Let me just mention a little bit about the history of our next presentation. So, we have this goal of trying to expand our membership base to include a lot more METS students and residents. So, what I thought we'd do at this meeting was use our Sunday morning for a resident research presentation and poster competition. Unfortunately, we only had one submission, and that is the next presentation you'll see. So, we kind of backfilled with some excellent lectures from Dr. O'Donnelly and Dr. Kenton, but the next one is a little 30-minute vignette on a resident's research efforts. So, hopefully in the future we can actually do this, do a little better job of sending out the call for presentations to our various residency programs throughout the nation. We've got the database now of all 73 ACGME programs within the Preventive Medicine Review Committee. So, I'm not giving up on the idea, I just have regrets that we weren't as successful this year. So, this presentation will be by Dr. Safiyyah Muhaddin. She graduated from Dow Medical College in Pakistan. She's a PGY-2 resident at the University of Mississippi Medical Center in Preventive Medicine. And her research project gave her a great opportunity to improve the health population in that community. She got more familiar with the Mississippi population and their health problems. She continued her scholarly activity by participating in various research projects. She's an active member of the American College of Preventive Medicine and LSM, I'm not sure what that acronym is, anybody know LSM? She's enrolled in the Master of Science in Population during her Preventive Medicine residency. Her future goals are to work in Lifestyle Medicine, also it must be Lifestyle Medicine, LSM, to make a difference in the life of the general population, aims to practice preventive care in the application of public health policies. Her hobbies include reading books, writing poems, and creating fine jewelry. So, Dr. Muhaddin. Hello, everyone. Today, the topic of my presentation is Bloodborne Pathogen, BBP Exposure, Sharp and Needle Stick Injuries, Prevention Protocol, Initial Phase of the Quality Improvement Project at Academic Medical Center. My name is Safiyyah Muhaddin. I'm a PGY-2 resident at Preventive Medicine Department at University of Mississippi Medical Center. My co-presenters are my co-resident, Dr. Kabir, my faculty member, Dr. Bidwell, Dr. Palmer, and our chair department, Dr. Mann. This is to affirm that I have no relevant financial relationship or affiliation with any marketing, reselling, or distributing healthcare goods or services consumed by or used on patients. The goals of Initial Phase of Quality Improvement Project are to identify the problem, incidence rate, the population at the risk, the place of the incident, type of injury, reduce BBP exposure events, collection of source blood samples when available, decreases time from exposure to student employee notification, reduce unnecessary laboratory analysis, reduce unnecessary prescriptions. Recently, the incidence of the needle injury has been increased at the Academic Medical Center. These are the numericals for BBP exposure at Academic Medical Center in last five years. We can see a little lower rate in 2021, which was due to lower number of elective surgery cases due to COVID-19 pandemic. When we analyzed the scope of the problem, it showed the increased cost at the level of the institution as well as the student and employee. This results in decreased productivity, increased mental distress, impaired physical health due to prophylaxis for the infections it leads to exposure to potentially harmful medications. Nationally, 64% exposures are preventable. We can see here how the single gloving can increase the risk of exposure to patient blood by as much as 87% when the outer glove is punctured. Characteristics at Academic Medical Center, the major causes of BBP are splash, sharp injuries, and needle strips. These are the parts of the body with most exposures of the sharp injury with hand, splash in eyes, and majority on fingers with 79%. Now we analyze who are affected most. So we found that nurses, house officers, physician, OR staff, and students are most affected. Occupational groups of healthcare personnel exposed to blood and body fluids, mostly nurses and house officers and residents, but when we calculated with the total number of the nurses and residents by the denominator, we found that the residents were the only, were the one who were affected most. Now analyzing what are the causes of the injuries, we found that mostly are due to equipments and procedures. Areas where most of the injury occurs are ICU, emergency department, and operating room. In this pie chart, we can see OR 38%, floor and ICU consists of 27%, and ED 9.3%. Major causes of needle stick injury or sharp injuries in operation room are with suture needles, scalpel blood, scalpel blade, passing sharps, and colliding with co-workers. We can see in this pie chart equipments causing injuries with 79% needle injuries. Causes of needle stick or sharp injuries in emergency room, recapping needles, or overfill sharp containers and splashes in eyes. In this pie chart, we can see 21% causing during assessing IV line, 21% when patient jumps during the procedure. So what happened with exposure to blood? It prone to develop HIV, hepatitis B, and C. We need to be prepared, be aware, and dispose with care. Prevention is key. We should avoid these, such as breaking the needles and discarding needles in overfilled containers. Sharp injury prevention strategies are blunt tip suture needle technology, double gloving or an indicator glove system, safety shield or retractable scalpels, hands-free technique by placing items in the container and passing the container to the surgeon. Engineered sharp injuries prevention mechanical device. Now question is, do we have equipment with built safety features? If yes, are we effectively utilizing them? If no, is there a commercially available option? To follow behavior protocols such as PPE, gown, goggles, face shield, mask to avoid a splash. Double gloving to avoid sharp needle sticks, this lower risk of perforation by four times. Hands-free techniques by placing items in a container and passing the container to the surgeon. Account for all sharp needles when cleaning up. Consists use of engineered safety products. Sharp container check at the beginning of shift and at the end of the shift. BBP exposure, immediate action. Thoroughly wash the wound with soap and water. Don't squeeze the wound. Don't apply alcohol or other chemical substance. For mucous membrane exposure, irrigate with water for 15 minutes. Report the injury to employ health services. Obtain labs immediately. Source patient if available, two gold top tubes and one purple tube. Complete the protocol according to academic center. Report and follow. Review source patient medical records if available for any known pathogens. Review exposed individual hepatitis B titer status and Tdap vaccine status. Boost vaccines if needed. Order baseline labs on exposed individual if source unknown. Provide viral transmission risk counseling and HIV profile access medication counseling. Schedule follow-up labs as indicated. Post-exposure profile access for HIV should be started within two hours ideally for more benefits but can be given within 72 hours. If source blood is available, then can wait for expedite results within two hours before giving PEP or drawing blood for injured person. Post-exposure profile access for the after the hepatitis B exposure. If the responder after complete series, nothing has to be done. And if the titers are greater than 10. If titers are less than 10, then the hepatitis B immunoglobulin and revaccinate. If non-responder, then give two doses of the immunoglobulin one month apart. For unvaccinated or incompletely vaccinated, hepatitis B immunoglobulin should be given and revaccination should be done. CDC recommendation for HCV testing following the BPP exposure. First follow-up at three to six weeks and final follow-up four to six months. Anti-HCV antibodies should be checked. Confirm with HCV RNA if positive. HCV RNA negative follow-up at four to six months and positive refer to care. Anti-HCV antibodies negative. We don't need to do anything further, but if positive, refer to care. CDC recommendation for HIV profile access following BPP. We should give the Truvada one tablet by mouth once daily, plus Ecentris or TBK. Duration for the 28 days. Now we have a plan for the phase two for implementation of protocol and availability of equipment and techniques. These are the references for my presentation. Let me know if you have any questions. Thank you. Thank you, Dr. Muhuddin. I do think we have a question from our live audience. Thank you very much for your talk. You mentioned that if after there's a needle stick, you clean the area with soap and water, but you said to avoid alcohol or other substances. Why is that? Hello? Make sure you're unmuted. Yeah. Can you hear me? Yeah. Yes, yes. Yeah. So because we don't want to penetrate that there with the alcohol, we just want the fresh water, soap. And we don't want to penetrate it in the skin too much. Hi, this is Parmar. I'm with Dr. Sophia. And I agree with her answer that alcohol may cause further tissue injury where there is penetration or where there is a needle stick has happened. That may help the virus to penetrate deeper. So we want to avoid alcohol or any other chemical agents that may cause further tissue damage at the site of injury. So it looks like y'all did a fairly good job of kind of reviewing needle stick protocols, prophylaxis. And have you identified any research questions? For example, have you studied the incidence rate of needle sticks at your facility and then considered using that to formulate a research question where you would introduce an intervention such as didactics modules and then after a time, remeasuring, comparing, contrast, whether or not there were any improvements? Yes. Dr. Sophia is already working on a module that we are planning. That's already like we have a health learning module for all our clinical people at the medical center, including nurses, house officers, and all. So we are going to do like pre and post-evaluation, post this learning module revision. So Dr. Sophia is already taking a lead on that research project. Very good. Any other questions? So you mentioned that in the OR, you would put a sharp into a container and pass that to the surgeon. How was that? Is that the culture there at your facility? Or did you introduce that? And how did that go? Because we have difficulty, we have had difficulty trying to have the surgeons do things differently in the OR. So recently we had a meeting with the OR people, OR facility, their manager, nurse manager, and she told me that they are trying to make it a culture and they are trying when they are training in beginning, the nurses in the beginning. So they have this upcoming in the July as well. When the new batch comes, they try to, but that is like difficult to make them like regularly practicing that. So we are trying to revising that intermittently as well. Great job. Thank you so much for this presentation too. Thank you so much.

Bloodborne Pathogen exposure

needle stick injuries

injury prevention

safety protocols

METS students