunctivitis following accidental exposure to influenza B virus. Journal of Infection.
2001;42:223-4.
Hosoglu, S. et al, Transmission of hepatitis C by blood splash into conjunctiva in a nurse. Am J Infect
Control. 2003;31:502–504.
Davidson, I., et al. Eye splashes during invasive vascular procedures. Br J Radiol. 1995;68:39–41.
McNamara, I.R., et al. Ocular contamination during lesional surgery. J Plast Reconstr Aesthet Surg.
2006;59:263–265.
Lange, V. R. Eyewear contamination levels in the operating room: Infection risk. Am J Infect Control.
2014 (4);42:446-447.
American National Standard Institute. Occupational and educational personal eye and face
protection devices. American Society of Safety Engineers, Des Plaines [IL]. 2003.
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.
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.
US Department of Labor. Occupational Safety and Health Administration. Bloodborne Pathogen
Standard. 29 CFR 1910.1030.
Association of Surgical Technologists. Recommended Standards of Practice for the Use of Eye
Protection During Invasive Surgical Procedures. 2008.
EPINet®, International Safety Center, 2016.
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Questions?
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Thank You!
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