Reducing bloodborne pathogen exposures

by Ron Stoker

Every now and then, something comes along to change the way we look at a certain medical procedures. It changes the way we work and makes us look in the mirror and reevaluate our methods and keeps us safer than we were before. Some medical procedures are complex with complex safety solutions. Other times it is the simple procedures with simple safety solutions that can bring critical value and lifesaving protection to those who use it.

Hospitals have come a long way in protecting healthcare workers from unnecessary exposure to blood and body fluids. Most departments are nearly flawless in their preparation and execution of safety measures to protect staff. For example, one would never conceive of a surgeon performing a procedure in the operating room without full gown, mask, gloves or goggles/face shield. Nor is there denying the fact that the presence of blood spray, droplets or spatter in most departments would trigger internal alarms that would take the area to “defcon level-5.”

Okay, that statement might be a little melodramatic. We have wonderful facilities with fabulous healthcare workers with good intentions to provide great care. Innovation has found its way into most areas of the hospital and raised the safety consciousness into the 21st Century. There is one department, however, that still seems to be stuck in the past when it comes to protecting the staff from blood spray and spatter.

The cutting of the umbilical cord during birth seems like a simple, non-threatening process. It can be an uncomplicated procedure for some healthcare workers and yet others will face what everyone in the healthcare industry tries to avoid … exposure to blood. Bloodspray during umbilical cord transection continues to be an issue that is dangerously ignored. Exposure can include physicians, nurses, spouses and even other family members. This seemingly blind indifference to basic safeguards and to the OSHA standards creates significant liability for the institution in the form of worker’s compensation costs, risk management costs and the costs associated with hospital-acquired infections (HAI).

Concerns Related to Indifference

There are four areas of concern that come out of this indifference to spray.

• First, there is a denial from many clinicians that blood spray happens.
• Second, blood spray from umbilical cord transection is seldom detected. In a recent study by Wendell Winters PhD, MD Sci., FAAM it was found that “90% of the clinicians who had contaminated face shields did not perceive they had been sprayed during the transection of the umbilical cord.”¹ Labor and delivery personnel are frequently exposed to blood and body fluids. Look at the shoes or scrubs or glasses of these healthcare workers if you don’t believe that it is an issue! You will see that they are frequently stained with blood and other bodily fluids. Without precautionary measures, the risk of infection to these healthcare workers can be high.
• Third, non-reporting of exposures. Now this really goes hand in hand with the second point. How does someone report an exposure if they did not perceive that they had been exposed? They don’t, which creates a whole other batch of issues regarding hospital-acquired infections.
• Fourth, it is troubling that exposed staff and their families must endure the stress and anxiety that comes with blood exposure and the possible ongoing prophylactic treatments. One study was able to put a monetary figure on this particular stressful event. The study found “when presented with the option of paying out of pocket for a hypothetical injury-prevention device … the median amount of money subjects were willing to pay to avert injury was $850. When adjusted for known patient risk status (HIV, HepC) the medical amount increased to $1270.”¹

Current Techniques

The practice of clamping the cord with a plastic clamp, using another clamp or hemostat to clamp the placental side and then using a sharp scissors to cut the cord has been in practice for nearly 50 years. This procedure no longer seems to be the safest way to effectively protect staff from blood exposure. Typically physicians and nurses while cutting the umbilical cord will turn their head, use their hands to block the spray or put a towel over the area to be cut.

These “techniques” are neither effective, safe nor compliant with the OSHA bloodborne pathogen standard. Put the scissors in the hands of a nervous father and now you have a recipe for disaster. Yes, the separation of the baby from the mother is emotional and memorable … so is getting sprayed in the eyes, taking months’ worth of prophylactic drugs and constantly worrying that life may never be the same because you may have contracted HIV, HCV, herpes and so on. The scissors and clamp method are not up to par with other innovations that have found their way into the labor and delivery room in recent past.

Safer Method

Safer results with fewer instruments, now that sounds like a win/win scenario. Bringing the labor and delivery room into the 21st Century means getting innovation into the hands of those who will benefit the most.  Physicians, nurses, risk managers, patients, all win with safer innovation and safer medical devices. The Joey SprayGuard is one of those products that fit the bill. Remember, the current cord transection process is riddled with potential safety issues and possible OSHA violations.

1. Scissors towards hands creates a sharps issue.

I am aware of several procedures where the OR nurse was cut by the scissors that were in the hands of nervous fathers. The problem of having family members cut the umbilical cord exposes both professionals and family to the inherent dangers of bloodborne pathogens and sharps injuries. Typically, the umbilical cord is cut with scissors while the clinician is holding two clamps, isolating the cutting area, and, often time, using another hand to attempt to shield the blood splatter. This procedure places a lot of hands in close proximity to a sharp. There is also a lot of exposure to cord blood because the area between two Kelly clamps is pressurized with nowhere for the blood to go but squirting out of the first incision in the vessels. Dr. James Ramsey, an obstetrician, has remarked that “Blood frequently splashes into the face of family members when cutting the umbilical cord—sometimes into their eyes and into their mouths.” It has been reported by his staff members that umbilical cord blood has been found eight feet up on the wall or ceiling following the delivery of a baby.

2. Potential blood spray without proper, commercially available engineering controls could result in OSHA violations.

OSHA continues to cite healthcare institutions for improper prevention of bloodborne pathogen exposures. Many of these citations come after employees have become frustrated with the lack of employer concern about bloodborne pathogen exposures.

3. Using a syringe to draw cord blood without proper safety precautions could lead to needlesticks.

Let me tell you about a safety product that not only clamps and cuts but minimizes blood spray to its lowest possible extent. The product is called the Joey SprayGuard. It is a single-handed device that cuts and clamps both the infant and maternal sides of the cord while minimizing blood spray to its lowest possible extent. The purpose of this product is to protect caregivers from cord blood spray … plain and simple. This device has been shown to be five times more effective and 10 times more efficient that the traditional method of cord transection.³ There are a few other reasons why this product makes sense.

1.      It is a single-handed safety device which positions the hand behind the protected sharp. Both benefits seem to be OSHA preferred.⁴

2.      The protected housing of the Joey SprayGuard can be used for safer cord blood gas draws.

3.      Very fast and efficient when delivery multiples.

4.      One tool replaces between three to five tools used in current process. For those supply chain executives, that means a serious (sku) reduction.

Dr. Van Bohman, Perinatologist at St. Rose Dominican has said, “It is very effective … you are changing the paradigm that has been in place for 20 years … it does what it is intended to do.”

The Joey SprayGuard is a unique device that is as cute as it is functional. New mothers and fathers will appreciate the whimsical appearance but the clinicians will know that it is protecting them from an inadvertent blood spray.

A single product with multiple solutions to many potential safety hazards found in the process of cutting the umbilical cord seems to me to be a very valuable tool. Again, sometimes simple procedures call for simple solutions. The Joey SprayGuard is a simple, economical, compliant solution that can bring your labor and delivery room into the 21st Century.

References

1.      Winters, Wendell D, PhD, MD Sci, FAAM. The Incidence of Face Shield Contamination During Cord Transection Using a New, Shielded Umbilical Cord Clamp and Cutter Device Compared Against the Traditional Use of a Hollister Clamp, Hemostat and Scissors Method, 2003.

2.      Fisman DN, Mittleman MA, Sorock GS, Harris AD. Willingness To Pay To Avoid Sharps-Related Injuries: A Study In Injured Health Care Workers, American Journal of Infection Control. 2002 Aug;30(5):283-7.

3.      Winters, et al.

4.      29 CFR 1910.1030 Standards Interpretation Letter from Richard E. Fairfax, Director of Enforcement Programs, to Qlicksmart Pty Ltd. November 21, 2008.

Ron Stoker, MS, is the executive director of the International Sharps Injury Prevention Society (ISIPS). He has 29 years experience in the medical device industry as a researcher, marketer, educator, consultant and healthcare worker advocate. He has written more than 200 medical journal articles, primarily on sharps injury prevention, infection control, and hand hygiene. Mr. Stoker has his BS in Pre-Medical Zoology from Brigham Young University, an MS in Bioengineering from the University of Utah and an “honorary doctorate” from the school of hard-knocks. As a result of a surgical mishap he was rendered a quadriplegic in December 2006. Informed that he would never walk again, with tenacity and a “supportive and mean wife,” Mr. Stoker taught himself how to walk again. He says that he walks like an “alcoholic” but is really just a recovering quadriplegic!

Mr. Stoker has conducted workshops and Congresses on sharps safety at national and international meetings for the last 10 years. He is a founder and lecturer for the Infection Preventionist Boot Camp Series. For more information contact Mr. Stoker at info@isips.org.