Doing no harm to patients is ingrained in all medical practices — but what about harm to one’s self?
OSHA describes hospitals as one of the most hazardous places to work. For instance, in 2011 it reported 253,700 work-related injuries and illnesses, which is about seven injuries or illnesses for every 100 full-time employees. Construction and manufacturing industries — often viewed as hazardous — each saw fewer incidents.
Updated five-year data should be released soon, but, based on OSHA’s projections, these numbers will reflect the same issues. While “First, do no harm” originally was directed at patients, trends indicate we need to apply it to clinicians as well.
First, do no harm while:
- Transferring patients to surgical tables: Overall, patients are getting heavier in the United States. Obesity trends tell part of this story, but even healthy-weight patients are getting taller and broader than before. Having one or two nurses transfer these patients is risky for the patient and especially risky for the clinicians. As a result, sprains and strains were responsible for 54 percent of the injuries reported to OSHA. Patient lift and assist devices offer a solution to this issue, but experts at the American Nurses Association insist transition to these systems has not been quick enough and has resulted in retention and safety problems.
- Scrubbing into a case: Cuts and punctures accounted for 3 percent of the injuries reported to OSHA, but the Centers for Disease Control and Prevention and other associations estimate nearly 400,000 of these incidents occur annually but go unreported. While sharps safety devices, such as blade covers, are available, many times they are not conveniently available unless a facility proactively purchases them. Instead, double gloving can offer precaution. This approach is met with resistance by surgical team members who often prize dexterity over safety, but many brands have introduced new gloves that offer that sense of touch without compromising risk of exposure to blood-borne pathogens from patients.
- Choosing the right apparel: The routine of mentally preparing, scrubbing in, downing and getting situated in the operating room is enough to think about before a case. But, all the involved sprays and fluids mean even before the case, the surgical team members need to recognize what apparel is important and when. The Association for the Advancement of Medical Instrumentation (AAMI) has fluid resistant guidelines, and ranks apparel on a scale of 1 to 4 with 4 being the most protective.
- Level 1 offers minimal protection for procedures such as simple excision biopsies and ophthalmological procedures.
- Level 2 offers low protection for procedures such as open hernia repair or most minimally invasive surgeries.
- Level 3 offers moderate protection for procedures such as mastectomies, open gastrointestinal procedures and endoscopic urological procedures.
- Level 4 offers high level of protection from fluids, such as orthopedic procedures, open cardiovascular surgery or cesarean sections.
Masks offer a similar ranking system for comparable procedures. What this comes down to is knowing what to wear when. This should already be available per OSHA’s requirement.
Of course, accidents will always happen, but finding ways to prevent issues will contribute to clinician confidence. What do you think? Is clinician safety a priority at your facility? Reach out to me at Rebecca.Rudolph@advantagemedia.com.
