Data Mining: Can it lead to healthcare worker safety

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Darren Barnett
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1 Data Mining: Can it lead to healthcare worker safety Dr. Sanjeev Singh Medical Superintendent Amrita Institute of Medical Sciences Kochi Agenda Health Care Worker Safety Data collection, warehousing, mining & analysis Role of Governance in HCWS National database Summary National Quality Conclave, 19 th Feb 2010 Patient Safety Environment Safety Healthcare Worker Safety Why all that fuss about HCW.. Richest resource in healthcare Largest production, but less considered J W Marriot Starbuck Coffee Tata Need for change Ranjita Raje Source: ALU Issue No. 47, April- June 2003 Asian Labour Update This happened in 2001 when municipal hospital authorities asked me to take unpaid leave. No cost of treatment was offered. I did not show any signs of weakness when we spoke at the union office, and was eager to go back to work. I had no sympathy from my colleagues. My in-laws, deserted me. They very well knew that I had not acquired the infection from any extramarital sexual relation My parents showed understanding. Yet remaining at home without work or earnings, with no fault of mine, had become unbearable. Ranjita Raje Source: ALU Issue No. 47, April- June 2003Asian Labour Update A 26 year-old nurse with occupationally acquired AIDS Detected accidentally, in a routine check up In 2002, approached the Municipal Nursing and Paramedical Staff Union for help Initially, hospital management promised to consider the demand, but in 2003 refused to take her back Could this have been prevented? Is she entitled for treatment cost? Is she entitled for compensation? 1

database Summary National Quality Conclave, 19 th Feb 2010 Patient Safety Environment Safety Healthcare Worker Safety Why all that fuss about HCW.

2 Bigger picture for HCWS Areas of risk. Radiation health hazards Nuclear Medicine hazards Ergonomics Lab / Chemotoxic / Chemical Injury Waste anesthetic exposure Inflammable/Corrosive substances Laser hazards Communicable diseases Occupational Safety & Health Administration (OSHA) Bloodborne Pathogen Standard (1992) Engineering controls and work practices Sharps Handling Disposal containers OSHA Guidance Document it is preferable to use devices which offer an alternative to needles Obey or Pay. OSHA inspectors reportedly are scrutinizing sharps safety, looking not only at devices, but also at containers But Where is the Indian data? Is No Data = No Problem 2

hazards Communicable diseases Occupational Safety & Health Administration (OSHA) Bloodborne Pathogen Standard (1992) Engineering controls and work practices Sharps

3 Hospital ID A B C D Type of Facility National Pooling of data Private Teaching Corporate Staff Pattern Private Teaching Private Teaching Doctors Nurses Others Total Bed Strength Wards Intensive Care Unit No. of Operation Theaters Accreditations ISO, NABH ISO, NABH NABH NABH, JCI HCWs reported injuries with sharps Nurses ( 55%) AIMS Kochi, Wockhardt, AIMS, Bangalore, Kochi; Escorts, Fortis Noida, Delhi; Escorts, Fortis, Delhi Noida; Wokhardt, BNG Blood bank Clinical laboratories Where did the injury occur? Emergency dept. Patient room/ward 38% Was the source identifiable N/A Outpatient clinic 2% Procedure room 3% Intensive care unit 5% Outside patient room 8% Operating room 13% Service/utility area 14% Other,describe 16% No 12% Yes 6 Unknown 27% AIMS Kochi, Wockhardt, Bangalore, Fortis Noida, Escorts, Delhi Device had a safety feature Not a safety Design 76% Unknown 5% Blood & Body fluids exposure N=20 16 NA 5% Safety Design (SEMD) 14% Eyes Non-intact skin 3

of Operation Theaters 230 126 122 93 24 9 16 10 Accreditations ISO, NABH ISO, NABH NABH NABH, JCI HCWs reported injuries with sharps Nurses ( 55%) AIMS Kochi, Wockhardt, AIMS, Bangalore, Kochi;

4 Impact factor.. Blunt suture needles Safer phlebotomy needles 86% 27% Publication sent in Peer Reviewed Journal Oct 2009 Incidence of Occupational Exposure among Healthcare Workers in a resource limited settings of 4 Indian Hospitals Murali Chakravorthy, Sanjeev Singh, Anita Arora, Sharmila Sengupta Cost Analysis Creating the culture.. Costing Parameters: Lab Investigation, Consultation, Admission, Vaccination, Treatment, Follow up and Indirect Cost January the cost of 1 vial of IG was Rs 3990/-. February onwards cost increased up to Rs. 6939/- Now available at 10 15K Total Cost for Immunoglobulin in 2009 = 3,59,866/- In next one year, globally, it is estimated What needs to be done Surveillance and pooled data Universal precautions awareness and regular education > 10,000 healthcare workers will contract HIV > 26,000 healthcare workers will contract HCV > 65,000 healthcare workers will contract HBV Provision to provide Post exposure management in all facilities and ensuring implementation Effected healthcare worker needs to taken care of - counseling, treatment Use of safer devices and technology Policy to implement safety guidelines * Pruss-Uston A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. American Journal of Industrial Medicine, 48(6):

of 4 Indian Hospitals -------------------------------------------------------------------------- - Murali Chakravorthy, Sanjeev Singh, Anita Arora, Sharmila Sengupta Cost Analysis Creating the

5 The Federal Safety and Prevention Act Law from Nov 2000 How to implement change Kotter's 8-Step Change Model Create Continue Legistation Our challenges short-term building -to make targets on any the change momentum Step --> Eight: Anchor the Sure-fire if stick, Fragmented 'now' is projects the right healthcare Targeted time towards no. of legislation. Access awareness Changes the sessions, in masses Culture data publishing Should Shortage become of core HC of staff healthcare How to safeguard the existing Creating a network of safe Step Seven: Build on the Change culture ones practices: Of Publishing influential pooled people data Step whose Six: Create Short-term Wins power Awareness To drive comes legislation - Spread from the a variety light of sources, sessions Step Five: Remove Obstacles Universal Healthcare Precautions delivery industry Safe devices Clinician community Step Four: Communicate the Vision Policy driving bodies NABH Step Three: Create a Vision for Change Awareness The Government of the risk at hand Indian Data All of the above working together Step Two: Form a powerful coalition Step One: Establish a Sense of Urgency What would I do if my Mom had a OE What would I do if my Motherin-law had OE Evidence Based Medicine Take her to an accredited hospital Post exposure Prophylaxis ALL DEVICES CHANGED TO SAFETY DEVICES Monitor Change can make a difference patient safety.mpeg Safety for Healthcare Workers is the responsibility of us all Without Healthcare Workers there would be no Health System 5

Access awareness Changes the sessions, in masses Culture data publishing Should Shortage become of core HC of staff healthcare How to safeguard the existing Creating a network of safe Step Seven:

6 Thanks 6

Health Care Worker Health and Safety: Preventing Needlestick Injury and Occupational Exposure to Bloodborne Pathogens

Health Care Worker Health and Safety: Preventing Needlestick Injury and Occupational Exposure to Bloodborne Pathogens World Health Organization International Council of Nurses WHO-ICN Project Preventing