Nurses play a key role in providing comprehensive healthcare to patients. This is why a proper, safe hospital environment for medical staff is so important. Nurses are most concerned about infections, not those transmitted by the respiratory route. By virtue of patient contact, the greatest risk is blood-borne viruses associated with nurses' work. More than 70% medical facilities do not use blunt needles to prepare medicines, with only 33% of them using safe equipment in most medicines.[1]
How often do doctors and nurses suffer injuries and stabbings at work?
Healthcare workers are a particularly vulnerable group to, among other things, exposure to biological material, punctures and sharps injuries, contact with toxic drugs and stress. In Polish hospitals, nearly 70% of medical staff injured themselves up to five times during their seniority, of which 40% did not report this to their superiors. The safety of medical staff, including the reduction of adverse events and other risks such as contact with cytotoxic substances, is one of the EU's priorities for the coming years. It is therefore important to also include an assessment of the safety of medical staff in policies for quality and safety in medical facilities.
WHO data show that medical workers are getting injured. Legislative action has therefore been taken at European Union level and in Poland to reduce the risk of injuries associated with the use of medical equipment. The role of safe equipment and reporting is extremely important as it helps to minimise the risk of dangerous situations and incidents in the workplace.
"In Polish health care institutions, there are about one hundred injuries related to the use of medical equipment by health care workers every day. This means that there are between 12 and 30 punctures per hundred hospital beds per year. These figures are alarming. Although regulations have been requiring facility managers to ensure that staff have safe contact with sharps for several years, according to experts, little has changed in this regard." - comments Dr. med. and n. o zdr. Paweł Witt, Chairman of the Expert Council of the Hospital Safety Coalition.
The 2018 epidemiological study shows that the leading cause of injury among medical staff is the sharp needle. It accounts for almost 36%. Drug ampoules are second, while needles (pen type) are third. Equipment such as scissors, sewing needles and infusion sets are also responsible for injuries among medical staff.
The survey asked about the most common cause of injuries. The results showed that these are most often haste, work pace, fatigue, nervousness and absentmindedness. There are also non-psychological causes like lack of safe equipment, failure to follow procedures or mismatched gloves. To make matters worse, as many as 30% nurses do not report incidents involving punctures and injuries. Why is this the case?
"Injuries are not only a health aspect, i.e. situations related to the acquisition of illness, anxiety, fear, absenteeism at work. In the workplace, the risk should be specified in order to be able to defend against dangerous situations as much as possible. The magnitude of the risk of occurrence depends on the decision that will be taken at the level of the management of the healthcare facility." - comments Dr Anna Szczypta, National Consultant in Epidemiological Nursing.
The role of safe equipment
Using appropriately designed equipment reduces the risk of injury to both patients and the nurses themselves. Safe needles, have reduced the incidence of needlestick injuries that posed a serious risk to medical staff.
"Based on my own experience, the number of injuries among nurses was significantly reduced when safe equipment was introduced. Therefore, it is worth introducing and correctly using equipment that reduces the risk of injuries. In summary, the introduction of safety equipment is very important, but there is a constant need for education in this area." - concludes Dr Anna Szczypta, National Consultant in Epidemiological Nursing.
The elimination of occupational safety hazards in medical facilities and hospital wards contributes to the reduction of testing, quarantine and staff absenteeism costs. This translates into the provision of appropriate patient care. Based on a study, the introduction of safety needles reduced the number of needlestick injuries by 21.9 % in Germany[2] and by more than 50% in Australia.[3] Safe drug delivery systems prevent overuse of pharmacological substances and minimise dosing errors. In addition, the use of safe patient immobilisation devices contributes to reducing the risk of pressure sores and skin injuries. In 2021, a decrease in the number of training courses attended by healthcare staff was found compared to 2017, accompanied by a decrease in knowledge on the prevention of bloodborne infections, despite the introduction of safe equipment.[4]
The nurse's role in reporting
Reporting is a key part of nursing practice, especially when it comes to your own safety. Nurses are required to accurately report any incidents, medical errors or situations that may compromise patient safety. Such reports enable problems to be identified, causes to be analysed, appropriate corrective action to be taken and the risk of recurrence to be reduced.
Support for safe patient care is provided by the epidemiological nurse. Her main task is to prevent the spread of infectious diseases and promote public health by identifying, monitoring and controlling infections. She develops procedures by applying scientific knowledge and national recommendations. The epidemiological nurse implements and modifies procedures, organises training on post-exposure management, and provides expert advice to nursing teams when an exposure occurs. All of these activities are vital to ensure safe patient care.
Summary
The Expert Council of the Hospital Safety Coalition is pushing for the inclusion of changes to design the hospital care management system so that the health of patients and medical staff is best protected. The experts support the direction of change as a starting point for a conversation about building a system based on quality and safety including, but not limited to:
- The collection of occupational exposure data and their systematic analysis is an important part of infection surveillance among healthcare workers;
- Creation of a national register of occupational exposure of the health sector;
- Systematic training of health care workers on occupational exposures increasing awareness of risks and influencing modification of staff behaviour with regard to activities that pose a risk of infection. Special attention should be paid to the system of pre- and post-graduate education in the health professions.
- Introduce safe equipment in healthcare facilities that reduces the risk of injury.
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The Hospital Safety Coalition was established in 2021 with the main aim of increasing the safety of healthcare workers in the workplace by, among other things, promoting and encouraging hospitals to use safe medical equipment. The Coalition's main project is the 'Safe Hospital is Safe Patient' programme, which is joined by medical facilities that adhere to its recommendations. Patronage of the project is held by: The National Health Fund, the Patient Ombudsman, the Supreme Chamber of Nurses and Midwives, the Polish Federation of Hospitals, the Supreme Medical Chamber, the Polish Association of Epidemiological Nurses, the Polish Society of Anaesthesia and Intensive Care Nurses, the Polish Society of Epidemiologists and Doctors of Infectious Diseases, the Polish Vascular Access Club, the Association of Hygiene in Healthcare, Polish Association of Private Hospitals, the Polish Pharmaceutical Society, the Supreme Pharmaceutical Chamber, the European Association of Clean Treatment, the Association of Healthy Polish Cities, the National Chamber of Laboratory Diagnosticians, the Polish Society of Microbiologists, the Polish Nursing Association, the National Trade Union of Physicians, the Institute for Patient Rights and Health Education and the Polish Society of Infusion Nursing.
[1] The report "A Safe Hospital is a Safe Patient".
[2] Hoffmann C, Bchholz L, Schnitzler P. Reduction of needlestick injuries in healthcare personnel at a university hospital using safety devices. J Occup Med Toxicol 2013;8:20.
[3] Whitby M, McLaws MT, Slater K. Needlestick injuries in a major teaching hospital: the worthwhile effect of hospital-wide replacement of conventional hollow-bore needles. Am J Infect Control 2008;36:180e6.
[4] Gabriella De Carli , Alessandro Agresta, Maria Giuseppina Lecce, Patrizia Marchegiano,Gianpaolo Micheloni, Dimitri Sossai, Giuseppe Campo, Paola Tomao, Nicoletta Vonesch, Sara Leone,Vincenzo Puro 1 and The Studio Italiano Rischio Occupazionale da HIV (SIROH) Group †: Prevention from Sharp Injuries in the Hospital Sector: An Italian National Observatory on the Implementation of the Council Directive 2010/32/EU before and during the COVID-19 Pandemic Int. J. Environ. Res. Public Health 2022, 19, 11144.