Thursday, September 30, 1999
University Hospital regroups on blood safety
BY BEN L. KAUFMAN and TIM BONFIELD
The Cincinnati Enquirer
Caught mishandling blood-tainted needles and improperly disposing of infectious wastes, University Hospital has agreed to pay a fine, upgrade its work practices and buy safer equipment to protect employees from AIDS and hepatitis.
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VIOLATIONS
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Violations found at University Hospital included:
• The hospital has implemented some engineering controls to minimize needle-sticks, such as adopting a needle-less IV system, but it failed to use other available safety devices.
• Patient blood soaked through employee clothing in the emergency department. Employees did not always wear fluid-resistant gowns.
• Some doctors and nurses in the operating rooms did not wear eye protection beyond personal glasses. The use of glasses with side shields or the use of face shields was not enforced.
• In the emergency and operating rooms, fluid-resistant shoe covers or boots have not always been worn, even though the hospital made them available to employees.
• On the infectious-diseases floor, used needles were found in sinks, under beds and on windowsills. Similarly, bandages and gauze that were heavily contaminated with patient blood have been placed in unlabeled black or dark green general trash bags.
• After employee clothing was soaked through by patient blood, it was placed in plastic, unlabeled, white or colorless “patient belonging bags.” University Hospital did not consistently enforce the prohibition on staff taking blood-soaked clothing home, and employees were not familiar with safety procedures despite training sessions.
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A settlement made public Wednesday between the hospital and the Occupational Safety and Health Administration (OSHA) details six “serious violations” of federal blood-borne pathogen regulations.
The agreement stems from an employee complaint that led to a weeklong OSHA inspection in late April. That probe uncovered several improper practices that could increase the risk of employees contracting infectious disease.
The concerns that led to the OSHA inspection stretch back several months. But to protect the whistleblower from any possibility of retaliation, OSHA would not say when the complaint was filed.
OSHA's original inspection in April yielded a notice to University Hospital that included eight violations and a proposed $15,000 fine.
The hospital contested the findings and penalty. After negotiations, OSHA agreed to drop two violations and cut the fine to $7,500 in exchange for the hospital's pledge to launch a comprehensive plan to improve employee safety.
Further, the hospital and OSHA agreed that nothing in the settlement “shall be deemed an admission” of any of the accusations.
“We're pretty impressed with their commitment to do ing this,” said William M. Murphy, area director for Cin cinnati's OSHA office. “To our knowledge, there is no other health care facility that has initiated these controls.”
Mr. Murphy said the settlement with such a institution may be the first of its kind with OSHA.
“I don't know whether we're any better or worse than anywhere else. I think our compliance rate (with
OSHA regulations) is very good,” said Michael Grodi, vice president of hospital services. “But in an organization as big and complex as we are, every employee doesn't do it perfectly every time.”
University Hospital is among the biggest, busiest hospitals in the region. Its employees report 120 to 130 sharp injuries a year, Mr. Grodi said. Typical examples include needle sticks during blood draws or inserting IV lines, scalpel cuts during surgery and injuries during suturing.
Nationally, some health care workers have contracted AIDS or the liver-damaging hepatitis B and C viruses from needle-stick injuries. However, Mr. Grodi said he was unaware whether any of the injuries at University Hospital has resulted in an employee contracting a disease.
To reduce the risks, University Hospital plans to use more medical supplies that feature safety design changes, such as self-sheathing needles, spring-loaded needles and blunt suture needles.
Exactly which devices would be bought and how much they would cost has not been determined. A committee plans to recommend in November which devices to adopt, Mr. Grodi said.
University Hospital's new approach is what OSHA, and many health care workers, would like to see at many hospitals.
“These devices ... can greatly reduce the frequency of accidental employee exposure incidents to patient blood,” Mr. Murphy said.
Nurses have long been concerned about the risks of needle sticks. Nursing groups have been pushing hospitals and other health-care organizations to adopt more safety devices.
“One of the scariest things you can ever encounter as a nurse is being stuck with something that carried a patient's blood,” said Karen Hills, past president of the nurses' union at University Hospital.
When employees suffer a needle-stick injury, they are supposed to call an internal treatment team using a number that Mr. Grodi said is posted on nearly every phone in the hospital. For those who work late shifts, emergency department staff are supposed to help deal with employee injuries, Mr. Grodi said.
Whether the hospital has done enough fast enough to protect workers is a matter of debate.
“I would like to see more protective devices for nurses to use and more formal in-services (on-the-job training) for nurses,” Ms. Hills said.
For example, many employees never knew until recently that they are supposed to drop off blood-stained, personally owned uniforms or clothing at the hospital laundry, Ms. Hills said.
While the hospital provides scrubs for nurses and staff in surgical and emergency care settings, nurses and staff in other parts of the hospital buy their own uniforms and work clothes. In addition to not knowing the rules, some skeptical employees also have wondered whether the laundry would lose or damage their clothes.
How far the new safety program will reach beyond University Hospital remains to be seen.
University Hospital is a member of the Health Alliance of Greater Cincinnati, a group that also includes the Christ, Jewish, St. Luke and Fort Hamilton hospitals.
While the Alliance hospitals buy most supplies as a group, it has not been decided whether all the Health Alliance hospitals will use the same safety devices, Mr. Grodi said.
Mr. Murphy said the accord with OSHA does not bind the Health Alliance hospitals to institute the same controls, but he said it would be hard for them to do otherwise.
Given the status of the Alliance hospitals in this region, Mr. Murphy said, he hoped their example would move others to pursue the same engineering controls.
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